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The Battle of the Bath

One of the more stressful behavioral issues family and caregivers have when caring for a person with dementia is waging “the battle of the bath.”  If you think about it, a growing fear and resistance to bathing makes sense since the process involves multiple steps and judgments, which may prove cognitively daunting for the person with memory impairment. It is also a deeply private and personal task, which is another reason why there are often struggles. There are a number of common anxieties around bathing, showering, intimacy and water which may have to be overcome. These include tubs that are filled with deep bath water, the rush of water from an overhead shower, the embarrassment of undressing in front of others or the shame of being incontinent. Here are some tips to make the personal hygiene care routine less stressful and more successful for those with dementia.

• Give frequent gentle reminders about hygiene and be flexible and persistent on the timing of your request. Sometimes, it might be easier to reason with the person that they should bathe before they leave the house or if they are expecting company.
• If bathing or showering causes the person distress, involve the person in decisions around washing and try and negotiate a sponge bath.
• Be tactful and cue them diplomatically with the sequential steps in the activity. To enhance privacy, uncover only the part of their body that you are washing at the time, leaving the rest covered. Offer practical help but try and preserve as much of their independence in the task as possible and give lots of encouragement.
• Try and make the experience as pleasurable as possible. This might be accomplished by distracting them with humor and stories and having a warm, comfortable well organized environment. Helpful equipment can include a handheld shower, preheated warm towels and robe, a tub bench and pleasant, familiar toiletries including a dry shampoo.
• Reinforce daily routines and schedules with visual guides if necessary to reinforce regular bathing.

If your loved one remains resistant to bathing and is having skin or urinary tract infections, discuss these resistant behaviors with their primary care provider, psychiatrist or neurologist who may be able to offer further treatment options.

Written by Anne Sansevero