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.
To make bath time successful, follow these tips:
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:
Shower, bathtub, sponge bath?
Consider what your loved one would prefer as well as what, realistically, you can provide.
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.
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.
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:
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:
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.
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.
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.
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.