Helpful Tips for Bathing People with Dementia

Caring for a family member with any type of dementia, such as Alzheimer’s can be very challenging when that person resists the care, or becomes combative with the caregiver. This is often the case when it comes to bath time. People with dementia virtually never worry about whether they look or smell good, and they usually always believe they have just recently had a bath–so why on earth should they take another one just because you think they need it? You may often find yourself having to get very creative about how you get them into the bathtub or shower.

As a dementia consultant, I tell my family clients that bathing is not required every day, or even every other day. As long as this person is getting a “wash-up” of the critical areas every day, then a full bath is not needed. These critical areas include the face, hands, armpits, peri-area, and under the breasts for women with large breasts. If this person with dementia is incontinent of bowel and/or bladder, then every time they are toileted, their peri area should be washed thoroughly. The skin is much more prone to breakdown if it is not kept clean. There are many good products on the market with gentle cleansing properties as well as lotions in them. This can be a good alternative to a soap and water scrub after every brief (adult diaper) change, and can make this often difficult task easier for both the caregiver and the person with dementia. Twice weekly baths should be sufficient for most people if those critical areas are kept clean daily.

You must always check the skin when you are cleaning them for any areas that appear to look different–either a redness that does not return to normal pink color after several minutes, or worse, if the skin appears white and does not become pink again after several minutes. Skin changes such as these could indicate the beginning of a pressure sore either from sitting or lying in one position too long, or from clothing rubbing.

Here is a list of tips to not only help get your loved one with any type of dementia into the tub/shower more successfully, but to also help make it a more calm and pleasant experience for both of you:

1.  First, prepare yourself!  Be person focused and not task focused.  Avoid having a rigid schedule.  When you are hurried and harried, your loved one will pick up on that and become resistant.  Make sure that smile is in place before you start!

2.  Adhere to this loved one’s preferences as much as possible.  If they preferred tub baths in the mornings before they had dementia, then chances are good they will be more willing to continue that routine.

3.  Prepare the bathroom in advance making sure it’s WARM–more warm than you like it, and all needed items are within easy reach.  It will probably need to be much warmer than you like it, but realize it will be much easier to get their clothes off if they’re not cold.  Add their favorite music and soft lighting if you think that will help.  Women tend to enjoy special items in the bathroom such as pretty towels in a favorite color, scented lotions or bubble bath, and possibly candles.

4.  To help provide an increased sense of security, make sure your tub/shower has grab rails/bars, non-slip decals or mats, and a seat in the shower.

5.   Have distractions in the tub/shower area–something not normally found there to use as a conversation point that will draw their attention away from the bath.  An example might be a plastic or silk tree with a big brightly colored parrot sitting in it.  If this loved one enjoyed fishing, then a picture of a large fish hanging where he can focus on it while bathing or getting undressed.  Even a small rubber duck sitting on a shelf.  You could pick it up and ask “I wonder where this came from?” Hand it to them and keep up a dialog about it, “Is this yours?  I wonder if there was a child in here taking a bath…”  When it’s in their hands, and they’re focusing on it, they’re not able to focus on the fact they are being slowly and gently undressed.  They can only focus on one thing at a time and you usually want their focus off the bath.

6.  Cover the mirror if they no longer recognize themselves in it or they will think there is a stranger staring at them and be very hesitant about undressing.

7.  Plan a pleasant activity prior to bathing such as singing, walking, or reminiscing.  This will help promote a relaxed and comfortable mood which can carry over into the bathroom.

8.  DO NOT discuss your intentions in advance.  DO NOT ask them if they are ready for a bath or if they want one.  If you do that, and get a “No” response, it’s pretty hard to change their mind at that point.  Just don’t go there.  Simply engage them in a topic of conversation and lead them into the prepared bathroom.

9.  Always toilet them first.  This is a good opportunity to remove the lower body clothing too.

10.  If this person with dementia has a painful, chronic condition such as arthritis, you may want to give them a prescribed medication such as Ibuprofen at least an hour prior to bath time to decrease the likelihood of pain being the reason for refusal or agitation.

11.  Monitor your body language and tone of voice at all times.  If you are tense, irritated or unhappy, your loved one will immediately sense that and reflect that back to you, making your task much more difficult.  Gentle and slow with a smile on your face and in your voice is what you need to be striving for.

12.  Use very simple instructions with few words such as “Take your shirt off now.”  “Take your shoes off now.”  “Thank you!”  That’s much easier for them to understand than “I need you to take your shirt off now, and then you can step into the tub…”

13.  Whether in the tub or shower, I have always found people with dementia to feel more comfortable if they were sitting on a washcloth or small towel.  It’s a simple thing and if it helps them be more comfortable, then it’s well worth the extra laundry.

14.  Take care to always maintain their dignity. Even if that means allowing them to hold a towel over their chest or legs the entire time.  It will be much easier for you to wash a few extra towels versus embarrassing your loved one and having to deal with that.

15.  It’s really okay to take a bath or shower with their clothes on!  If that’s the only way you’ll get them in there, then do it.  They will be more willing to remove wet clothes than dry ones, and you can run the soapy washcloth under the clothes to get the important areas.

16.  Distract them from the bath with conversation the entire time–or sing with them.  There have been many, many times when I’ve been able to accomplish a bath with an initially resistant person with dementia simply by starting to sing their favorite song.  Once they began to sign with me, I knew they were ready to begin the bath.  Relaxed and happy people often sing and wouldn’t that be a great way to get the job done?

17.  If appropriate, offer to join them in the tub/shower.

18.  Allow them to do as much as possible for themselves.  Hand them a washcloth or sponge with the soap already on it.  Have several washcloths handy so you can be using one for their back at the same time, and you may need a dry one if they want to wipe the water out of their eyes.

19.  If you suspect your loved one has developed a fear of the water, you can add bubble bath to cover the water, but be aware it will make it more slippery for them.  Only fill the tub a few inches deep with water.

20.  Try a handheld shower spray in the tub/shower with the spray gently directed at their feet.  Work up the body slowly, and don’t worry about rinsing the soap off until last.

21.  If eating is a favorite activity for this loved one, you may consider providing a snack such as an apple, small sandwich, or banana while in the tub.  If this helps keep them distracted, it’s worth it.

22.  Use humor as much as possible, but take care they don’t perceive it as you are making fun of them or laughing at them.  If they perceive this as a fun thing to be doing, your job will be much easier.

23.  Do not get their head wet until the last possible minute, because they will quickly get cold and sometimes panicky once their head is wet.

24.  Be sure to use a very gentle “tearless” shampoo and soaps that won’t dry their skin.

25.  If at all possible, have their towel or bathrobe warmed by the clothes dryer, so it’s a very comforting experience for them to have it wrapped around them.

26.  Never, ever leave them unattended, even for the 20 seconds it may take to go get the towel out of the dryer.  It’s truly like leaving a child in the tub only this elderly adult will break bones much easier.

27.  When drying them off, be sure to quickly inspect their skin for rashes, dry areas, red or white areas and skin tears.  They may have injured themselves without your knowing about it, and then forgot about it themselves.

28.  Always apply lotion, especially to the feet and elbows.  Putting the bottle in the sink half full of hot water will warm it while the bath is being accomplished and make the experience more enjoyable.

29.  Remember, tub baths or showers are not required to maintain cleanliness.  Sink baths can be effective as long as their hair is being washed regularly.  In fact, many elders today who do not have dementia, prefer to give themselves a “wash-up” at the sink and rarely take baths or showers.

30.  Occasional use of a dry shampoo is an alternative if they are frequently resisting having their hair washed.  Consider if it is possible to either take them to a hairdresser/barber, or have one come to your home.

31.  If they have become prone to sundowning in the evenings when they would normally bathe, try switching to mornings when they are more calm.

32.  Use begging, bargaining, or pleading ONLY if you feel it will work and if it doesn’t work, don’t press to continue.  Try later in a different manner.

33.  Realize that sometimes no matter what you do, or how you do it, it just doesn’t work.  Stop, step back and try again later.

34.  Never force them or argue with them.  Their damaged brain cannot comprehend your viewpoint and they can easily become combative resulting in injuries to themselves and/or you.

35.  In Joanne Koenig-Coste’s book “Learning To Speak Alzheimer’s,” she tells a wonderful story of a very resourceful and determine wife who would wait until her husband was deeply asleep and then start bathing him one area at a time!  When he started to awaken, she would quickly disappear and begin again when the snoring had deepened.  I realize that would only work for a limited number of people, but what a great way to get the job done when nothing else worked!

36.  Remember, what works well today may not work at all in a few weeks.  Just keep that calm, relaxed and smiling attitude at all times and try the next idea.

When you care for a person with dementia you often find yourself deciding which battles you will fight. Bathing should not be one of them. If it’s a struggle to even get them bathed once weekly instead of twice, so be it. Even for the most resistant people, as the dementia progresses, something you attempted a few months ago may now work well with them. It becomes a game of constantly changing rules, and the more flexible you are, the less stress you will feel. Try to keep in mind that one of the goals is to keep your stress level reduced, and the other goal is to keep your loved one clean and happy–but missing a few baths, in the grand scheme of things, won’t really matter that much, so try to not take on that stress.

Here’s to a calm and happy bath time!

Cindy Keith, RN, BS, CDP
© Cindy Keith, RN, BS, CDP May, 2010

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