My dad has Alzheimers. When the caregiver is trying to give him a shower, he becomes very mean and belligerent. He yells about the water being hot and how his eyes are burning. The water is very lukewarm, for I have felt it when he is given a shower. I also saw him try to get up out of the chair and was so intense that I was fearful he was going to hurt the young woman with his flailing arms. He was like this when I cared for him during a night after he had surgery. His thin arms are very powerful and the bones are strong weapons. The caregiver wants a family member to be at the home for when he takes a shower because she said he is much calmer. I thought it was awful enough when I was there. Is there a way that we can prevent the caregiver from being hurt and making it less traumatic for my dad? The worse part of cleaning my dad is the hair and face region. The washing of the rest of his body was much easier.
Difficult behaviors during bathing are very common issues for caregivers. Bathing is one of the activities of daily living that is basic to one’s sense of dignity, autonomy, and mastery. The loss of self-care abilities and control over such personal activities can lead to frustration, embarrassment, and a sense of inadequacy, which can result in outbursts, aggression, and other challenging behaviors.
Some of the following strategies may help with your situation. If the bath is distressful to your father, try breaking it up into more manageable steps. For example, separate face and hair washing from body washing. Or wash the face and upper body separate on a different day from the lower body. If washing his face is the most challenging part of the bath, try handing him a washcloth and asking him whether he wants to wash his own face. Try letting him do as much of his own washing as he can. Giving him this choice may help increase his level of cooperation.
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Do not force him to bathe. If he does not want take a bath, consider whether he really needs it. It may be possible to bathe only one to three times a week with towel/sponge bathing and spot cleansing in between the full baths.If he is uncooperative, try to find out the reasons for his behavior and try to address them. It is important to respect his personal preferences and his privacy and modesty as much as possible. Try to tailor the bath to the needs and comfort level of your father. For instance, if your father feels that the water is too hot, try allowing him to set the water temperature to his comfort level. Perhaps he is having perception problems due to sensory nerve or brain damage and finds even warm water uncomfortable. If you feel that the water is too cool, consider warming up the room by turning up the thermostat or placing a space heater
in the room while he is bathing. You can also try to warming up the towels and bathrobe in the dryer just prior to use to increase his comfort level. And keep him covered as much as you can.
Before the bath, try to make sure he is as pain-free as possible. If he has conditions that cause chronic pain or pain with movements, such as arthritis, then try pre-medicating him just prior to the bath. Then show patience and understanding. And allow plenty of time for the bath.
Evaluate the best time of day for bathing. Consider what part of the day he is relaxed and functioning well. Avoid approaching the topic of bathing during those times of the day when he is tired or irritable.
Try to give him some sense of control of the situation. Provide assistance and use cueing and guiding when necessary, but try to let him do as much for himself as he can. Reinforce effort by giving praise and showing appreciation for any attempt to do things for himself.
It is important to use effective communication. First, gain his attention and maintain eye contact. Explain what you are doing or want him to do before each step. Use simple, familiar terms. Repeat and rephrase as needed to increase understanding. Say the important word last as he will be more likely to remember it. Break up the activity into simple steps, and give simple instructions consisting of one or two concrete steps.
Caregivers should try to present a positive attitude through body language and tone of voice. Use a calm, pleasant tone of voice, comforting gestures, plenty of smiles and reassuring words, and gentle, appropriate touch. Never scold or embarrass the person for needing assistance with bathing or making mistakes. Additionally, humor can help overcome and lighten a difficult situation.
Make the environment comfortable and relaxing for him. Make sure the room temperature is comfortable for older people, who are more sensitive to cold. Try to create a familiar, pleasant atmosphere by placing familiar objects in the bathroom, playing soothing music that he enjoys, and providing relaxing fragrances, such as lavender, Melissa oil (lemon balm), or mint. Try to have the bathroom and bathing accessories prepared prior to bringing him in for the bath, so that there are no unnecessary delays.
In addition to these strategies, you should also consider discussing this issue with your father’s physician to see if there are medications or treatments that can help manage his discomfort or difficult behaviors during bathing. And continue sharing your experiences and asking for advice from other caregivers, support groups, and organizations that provide caregiving information, such as the Alzheimer’s Association.
I hope some of these strategies can help you. Remind yourself that you are trying to do the best you can. Good luck.
Dr. Mindy Kim-Miller is a trained medical physician who provides useful, but general answers to questions provided by online visitors. While Dr. Mindy can not provide specific medical advice or services, we hope you find her responses useful in your personal education. All information is provided for informational and educational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. If you suspect you have an illness or disease, or a health related condition of any kind, seek professional medical care with an appropriate health care professional immediately. Do not postpone or delay seeking treatment or disregard professional advice based upon the general answers provided by Dr. Mindy. Dr. Mindy’s advice is not intended to substitute for a visit to your personal physician or other qualified health provider. Any specific medical concerns or questions you may have should be directed to your personal physician or other qualified health provider.