Preparing for Bath Time

Did You Know

Some care partners find it useful to associate bath time with some sort of positive experience for afterwards, such as dinner, a visit with a loved one, or another activity that the person with dementia enjoys.

For people who are used to taking care of their own personal hygiene, suggesting that they may need help with bathing can cause confusion, resistance, or refusal. Persons with advanced dementia may know that bathing was something they used to be able to do, but they may no longer be able to understand or perform it. They might not realize that they need to bathe. They might even insist that they are clean or that they have just had a bath. The actual process of taking a bath can be frightening as well – your loved one might react with fear to water, whether being submerged in a tub or being sprayed with a shower head. Being washed and handled can also be difficult as many people are accustomed to bath time being a private act.

Suggestions for Caregivers

To make bath time successful, follow these tips:

Scheduling bath time

Plan for bath time as if it were an event on your schedule. Before their diagnosis, your loved one might have enjoyed a shower every morning before work or perhaps a warm tub bath after a long day. When scheduling a bath, try to work with the times and conditions that are most enjoyable or tolerable to your loved one if possible:

Form of Bath

Shower, bathtub, sponge bath?

Consider what your loved one would prefer as well as what, realistically, you can provide.

Time of Day

Morning, afternoon, evening?

Does your loved one seem more confused or agitated in the evenings (a phenomenon called sundowning) but does okay in the mornings? If so, consider giving him/her a bath as soon as s/he gets up for the day.

Frequency

Once a day, every other day, twice a week?

Most adults shower every day or every other day, but you may not need to bathe your loved one as frequently. It may be sufficient to give him or her a sponge bath twice a week and a shower once a week.

Safety and comfort issues

Make sure that the bathroom environment is as safe and comfortable as possible. Non-slip bath mats, grab bars, and bath/shower chairs are especially useful as the disease progresses to affect coordination and sense of balance. Assisting with a bath might simply mean handing your loved one the appropriate items as he or she needs them. However, as their dementia progresses, you may have to calmly remind your loved one how and where to clean their body with these items - you may have to take over washing responsibilities for your loved one. As you are touching and assisting him or her, describe what you are doing as you go so that he or she can feel comfortable and in control. It can also be useful to have a towel or a robe available to use should your loved one be uncomfortable with being nude – you can adjust and move the towel to respect their dignity. Other tips include:

  • Have the water already drawn
  • Make sure that both the water temperature

    Water Safety in the Home

    Just as with young children and infants, older adults have more sensitive skin and are at a greater risk for burns and scalds from hot tap water. The Consumer Product Safety Commission estimates that nearly 4,000 individuals are injured in the home each year due to this risk. Scalding can present even more of a danger to persons with dementia as they may not be completely aware of dangers in the environment.

    There are a couple of simple adjustments that you can make to prevent your loved one from suffering both minor and serious burns:

    • Lower the temperature on your hot water heater – Many hot water heaters are set to 140 degrees, which can scald an adult in 5-6 seconds. By lowering the temperature 20 degrees, you can further prevent scalding as as 120 degrees it would take at least 10 minutes for an adult to be burned.
    • Install an anti-scald device – Anti-scald devices, when installed on a faucet or shower head, can prevent scalding regardless of the setting for the temperature on a hot water heater. The device will automatically prevent water from coming out if it gets too hot.
    • Never leave a loved one unattended – Persons with dementia may not be able to tell the difference between a hot and cold water faucet. As they also often lose coordination, they also might not be able to quickly react to a burst of hot water. By supervising your loved one, you can prevent such accidents.
    and room temperature are warm enough to be comfortable.
  • Have all the items that you will need (wash cloths, shampoo, soap, etc.) set out and close at hand so that you won't have to leave your loved one's side
View References Canadian Health Network. Seniors: breaking down barriers to independence. March 15, 2005. Available at: Accessed March 21, 2006.

Consumer Product Safety Commission. Tap water scalds. October 5, 2004. Available at: http://www.cpsc.gov/CPSCPUB/PUBS/5098.html. Accessed March 21, 2006.

Mace NL, Rabins PV. The 36-Hour Day. 3rd ed. Baltimore: Johns Hopkins University, 1999.

Coping with resistance to bathing

If you meet with difficulty or resistance while you are bathing your loved one, you might simply be able to change the subject or refocus their attention on the task at hand. If there is still resistance, you can try scheduling the bath for later on when s/he is in a better mood. It is not necessary that your loved one has a bath every day. However, it is important that his or her hands, face, and private areas are washed every day for health and well-being. Even if he or she refuses to take a bath, encourage him or her or ask if you can assist in washing these areas.

Health check at bath time

Bath time provides an opportunity to look for any skin problems such as rawness, bedsores, or bruises, as these can indicate falls, care issues, or even elder abuse.

Bathing in Late Stages of Dementia

Eventually, you may have to do all of the bathing. Be gentle and avoid friction as your loved one's skin may be fragile and tear or bruise easily. Use a blotting motion to dry the skin. Online guides below offer details on how to provide in-bed baths and shampooing hair without causing a chill for your loved one. Cleansing towelettes may help keep face, hands and private areas clean between baths. No rinse soaps used in a "towel-bath" are another possible option. This alternative may decrease agitation and aggression and improve skin condition.

Resources
Source: 
Alzheimer's Association
Description: 
This printable fact sheet provides practical tips and guidelines for bathing someone with dementia, including how to prepare the bathroom and how to assist the person with the activity.
Source: 
ElderCare Online
Description: 
This web page lists possible fears and problems your loved one may have that you should take into consideration when attempting to give a bath and ways to adapt the bath to your loved one's needs. It also provides tips on grooming, with sections on hair, shaving, nails, and teeth.