We are aware that some of you may have stopped your DSL personal cares support, whilst for others the COVID-19 restrictions may have coincided with symptom changes resulting in bathing becoming a more stressful time. A reluctance or refusal to shower/bathe is relatively common for people who have dementia type conditions so try not to take it personally.
This week we will look at some of the potential reasons a person may be reluctant to wash, how our own perceptions may need to change, and some techniques to try. It is important to remember that every person is unique and so these may not work for everyone and what works this week may not work next week. However, we hope you will find the confidence to try different and new ideas.
To try and make the ideas easier to remember we have broken bathing up into 3 main areas: person, method and environment.
Every person is an individual with different life experiences that may affect their approach to bathing. But one thing that most have in common is that, in general, bathing is a private, independent task that is only ever shared with a spouse.
Wherever possible encourage the person with dementia to be independent even if it takes extra time. Give them their own washcloth to actively participate in the experience, even if you have a second cloth to help with back washing or particular unclean areas. Try giving verbal prompts to help the person with dementia.
Just because a person has a dementia diagnosis it does not mean they lose their self-identity or awareness. A person experiencing dementia may not want to be naked in front of one of their children or a spouse they no longer recognise. Try using large bath towels or shower capes for privacy.
Are you fully aware of the person you are helping to bathe’s history? Did they always shower or when they were younger? Was a bath or strip wash their normal routine? What time of day did they usually wash? How often did they wash when they were younger? Is there a possibility the bathroom could hold negative memories/triggers? All these factors could affect why an individual may not want to bathe when and how you believe they should.
If a person is on regular pain relief, then try and time these so that they are effective during bathing time.
Some people with dementia experience changes in pain perception. This means that the feeling of shower water can be painful on the skin making the experience of a shower unpleasant. Try a bath or strip wash instead.
Don’t forget to use humour. Humour is a great tool to reduce anxiety, increase comfort and distract from the task at hand.
Consider Using a No-Rinse soap and shampoo – this can be very useful if the person with dementia becomes distressed when trying to wash their hair or where a shower is painful but there is no bath.
Use Different Words
Some people react to specific words such as “shower time.” Try naming it “getting ready for the day.” Avoid saying ‘you haven’t showered’ or ‘your hair needs washing’. The person may dislike being told what to do. When encouraging the person to shower, observe their reactions/emotions. Respect their dignity/privacy.
Use an Experienced Home Carer
This is not possible right now but for those who are experiencing difficulty with bathing for the first time it may be useful post COVID-19 restrictions. Some people respond better to someone who is not a family member when it comes to an intimate task like bathing. You may be eligible for supports through Disability Support Link which you can be referred to by a GP or Dementia Waikato. Consider a caregiver of the same sex to provide assistance with personal cares.
Try a different approach
Try a different family member where this is possible. It’s not unusual for different family members to receive different reactions.
Assist with sponge bathing if necessary. The ideal may be a shower or a bath, but you might still be able to accomplish the goal by sponge bathing/washing.
Consider using a bar of soap/body soap which is a different colour to the inside of the shower box/bath. Doing this may make it easier for the person with dementia to locate the soap/body soap. Remove containers of shampoo etc from view, so the person does not become confused with liquid soap/shampoo.
If a person with dementia does not like being told to have a shower or keeps saying they have already had one, then try a different approach. Some people with dementia try and mask their difficulties and will not admit or try and hide when they have forgotten something. Try getting the bath or shower ready but approach the subject as if it is the person’s idea… “That bath you are running is getting a bit full”, “Your shower looks ready, let me know when you’re done, and I will have one” or any other phrase that works for you. If your partner has a dementia diagnosis, you may consider showering with them, and giving assistance.
If you notice piles of unwashed clothes-you may be able to remove/replace them with clean items whilst the person is bathing. When buying clothes – consider buying several items of the same colour.
Change your perception
A person with dementia can change. Where they may have used to enjoy a shower every day it does not mean they want that now. Consider; are you pushing for a bath or shower because it is needed or because it is what you think the person should have. With the current restrictions we are doing less and so long as there are no incontinence or medical reasons, washing is not needed every day. A strip wash can be just as effective as a shower or bath, so you may wish to try this as an alternative.
Have the soap and shampoo ready, as well as a large, warm towel. Instead of arguing prepare everything for the shower and say something like ‘I know you love a shower before bed’. Be respectful but matter of fact. Know when to quit if they continue to refuse to shower. Try again later.
Offer a choice between a bath and a shower
Some people might not have a strong preference, but for some, providing this choice can improve the outcome. A lot of water in a bath may cause fear for some, while the spraying of a shower can make others anxious or be painful.
Adjust the time of day
If an evening shower is not working, then try one in the morning. Be flexible in your approach and do not dwell on what the person used to do just before they were diagnosed. Remember, people’s habits may change over a lifetime and the person with dementia could have reverted back to a time when they had different habits.
As much as possible, stick to a routine, both as it relates to the time of day for a shower and the steps you use when helping the person bathe. Routine becomes more important as dementia progresses and may help make thing easier.
Ensure a warm room temperature
Ensure that the room is warm enough, especially as we go into colder weather. A cold room plus water does not equal a positive experience. Warmth makes the room inviting and may help when removing clothing.
Create a pleasant setting
Rather than have the shower room look sparse or cold, place some art on the walls, music in the air and invest in towel heater for comfort. An inviting environment may get a more compliant response.
Use music in the bathroom to set the tone. Choose music the person with dementia enjoys and perhaps could join in the singing. Music can have a great calming effect and make the atmosphere more inviting.
To reduce the risk of falls, use a non-slip mat in the shower/bath. If the person has been prescribed a shower stool, try and encourage them to routinely use it. It is often easier/safer for a person with dementia to sit while they are washing/drying. Sitting on shower stool will also reduce the risk of falls.
Once COVID-19 restrictions have been removed and we are able to resume visiting hairdressers, consider routinely asking the hairdresser to wash your family member’s hair prior to haircuts.
Finally, Be Kind to Yourself
You are human. None of us are perfect-especially during these times at home.
Take care of yourself, as well as your family member who has dementia.
Feel free to contact us at Dementia Waikato if you need to talk about any issues you are having with the person you are caring for. Dementia Waikato staff are all working from home and can speak with you on the phone 07 929 4042 or via email firstname.lastname@example.org