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Saturday, December 24, 2011

How to Get An Alzheimer's Patient to Bathe

 Doctors recommend older adults shower or bathe a minimum of twice a week to reduce the chance of infection including urinary tract infection.

Many Alzheimer's caregivers face this common problem, how do you get a recalcitrant dementia patient to bathe or shower?

It is not uncommon for a caregiver to want to "pull their hair out over this one".

Here are a list of tips that might help the task of bathing go easier :
  • Doctors recommend older adults shower or bathe a minimum of twice a week to reduce the chance of infection (especially UTI’s in women). If you can get them to bathe more, kudos to you. If not, be satisfied with twice a week, unless another medical condition demands more frequent bathing.
  • To combat the “NO’s” try to make it seem as if the request is just a routine part of daily life as in, “It’s Tuesday morning. We always take our bath on Tuesday morning. Let’s go get cleaned up, and then I’ll make you a nice breakfast.”
  • Follow up on the positive reinforcement (as Bob calls it), so that your loved one does get rewarded for complying. Doing this over and over, as part of the regular routine, imbeds in your loved one the behavior you want to happen. Yes, it can be done with enough practice! ALWAYS PRAISE AND COMPLEMENT THEM AFTER THE BATHING IS DONE.
  • Have everything ready (soap, shampoo towels, washcloth, etc…) in advance, all laid out ready to go. The room temperature is warm, maybe soft music is playing. You say something on the order of “your bath is ready for you. Here, let me help you with your shirt (or shoes, or whatever). Start helping, turn the water on in the tub and temper it and say something like “madam (or sir) you spa awaits you.”
  • If there is no other way to get them to bathe. Ask their doctor to write on a prescription pad something like this: “Mr. So-and-so needs to bathe two times a week for infection control”. Make several copies of the prescription (in case they tear it up). Show the prescription to them and say “Doctor’s orders”.
  • The bathing should take place at the time and in the manner the person always used to bathe, meaning if they were a morning before breakfast bather, then you should have them bathe in the morning before breakfast. If they were a shower person, then they should have a shower, not a bath, unless medical or physical reasons preclude that.
  • Some persons with dementia actually grow afraid of the water, especially water coming out of a wall mounted shower head. It becomes threatening to them. If this is the case consider getting a flexible hand held shower head. That way you or your loved one can control where it sprays on them.
  • Allow your loved one to do as much as they possibly can to wash themselves while in the bath. If they can do a credible job on their own with just reminders from you to wash here and there, let them do that. Even if they don’t do a credible job and you have to redo the washing, I suggest you have them wash themselves first. It gives them “ownership” of the task and gives them something to be successful at Even if all they can do is hold a washcloth while you do everything else, let them do that. At least they are participating in the task as much as they can. The same goes for hair washing.
  • The same advice goes for drying themselves. Allow them to do as much as they can, even if you have to go back over what they have done. ALWAYS PRAISE AND COMPLEMENT THEM AFTER THE BATHING IS DONE.
  • Some people need to be distracted with something while you give them the bath or shower. Distractions that could be used are singing in the shower, giving them something colorful to hold and look at while in the shower (or several somethings to hold and look at) such as a squeeze ball or a shower scrub in the shape of an animal.
  • Some people are extremely modest, be aware that that may be the reason for saying “NO”. Respect their dignity by allowing them to cover up with something while in the shower. Perhaps a towel or a sheet or even a poncho. Just wash under whatever they use to cover up.
  • Safety comes first. There need to be grab bars positioned for them to hold on to while getting in and while bathing. Their needs to be appliqués on the shower or tub floor to give them traction under their feet.

Keep these additional tips in mind:

I’m not fond of bath mats. I’ve seen them lose suction and slide under the person’s feet too often.

If the person is unsteady, a shower chair is needed. I’m not a fan of using the bedside potty chair as a shower chair because using it in the shower tells that person that it is ok to go to the bathroom in the shower or bath.

If the person is scared to get into the tub because they have to step over the tub wall, try using a “transfer board”. It is a fairly long straight plastic board that you place in the tub with one set of legs outside the tub and the other set of legs inside the tub. Your loved one sits on the outside part and you help slide their behind to the inside part (and lifting their legs over the tub wall, of course). Poof fear of falling is gone.

Finally, after the bathing is completed and, your loved one is dressed PRAISE AND COMPLEMENT THEM and ask them to cross off that day on a year long calendar showing the year by months. Have them do this every time. Eventually you will have visual proof that they have taken their shower or bath every Tuesday and Friday (for example) for months and that it is a normal thing to do.

It also squashes the “I took a bath/shower earlier today or yesterday” protest. Nothing works like visual proof.

By Carole Larkin MA,CMC,CAEd,QDCS,EICS

1 comment:

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