A common challenge in caring for a loved one with Alzheimer’s is showering. There are many reasons for this, including fear of the water or vulnerability or perhaps an old memory of abuse or crisis. But often it is simply because the person is no longer able to sequence the steps needed to go from fully dressed to getting inside the shower and actively showering. If you think about it, breaking down the act of showering results in many sequential steps. For the person with Alzheimer’s who is now unable to sequence, this is an overwhelming task, which they may not be able to understand themselves and/or articulate. Because their emotions remain intact, this “stalemate” could also be embarrassing to them.
Mindful of their emotions, including sense of pride, dignity, and modesty, family members and/or caregivers should approach the topic of showering delicately. Rather than telling the person he/she must shower, reminding them of how great they feel from the shower may be better received. Suggesting they try a new shampoo or bath loofah or sponge that you just picked up may make the shower activity more inviting and less threatening.
Most importantly, provide a sense of privacy for the person even when having to assist them with undressing, getting in and out of the shower, and if you need to help them wash. Demonstrate taking off tops and pants as you suggest they undress while you get the shower started and water warmed up. Then keep your back to them while readying the shower so they can have privacy undressing. Offer a terry cloth bathrobe or a towel to drape around them as you assist them getting into the shower. Reassure them that their privacy is being respected and you want them to feel comfortable.
Lather the bath cloth or sponge for them and hand it around the drawn shower curtain suggesting they use this to wash their body. When time, suggest they turn their back to the shower spray and put their head back to get their hair wet. Then apply the shampoo to their hand and tell them to rub it in their hair and head.
If the person needs you to wash them, it’s best to use a shower chair so they are safely seated and don’t need to rely on balance. If the person is resistant to being naked in front of you, keep the towel or bathrobe on them as you wash. After all, it’s actually a giant washcloth and you can use it as one! When using the shower chair, use a pull-down shower head and start rinsing and washing at their feet and work your way up the body. Sometimes, people with dementia are afraid of getting water in their face or on their head. This method of working from feet up gives the person time to adjust to the water and reduce the fear of it. If the person remains fearful, give them a hand towel to hold at their face, which will give them a sense of protection.
When they are finished washing, guide them to turn off the water (or you explain you are doing so) and hand them a dry towel or a terrycloth bathrobe to wrap themselves in before getting out. Then assist them exiting the shower stall and help with drying if necessary. Sometimes they just like to sit for a few minutes outside the shower because this has taken a good deal of their brain energy. Give them the privacy to dress themselves, if they are able. Keep chatter positive and upbeat and compliment how nice the shampoo smells, etc.
Throughout this process, be sure to keep the conversation adult-like. Words and tone of voice should always be respectful of the person’s age, not geared to one’s disabilities and definitely not child-like. As always, we need to remember that their emotional memory remains intact so they are very sensitive to patronizing or infantilizing conversations and tones.
Be mindful as well that this process is an emotional one for them so they may feel either invigorated or fatigued from it. It’s best to choose a time of day when they are typically more receptive to the challenge that this presents them. Following the shower with a comforting activity such as enjoying a cup of tea and cookie or applying lotions to their arms and feet may prolong the positive feeling for them. And it wouldn’t hurt for you the caregiver to do the same for yourself!
~ Joan F. Wright, CDP, CADDCT