Challenges in Bathing for Those Living with Dementia and their Caregivers

Written by Denice Tomlinson, Director of Memory Care, The Kensington White Plains Assisted Living Residence

Bathing can be one of the most challenging of tasks when living with mild to moderate dementia. Imagine yourself with your healthy brain and all the tasks that encompass bathing. Have you ever forgotten whether you washed your hair, face, or feet while you were bathing?

Many times, we become distracted by thoughts and have forgotten where we are in the process. Ask yourself, what compels you to want to bathe; smell, sweaty skin, dirty hair or just to wake up. Feeling the warm water on your sore muscles or to cool water off on a hot day? Or the scent of your favorite shampoo or soap? Do you adjust the shower head spray so that the stream is forceful or a gentle wide shower spray?

Most of us consider bathing one of the most private and personal activities that we do. Still imagining with your healthy brain, add a stranger in the bathroom, or an unfamiliar bathroom, painful joints and maybe a little fear of falling and the task of bathing is not our usual relaxing experience.

Often those living with dementia do not want to bathe. Many of the reasons for bathing are no longer important. Many do not feel the urgency of needing to bathe. Where am I going? When living with dementia our senses no longer give us the signals that we need to bathe. And as dementia progresses and our brain starts to lose connections, many begin to experience a decrease sense of smell, loss of vision and slower processing in hearing words. Bathing can be scary (falling, water too cold or hot, the water stings, rubbing of towel hurts). So, when all this is considered we can begin to understand the resistance to bathing.

Bathing is one of the most complex tasks. Try writing down step by step what you do when you take a shower. Beginning to end. Start the list from your bedroom and end it when you are back in the bedroom. The list is very long.  For someone living with dementia, staying on track with this many tasks can be overwhelming.

We should not forget our sense of modesty. For many of us our modesty develops during puberty and continues throughout our 90 years or more. The thought of undressing and washing up with someone else present is very uncomfortable.

When we, the caregivers start from a place of understanding and empathy with our healthy brain, we will be more successful in helping those who are living with dementia to achieve bathing tasks. But there is more that we can do to increase our chances of successful bathing.

The caregiver needs to use their healthy brain to plan out the shower, be organized, simplify tasks and limit the tasks that need to be achieved. Think back to your list of tasks start to finish. How can you simplify the list? Which tasks must be achieved, which can be saved for another day or achieved in another setting? For example, can washing feet be achieved with a foot spa, followed by a foot massage?

Let’s consider how to make the bathing process a success by planning ahead and remembering that the environment is very important:

• 6 Towels! That may seem outrageous, but you may need every one of them. Towels should be warm if possible (right out of the dryer). One should be placed on the shower seat, two that will get wet (this will be explained later) and two for drying. One possible for the floor if wet. Always an extra.
• Soap – Body wash is easier to use and can be used for both the body and hair.
• Wash cloths – at least four to five (face, body, groin area, soiled areas). Wash cloths need to be soft and very soapy to glide over sensitive skin.
• Temperature in the room – should be very warm before they enter.
• Handheld shower head can direct the water to specific areas and not other areas

The caregiver approach and patience during the bathing process is also important. Often those living with dementia will take cues from their caregivers. The caregiver should be calm, smiling, and confident (but not overpowering). If you are having a stressful day or are tired, the bath will not go well!

• Words should be simple, kind and reassuring. “let’s get washed”, “let me help you”, “I know this is hard”, “we will do it together”, or “let me get you started”.
• Have them hold a washcloth even if they cannot wash themselves.
• Give choices “do you want to wash this or that”? Coach them through the bathing process.
• Caregivers should smile, sing, play relaxing music, tell a story to distract.

Bathing is often about trust and will take practice, routine and maybe several tries to achieve success. Think about what went well and what can be changed for next time. Even with all the careful planning, those living dementia can still be resistant.

Some ideas to consider when caregivers encounter resistance –

• Time of Day – changing the time of day may offer success. Some of those living with dementia are so sleepy in the morning and do not wake until later in the day. Mornings or even afternoons may not be a good time for them. Often after dinner might be more acceptable.
• Which caregiver can get it done? Try different caregivers. Sometimes the least likely person is the person that can get the task done. I have heard many times that the weekly housekeeper that has been coming to the home for years is a trusted and accepted person. They are often not skilled, but they often get the job done.
• A common mistake that is often made is to talk about bathing when the person is in the bedroom or in bed. Bathing should be discussed once in the bathroom not before. Otherwise the idea of bathing becomes an overwhelming thought.
• Always cover modest areas – place towel over shoulders and groin. Remember the environment was prepared with towels to get wet in advance.
• If there is resistance taking off clothes you can wet the towel and clothes and then they are more likely to allow them to come off.
• Many caregivers will ask what is better – sponge bath in the bed or at the sink versus shower? Whatever gets the task done, is the right answer.
• Caregiver needs to remain calm and never be anxious even when the bathing process becomes an argument or fight.
• Once bathing becomes a fight, it becomes dangerous with risk of fall or injury for both parties. Once you have a fight, then the demented individual will want to take flight. You need to help them get out of the situation and help them calm down. Calming phases help such as, “I am so sorry this happened”, “let me help you get to bed” or “let me help you get warm”, “Let’s go, get away from here” or “Let’s get dressed and get something to eat.”
• Have a favorite food or drink nearby; sweets if you can. Add cookies to the preparations and have them in the bathroom or bedroom.
• When resistance and a fight occurs regularly there should be a second caregiver or family member nearby. That second person can be the “rescuer” and can take over the end of the process and get the demented person to “safety”. The first caregiver should step out of sight but stay nearby.
• Remember it’s ok not to get it done today! And it is ok if you need to be rescued.

Bathing can be a real challenge and often the caregiver will need regular help and support of skilled healthcare professionals. Worries and concerns should be shared with other caregivers, family members and medical professionals. Websites such as the Alzheimer’s Association, community caregiver support groups and personal counseling or coaching can help caregivers feel they are not alone.

It’s important to know you are not alone and others are experiencing the same emotions and struggles you are. Even though caregiver’s brains are healthy, we need help too!