BATHING We Americans are fanatic about bathing. Many of us shower at least once a day. However, many of our elders are of a generation that often bathed only once a week. Of course it’s important that we keep clean, but this can be achieved in several different ways: showers, tub-baths, sponge baths and no-rinse washcloths. A no-rinse wipe-down is just as effective at cleaning a person as a vigorous shower. BATHROOM BASICS  • You’ll want to install safety bars on the walls, by the tub or shower and next to the toilet. If you’re using a tub, you can also attach a clamp-on railing to the side of the tub to make getting in and out easier.  • Use a tub or shower chair and handheld shower.  • Use a non-skid pad in the bottom of the tub or shower. Also, make sure the bath mat is non-skid.  • Avoid bath oils that make the tub or shower slippery.  • Assist the person in and out of the tub or shower.  • Always supervise bathing.  • Use shampoo, soap, bath gel etc. very sparingly. Elderly people already have a problem with drying and fragile skin. All these substances tend to dry out the skin and scalp.  • Important: Warm up the bathroom ahead of time and have everything that you need laid out and ready. The shower chair may be cold, so you might want to lay a towel on top of it to make it more comfortable. Consider the person You’ll have greater success when you conform to his customary routine: • Did he prefer to shower? • Did he prefer tub-baths? • How frequently did he bathe? (Once a day, once a week or?) • At what time of the day did he bathe? (Morning or evening?) • Did he use a washcloth, sponge or brush? • Did she wash her hair in the shower or have it done in a salon? Strong resistance to bathing in an Alzheimer’s person may spring from one or more of the following reasons: If she’s in the early stages and still living alone, she may be depressed and therefore losing interest in personal hygiene. (This may be sign that it’s time for her to get professional assistance at home or move to an assisted living home.) The person may not be feeling well. She could have the flu, a cold or an infection, like a UTI (urinary tract infection.) She may be afraid of stepping into the tub due to her inability to judge where the edge is or how deep the tub is. - Use colored bubble bath or a colored bath mat to make it easier to judge the depth of water. Avoid a very dark colored mat, which may look like a hole to an Alzheimer’s person. If the person has a fear of bathing in a tub, it could be the result of a childhood incident, e.g., near drowning or other unpleasant water experience. As the disease progresses the Alzheimer’s person spends more and more time in an altered reality, often drawn from childhood experiences. This may have awakened long forgotten traumas that are then aggravated in these situations. The person may be confused about the routine of washing, may not remember what the bathtub or shower is for - or how to work the faucets. He may not be able to adjust the water to a comfortable temperature. Even when you adjust it for him, he may have problems gauging the level. His senses of hot and cold are no longer as keen as yours. You may be concerned or uncomfortable with your role. Your discomfort may be showing and influencing the person with Alzheimer's disease.   If the Alzheimer’s person has moved to a facility you may face new issues: His modesty may be challenged. He may be uncomfortable with a staff person (stranger) assisting him. Ask the staff to let him keep his underwear on or drape a towel over his lap when he’s sitting on the chair in the shower. Staff can wash everything on top and then everything on the bottom and then quickly wash the remainder as he’s standing up to get out of the shower. If the person needs to wear a hearing aid to help with communication, you’ll want to watch for water getting into the ear. You may need to remove the hearing aid if you are washing the person's hair. Keep the person busy with washing and then take out the hearing aid when it is time to wash their hair. Or, use shampoos that don't require water. I often hear from hospice personnel of the reluctance of staff at care homes to support alternatives to a tub bath or a shower. If you are associated with a facility, you might want to reiterate this fact with your staff and remind them that by the time a person needs the services of hospice, his skin is often extremely sensitive to touch and a regular bathing routine can be painful. Communication & Bathing The above assumes that your person is somewhat cooperative with you. What do you do when the person refuses? The following exchange will sound familiar to many a caregiver of an Alzheimer’s person: “Do you want to take a bath?” “No!” “But you need one.” “No, I just had one yesterday!!” “Dad, it’s been a long time since your last bath.” “I’m not dirty.” “You’re starting to smell, Dad.” “You take a bath. Leave me alone!!!” What are the problems with this exchange? In so many words, you've managed to call him a filthy liar. First you’ll want to drop the phrase “Do you want to take a bath?” It will likely elicit an immediate "NO." You’ll want to avoid arguments. If he thinks that he took a bath yesterday, there’s probably no way you can dissuade him from that belief. Compliments are very effective, especially when you connect them to the situation. Try this version: “Hey Dad, you said you wanted to take a bath; I have everything ready for you.” (It’s his idea rather than yours) “No!” You’ll ignore his protest and keep talking. “You wanted to try the new great smelling soap.” Get him in a gentle arm-hold as you steer him into the bathroom, while you keep talking about the soap: “Come, let me show you. - You know Dad, you’ve always had a particularly good nose for soaps.” As you help him with his bath, keep talking to him about this or that, sprinkling your chatter with compliments. If he starts to get anxious, you can tell that in Florida it’s illegal to shower naked. (This is an actual Florida law still on the books today.) He will mimic your attitude. If you’re worried or in a rush, he’ll pick up on your vibes and it’s almost a guarantee that you’ll have problems. Stay positive and cheerful. The terms “bath” or “shower” may evoke an immediate negative reaction. In that case, don’t use the words. Instead, you can take him by the arm and as you gently lead him to the bathroom, as you cheerfully say: “Come Dad, let’s go this way”   Help him undress while talking about something unrelated. Stay upbeat and positive. Use compliments as much as possible. Encourage him to wash himself as much as he can without stress. When necessary, use clear single sentence directions, one at a time. Give him plenty of time. After the bath, share a cup of tea, relaxed conversation, or a good story. Chances are that this “after-the-bath” ritual will help make the your bath routine a positive experience for both of you. And don’t forget the alternatives. If he’s too spooked by the bathroom, or you find it impossible to coerce him into the bathroom, you can give him a sponge bath or no-rinse wipe-down anywhere in the house, wherever he’s comfortable. No-rinse products are available from many different sources. Check with your local pharmacy or go to your internet search engine and type in “no-rinse washcloths” and “no-rinse shampoo.” Good luck!