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As a caregiver, you may find yourself in a battle to get your loved one with dementia to bathe. You are not alone. This is a common issue. It is important to help your loved one maintain hygiene because poor hygiene can lead to skin and urinary tract infections.

Why is bathing such a battle? There are several possibilities.

• They do not remember they have bathed and are offended that you are asking them to bathe again.
• They do not remember who you are and feel uncomfortable bathing in front of you.
• They do not like the feeling of water on their skin, or the hot or cold water is painful to them.
• They no longer know all the steps to bathing and may shower with their clothes on or not use shampoo and soap.

When you notice your loved one’s hygiene starting to decline, it is time to step in and assist them. Your help will ensure their safety and that they are getting as clean as they need to be. As with any assistance you give your loved one, try to encourage their independence as much as possible. They are still an adult and deserve to be treated like one. When you are troubleshooting, try to think of the situation from their perspective.

There may be a learning curve… yes, even for something we all do, like bathing. If you are a man caring for a woman, you may have never helped clean a woman’s body before and vice versa. There may be things you have never considered.

Getting to the Bathroom

Sometimes, using words like “bath”, “shower”, or “bathroom” can cause stress because they do not want to be forced to take a shower. If you are having trouble getting them to the bathroom, ask your loved one to come with you and just walk to the bathroom while talking about something else. OR try telling them you are treating them to a special spa day.

Prepare the space ahead of time. Set the mood for the bathroom to be an inviting place. Make sure it is warm. Play some of their favorite music. Have some warm towels ready from the dryer, so they feel comfortable in the space.

Undressing

Once again, prepare ahead of time. Set out a new set of clothes for them to change into after they have freshened up. Keep the outfit simple with minimal to no buttons or zippers to promote independence and make the process easier.

If needed, give verbal cues, one at a time, on how to get their clothes off. Offer a large towel, robe, or salon cape, so they can cover themselves as they undress. After they have undressed from their old clothes, move those out of sight, so they are not tempted to put the same dirty clothes back on.

Assisting in the Shower

Unless you have a special assisted bath at your house, showers are preferred, as regular baths create a much greater fall risk. Install handles and use a floor mat to avoid the hazard of slick floors. A handheld showerhead can be very helpful.

Keep the shower simple. Label bottles clearly to avoid confusion or use a 3-in-1 product. Test the water on your forearm first to make sure it’s not too hot or too cold. Run water gently on their feet to see if they are comfortable with the temperature and water pressure. While you might like high water pressure, it can be painful for those with dementia. Try a gentle rain-like setting.

If you are assisting with applying soap, use a washcloth, so your hand is not directly touching any sensitive parts of the body. You can also help guide your loved one’s hands to wash different parts of their body. Start with the legs or another area that is less personal and work your way to those personal areas last. You can also try modeling what you want them to do. Keep instructions short and simple. One step at a time.

It is not necessary to have a full bath or shower daily. In fact, daily bathing can cause problems with our natural body oils as we age. Try 2 to 3 times per week. Use a washcloth to tend to personal areas on non-bath days.

Hair Washing

For shampooing, encourage them to tilt their head back when you rinse the shampoo out, so it will not get in their eyes. Try washing their hair less if makes them anxious. Your loved one’s hair type, scalp, and personal preferences will determine how long you might be able to go between washes. If you’re unsure about how to keep your loved one’s hair at its best, talk to your loved one’s hair stylist or dermatologist. If you feel like you are struggling to keep up their current style, consider getting a style that is easier to maintain. Or ask for help from a professional or family member.

Dry shampoo can help you stretch the time between washes. Just be aware that it can make your scalp itchy if overused (due to build-up and drying agents used in the dry shampoo). You can find dry shampoo on the hair care aisle of any major store. It comes in spray, foam, and powder form. A rinse-free shampoo cap is another option to try.

Female Care

Do not use scented soap on the female pubic region. This will cause irritation. You can cleanse the outer skin covered with an unscented, simple soap (like Dove Unscented). Do not clean with soap inside the inner folds and vaginal area. The vagina is a self-cleaning organ, and using soap can interrupt the pH balance, causing extra discharge, itching, and even infection. Warm water is sufficient.

Be sure to clean and dry under the breasts and any skin folds. This is especially important if your loved one has large breasts or sweats easily. Skin folds can easily become irritated and harbor yeast infections from moisture. If your loved one uses briefs or pads, ensure they are changed as often as possible to avoid moisture and skin irritation. Well-fitting, cotton underwear is best to wear if not using briefs.

Male Care

Loose, cotton underwear is the best choice for comfort and best for skin. When cleaning the penis, make sure to clean around the entire scrotum. For those who are uncircumcised, clean under the foreskin often as well. Again, avoid scented soaps and opt for an unscented, gentle soap for this area. Keep the pubic region and any skin folds washed and dried well to avoid skin irritation or yeast infection. Help your loved one change his briefs as soon as possible after it is wet or soiled.

Do you have any hygiene-related questions not answered here? Give us a call at 901-854-1200. We would be happy to listen and share advice.

Written by Katie Fowler, RN