Bathing a person with Alzheimer’s or other types of dementia can be a highly stressful activity for the caregiver. It can also be an emotionally demanding experience for the person with Alzheimer’s or other types of dementia, who may be especially stressed by fear of running water, discomfort from cold drafty rooms, embarrassment at being seen naked, fear of falling – especially when moving in or out of the tub, or confusion due to memory problems. The person may think he or she has already bathed – or may be simply overwhelmed by the bathing process itself, no longer understanding how or what to do.
But the good news is that stress from bathing can be reduced. In this section, we share seven key steps that should reduce or eliminate the top stressors. Our goal is to help both you and the person for whom you care have a more pleasant bathing experience.
Step 1. Get the Room Ready
People with dementia have short attention spans and become easily irritated while waiting, so have all your supplies ready to go. Large plush towels and baby washcloths are more comfortable against older skin. A colorful towel placed on the bath seat can reduce a person’s fear of getting into the tub, as it helps the person see clearly where to sit. A bath mat on the floor by the tub makes the floor warmer to stand on and helps absorb any spills. And, of course, you’ll want a non-slip mat or strips inside the tub.
Place large-lettered labels on bathing products to help the person identify items. Make sure to use a mild cleansing soap to minimize skin irritation and dryness. Finally, remove all unnecessary items, including bottles and razors, to reduce distraction – especially if the person is obsessed with details.
Once all the supplies are ready, the next step is to get the room ready. Warm up the room beforehand, as many older individuals become quite upset by cold and drafty spaces. Close any open windows and turn off the air conditioning. Consider replacing the ceiling light with a combination ceiling light and heat lamp, which makes a bathroom warm and cozy. Or, turn on a portable space heater for a few minutes, but be sure to remove the space heater or place it in a safe location, away from flammables and walkways. If you have a separate shower stall, make sure to open the door so that space gets warmed up too. And closing the bathroom door while the person is showering will help keep out cold drafts – and keep the person happier.
Next, check the water temperature. Water that is too cool or too hot can trigger agitation – and extremely hot water can cause burns. Water temperature around 98° to 100° is comfortable for older adults. Use a bath thermometer or the back of your wrist to test the water.
Setting a relaxing and pleasant mood can really help. Put on the person’s favorite music – before the person enters the bathroom. Just watch the volume level; if it’s too loud, the person will not be able to hear you – and loud music can be a stressor, too. If it helps, try singing – some caregivers have great luck with “singing baths” – singing songs solo or together is a great way to have fun and get the bath accomplished.
Entering a fragrant room can help the person relax, too. Choose natural fragrances over chemical room fresheners as some research has shown relaxation benefits from ingredients in natural oils. Try spraying the room with a citrus, pine, lavender, or spice scent. Start with a light spray to see if it’s a fragrance the person will enjoy. Be careful of bathing oils however, as they make the bathtub quite slippery.
Step 2. Get the Person Ready
For many individuals, being naked is a major cause of embarrassment – and the main reason for resisting bathing. If needed, hand the person a large towel to wrap around or hold in front of him or herself. This can also keep the person warm.
Or you can use a special waterproofed bathing outfit – garments that have a Velcro wrap around for the person’s bottom and a bib-like top. Such garments help maintain the person’s privacy while bathing and still provide both you and the person easy access for washing. This garment remains on the entire time as you and the person wash around and under it. Some people enjoy a towel wrapped around their shoulders even with the bathing outfit on until you wash their shoulders and back.
For privacy, it’s best to wrap the outfit or towel around the person before you help remove the person’s clothing.
Some people are more receptive to bathing at certain times of the day than at other times. So be sure to choose a good time, when the person is calm and rested. You also should allow plenty of time; rushing a person is a major trigger for agitation.
People with dementia pick up on body language and tone of voice, so you’ll have a lot more success if you keep a relaxed warm manner and smile when approaching the person with the bathing invitation.
If the person usually resists bathing, don’t use the word “bath.” Instead, say something to which the person will most likely respond positively, such as “It’s time to freshen up.” The words you use can make all the difference in getting the person to accept the invitation!
Then, if needed, gently take the person’s arm and guide him/her into the bathroom.
If the person is very resistant and a little coaxing isn’t working, try later, after first doing an enjoyable activity together.
Step 3. Transfer the Person into the Tub
There are several ways to have the person get into and out of the bathtub, depending on the person’s abilities and the type of bath or shower that he/she enjoys. A transfer bench is the easiest and safest way to get into and out of the tub. If the person still takes full baths, see our section on grab bars.
To get into the tub, the person sits on the outside of the transfer bench, and, swiveling their body, lifts his/her legs, one at a time, over the side walls. You may need to assist by giving step-by-step instructions or by physically lifting the person’s legs, gently and slowly. You can read more about transferring dementia patients here.
When the person’s legs are in the tub, tell them to scoot further over or point or tap to where you want the person to sit. He or she can use either the wall grab bar or the sidearm on the chair to scoot over.
Once the person is seated properly, check to see if the person’s feet are dangling and, if so, place a plastic bucket or stool under the person’s feet for support.
Step 4. Start the Bath
Don’t start the shower with the water aimed at the person’s face or head. People with dementia are hypersensitive to water flowing onto their scalp or into their eyes and ears. For most people, it’s the main cause of agitation when bathing.
Instead, use a handheld shower hose that has a gentle spray and consider aiming the water at the person’s feet and legs. This gives him/her time to get used to the water in a non-threatening way. Smile and speak softly, telling the person what will happen, step-by-step, in simple sentences. To avoid startling the person, move slowly and gently.
Step 5. Encourage Them to Help
First, gently tell the person where to wash. If the person doesn’t respond, demonstrate what to do by using the “Simon Says” technique. Put a washcloth in your own hand and show them how. You can point your own arm and make washing motion. Then you can place the washcloth in person’s hand and tell them where to wash ( say “Wash your arm”), and if needed demonstrate by pointing your own arm and making a washing motion.
Step 6. Wash the Person
If the person needs helps with washing and is resistant, try asking, “Can I wash your back?” or just say, “I’m going to wash your back now.” This is usually a safe place to begin. Be gentle when washing if the person has delicate skin – scrubbing a person with vigor can cause discomfort and trigger agitation.
It’s important that a person’s private areas are washed – not only for overall hygiene but also to reduce the risk of infection, especially urinary tract infections in women. If the person can no longer wash him/herself, you or someone else will need to help. It’s not an easy caregiving task, but you can read our suggestions for ways to make it easier.
If the person can stand, then say, “Put your hand on the grab bar while you stand.” Point or tap to where you want the person to hold. Because of visual disturbances experienced in some forms of dementia, you may need to guide the person’s hand to the grab bar. Again, wash gently – many older adults have delicate skin, especially in these sensitive areas.
Praise as you go. Saying something like, “You’re doing a great job!” gives the person a sense of accomplishment.
Step 7. Groom After the Bath
There are many things you can do to make grooming after the bath safer and more pleasant.
You should always use absorbent mats on the floor. If you have a wider toilet seat you can seat the person on the toilet seat, or if you have extra room, you can place a stable chair in the bathroom. After the bath, you should gently pat the skin dry and this is also the time to check for dry skin or any other scratches, bruises etc. they may have.
Since bathing dries the skin, you should always use appropriate skin lotion to moisturize the skin. Start with the face and hand and then move down the body while encouraging the person to massage the lotion into their skin. After the skin has absorbed the moisturizer and the skin feels dry it is time to have the clean clothes ready and start dressing.
If you need to use a hair dryer, try to find one that is not too loud or use the more quiet setting on the dryer. After the person has been bathed, dried and groomed you should congratulate him/her!
These seven steps will make bathing a lot easier and safer for most individuals. But for people who are fearful of running water, sponge baths at the sink or toilet can be very effective. Or, for those with small, inaccessible bathrooms, it’s best to give “the bath” in another room.
This can be done easily using a no-rinse soap (available in liquid form or in disposable towelettes), which makes cleaning faster and a lot less stressful; this “bathing” can take place in a chair or in a bed. For individuals who have very short attention spans, consider only washing one or two areas, like the arms or legs, per day.
Being a caregiver is not easy, but it does have many rewarding moments, including helping the person to have a better bathing experience.
