Showering 101: Tips for bathing someone with a form of dementia
Dementia-related brain changes transform solitary, straightforward habits into complex processes requiring a Care Partner’s compassionate support.
What had once been rote routine, like, say, showering, may now feel unpleasant, even painful, for the person experiencing neurological shifts.
“The nervous system is tied to the brain and so our sensations and how things feel, even fabric, can feel different as the brain changes,” says Ashley Gravatte, Director of Arts and Wellness for the Alzheimer’s & Dementia Resource Center.
Edith Gendron, who facilitates ADRC’s Dignified Dementia Care: A Partnership series, echoed this idea in a 2023 Informed Aging podcast.
“This is really important to remember is with progression that the brain changes. You’ll see it, and you’ll get warned. You’ll see it because maybe they start pulling at their clothes or they don’t want to wear their favorite shirt anymore because it hurts, and that shower, that water falling out of the sky onto their body, now hurts,” she said.
That said, there are ways to better the bathing experience for both involved parties — an undertaking that starts before even entering the bathroom, with the language used to discuss the objective.
“We’re not going to say, ‘It’s time to shower,’ or, ‘You smell,’” Gravatte says, noting that the person might shut down if she feels like she’s being told to do something.
Instead, Gravatte suggests phrases such as, “Let’s freshen up,” or “Let’s get cleaned up.”
“Another thing we have to keep in mind is no means no, and we hear that all the time, don’t we?” Gendron said in the podcast. “So, if you say, ‘Do you want to take a shower today mom?’ (and she responds) ‘No,’ or even, ‘Let’s take a shower mom,’ (and she responds) ‘No,’ well, you’re done for that moment in time.”
“We’re gonna wait, minimum two hours, preferably a day or two, and then we’re gonna come back to the task with different language – ‘Let’s get freshened up,’ (or) ‘Let’s have a spa day,’ something like that,” she adds.
If the person experiences incontinence, language like “Let me help you get more comfortable,” could be helpful, Gendron said, noting that it’s helpful to have two people to assist her.
Beyond that, we also want the environment to be comfortable.
This means the bathroom should be warm when the person enters. Perhaps the Care Partner has already turned the water on so that the space is steamy, and brings towels fresh from the dryer.
The countertops and tub should be cleared, so that only the essentials — soap, conditioner — are available.
“(The goal is) simplifying what they have to choose from in the shower,” Gravatte says. “If the soap bottle looks like the shampoo, maybe switch to a bar of soap.”
One man that Gravatte spoke with said that his wife was having a difficult time distinguishing between the shampoo and conditioner, so he’d covered the wording and labeled each container in big bold letters.
“Their brain is changing and so, (we are) reducing the chances of error and setting them up for success,” Gravatte says.
Beyond that, Care Partners will want to incorporate high contrast colors in an otherwise stark-white bathroom, and replace dark bathroom rugs because these can be perceived as holes in the floor. The entire space should be well-lit and inviting.
“Sometimes, people as they progress — mirrors can be upsetting because they don’t recognize who they see,” Gravatte says, adding that it might be helpful to cover the mirror in those cases.
A shower chair is essential.
“You want something sturdy,” Gendron says in the podcast. “Use a towel, drape it over your person, make sure they have dignity there, and get a handheld shower that you can control so it’s very, very soft and not really even shower force but kind of like a faucet force, where it’s gonna come out gently.”
“And just use it in the areas that are necessary, never the face, never the head, and talk,” Gendron adds. “(Say things like) ‘I’m gonna wet your back, mom. I’m gonna wet your back,’ and show her, ‘I’m gonna wet your back,’ that kind of thing.”
Besides towels, modesty tools might include showering capes, and Care Partners might offer their person a netted bath sponge.
“Put something that smells nice on there — a soft soap that your person thinks smells nice — get them wet, put one in each hand of your person, right, and you can encourage them, maybe (say something like) ‘Here, you start here,’ and kind of encourage their dominant hand to wash their non-dominant shoulder, (and) get those hands going toward their body, while you quickly and efficiently take care of business down below,” Gendron says.
The water pressure should be a slow-flow, gentle setting, to accommodate the shifts in sensation for the person navigating dementia symptoms.
And it might be beneficial to incorporate relaxing music that she enjoys.
The goal is to align the showering routine with the person’s previous habits regarding timing and frequency.
“I take my shower in the morning. Some people take their showers for the next day at night. So you need to know… your person, right? If you try to get me to take a shower, when I’m well along the road, at 8 p.m., I’m probably going to give you a hard time, right? Or if you try to have someone who’s used to a nighttime shower and then jumping into a comfy bed, try to do it at 7 a.m., right? So, first go with their needs.”