03: ADLs: Assisting With Bathing & Showering

This program will present:

• Principles for assisting with activities of daily living (ADLs)
• Strategies for assisting with bathing and showering
• Tips on designing a bathing space for safety and comfort

• There are no easy answer when its comes to the care of another
• Our hope is to offer you useful information and guidelines for caring for someone with dementia
• These guidelines will need to be adjusted to suit your own individual needs

• Opportunities to spend more quality time with the person
• caregivers should approach ADLs with understanding and compassion
• Prevent difficult behaviors and improve quality of life

• Skin becomes thinner and more fragile
• Easily bruises
• Temperature regulation declines
• More sensitive to temperature
• Vision and hearing decline
• Difficulty hearing instructions and seeing things
• Joints become stiff and painful
• Limits motion and causes unsteadiness
• Falls become a greater risk

AMNESIA:

• memory decline and loss

APRAXIA:

• loss of automatic skills or inability to use common objects

AGNOSIA:

• inability to recognize objects

DYSPHAGIA or APHASIA:

• difficulty understanding and creating speech
• Attention and concentration decline
• Stress threshold recognition declines
• Ability to avoid stress decreases
• Loss of impulse control
• Organizational ability declines
• Ability to adjust to new environments declines

What do you think Mary could have done to make this shower experience more positive?

• A. She could try reducing frequency of showering to 1 to 3 times a week with towel baths or spot cleansing on other days.
• B. Mary could have covered Robert with a blanket, robe, or towel while he was undressed and waiting to enter the shower.
• C. Mary should not have left Robert alone, particularly in a cold and drafty bathing area, or in areas where wet floors could cause a fall.
• D. Mary should have placed Robert’s needs before her own agenda. Robert indicated that he wanted to take a nap.
• E. All of the above.

Choice A: She could try reducing the frequency of showering to 1 to 3 times a week with towel baths or spot cleansing on other days, is a good choice.

• Bathing too frequently, particularly with harsh soaps, can be harmful to thinner, more fragile skin
• Skin needs to be cleansed to remain healthy
• Use the bath time to check for skin rashes, burns, sores, cuts, or abrasions
• Be gentle

Choice B: Mary could have covered Robert with a blanket, robe, or towel while he was undressed and waiting to enter the shower, is another good choice.

• Covering exposed body parts prevents chill and respects privacy
• Do not have the person undress until everything is ready

Choice C: Mary should not have left Robert alone, particularly in a cold and drafty bathing area, or in areas where wet floors could cause a fall, is another possibility.

• Do not leave someone with dementia alone in potentially dangerous areas or situations

Choice D: Mary should have placed Robert’s needs before her own agenda, is also a good choice.

• Assess for fatigue and pain
• Give pain medication prior to activities as a preventive measure
• Plan activities for times when the person is not tired

Choice E: All of the above, is the best choice.

PHYSICAL AND HUMAN ENVIRONMENTS

• Physical bathing environment
• Physical space, furniture, lighting and temperature
• Human environment
• Autonomy, comfort, love and respect
• PHYSICAL BATHING ENVIRONMENT
• Space for 2 people and a chair/wheelchair

PHYSICAL BATHING ENVIRONMENT

• REDUCING FALLS
• Non-slip surface and dry floors
• Nonskid floor mats/bathmats on tile floors
• Safety strips or nonskid bathmats in bathtubs and shower

s

• Avoid bath products that will make the bathtub slippery
• Rubberized or unglazed ceramic tile floors in showers
• Carpet of a single color on floors
• Organization
• Simplify the environment
• Remove clutter and obstacles
• Label and lock away cleaning products and other harmful substances
• Make sure door locks can be opened from the outside
• Or remove/disable door locks

Physical Bathing Environment (Continued) Furniture & Lighting

• Shower and bathtub chairs and benches should have padded seats and backs
• Non-fixed chairs should have non-slip grippers on the feet
• Sling seats
• Fold-down chairs
• Handheld shower head
• Hand rails and grab bars
• Sturdy, stable furniture and doors
• Provide bright overhead and task lighting
• Reduce glare
• Wall and floor colors should contrast

• Use grab bars
• Assist if stepping over
• Assist if sitting on edge and swinging legs over
• Consider using a transfer bench
• Consider overhead trapeze
• Drain tub first and avoid oily products
• Consider a sling seat
• Consider commercial tubs with side doors
• Provide nonslip floor covering
• Offer a towel and robe

• Water temperatures greater than 120F can cause burns
• Comfortable bathwater is usually around 100F
• If using water heated above 114F, consider installing some form of anti-scalding device
• Anti-scald devices reduce water flow to a trickle when the output water temperature exceeds a set limit
• Install single lever faucets
• Clearly label hot and cold taps
• Start running the cold water first, and then add the hot water
• Place soft (childproof) covers on faucet taps

• Person-centered care: focuses on the person, considers comfort, feelings, preferences, abilities, history, strengths, and addresses any needs
• Challenging behaviors such as agitation and combativeness are seen as expressions of unmet needs
• Find out what might be frightening them or what they might need

• Gain eye contact, speak clearly and slowly, use familiar terms, repeat and remind, use effective expressions and gestures
• Observe the person’s body language for comprehension and comfort
• Say important words last
• Break up activities into simple steps and give only one or two instructions at a time

To learn more about communication skills for caregiving.

• Bath items should be simple, assembled, and within reach when needed
• Break up the bath or shower activity into smaller, more manageable steps
• Offer simple choices
• Select the best time of day for bathing

• Have the bathroom prepared prior to bringing in the person
• Fill the tub before the person enters the room
• Drain the tub before the person steps out
• Consider comfort on the way to the bathing area
• Set a comfortable room temperature
• Cover exposed areas
• Warm towels and robe

• Familiar caregiver with a pleasant, calm manner
• Familiar and pleasant objects
• Calming, favorite music
• Relaxing fragrances
• Good lighting, without glare or shadows
• Cover or remove mirrors if necessary

• Physical disabilities and sensory impairments must be considered
• Listen and look for signs of fatigue and discomfort
• Consider giving pain medication prior to the activity as a preventive measure
• Keep in mind that some pain medications can cause drowsiness or dizziness
• Consult a healthcare professional about pain management and any concerns

• Maximize individual abilities and minimize disabilities
• Encourage them to do as much for themselves as possible
• Reinforce effort and show appreciation
• Offer simple, appropriate choices
• Provide cues and guidance only when needed
• Demonstrate if necessary
• Allow plenty of time for the activity

• Learn the person’s likes and dislikes, bathing preferences, and important life events.
• Address individuals by their preferred names
• Engage people by facing them, gaining eye contact, saying their name
• Do not hover or ignore people
• Respect personal and cultural preferences about touch
• Ask permission to touch sensitive or private parts
• Respect privacy and modesty
• Close doors and window coverings

• Use gentle persuasion rather than coercion
• Allow people to feel as though they are in control
• Find out the reason that the person does not want to bathe
• Frequently offer reassurance
• Have in mind a list of reasons for why they should bathe
• Avoid the words “wash,” “bathe,” and “shower”
• Drop the subject and move on until later when the person may be more cooperative
• Consider a towel bath or spot cleansing
• Break up the bath into smaller parts
• If distressed by deep water, try filling the bathtub with just a few inches of water or using a bath chair
• Try using bubble bath

• Give a reason to take off the clothes
• Schedule the bath for when the person has to change clothes anyway
• Try cueing the undressing process
• Have the person undress in small steps while bathing
• Let the person enter the bath while still dressed
• Limit the amount of time the person needs to be undressed

• Planned and organized the activity before hand
• Time of day
• Familiar bath accessories
• Used effective communication
• Smiled, made eye contact, oriented him to the activity
• Used short, simple directions
• Said the important word last
• Used gentle, appropriate touch
• Used cues when necessary
• Engaged him in the activity

• It is safer to shower in large shower stalls rather than bathtubs
• A hand-held showerhead is a helpful tool
• Cover the person with a towel and uncover just the part of the body you want to wash
• Let the person first feel the water with a hand before spraying the water on other body parts

• A small hair-washing basin can be used to rinse hair
• Use tear-free soaps/shampoos or rinse-free soaps/shampoos
• Be patient and reassuring
• Provide modesty by covering the parts of the body that are not being washed
• Towel or sponge baths can be broken up into smaller steps
• Remember that bath time is a good time to inspect the person’s skin for areas of breakdown,rash, or reddening, particularly over bony areas such as the heels, tailbone and hips

• RECOMMENDED SUPPLIES
• 1 or 2 bath blankets or large towels
• 3 or more washcloths or sponges
• No-rinse or tear-free soap for body and hair
• 2 or more bath towels
• 2 to 3-quart basin of water, approximately 105F
• Second basin of water for rinsing if needed
• Separate basin for hair-rinsing if needed
• (In a professional care facility, fill water into a plastic bag within a basin or pitcher)

• Practicing person-centered care can improve quality of life
• Use effective communication skills
• Keep reasonable expectations; plan activities with simple steps
• Allow plenty of time for the activity
• Use cueing and guiding only when necessary
• Tailor the bath/shower to the needs and comfort level of the person
• Respect the person’s privacy and modesty
• Watch for signs of pain and fatigue
• Provide a familiar, pleasant atmosphere with simple routines
• Consider giving baths 1 to 3 times a week with towel baths and spot cleansing in between
• Use gentle persuasion and adjust strategies as needed
• Show patience, a sense of humor, and a positive attitude
• Consider both the physical and human environments

Written by:

Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:

Sasha Asdourian

www.LightBridgeHealthcare.com

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