Challenging Behaviors for the Caregiver

Strategies for Successful Bathing
by Anna Ortigara RN, MS

Assisting a person with Alzheimer's disease in taking a bath or shower can often be the most challenging task of a caregiver's week. Bathing can be a frightening, complicated and overwhelming task for many people in the middle and late stages of Alzheimer's disease.

There are a number of reasons why this activity can be so stressful. One is the vulnerability the person with Alzheimer's may feel when another person takes his or her clothes off. Another is the sudden change in temperature that takes place when the person enters the bath water or shower. Perhaps the person feels out of control and misunderstands the purpose of bathing. Perhaps, when a caregiver says, "It's time for you to take a shower," the person with dementia may think that he or she has already taken a shower.

In addition, the person with dementia may resist or deny needing any help. One key principle to follow in caring for people with dementia is to try meet the person at his or her level of reality. Experienced caregivers know that trying to force someone with Alzheimer's disease into rational, here-and-now reality often causes confusion and agitation. How can bathing be accomplished with the greatest success for both the person with the disease and the caregiver?

Here are some strategies:

Engage the person in the bathing activity. Approach him or her in a calm, gentle and non-threatening manner. Begin a social conversation instead of focusing on the bath right away.

Pick a time when the person is having a good day.

Plan the bath when you are not feeling rushed. If the person is uncooperative, try again later.

Consider giving the person a reason for the bath that makes sense to him or her. For instance, say, "It's time to get ready for work."

Schedule the bath at a time when the person is already engaged in a related activity, such as in the morning when he or she is in the bathroom and needs to change out of pajamas.

Prepare the room.

The goal here is to make the room as inviting as possible.

Is the light bright enough but not glaring?

Is the room temperature warm but not hot and humid?

Do you have all of the equipment you need in advance so you don't have to leave the room after you start the activity?

Understand the person's bathing routine.

The more familiar and comfortable the activity, the greater the likelihood of success. Knowing about the person's past habits may be useful. Some things to consider are:

Did he or she generally take a shower or a bath?

Was he or she always very private and modest?

Was there a preferred time of day or night in the past?

Would the person feel more comfortable and safe with a same-sex caregiver?

Sometimes a man is more receptive to a male caregiver than to his spouse or daughter.

Understand what is going on during the bath.

The idea here is to focus on the person's mood and behavior rather than the task itself.

Is the person becoming frightened or threatened?

Prevent agitation from escalating.

Praise the person and let him or her know that the task is going well.

Keep saying what you are doing in simple, step-by-step terms.

Go slowly. Moving quickly will probably result in the person feeling unsafe and out of control.

Give the person something to hold onto, such as a washcloth, towel or grab bar to lessen the feeling of being out of control.

Refocus aggressive behavior.

If the person begins hitting or striking out, it may be due to a perceived need for self-defense. Try to discern the person's anxiety when it is still mild and then remove the source of discomfort. Keep reassuring the person of his or her safety.

Consider involving an assistant who can focus on the person while you focus on the steps of the bath. Encourage the person with the disease to help as much as possible in order to promote a feeling of personal control over the situation.

Consider alternatives. Giving personal care to a relative can be challenging because of the role change it represents. For example, bathing one's father or wife is not part of the usual relationship.

Consider hiring a bathing assistant if the act of bathing is too physically or emotionally overwhelming to do alone. Possibly enlist the help of another family member who has a higher comfort level with personal care.

Published by the RADC 1998

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