Bathing

Bathing1Bathing is often the most difficult personal care activity that caregivers face. Because it is such an intimate experience, people with dementia may perceive it as unpleasant or threatening. In turn, they may act in disruptive ways.

Behaviors during bathing

People with dementia may resist, scream or hit during bathing. Such behavior often occurs because the person doesn’t remember what bathing is for or doesn’t have the patience to endure such unpleasant parts of the task, like lack of modesty, being cold, or other discomforts. Loss of independence and privacy can be very difficult for a person with dementia. The disease also may increase sensitivity to water temperature or pressure.

Do not take disruptive behaviors personally. Remain flexible, patient and calm, and try the tips on this page.

When bathing a person with dementia, allow the person to do as much as possible, but be ready to assist when needed. Assess his or her ability to:

  • Find the bathroom
  • See clearly
  • Keep balance without fear of falling
  • Reach and stretch arms
  • Remember steps in the bathing process, follow cues or examples
  • Know how to use different products (soap, shampoo, washcloth)
  • Sense water temperature

Preparing the bathroom in advance:

  • Gather bathing supplies such as towels, washcloths, shampoo, and soap before you tell the person that it’s time to bathe.
  • Make sure the room is warm.
  • Use large beach towels or bath blankets that completely wrap around the person for privacy and warmth.
  • Have a washcloth ready to cover the person’s eyes to prevent stinging from water or shampoo.
  • Make sure that soap and shampoo are easy to reach. Try using hotel-sized plastic containers of shampoo.
  • Pad the shower seat and other cold or uncomfortable surfaces with towels.
  • Fill the tub (only use 2 to 3 inches of water) and then assess the person’s reaction to getting into the water. It may be better to fill the tub after the person is seated.
  • Try using a hand-held shower head and make sure the spray isn’t too intense.
  • Monitor the water temperature. The person may not sense when the water is dangerously hot or may resist bathing if the water is too cool.

Helping the person feel in control

  • Give the person choices. For example, ask: “Would you like to take a bath or a shower?” “Do you prefer to bathe now or in 15 minutes?”
  • Be sure the person has a role. Have the person hold a washcloth or shampoo bottle.
  • Be aware that the person may perceive bathing to be threatening. If the person resists bathing or acts out, distract him or her and try again later.
  • Praise the person for his or her efforts and cooperation.
  • Always protect the person’s dignity, privacy and comfort. Try to help the person feel less vulnerable by covering the person with a bath blanket while undressing.
  • Cover or remove the mirrors if a reflection in the bathroom mirror leads the person to believe there’s a stranger in the room.
  • Have a familiar person of the same sex help, if possible.
  • Be flexible. If necessary, allow the person to get into the tub or shower with clothes on. He or she may want to undress once clothes are wet.
  • Have activities ready in case the person becomes agitated. For example, play soothing music or sing together.

Adapting the bathing process

  • Set a regular time of day for bathing. If the person usually bathes in the morning, it may confuse him or her to bathe at night.
  • Be gentle. The person’s skin may be very sensitive. Avoid scrubbing.
  • Simply the bathing process by sewing pockets into washcloths to hold soap or using soap that washes both hair and body.
  • Use simple phrases to coach the person through each step of the bathing process, such as: “Put your feet in the tub.” “Sit down.” “Here is the soap.” “Wash your arm.”
  • Use other cues to remind the person what to do such as the “watch me” technique. Put your hand over the person’s hand, gently guiding the washing actions.
  • Use a tub bench or bath chair that can adjust to different heights. The person can sit while showering if it is easier.
  • Washing the person’s hair may be the most difficult task. Use a washcloth to soap and rinse hair in the sink to reduce the amount of water on the person’s face. Dry shampoo may work well as an alternative.
  • Be sure the person’s genital areas are washed, especially if incontinence is a problem.
  • Be sure the person is washed between folds of skin and under the breasts. You may want to install a hand-held shower to wash hard-to-reach areas.
  • Don’t worry about the frequency of bathing. “Sponge baths” with a washcloth can be effective between showers or baths.
  • Watch your own back, and don’t bend, stoop, or lift anything heavy. If your back “goes out,” you won’t be much help.

After-bath care

  • Check for rashes and sores, especially if the person is incontinent or unable to move around.
  • Seat the person while drying and putting on fresh clothes.
  • Be gentle on the skin. Pat skin dry instead of rubbing.
  • Use cotton swabs to dry between the toes.
  • Check fingernails and toenails, and trim as necessary.
  • Apply lotion to keep skin soft.
  • Use cornstarch or talcum powder under the breasts and in the creases and folds of skin. If the person won’t use deodorant, use baking soda.

Bathing alternatives

  • Wash one part of the body each day of the week.
  • Consider shampooing hair at another time or on a different day.
  • Sponge bath the person with a washcloth between showers or baths.
  • Use a non-rinse soap product (available at pharmacies and drug stores) with warm/wet towels. Research states that regular, thorough use of a non-rinse soap product is equally effective in getting a person clean.

Bathroom safety

  • Never leave the person alone in the bathroom.
  • Lower the thermostat on your water heater to prevent scalding injuries, and always check the water temperature, even if the person draws his or her own bath.
  • Place non-skid mats on floors.
  • Install grab bars on the wall and tub’s edge.
  • Use a tub bench or bath chair that can adjust to different heights.
  • Make sure there are no puddles on the bathroom floor; think about installing carpet.

The Alzheimer’s Association has come up with very useful information on tips to be a better caregiver. These resources are of great benefit to our caregivers; please use them.