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

02: Dementia, Delirium and Depression: Causes and Risk

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion

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