Overcoming Difficulties in Bathing or Showering
To ensure success with this important activity, tailor your support to match your loved one’s ability.
Helping your loved one with any personal care activity can be a difficult assignment, but perhaps none is more challenging than helping your loved one bathe or shower. Because bathing is such a uniquely private activity, your loved one may not want your help, and may even resist your help. But for most of our loved ones with Alzheimer’s disease, the time will come when they need some assistance. Despite the challenge, bathing is an example of a vital activity that needs to happen with some regularity. A caregiver can’t choose to “let it go,” at least not for long.
To help ensure your caregiving success with this important activity, you need to tailor your support to match your loved one’s ability. Alzheimer’s disease alters how they perform any task over time, and so the stage of the disease determines the most effective way to support them.
In the early and mild stages of Alzheimer’s disease
Your loved one most likely will be capable of bathing or showering independently. However, they will also have a relatively higher understanding and awareness of what's involved in a particular task, and so may create more anger and embarrassment if it is suggested they need supervision. Caregivers should openly discuss any concerns with their loved ones; the key is to focus on safety and use strategies to reduce embarrassment.
Sometimes all that is required is a reminder about showering.
Consider using a calendar with an "S" marked on it, indicating to your loved one that it's a “shower day”, to give a visual cue.
Your loved one will also benefit from your ensuring that the bathroom is well stocked with all the supplies they need such as soap, shampoo, and towels.
In moderate stage Alzheimer’s disease
In moderate stage, cognitive ability is reduced as well as functional ability to complete a task. Your loved one may be less capable of performing a task, but still become frustrated or indignant from attempts to help them. In this stage it can take some thoughtful planning to find a way that you can work with your loved one to set up the shower or bath and help them do as much as possible on their own. Finding ways to make your loved one successful is critical in this stage. In this stage, your loved one will likely also need reminders on a calendar. In many cases, this will be enough to get them to successfully complete a shower or bath. At some point, however, they may forget to do a certain part of the bathing process, so you should be ready to assist when needed.
In severe stages of Alzheimer’s disease
Cognitive and functional abilities decline and mobility issues become limiting in the severe stages. In this case, your loved one requires full support for bathing. Caregivers should use strategies that focus on personal comfort and efficiency for their loved ones. Safety concerns for your loved one and yourself often mean bathing alternatives should also be considered in this stage.
In all these cases, communication Is key. If you haven't already, review our Caregiving Essentials presentation on Beneficial Communications Practices for Caregivers, which has a specific example of how to talk to your loved one about taking a shower or bath.
If your loved one is accepting of your help, the strategies listed below for setting up the bath and shower apply, but with one exception: Since mobility is declining in the severe stage of the disease, we advise use of a shower chair or bench (preferably along with using a hand-held shower head). Or, depending on your loved one’s level of mobility, it may be best to move to sponge baths at this stage.
Here are some strategies to help reduce any upset or agitation that may occur in this stage, due to your loved one's decreased ability to understand what is happening to them.
Try bathing at the same time of day, preferably one that your loved one is used to from previous times.
Be aware that your loved one may perceive bathing to be threatening. If they are resistant, distract him or her and try again later.
Always protect your loved one’s dignity, privacy, and comfort. Consider covering the person with a bath towel while undressing to decrease feelings of vulnerability. Try having a familiar person of the same sex help with bathing if that is more comfortable for the person living with dementia.
If possible, give your loved one a role in the bathing process. For example, have the person hold a washcloth, sponge, or shampoo bottle.
Simplify the process. Skip using bar soap, which can easily fall. Instead use an all-purpose gel to wash both hair and body.
Use simple phrases to coach the person through each step of the process, such as, “Put your feet in the tub.” “Sit down.” “Here’s the soap.” “Wash your arm.”
Use other cues to remind the person what to do, such as the “watch-me” technique where you demonstrate the action, putting your hand over the person’s hand, gently guiding the washing actions.
Have activities ready in case your loved one becomes agitated. For example, play soothing music or sing together.
Safety tips
With bathing, it is very important to focus on safety for both you and your loved one. You can follow these tips for a safe bath time:
Never leave a confused or frail person alone in the tub or shower.
Always check the water temperature before he or she gets in the tub or shower. In fact, consider lowering the thermostat on your hot water heater to prevent scalding injuries.
Use a hand-held showerhead.
Use a sturdy shower chair to support a person who is unsteady, and to prevent falls. You can buy shower chairs at drug stores and medical supply stores. Often the shower chair will feel more comfortable to sit on if the caregiver adds a pad or towel that can be hung up to dry afterwards.
Use a rubber bathmat or floor decals, and safety bars in the tub.
Use only non-skid bathmats on the bathroom floor.
Watch for mobility issues. If your loved one has a lot of trouble getting in and out of the bathtub or shower, do a sponge bath instead.
Remember to consider your loved one’s stage of disease to determine which strategies may be helpful.
Help setting up a bath or shower
Before starting a bath or shower:
Get the soap, washcloth, towels, and shampoo ready.
Make sure all supplies are within arm’s reach.
Have extra dry washcloths to cover your loved one’s eyes if they are sensitive.
Make sure the bathroom is warm and well lighted.
Play soft music if it helps to relax the person.
Be matter-of-fact about bathing. Say, “It’s time for a bath now.” Don’t argue about the need for a bath or shower.
Be gentle and respectful. Tell the person what you are going to do, step by step.
Make sure the water temperature is comfortable.
Avoid bath oils or bubbles, which can make the tub slippery.
Tips to improve bath time if it upsets your loved one
Allow your loved one to do as much as possible. This protects his or her dignity and helps the person feel more in control. Here are some tips:
Warm up the bathroom if possible.
Create a ritual or routine and do the same thing each time.
Consider combining a bath with something your loved one will enjoy. For example, you might say: “Let’s shower and then head out for breakfast.”
Consider playing music they enjoy.
Based on their current abilities, give your loved one specific tasks to complete.
Let your loved one wear loose clothes in the shower. You can still use a washcloth to clean under the clothes.
Put a towel over the person’s shoulders or lap. This helps him or her feel less exposed. Then use a sponge or washcloth to clean under the towel.
Offer choices if possible:
Ask if they want to take a bath or shower (if either can be done safely).
Ask them to choose which soap they prefer.
Distract your loved one by talking about something else if they become upset. An activity or favorite food that follows the bath could be motivating.
For the highly resistant loved one
Try all the above suggestions, and:
Consider saying ”It’s doctor's orders”. Sometimes a request from an authority figure carries more weight. You may also consider invoking a favorite family member or caregiver that may also persuade your loved one.
Make it short. If a longer bath time increases anxiety, skip the rinse cycle, and instead use no-rinse shampoo and body soap.
Hire an experienced home healthcare aide. Some people respond better to someone who is not a family member when it comes to an intimate task like bathing. You can find a list of private duty care companies here.
Try a different family member. It's not unusual for your loved one to react a bit differently toward different family members. Sometimes there is no explaining this, so don’t let it upset you. If your father is extremely resistant to your help with a shower, for example, perhaps your brother or another sibling may have more success. This may be very important if you are of the opposite sex.
Give your loved one a washcloth to hold. It will keep their hands occupied in case they try to physically resist your help.
Pick your battles: The bathing edition
In some situations, your loved may resist bathing so much that you are both at risk of getting hurt if you try too hard. In that case, though it can be particularly difficult to lower your standards and not have your loved one shower daily, that is sometimes the best course of action at the time. If you find yourself in that situation often, here are some alternatives you may want to consider.
Keep in mind, for most people a full bath or shower two or three times a week is enough.
If someone has significant incontinence it will be best to have at least a sponge bath of the private areas daily. Be sure to clean gently between folds of skin and under the breasts.
Consider non-shower/bathtub options such as a sponge bath. This can be just as effective and far more tolerable.
If you need to keep it really brief, wash one part of the body each day of the week.
Shampoo hair at another time or on a different day OR use dry shampoo or no-rinse shampoo, which can be found at many drug stores.
Use a non-rinse soap product with warm, wet towels to clean the person, or consider using non-rinse bath wipes
Consider finding someone else to help with bathing:
For some loved ones, a person of the same sex is preferable.
You may want to hire a trained caregiver or nursing assistant to come to the house to bathe your loved one.
After-bath care
Make sure there is a non-skid bathmat on the bathroom floor.
Have your loved one take a seat! Falls happen all too often while drying off and dressing.
Make sure your loved one’s skin is completely dry. Avoid rubbing the skin repeatedly with the towel, and instead use a gentle “love pat”.
Look carefully in the private areas and under folds of skin. Check for rashes, sores, or red areas, especially if your loved one is incontinent or unable to move around.
If your loved one has diabetes, use cotton swabs to dry between the toes and take note of any sores or red spots.
Gently apply lotion to keep skin soft (again, love pats, not rubbing). The lower legs, elbows and heels are often in most need of lotion.
Use cornstarch or talcum powder under the breasts and in the creases and folds of skin. If the person will not use deodorant, use a dusting of baking soda inside the armpits of their shirt.
If your loved one has urinary or bowel incontinence, it is best to use a protective ointment, such as petroleum jelly, around the rectum, vagina, or penis.
Please talk with your own/loved one’s healthcare provider before using any of this information.