The topic of baths and showers came up recently in our Caregivers Community. It is one many caregivers struggle with, as they see an aging parent’s hygiene slipping. Sometimes you notice an odor or just realize Mom is rarely bathing or changing clothes. We’ll share tips from one of our EasyLiving caregivers on how she gets even the most “resistant” clients to take a bath (and be happy doing it). We’ll also share some words of wisdom from the family caregivers in our group.
Why won't my aging parent take a bath?
This behavior tends to arise from fear or physical challenges. You may think nothing feels better than being clean and fresh. Taking a bath or shower seems like a routine, simple task. But, with an aging body, it can be a difficult, scary experience. Many elders lose muscle mass and balance, making getting in and out of showers and tubs challenging. They might have trouble reaching or standing for any length of time. As a person becomes less active, bathing may seem less necessary and simply a hassle.
Even more debilitating can be the fear of falling or getting hurt. And, that’s not unfounded since many elders fall in the bathroom or injure themselves when bathing. For the person with even mild cognitive issues, this fear might be amplified. The spray of the overhead shower may be startling. What was once routine becomes unfamiliar and overwhelming. Hygiene involves a series of tasks, and some elders may not be able to follow the steps.
Our Caregiver’s Tips for Getting Anyone to Take a Bath
Set up a safe environment that makes the tasks involved easier.
Statistics show the bathroom can be the most dangerous room in the house. Every year, over a quarter of a million people visit the ER due to injuries in the bathroom. Our team sees a huge red flag if we go into an elder’s home and there’s a standard tub with no accommodations. For the person still taking baths by themselves, this is truly an accident waiting to happen. Minimally, elders should have proper grab bars and anti-slip surfaces. In most cases, a shower chair and handheld shower would be optimal.
When our caregivers help clients take baths, safety remains paramount. Having the bathroom set up in the right way ensures both the client and caregiver remain safe. In addition to the obvious points mentioned, this includes having items in easy reach and having any rugs well-secured. There’s no reason to be reaching for soap or crossing a slippery floor to get a towel. Not only are these safety risks, but they also make the experience less comfortable.
Comfort is key. Make it a pleasurable experience.
Start with good preparation. This makes bathing both a safer and more comfortable experience. Get everything organized before starting.
Our caregiver recommends starting to run the water in advance to get the temperature right. Speaking of temperature, older clients tend to feel cold so make sure the room is warm enough. Check that no cool air is blowing on the area where the client will be. And, always check in on the water temperature. Have towels ready and use extra towels for privacy and warmth. Get soaps, shampoos, and lotions in scents the person enjoys. Using a loofah or scrub brush makes it easier to reach the whole body, helps the client to participate, and feels good on the skin. You might need to try a couple to find the right one for the person (remember, older people’s skin can be fragile). Water tends to create fear in people with dementia, so take things slow. If using a handheld shower, avoid spraying them directly at first; allow them to get comfortable.
Break down the steps, talk the person through what you’re doing and confirm permission. This will reduce fear and uncertainty. Pleasant conversation with the person can make it less awkward too. Remember, your attitude affects everything. If you’re nervous or embarrassed, that comes through. If you’re relaxed and kind, the person will automatically start to relax.
Typically, once our caregivers give a client a bath the first time, they’re glad to do it moving forward. It’s vital to make it a pleasant, dignified experience so they’ll actually look forward to some pampering. And, of course, they begin to feel better being clean and fresh too.
Create a routine and use positive reinforcement.
One of our group members shared these words of wisdom: “Routine is key. If she has a calendar it might help to put it on there as a matter of routine. And maybe tie shower day to some other activity she enjoys. ‘Hey Mom, after your shower how about we play a game of Gin, Yahtzee, etc.’ Or we can go do X or Y. Or I'll make you a hot cup of tea.” Another member mentioned telling her Mom how good she smells or how nice she looks after the bath. Everyone wants to feel good about themselves and positive reinforcement helps build this into a habit they look forward to.
Our caregivers find this to be true, as they build a comforting routine with the client. It becomes part of a regular schedule and they incorporate the ways each individual client likes things done. The whole process, including little rewards like rubbing lotions on their feet afterward or brushing their hair becomes something clients go from dreading to anticipating happily.
Successful Conversations about a Sensitive Topic
Positive reinforcement serves a useful role in initial conversations too. Naturally, this is an awkward subject. No older adult wants to hear they’re unclean and not taking care of themselves, especially from their child. Think about how to approach the subject gently and as a benefit to them. You might talk about noticing how certain things have become difficult and you want to offer assistance. Or, you might talk about what a friend (or you) have done to rearrange your bathroom for safety. Ask questions to get an idea of their habits and what might be holding them back. Listen carefully rather than coming back with arguments. You’ll uncover a lot if you patiently hear what they’re saying (and aren’t).
Sometimes it’s easiest on the ego to help or get someone to help when it’s related to a recent illness or injury. We all understand needing someone to assist with personal care when we’re in the hospital or recovering from surgery.
Another approach is to get help from a third party. The doctor can bring it up in asking about skin health and medical issues. The doctor might also be able to “prescribe” bathing help or a home assessment. A care manager can assess the home environment and make suggestions such as bathroom modifications and help with personal care. The assessment also uncovers what the underlying problems might be and provides the best resources to help.
Special Note on Loved Ones with Dementia
It may be become impossible for the person with dementia to follow through on complex personal care routines. It's important to gauge their abilities or conversations may be fruitless. For someone in early stages, accommodations and reminders may work. In later stages, most clients cannot complete personal care on their own. Many caregivers also find it is actually easier to make the personal care routine the same every day. So, even if not necessary, they may find it works better to make the bath a daily ritual.
How often does my parent need to take a bath? Am I just nagging or is there really a problem?
Sometimes getting an assessment can also help with your expectations and concerns. As an older person becomes less active and their skin drier, they may need to take a bath less often. The frequency depends on a number of factors. A person suffering from incontinence may need additional hygiene. And, many things can be done in between baths to help elders stay clean and safe, such as using wipes and “spot cleaning”/sponge baths. Anyone wearing briefs or pads needs to change them frequently.
With incontinence, it’s also important not to assume that it’s just part of getting old. Medications or specific issues may be causing the problem. And, it may be possible to resolve or minimize with a number of interventions. A regular “toileting schedule”/frequent reminders can keep accidents at bay. It’s also vital to monitor the person’s hydration, as some elders cut down on liquids when worried about incontinence. And, it’s essential to make sure their skin doesn’t break down and they’re keeping the area clean and dry as much as possible.
The care manager looks at all these issues and provides expert input. This leads to solutions, but more importantly peace of mind for you that everything is okay.
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