13. Bathing

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Safety

The bathroom is one of the most dangerous places in the home, especially for older adults. Each year numerous individuals slip or fall causing serious injuries. Older adults are at greater risk of injury because some medications they take can cause dizziness or low blood pressure and they may have difficulty standing or walking. Surfaces in the bathroom (metal, cold tile and porcelain) are slippery when wet and have no cushion when a person falls.

If the person does not have the right equipment to give a safe shower, ask your supervisor to contact the care manager to request a physical therapy evaluation.

General Tips for Bathing

  • Encourage the person to bathe herself/himself as much as possible.
  • If bathing is difficult, do it only as often as in the plan of care.
  • Make sure that the hands, face, and genital area are washed every day.
  • Have all supplies ready before starting a bath. Keep the room comfortably warm.
  • Respect the person’s privacy. Keep her/him covered when possible.
  • Wear gloves.

Safety is important when giving a shower. If a shower chair is used, check it to make sure it’s sturdy.  Adjust the height as needed. Put a bath mat or towel on the floor outside of the shower to prevent the person from slipping on a wet floor when she/he steps out of the shower.

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Always stay with the person while she/he is in the shower.

If the person becomes dizzy during a shower, turn off the water. If the person is standing, have her/him sit down and lower the head as much as possible. Cover the person with a dry bath towel.

During the shower, look at the person’s skin for areas of redness, rashes, rough areas or tenderness. Look at the person’s feet to see if there are any sores, blisters or redness. Report this information to your supervisor.

Procedures for a Shower

1. Get everything you will need.

2. Make sure that the bathroom is warm.

3. Make sure the shower chair is clean. Clean the chair if necessary.

4. Place a nonskid mat in shower stall if the person is standing during shower.

5. Explain what you are going to do. This is very important for persons with dementia.

6. Wash your hands and put on gloves.

7. Ask the person if she/he needs to go to the bathroom. It may be easier to undress the person on the toilet.

8. If the person wants to undress in her/his room, assist the person to undress and put on robe and slippers.

9. If the person cannot walk, take the person by wheelchair to the bathroom.

10. Transfer the person to the shower chair.

11. Turn on the shower and adjust water temperature. Direct water spray away from the person while adjusting. Flow rate should be gentle. Check water temperature on an inner surface of your forearm. NEVER have a person step into a shower before the water temperature has been tested.

12. Help the person to wash as needed. If the person can’t help, start with the eyes then wash face, ears, neck, arms, hands, chest, abdomen, and back. Ask the person if she/he wants soap used on the face.

13. Rinse with warm water.

14. Wash legs, feet, genital area and in between toes. Wash genital area from front to back. NOTE: Wash female genital area from front of chair; wash anal area from under the chair. Rinse well with warm water; discard washcloth in a laundry basket.

15. Turn off shower and cover the person with a towel; place towel around hair if wet.

16. Assist the person out of shower.

17. Remove and dispose of gloves.

18. Uncover the person one area at a time and pat dry. CAUTION: Once a towel has been used to dry any area below the waist, it should not be used on other areas.

19. Apply non-talcum powder, lotion, and deodorant if the person wants the person. During the entire process, check the skin for breakdown, unusual bruising, cuts, or anything unusual.

20. Assist with dressing.

21. Help the person to a comfortable place and assist with any personal care such as shaving and hair care.

22. Do not cut fingernails or toe nails.  If the nails are a problem, report it to your supervisor.

23. Return to bathroom, remove soiled articles, and clean the shower chair.

24. Wash your hands.

25. Report anything unusual to your supervisor.

Bathing Persons with Dementia, Alzheimer’s disease or Cognitive Deficits

Bathing may be difficult when bathing persons with Alzheimer’s disease, dementia, or other cognitive impairments. Cognitive impairment is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life.   Some persons may refuse to bathe. If the person continues to refuse, it is probably because the person is afraid of something about taking a bath or shower.  Individuals with dementia, Alzheimer’s disease and cognitive impairment may not be able to tell you what is bothering them.

Tips

Daily routine

Establish a regular daily schedule that includes bathing at the same time every day.  It becomes a normal part of their day, like eating or sleeping.  A predictable daily routine reduces stress and anxiety.

Comfortable and Warm Bathroom

Many older adults don’t like bathing because they are afraid of being cold. Older adults feel cold more easily than a younger person.

Avoid Arguments

Don’t argue about bathing. Keep sentences short and simple. Make eye contact, and smile. Extend your hand so they’ll take it, get up, and let you escort the person toward the bathroom.  Talk about something positive or rewarding to change the focus. Ask about their favorite things like music, TV shows and movies. Ask the person about their children or grandchildren. Find out what makes the person happy.  Have this conversation in advance to be prepared with positive topics.  Do this often so that when the person takes a shower, they think of positive things that they enjoy.

Calming

It is best if the atmosphere is calm. Use calm, soothing tone of voice, or play soothing music they like. When the water is warm, slowly spray water on body parts to give the person time to adjust to the feeling.

No Surprises

There are many steps to bathing which may be upsetting to someone with dementia, Alzheimer’s’ Disease or cognitive disability.  Let the person know what’s going to happen and talk the person through it to avoid fear or anxiety.

If the person really does not want to bathe or shower, do not force the person.  Wait for several hours or the next day. Report this to your supervisor.

If the person is incontinent, try to wash the urine or feces from the area.  Explain that you’re doing it so the area won’t be sore and painful.

How to Give a Bed Bath

Supplies

  • Water basin and washcloths
  • Bath towels
  • Soap, lotion, and deodorant
  • Lightweight blanket
  • Clean clothes

Preparation

  • Close the windows and turn up the heat to keep the room warm.
  • Fill the water basin with warm water and check the water temperature.
  • Place towels under the person to keep the bed dry.
  • Cover the person with a blanket or towel. Use the blanket or towel to keep the person warm.

Process

  • Make sure the person cannot fall out of bed.
  • With soap and water, wash and dry the face, neck, and ears.
  • Wash one side of the body from top to bottom and repeat on the other side. Start by washing the shoulder, upper body, arm, and hand then the hip, legs, and feet. Rinse the soap off of each area and pat dry. Check for redness and sores during the bed bath.
  • The genital area is the last area to be washed. For women, wash the genital area from front to back. For men, make sure you wash around the testicles. Roll the person to the side to clean the buttocks.
  • Apply lotion to the arms, legs, feet, or other dry skin areas.
  • Remove all dirty washcloths and towels and help the person dress.
  • Clean the water basin.
  • Report any skin changes, like redness, to your supervisor.