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Overcoming Personal Care Challenges

Monday March 24, 2014

For those with dementia, personal care routines, such as nail clipping, bathing, dressing, and eating, that were once simple are no longer so. These activities of daily living are a process, with steps to follow and decisions to be made. Because individuals with dementia are not able to understand the steps needed to complete a task, personal care can be challenging.

Someone with dementia may resist help with bathing or may refuse to brush their teeth, and for caregivers who are trying to make sure that their loved one is happy and properly taken care of, this resistance can be frustrating.

If you, as a caregiver, have faced challenges in providing personal care for your loved one, we hope that you will find the following suggestions helpful.

Give clear, step-by-step directions.

Simplicity is best. Break down the process into parts, giving instructions one step at a time. For example, instead of saying, “Get dressed,” say: “Put your underwear on.” “Put your socks on.”

Use both verbal and physical cues.

In other words, tell with your voice and show with actions. If you would like for your loved one to sit down, it may be easiest for you to tell him, “We are going to sit down,” and then to sit down with him.

Limit distractions.

Once your loved one is distracted, it may be difficult to bring their attention back to the task at hand.

Have what you’ll need ready beforehand.

Have clothes laid out in the order they are to be put on. Also, give your loved one simple choices to help her maintain a sense of independence. Instead of having her choose from the whole closet for an outfit, pull out two shirts and have her choose between the two.

Limit the number of choices on the bathroom counter and in the shower or tub.

Tubes of ointment, such as Neosporin or denture cream, can easily be mistaken for toothpaste, so put these extra items in a drawer or medicine cabinet and have only the toothpaste easily accessible.

Catch them at their best time.

For a majority of our clients, that time is the morning because they are well rested, but for your loved one, that time may be different. You might try following their regular routine. If they have taken a shower at night for the past 40 years, try bathing at night.

Don’t ask.

When you ask, you give your loved one an opportunity to say no, and if they say no, how will you respond? You must make the decision for them. Instead of asking, use a positive tone of voice and say, “We need to…,” or “We are going to….”

Don’t argue.

Your loved one may be living in their own reality, and arguing is pointless because you will lose every time.

Learn to pick your battles.

Save the “No’s” for when they really matter. For example, Mother wants to wear sweat pants to Sunday morning service. Does it really matter if she does this? Will it compromise her safety or well-being? On the other hand, Dad wants the keys to the car so he can drive again. Will this compromise his safety or well-being? Think about what is truly important.

Validate their feelings.

If your loved one refuses care, it may mean that they are scared, that they don’t understand what you are asking, that they don’t feel good, or that the task you are asking them to complete is painful. Know that they are not trying to be difficult. Take a step back from the situation to see what might be causing their resistance.

Often, a spouse may not recognize their caregiver as their husband or wife. The person living with dementia may believe themselves to be much younger. If this is their reality, it is more understandable if they don’t want to disrobe in front of an older man or woman – no matter how nice they are to them.

Be patient.

Patience is key. If what you’re doing isn’t working, step away. Assess the situation, and re-approach at a later time. If your loved one is refusing to brush her teeth, shift attention to another part of her care routine such as combing her hair or putting lotion on her hands. After you’ve done these things, try re-approaching the situation with new verbal and physical cues.