As Alzheimer’s progresses, people living with the disease eventually need help with bathing. This need commonly begins in the middle (sometimes referred to as moderate in a medical context) stage and continues into the late (severe) stage.
Bathing can be a challenge because people with Alzheimer’s may be uncomfortable receiving assistance with such an intimate activity. They may also have depth perception problems that make it scary to step into water. They may not perceive a need to bathe or may find it a cold, uncomfortable experience.
If people regard bathing as scary, embarrassing, unpleasant or uncomfortable, they may communicate their discomfort by verbally and/or physically resisting attempts to bathe. In some cases this can escalate and become be unsafe and upsetting for all who are involved. There are ways to make bathing easier and more comfortable — however, each situation is unique, and finding what works is often the result of trial and error. The following tips on this page can help. For more ideas, join ALZConnected, our online support community where caregivers like you share tips on bathing a person with dementia.
Know the person's abilities
Know the person's abilities. Encourage the person to do as much as possible, but be ready to assist when needed. Understanding the person’s abilities will help you know where to focus your help. Assess his or her ability to:
- Find the bathroom.
- See clearly.
- Maintain balance without fear of falling.
- Reach and stretch arms.
- Remember the steps in the bathing process and follow cues or examples.
- Know how to use different products (i.e., soap, shampoo, washcloth, etc.).
- Sense water temperature.
Making the bathroom safe
It's important to make the bathroom as safe and comfortable as possible. Install grab bars, place non-skid mats on floors, use a tub bench or bath chair that can be adjusted to different heights, watch for puddles and lower the thermostat on your hot-water heater to prevent scalding injuries. Also, take care to never leave the person with dementia alone in the bathroom, use products made of non-breakable materials, and keep sharp objects (i.e. tweezers, scissors) out of reach.
Focus on the person living with dementia, not the bathing task
- Give the person choices. For example, ask if he or she would like to bathe now or in 15 minutes, or take a bath or a shower. Try saying “Let’s wash up,” instead of “Let’s take a bath.”
- Be sure the person has a role in the bathing process. For example, have the person hold a washcloth, sponge or shampoo bottle.
- Be aware that the person may perceive bathing to be threatening. If the person is resistant, distract him or her and try again later.
- Praise the person for his or her efforts and cooperation.
- Always protect the person’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.
- Try different approaches to coax the person into the tub or shower. For instance, allow the person to get into the tub or shower with a towel on to reduce embarrassment or to help the person feel warmer.
- Have activities ready in case the person becomes agitated. For example, play soothing music or sing together.
Adapt the bathing process
- Try bathing at the same time of day the person is used to. If the person is usually a morning bather, a bath in the evening may be confusing.
- 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.
- Use a tub bench or bath chair that can adjust to different heights so the person can sit while showering, if easier.
- Washing the person’s hair may be the most difficult task. Use a washcloth to reduce the amount of water on the person’s face.
- Be sure the person’s genital areas are washed, especially if incontinence is a problem, as well as between folds of skin and under the breasts.
Simplify the process
- Sew pockets into washcloths to hold soap.
- Use an all-purpose gel to wash both hair and body.
- Use a nylon net sponge, which requires less work to make suds.
Consider bathing alternatives
- Be open to adjusting your bathing standards. Your preferences regarding bathing may not match the needs or realities of the person for whom you are caring.
- Wash one part of the body each day of the week.
- Shampoo hair at another time or on a different day.
- Give the person a sponge bath with a washcloth between showers or baths.
- Use a non-rinse soap product with warm, wet towels to clean the person. Research shows that regular, thorough use of this type of product, which can be purchased at a pharmacy or drug store, is equally effective.
- Have a trained caregiver or nursing assistant come to the house to bathe the person
- Check for rashes and sores, especially if the person is incontinent or unable to move around.
- Seat the person while drying and putting on fresh clothes.
- Make sure the person is completely dry. Pat the person dry instead of rubbing.
- Use cotton swabs to dry between the toes.
- Gently apply lotion to keep skin soft.
- Use cornstarch or talcum powder under the breasts and in the creases and folds of skin. If the person will not use deodorant, use baking soda.