How to Safely and Effectively Assist an Individual with Dementia with Bathing

Causes of Bathing Challenges Associated with Dementia

Alzheimer’s patients resist bathing for numerous reasons.

Bathing is intimate and personal, and can feel intrusive and embarrassing for someone with dementia. In fact, it can be the task that caregivers find most difficult. Someone with Alzheimer’s disease (or related dementia) might not understand the point (as in: literally cannot remember what purpose bathing serves), and having to undress and be washed by someone, even someone coming from a place of love, can feel like the ultimate loss of independence. Someone with dementia is prone to be more sensitive to water temperature and may actually fear water, especially being submerged.

If your loved one refuses to take a bath, don’t push too hard. How often an elderly person bathes should probably be a few times per week, though it’s important that hands, face, and private areas are washed every day for health and wellbeing. Even if your loved one won’t bathe, encourage cleanliness in these areas. Ask for assistance (always gives as much control as possible), or ask to be allowed to wash there yourself.

Solutions for Bathing Challenges Associated with Dementia

Planning is the key to making bath time manageable. There are things you can do (behavioral) and things you should have (bathroom upgrades) that will make bathing your loved one easier. Remember, above all, to be gentle. Avoid scrubbing and make sure the water pressure isn’t too much. Don’t buy bathing products like soap or shampoo that come in breakable containers.

Behavioral

Stick to a Schedule. Establishing routines is crucial for managing symptoms of dementia, so be consistent with bath time. Before the diagnosis, your loved one might have enjoyed a shower every morning before work, or a warm bath after a long day. Look for times and conditions that are most enjoyable or tolerable. (If, for example, sundowning is an issue, then don’t wait until evening.)

Consider Frequency. How often should someone with dementia bathe? Should it be every day, or every other day, or twice a week? Though most adults shower every day or two, you may not need to bathe your loved one that frequently. Determine whether it might be sufficient to have a sponge bath twice weekly and a shower once a week.

Choose Wisely. What’s the best way to bathe? There’s no standard answer. Your loved one may prefer a shower, a bath, or (especially in late-stage dementia) a sponge bath that causes very little stress. In early stages, ask about preference because you want to give as much control as possible.

Encourage Independence. Speaking of control, encourage and allow your loved one to function as independently as possible. In the early stages, a verbal prompt to take a bath or shower might be sufficient. As the disease progresses, more assistance will be required. If the person can help put soap on a washcloth or wash a part of the body without help, encourage it. This can be empowering.

Be Prepared. If it’s to be a bath, have the water drawn. Gather a big towel, soap, and shampoo ahead of time, and place those items within reach. Make the bathroom comfortable by minding chilly surfaces and padding them with a warm towel.

Mind Temperature. Like young children and infants, older adults have sensitive skin and are at great risk for burns and scalds. Scalding is worse for someone with dementia, who might not understand the source of the pain.

Some simple adjustments can prevent minor and serious burns:
– Lower the temperature on your hot water heater. Many are set to 140 degrees fahrenheit, which can scald skin in five or six seconds. By lowering the temperature by 20 degrees, you can prevent scalding. (It takes five to 10 minutes for 120-degree water to scald.)
– Install an anti-scald device on the faucet or showerhead, to prevent burns regardless of the setting on the hot water heater. The device prevents water from pouring if it gets too hot.
– Always test the water with your hand before your loved one bathes.

Don’t Leave. Never leave your loved one unattended in the bath. Someone with dementia may not know the difference between the hot and cold knobs. Confusion and loss of coordination are important considerations, and supervision prevents accidents.

Play Soothing Music. Playing music can help relax or even distract your loved one during bathing. For more on how music helps people in various stages of dementia, click here.

Remember Dignity and Privacy. Being naked in front of a caregiver can be embarrassing, so consider shielding with a towel as your loved one undresses, and let them cover up with a towel or robe as soon as they step out of the bath.

Consider the Sponge. Sponge baths allow you to clean your loved one without submersion or shower spray. This can be particularly useful in later stages of dementia, when bathing is more confusing for your loved one, and when getting in and out of the tub or shower becomes difficult.

Bathroom Upgrades

Someone with dementia (any stage) is more susceptible to falling, especially in the bathroom. These small upgrades can lower the danger risk:

Grab Bars. These are installed on the walls of the shower to give your loved one something to hold on to. They can stick to the surface with suction cups, though mounting hardware like screws is probably preferable. Grab bars can have anti-slip grips. Poles secured from floor to ceiling of a shower are also good options.

Non-slip Bath Mats. Hundreds of thousands of people are injured every year when they slip in the bathroom, and elderly people are particularly vulnerable. Non-slip surfaces are available that adhere to the floor of tubs and showers, and also to the tiles on the floors of the bathroom.

Go Hand-Held. A hand-held showerhead, as opposed to a typical fixed head, allows for easy access to harder-to-clean areas and simply cuts the stress of having to contort to wash important areas like under folds.

Bath Chair. These are useful in both the bathtub and shower. Bath chairs can be sturdy, with non-slip leg tips, and adjusted to a comfortable height. Put simply: Someone sitting is less likely to fall. The feeling of security can also allow for more independence, as your loved one can do more without worrying about staying upright.

After the Bath

Have your loved one sit while you do the following, encouraging as much assistance as possible. (In early stages, it’s possible these can be done independently, though you’ll still want to supervise):

– Pat the skin dry with a towel, instead of rubbing.
– Apply lotion. This can be soothing as it also helps with dry skin.
– Powder hard-to-reach areas, like under folds.