Activities of daily living (ADLs) include eating, bathing, grooming, dressing and going to the toilet. People with dementia may need aid to perform these tasks. Questions about ADLs help decide what type of care a person needs.
Behaviors during bathing
People with dementia may become resistant to bathing. Such behavior often occurs because the person doesn’t remember what bathing is for or doesn’t have the patience to endure lack of modesty, being cold or other discomforts. Loss of independence and privacy can be very difficult for the person with dementia. The disease also may increase sensitivity to water temperature or pressure.
Do not take disruptive behaviors personally. Remaining flexible, patient and calm will serve you best as you try the tips on this page. For more ideas, join ALZConnected, our online support community where caregivers like you share tips on bathing a person with dementia.
Before you begin
When bathing a person with dementia, allow the person to do as much as possible. Be ready to assist when needed, but try to offer only the level of help necessary. In the earlier stages, the person may only need a reminder to bathe. As the disease progresses, he or she will require more assistance.
Prepare the bathroom in advance by:
- Gathering bathing supplies. Have large towels (that you can completely wrap around the person for privacy and warmth), shampoo and soap ready before you tell the person that it’s time to bathe.
- Making the room comfortable. Pad the shower seat and other cold or uncomfortable surfaces with towels. Check that the room temperature is pleasant.
- Placing soap, shampoo and other supplies within reach. Try using hotel-sized plastic containers of shampoo, and have a washcloth ready to cover the person’s eyes to prevent stinging.
- Monitoring water temperature. The person may not sense when the water is dangerously hot or may resist bathing if the water is too cool. Always check the water temperature, even if the person draws his or her own bath.
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.
Helping the person feel in control
You may need to experiment to determine if the individual prefers showers or tub baths.
- Give the person choices. Ask: “Would you like to take a bath or a shower?” or “Do you prefer to bathe now or in 15 minutes?”
- Fill the tub with 2 to 3 inches of water. Then assess the person’s reaction to getting in. It may be better to fill the tub after the person is seated.
- Be sure the person has a role. Have the person hold a washcloth or shampoo bottle.
- Be aware that the person may perceive bathing to be threatening. Have activities ready in case the person becomes agitated. For example, play soothing music or sing together. If the person resists bathing, distract him or her and try again later.
- Always protect the person’s dignity and privacy. Try to help the person feel less vulnerable by covering the person with a bath blanket while undressing. Let the person hold a towel in front of his or her body, in and out of the shower or tub, to help ease anxiety.
- Have a familiar person of the same sex help, if that is more comfortable. Cover or remove the mirrors if a reflection leads the person to believe there’s a stranger in the room.
Adapting the bathing process
You may experience the most difficulty when attempting to wash the person’s hair. Try using a washcloth to soap and rinse hair in the sink to reduce the amount of water on the person’s face.
- Set a regular time for bathing. If the person usually bathes in the morning, it may confuse him or her to bathe at night. Determine what time of day is best for the person with dementia. Then set a routine.
- Be gentle. The person’s skin may be very sensitive. Avoid scrubbing. Check the spray on the shower head to make sure the water pressure isn’t too intense.
- Simplify the bathing process. Try different approaches to make bathing easier. For example, sew pockets into washcloths to help the person hold on to the soap, or use soap that washes both hair and body.
- Coach the person through each step. For example: “Put your feet in the tub.” “Sit down.” “Here is the soap.” “Wash your arm.”
- Use other cues to remind the person what to do. Try using a “watch me” technique or lead by example. Put your hand over the person’s hand, gently guiding the washing actions.
- Use a tub bench or bath chair. Having the person sit while showering may be easier and safer. Look for a chair that can be adjusted to different heights.
- Be sure to cleanse hard-to-reach areas. Wash between folds of skin and under the breasts. It is important that genital areas are cleansed, especially if incontinence is a problem.
- Sponge bathe as an alternative. Don’t worry about the frequency of bathing. Sponge baths with a washcloth can be effective between showers. You may want to try non-rinse soap products, which can be used with warm towels and applied under the guise of providing a “massage.”
- Check for rashes and sores, especially if the person is incontinent or unable to move around.
- Seat the person while drying off skin and putting on fresh clothes.
- Be gentle on the skin. Pat skin dry instead of rubbing. Apply lotion to keep skin soft.
- Use cornstarch or talcum powder under the breasts and in the creases and folds of skin.
*Provided by the Alzheimer’s Assocation – www.alz.org