By: Jennifer Beach, LSW, MA, C-SWCM
Mrs. Smith is 87 years old and lives in an Assisted Living Memory Care center. Janet, her daughter, frequently gets calls from the facility, letting her know that her mom “refuses” to take a shower. Janet is not surprised, as she recalls the changes in her mother’s hygiene and grooming in past years when her mother was still living in her own home.
Challenges with hygiene often go hand-in-hand for individuals with dementia. Their overt and non-verbal refusals are frequently ignored and the battle over showering, bathing, and getting “cleaned up” continues, despite their angst.
Many challenges with bathing involve the individual with dementia and the caregiver, but in most cases, these challenges can be prevented. The caregiver may have cultural, personal or supervisory influences that make them feel they must “get the person clean” the way they think or feel it should be done.
The National Institute of Health (NIH) is one of many organizations that have completed studies, clinical trials and interventions to improve the bathing experiences for individuals with dementia. The outcomes all focus on a person-centered approach. When using what works best for a particular individual, studies have found a significant decrease in agitation and anxiety for the individual receiving the care, as well as a decrease in the caregivers’ agitation and distress.
Mrs. Smith grew up taking baths and continued to bathe most of her adult life. She was never comfortable taking a shower. In her current Assisted Living setup, the shower room is located outside of her room. The shower room feels cold, loud, bright and overwhelming. Mrs. Smith verbally tells the caregivers she does not want a shower and her body language clearly reinforces that this is not something she wants to do.
Mrs. Smith and many individuals from her generation grew up taking baths and simply are not comfortable with standing in a shower. When water is spraying on an individual’s head and/or face it can be a trigger for anxiety with many individuals with dementia. In addition, hearing and balance issues can cause difficulty in a shower situation. The time of day, temperature, lighting and sound may also play a role with taking a shower.
Our job as care providers is to work with and understand the individual we are caring for and subsequently find ways to make the individual most comfortable. The challenging reality of dementia is that what may work today may not work tomorrow.
There are many techniques that can be used to help reduce some of the challenges individuals with dementia may experience during hygiene tasks.
Consider these alternative bathing techniques:
- Sponge or Towel Bath – This often works with a frail person or individuals with difficulty moving. Wash the individual while they are in their bed.
- Toilet or Commode Bath – While the person on commode this may be a natural time to wash an individual.
- Recliner Bath – Many people sleep in recliners for a variety of reasons. The same concept of a sponge bath works here, but can be completed directly in their recliner.
- Section-a-Day Bath – Breaking down washing into small sections and short time frames simplifies and shortens each session. Example: washing feet and lower legs one day, arms and back another day and so on.
Tips:
- Heat the area to keep the individual warm
- Use soft lighting
- Play relaxing music or have sing-along during the hygiene task
- Keep individual covered or wearing clothing over areas not being washed
- Try different times of the day that may work best for the individual
The assisted living facility is now implementing several of these suggested techniques and Mrs. Smith’s hygiene routine has improved. Caregivers discovered that after lunch is the best time for Mrs. Smith to be bathed. Instead of going to the shower room, they bathe her while she is sitting on a chair in her bathroom. Because it’s in a smaller setting and the room is familiar and warm, she tolerates the bath much more now than before. They also play soft music so now bathing is no longer a battle; it’s something Mrs. Smith actually enjoys!