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 the process or be able to do 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 that is being submerged in a tub or being sprayed with a showerhead. Being washed and handled can also be difficult, as many people are accustomed to bath time being a private act.
To make bath time successful, follow these tips:
Schedule Bath Time – Plan for bath time as if it were an event on your schedule. In other words, make it part of your regular routine. 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. If possible, when scheduling a bath, try to work with the times and conditions that are most enjoyable or tolerable to your loved one.
Pick the Time of Day – When setting a regular routine of bath time, it’s also important to consider what time of day is best for your loved one. For example, is your loved one 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 shortly after getting up for the day.
Choose the Form of Bathing – Consider what type of bathing your loved one prefers. Is it a shower, taking a bath, or would a sponge bath create the least amount of stress and / or resistance? When considering the form of bathing, it’s also important to consider realistically what you are capable of providing.
Choose the Frequency – Think about the frequency in which your loved one should bath. For instance, should it be once a day, every other day, or twice a week? Most adults shower every day or every other day, but you may not need to bathe your loved one as frequently as that. It may be sufficient to give him or her a sponge bath twice a week and a shower once a week.
Encourage Independence – In the process of bathing a loved one with Alzheimer’s, encourage and allow the individual to function as independently as possible. In the early stage of dementia, a verbal prompt to take a bath or shower might be sufficient. However, as the disease progresses into the middle and late stages, more assistance will be required. Even so, if the individual is able to help put soap on a washcloth or wash a body part, encourage him / her to do so, as this can create a sense of control over the situation.
Tactile, verbal, and visual cues can all be used to assist your loved one with bathing. To learn more, watch a short video (1 minute 30 seconds).
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 bathing items, as they are needed. However, as the dementia progresses, you may have to calmly remind your loved one how and where to clean their body with these items. You may also 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 do it 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.
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:
If you are met 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 she / he is in a better mood. As mentioned previously, it is not necessary that your loved one bathe every day. However, it is important that his or her hands, face, and private areas be washed every day for health and wellbeing. Even if your loved one refuses to take a bath, encourage him or her to assist, or allow you, to wash these areas.
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. When drying skin, use a blotting motion. Cleansing towelettes may help keep the face, hands, and private areas clean between baths. No rinse soaps / shampoos used in a “towel-bath” are another possible option. This alternative may decrease agitation and aggression and improve skin / hair condition.
Persons with middle to late stage dementia also require assistance with dressing themselves. Watch a short video for tips on providing assistance dressing (3 minutes 30 seconds).