Bathing may become a challenging activity for persons living with dementia— completing bathing and showing reluctance to take a shower can be some of the issues. When a person living with dementia is resistant to bathing, there can be many possible reasons for their hesitation.
- Lack of understanding: A person living with dementia might not understand why a caregiver is present when they take a bath, why someone is trying to undress them or why they need to take a bath.
- Memory impairment: The person may think they already showered that day or may forget the steps to bathe or use the shower.
- Modesty: If a person is concerned about privacy, bathing in someone else’s presence could make them feel uncomfortable or embarrassed.
- Fear/anxiety: Some people may be afraid of water, whether it is due to a past traumatic incident or increased anxiety. Others might be afraid of falling when stepping in/out of the tub.
Strategies to Improve the Bathing Experience
Offer a choice between a bath and shower: As long as the person has the mobility and strength to safely get up from a seated position in a tub, offering choice may improve the outcome. For some people, spraying water may cause anxiety, whereas others may be fearful about a tub full of water.
Don’t Argue: Don’t try to argue with the person about how many days it’s been since their last shower, or why good hygiene is important. Demanding or correcting constantly can increase anxiety, try to encourage or asking instead of arguing.
Consider time of day: If possible, find out the person’s preference for time of day to bathe and their previous routine – maybe they liked to start their day with a shower or enjoyed a relaxing bath before bed. Consider factors such as sun-downing behaviours or when a person may have more energy or less pain.
Routine: As much as possible, stick to a routine, both for the time of day for a shower and the steps you use when helping the person living with dementia to bathe. Consistent routines can help you manage your own life and caregiving responsibilities.
Consider a PSW/hired caregiver: Some people respond better to someone who is not a family member when it comes to a personal task like bathing. If the person is embarrassed or becomes sexually disinhibited, offer a caregiver of the same sex to provide assistance.
Try different words/approach: Some people respond negatively to certain words such as “shower time.” Try naming it “washing up” or “getting ready for the day.” Consider explaining to the person that it is their “doctor’s orders” to have a shower. Or, talk about a fun activity that the person will do after the shower/bath.
Spa-like bathroom: Create a pleasant atmosphere– warm lighting, art on the walls, soothing music, warm towels (put in the dryer before shower).
Prepare items: Have all necessary items ready and within reach– soap, shampoo, washcloths, at least one large towel before beginning the process.
Temperature: Ensure that the bathroom is warm enough and the water is warm (not too hot). Have warm towels and a bathrobe within reach.
Explain what you are doing: Let the person know in simple statements what you will be doing before beginning each step.
Encourage independence: Even if it is not safe to leave the person alone in the bath/ shower, encourage them to wash themselves or participate as much as possible and provide cueing or supervision as needed. Maintaining independence improves feelings of self-esteem as well as range of motion and mobility.
Coverage: Provide a large bath towel over the person’s shoulders or a “shower cape” or “modesty towel.” Keeping someone partially covered during a shower helps with privacy as well as provides warmth.
Pain management: The person may be resistant to a shower because they are in pain. If so, speak to their physician about trying pain medication prior to bath time.
Use humour: Humour can be a good way to reduce anxiety, increase comfort and provide distraction.
Alternative methods: If a shower or bath is not feasible and causes a battle, consider sponge bathing and use of no-rinse soap/shampoo. For a sponge bath at the sink, it is best to keep the person covered and only uncover the part of the body being washed. There are also options such as inflatable basins that can be used to wash hair in bed.
Washing Hair: If washing hair is part of the hesitation, separate hair washing from shower time. Consider dry or no-rinse shampoos or going to a salon for hair washing.
Be aware of possible visual perceptual difficulties: Avoid patterned shower curtains, floor tiles and mats that may cause confusion. Use contrasting colours to differentiate between grab bars and the wall, toilet seat and other fixtures.
Equipment: Consider equipment such as a shower chair, tub transfer bench, grab bars, non-slip mat or decals inside the tub or shower space to reduce the risk for falls and increase feelings of safety and security. A rubber backed bath mat outside of the shower is also recommended. If the person sits down to shower, a hand held shower head helps to control the water and makes the experience more pleasant. It is best to install one with a pause button so you can shut off the water flow while lathering. Consult with an Occupational Therapist if you have questions about optimal bathroom equipment or modifications.
- Keep in Mind: On some days, bathing might be a battle that’s not worth fighting, especially if the person’s safety is at risk. If the person still refuses despite these strategies and approaches, it is best to stop and try again at a later time.