Bathing does a lot for a person – it refreshes and relaxes; eliminates body odor; removes dirt, oils and dead skin cells; and stimulates blood flow (circulation) through the body. Good blood flow to the skin helps to keep the skin healthy. 

When and how a person chooses to bathe can be influenced by factors such as the person’s culture, religious beliefs or long-standing habits. Always make an effort to accommodate a person’s preferences for bathing.

Have you ever had to be bathed by another person? If so, how did you feel? Was the person who bathed you sensitive to your feelings? When you are assisting a person to bathe, be aware that the person may be embarrassed about needing help. Encourage the person to complete as much of the bath as he or she can independently, and take measures to keep the person warm and protect his or her modesty. 

 

When you are scheduling bath times, take into account the person’s preferences as well as your employer’s policies. Be aware that the people in your care do have the right to refuse a bath. However, if this happens too frequently, you will need to talk with the office because regular bathing is necessary for good hygiene.

 

Because of the slow, gradual degeneration of brain cells, a person with Alzheimer’s may be unable to understand what’s happening to them. And events that were once familiar – such as bathing – become frightening and humiliating experiences which may trigger aggressive behaviors against caregivers. But, there are proven techniques you can use to significantly reduce aggressive behaviors during bathing.

 

DIGNITY AND RESPECT
A key factor in preventing patients from becoming aggressive during bathing is to avoid doing things that are interpreted as not respecting their dignity – even elders with Alzheimer’s still have a sense of dignity. These include:

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• touching them without permission;

• rushing them; and

• using inappropriate language. 

 

The entire bathing process should be explained to the person beforehand. While doing this, talk softly, stroke their hands or shoulders gently, and smile. Provide reassurance by singing a familiar song or playing gentle background music, and respect their need for privacy. Keep doors and blinds closed, and allow them to keep their underwear on or a towel around their body if they wish. Treat them like you would like to be treated – with respect, love and kindness.

 

BATHING PREFERENCES
According to a randomized trial by Dr. Philip Sloane of the University of North Carolina, it’s extremely important to address the patient’s preferences and lifelong habits.
Find out whether the person likes to take a shower or a bath, and ask about: 

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• their preferred bathing products;

• frequency of bathing; and

• preferred time of the day for bathing.

 

Letting the person have their preferences in bathing works! In research studies, person-centered showers – which involve using the patients’ preferred bathing products and intensity of shower spray, while keeping them warm with a towel – led to significant reductions in bathing-related aggressive behavior in Alzheimer’s elders.
 

COPING WITH AGGRESSION
There may be circumstances, though, in which a person becomes aggressive, no matter what you do to prevent this from happening.

Yelling, kicking, hitting and biting are common in these cases, and cause enormous distress to everyone involved.
It is extremely important that you know how to deal with these situations; and that you do this effectively while respecting your elder’s dignity. 
 

The key is to put yourself in the person’s place. Keep in mind that their behavior originates from a combination of fear and confusion, due to the disease itself. This makes them unable to understand what’s happening around them; plus the embarrassment and humiliation of being naked in front of strangers.

 

PROVIDE LOVING HELP
The person just needs your loving help. Avoid being confrontational, don’t argue or raise your voice. Talk calmly and gently, reassure and distract them, for example by offering a snack, a favorite object, or the picture of a loved one to cherish.

 

ENSURE SAFETY AND COMFORT
Make the bathroom safe:

• Check that non-skid mats and grab bars are in place.

• Test the water’s temperature before the bath.

• Have a waterproof chair for the shower.

• Ensure the floor is dry.

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Remember that you should never leave the client alone. So, prepare in advance all you need:

• Shampoo

• Soap (preferably one that does not require rinsing)

• Washcloths

• Towels

 

Towels should be warm and large enough to completely cover the person. Place soap into a cloth for easy holding. Ensure the room is warm and well lit.
 

Cover mirrors and other reflective surfaces, including windows. Since Alzheimer’s elders cannot always recognize their image, they may think there is another person in the room and become upset.

 

INVOLVE THE PERSON
Make the person feel helpful. Ask them to hold the sponge or the soap for you (this also keeps their hands busy preventing them from scratching, pushing, etc.).
 

Praise and thank them often. 
 

If appropriate, allow the person to wash themselves, but make the task easier for them:

• Show what they need to do.

• Provide simple one-step instructions.

• Use tactful reminders for important areas that need to be washed, such as the genital area.

 

Provide help if needed, but avoid scrubbing since this may cause severe skin damage.
 

Be sure to check for reddened skin areas, particularly if the person is at risk of bedsores, because of limited mobility or incontinence problems. If showering, use hand-held shower heads, as they can be directed at one part of the body at a time, and are therefore less frightening.

For the same reason, use the less intense spray or cover the shower head with a cloth for a softer stream.
 

During hair washing, have the person hold a cloth on their forehead to prevent the water from running over their face.
After bathing, pat the person until dried, particularly within skin folds and under the breasts. Dry well between the toes and fingers, and apply a mild lotion to help maintain a soft skin.

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BE KIND AND CARING
Research shows that caregivers’ attitudes have a great influence on the likelihood of a person becoming aggressive. A hurried pace of bath, touching without permission, spraying water without warning, confrontational or disrespectful language, and failure to explain – and prepare for – the bathing routine were associated with increased occurrences and severity of aggressive behaviors in Alzheimer’s patients.

Be sure to:

• Explain the bath beforehand.

• Use kind and respectful speech and body language.

• Keep your tone of voice calm, soothing and kind.

• Maintain eye contact and smile sincerely.

• Say “please” and “thank you,” and praise often.

 

FOLLOW THE BATH WITH GOOD GROOMING

Good grooming is a gift you can give as a caregiver. Everyone knows good grooming is important because it promotes self-confidence, builds self-esteem, encourages a positive attitude and improves their approach and enjoyment of the day. Men always want to look handsome and women always want to look pretty, no matter their age. Sometimes they need help to look the way they want to. Good grooming involves all aspects of personal hygiene and is performed to promote health, prevent irritations and infections, and reflect a neat and well-cared-for appearance.
 

Fingernail care – always check with your supervisor before performing fingernail care. If there are no restrictions, soaking the nails in warm, soapy water for a few minutes feels good and helps clean the nails and soften the skin.
Most women love manicures and polish and many facilities provide such services by either volunteers or specialists. 
 

Toenail care – is basically the same as fingernail care. Foot massage is comforting and may be added but must be approved by your supervisor. Some women also like to have their toenails polished. Some facilities also provide pedicures.
 

Hair care – combing, brushing and styling. Shampooing is usually done along with the bath or shower or at the beauty shop. Include the resident as much as possible and let the resident choose the style and what adornments are to be used.
 

Facial hair care – both men and women want to be well-groomed facially. That means removal of unwanted hair on and about the face, unless removal is contraindicated or the resident does not wish it done. Electric razors are better because they are safer and allow more resident participation. Also note that women grow facial hair, especially chin hairs that have a tendency to stick out straight and be noticeable. Some older women grow mustaches and have unruly eyebrows.
 

Skin care – allows for observation and preventative measures to guard against irritation, infection and sores. Lotion keeps the skin from becoming dry and flaky and irritated. And note: Nothing dampens an appearance more than glasses that are dirty or have medical tape holding them together. 

Clothing – choice of clothing should be left to the resident unless the resident is unable to do so. Then the choice is left up to you and your sense of style and knowledge of what is appropriate. At night, pajamas and nightgowns should be offered. Beware of dressing the resident for convenience sake (sweats, hospital gowns) unless absolutely necessary because of physical condition. Clothing should match, fit properly and be color coordinated with socks and shoes.