For most family caregivers bath time seems like a battle of the wills. To often someone gets hurt. I don’t mean hurt feelings but truly injured. This is just wrong. Totally unnecessary. When caring for someone the last thing you should want is to make this person upset and bathing should not bring any kind of tears to anyone. If it does then stop! Step back and examine what you’re doing and try another approach.
As caregivers we want to make sure our loved one is clean. Why? To keep odors down and illness away. If there is any other reason then you need to rethink being a care giver.
Lets start with the basics, asking the person with dementia to conform to your will is one way to get the job done. However your asking the person least capable of learning new tricks to be the one to do the learning. If you are the competent adult and best able to learn, perhaps you need to adjust your way of doing a task.
Every cat owner knows there are ways of getting kitty to moderate her behavior. However telling her to is not one of them and man handling her is a good way to get bit and find kitty now pees in the living room.
As an old friend always says “You gotta be smarter than it”.
Step one – you need to find out why your loved one does not enjoy bath time. Find out whats so horrible about it. Asking questions is always good but you can only find out so much that way. True knowledge comes first hand. Go ahead and become the one being given a bath to. After all its just a bath right?
Get someone to give you the same bath experience, not your spouse but a caregiver. Don’t help more than your love one is capable of. If you need to ask your son or daughter or perhaps a friend. The goal is to learn so become Sherlock Holmes. This is your fact-finding mission.
Make a note of all the thing you don’t care for.
Are you embarrassed? How long did it take to get over that feeling?
Are you cold by the time you get in the shower?
Do you find the wash cloth rough, or the floor slippery? Remember one fall could lead to a broken hip – a slow painful death.
If you’re siting on a tub stool is it solid and secure? How secure were you in moving in and out of the tub or shower.
You normally stand in the shower with the water spraying in your face. How does it feel when someone else has control and you have water spraying in the face. Many intelligent adults find the feeling very unpleasant almost akin to drowning. Emotions are funny that way.
Are you cold before you get in the shower? Cold while taking a shower and even colder when you get out waiting to be dried off. Whats it like when your standing there getting dried off.
Any problems with pain? Well your charge may have arthritis or muscle ache. Could they find it painful? How long did it take? Think in terms of the endurance of ability of your loved one. The bathroom lighting may be fine for you but put yourself in their shoes is it harsh.
OK now that we have tested the water so to speak next lets look at a few additional concepts. As we get older our skin looses natural oils that kept our skin moist. Bathing washes away dirt and body oil, often causing dry skin. Dry skin can be minor irritation such as flaking or it can be truly annoying causing a constant itchy feeling. Dry skin still sounds minor. What if it leads to cracked and bleeding skin. That not only really hurts but can lead to infections.
In short people of advanced years who don’t sweat as much as younger adults should not take baths daily because it is unhealthy for their skin.
Our goal is to keep odor down and illness away. Drying out the skin is not the way to keep illness away. Rather it invites it.
Step two – decide how often you really need to ask your loved one to do what they clearly don’t want to.
How often should someone bath? That depends on activity level and the body’s sweat glands. Some areas of the body like the groin daily or in the case of someone with incontinence as many times as required. Arm pits or under a woman’s breast once a day. Hands often each day. Legs, arms, torso, hair perhaps once or twice a week is more than fine.
Step three – Think outside the box. Getting clean and staying healthy does not require a shower or tub. Wash cloths water and soap is what is needed. In fact some soap doesn’t even need to be rinsed off. (try your local medical supply store)
When I am at the doctors I do feel better about being naked by having most of my body covered and only exposing a portion of my body at a time. The doctor exposes one breast then recovers it and exposes the other and so on. Try this technique with large heavy towels. You will find you don’t always need to expose the skin to clean it. Yes you should keep an eye out for moles or bruises or what ever but you don’t need to invade someones privacy daily to do that.
NO Shower NO Tub method.
For the big wash days have a bowl full of hot soapy water with a half-dozen wash cloths and a sink full of hot clean water for rinsing. Replacing soiled wash cloths after areas like the groin or arm pits and feet. Wash and area, rinse, dry then cover back up. Moving from area to area until you are satisfied.
Matters not where the bathing takes place. This kind of bath time works just as well in bed as seated on the toilet or walker. What matters is that no one should walk away angry upset or worse injured caregiver included. As bath time will no doubt be less often you can afford to spend a little more energy on the one or two big days a week. Follow it up with a massaging body lotion/ oil to replace what you have just washed away. Not only will it make the skin healthier but it will feel great and you may find anger has turned into purrs.
Here in the US we have been so conditioned to think that the only way to get really clean is with lots of water. It’s just not so.
Alternative Daily clean up Method.
Moisten wipes work out great for daily bathroom clean up. Keeping a covered waste can in the bathroom by the toilet makes the additional clean up a breeze. Disposable wipes should not go down the toilet. If they occasionally get flushed it’s no big deal but if they are used daily you will likely find the plumber more expensive than the waist pail with the fold up lid.
Step four – Be patient with the patient and your skills at learning new tricks.
Many will find instant success others will have to make several attempts before hitting the right combination of changes.
Rethinking baths require looking at your loved one in a loving caring way. It’s all very personal and the ideas you find are just some suggestion. You will need to tailor it to your loved one. If you know they keep their room dim then try dimming the lights so bathing becomes easier on their eyes. If they seem to hold their breath perhaps the soap smells unpleasant to them. Try and find out what they used before. Some may just need a bath once a week some may be able to handle cleaning themselves daily but will need help for the big days. Others may need to have the job done in short tasks like above the waist on Saturday and below on Thursday. Still others will need something else. Maybe smell of the soap or the type of soap is what you need to be looking into.
If you still find that bathing is bringing heart ache then check out Bathing Without a Battle: Personal Care of Individuals with Dementia (Springer Series on Geriatric Nursing) Ann Louise Barrick PhD (Editor), Joanne Rader MN RN FAAN (Editor), Beverly Hoeffer DNSc RN FAAN (Editor), Philip D. Sloane MD MPH (Editor) or www.bathingwithoutabattle.unc.edu/ This site has great in-depth ideas as well as the book and DVD. 
I can’t recommend Barrick’s book more highly. We have only touched on some of her findings here. If you have walked away with questions or doubts I suggest you look into her video’s or books.
Dementia Wanderers Good News 