Bathing Dilemmas and Dementia

Bathing can be one of most difficult personal care activities that caregivers face. The reason? Bathing and showering is an intense and intimate experience for people with dementia. Such people may perceive this hands-on procedure as being a threatening, even horrifying experience.

Some caregivers may witness their charges refusing to bathe at times, or even always. This behavior may have developed only because the dementia has caused confusion, such as the belief that he or she already bathed, or they may not actually comprehend what bathing even is at that moment.

I have a dear friend diagnosed with Lewy Body dementia, and she has told me straight out that she’s never bathing or showering again! My response to her was, “Does your husband know this? It won’t take long before he figures it out!” She explained that the minute the water touches her skin, she goes into hallucinations of cockroaches or other multiple legged critters crawling all over her. How terrifying is that?

Naturally, there is also the loss of independence and of privacy. As the caregiver, try not to take their behaviors personally. Having a calm, friendly demeanor will serve you best when coping with the negativity.

Here are some handy hints: When you begin the bathing process always remember to keep to a familiar routine. This could be the key to everything. For instance, if your loved one has always shaved before the shower, don’t upset the pattern. Let them shave. Just by changing this familiar repetition will likely cause bathing time to end in utter chaos.

Make sure your patients or loved ones with dementia are allowed to do as much as possible on their own. What you have to do in the initial stage of the disease is assist when needed and only with what is necessary. As the disease progresses they will need more assistance.

Prepare the bathroom ahead of time. This is very important. Make sure the room is comfortable and that the room temperature is pleasant; this is key. Tub baths can be difficult and dangerous. Always remember that those living with dementia are at risk for falling. If you are using a shower move in slowly as water suddenly hitting them on the tops of their heads might frighten them. Therefore, hand-held shower nozzles, a shower chair, rubber non-slip strips on the shower floor and sturdy, well-placed grab bars help ease movements and provide security for an often-precarious task.

No situation is exactly the same. And please, this is not a car wash folks. We’re not trying to pressure wash them: keep the water pressure turned down.

If someone with dementia is adamant and doesn’t want to bathe, don’t insist. Simply try again later, maybe using a different approach. A simple sponge bath will be fine at this point. If incontinence hasn’t occurred, they may not need a full bath every day. A couple of baths a week can be sufficient. The simple wash-up of face, hands and chest area can be done fairly easy at the sink.

Again, routine is crucial. Always bathe them the same time of day whenever possible. Also, use of the same bath products will help immensely. If they are used to a green-colored shampoo and you suddenly pull out one that’s pink, it may startle them, raising their anxiety level. Also, you will also want to use the same aromas. If they are used to a strawberry-scented hair product, stick to that.

Again, always be flexible. It may seem unorthodox but you may have to give them a bath while they are fully clothed. Use a warm, soapy washcloth under their clothing. Start at the top and work your way down, face first, then to the more critical areas such as armpits, the chest or under the breasts, then on to the perineal area. Use a large bath towel to cover their embarrassment. He or she will feel less embarrassment and at the same time will remain warm and comfy.

Remember, choose your battles; if one approach doesn’t work, try another. Taking the right approach when bathing those living with dementia will result in a satisfying experience for you and them.

Overall, building a positive, trusting relationship is cardinal. Use a positive approach, complete with conversation, care and consideration.

What you do and say makes all the difference. Be mindful of your demeanor as they are watching you closely and can pick up your

Please remember: the person with dementia is not trying to give you a hard time. They are the ones having the hard time.

Gary Joseph LeBlanc, CDCS
Director of Education
Dementia Spotlight Foundation