Dementia-friendly bathing

A nice hot bath is one of life’s simple pleasures. However, bathing a resident with dementia can be a frustrating—and even dangerous—aspect of caregiving. It’s not uncommon for a person with Alzheimer’s or another dementia to argue about needing a bath because he or she often thinks that it was already taken.

Fear of bathing can be a source of frustration for the resident with Alzheimer’s and the caregiver. In 2004, Cindy Keith, RN, BS, CDP [certified dementia practitioner], founded M.I.N.D. [Moving in Nurturing Directions] in Memory Care, to train facility and family caregivers on the best ways to work with residents with Alzheimer’s or dementia. M.I.N.D. in Memory Care is also a comprehensive resource on how to deal with issues and challenges of dementia.

PREPARING THE RESIDENT FOR BATHING

Many residents with dementia have an aversion to water and may be reluctant to cooperate with the caregiver. Keith advises the caregiver to focus on the person, not the task. “Talk to the resident in a friendly tone. Be upbeat, cheerful and creative when getting the resident ready to bathe,” says Keith. She finds that singing to or with the resident has a calming effect. “One of the favorite songs they respond to is ‘Amazing Grace,’” she notes.

“However, if the resident is adamant in refusing to bathe, let it go,” Keith says. A full bath every day isn’t required to maintain hygiene; two baths a week are sufficient, she advises. However, critical perineal areas, along with the face, hands and chest, should have a daily sink bath or “wash-up.” This becomes even more imperative for good skin care if the person is incontinent.

PREPARING THE TUB ROOM

Before you bring the resident with Alzheimer’s or dementia to the tub room, it is important that everything is in place so that the resident is the caregiver’s only focus. “First, be sure the room is warm and that mirrors are covered,” says Keith. Doing this, she says, will make the resident feel more comfortable about undressing since he or she might not recognize the reflected image as their own.

Be sure that there is soft music and lighting in the area. “It’s all about providing the most comfortable and least intimidating setting possible,” Keith explains. She recommends using pretty towels and soft scents also to add to the experience. “In many facilities, the tub rooms have been converted to ‘spa’ areas to enhance the bathing experience,” she says.

Plants, pictures and interesting accessories provide distraction and encourage conversation. In the “Helpful Tips” section of Keith’s website, she explains that a brightly colored parrot in a silk tree can initiate a discussion. Let the resident hold it and ask, “I wonder how this got here?” “Is this yours?” Simple questions and answers engage and distract the resident to make it easier to help the person undress. Simple engagement techniques, such as this, also help preserve a resident’s dignity during this most personal ritual.

Finally, before you begin the bath, Keith advises the care giver to be sure that towels, nightclothes and a robe are nearby. Filling the sink with hot water and warming skin lotion in it while the resident bathes will be a luxurious and calming treat at the end of the bath. “Rubbing a creamy, warm lotion on the skin not only is good skin care, it adds a comforting conclusion to the bath,” she explains.

DEMENTIA-FOCUSED BATHING TECHNIQUES

Because some residents may have a fear of water, Keith stresses the need to be flexible with bathing. “If a person experiences ‘sundowning’ behavior, a morning bath may be more successful when the resident is less restless,” Keith explains. Some residents might be more comfortable in a shallow bath using bubbles to disguise the water, while others may prefer being bathed with a handheld shower. Determine the most comfortable bathing style for the resident at the outset.

Keith also recommends that you encourage the resident to use the toilet before helping him or her into the tub. Not only is this more sanitary, it provides a good opportunity to easily remove lower clothing. After toileting, continue to distract the resident with conversation while he or she gets safely situated in the tub.

Keith has found that a person with dementia is more comfortable seated on a small towel or washcloth. And if the individual is more comfortable covering their chest or legs with a towel during the bath, let them. “If this helps the person preserve his or her dignity, it’s worth a little extra laundry,” she says. To keep the bath moving along, Keith recommends having a number of washcloths readily available. While the resident is busy washing her chest, the aide can be soaping up her back and legs.

You might think that a proper bath can only be given when a person is undressed. If that’s so, you’re wrong. “If being fully clothed is the only way to get someone with dementia into the tub, then do it. A soapy washcloth used under the clothing will get to the critical areas of armpits, perineal area and under the breasts,” says Keith.

FINAL STEPS

Save hair shampooing until the end of the bath. People with dementia can become cold and panicky when the head is wet, notes Keith. “Be gentle. Do not startle the bather with a sudden deluge of water over his or her head or a stinging spray from a handheld shower,” Keith advises. However, if a person becomes adamant or combative when trying to wash the hair, Keith says to let the shampoo go. “As long as the hair gets washed at least once a week, a dry shampoo that brushes out of the hair can replace a wet wash,” she says.

When exiting the bath, wrap the resident with Alzheimer’s or dementia in warmed towels to keep him or her calm and cozy. “This is the point where you massage the warmed lotion into the skin, paying special attention to the knees and elbows.” Be sure to use this time for a skin inspection, she adds, looking for skin tears, redness, rashness and any other abnormalities that might indicate an injury or the onset of a pressure ulcer.

CONCLUSION

Taking the right approach to bathing a resident with Alzheimer’s and dementia results in a more satisfying experience not only for the resident but for the caregiver as well. The key is to build a bond with the resident with conversation, consideration and care.

Sandra Hoban

Sandra Hoban was on I Advance Senior Care / Long-Term Living’s editorial staff for 17 years. She is one of the country’s longest-serving senior care journalists. Before joining Long-Term Living, she was a member of the promotions department at Advanstar Communications. In addition to her editorial experience, Sandi has served past roles in print and broadcast advertising as a traffic and talent coordinator.