Bathing in the bathroom
In the run up to publication of my new book Carers and Caring; the One Stop Guide; how to care for older relatives and friends, I am sharing some of the practical solutions learned from research and experience. Read to the end for my three top tips.
If you think any problems have been missed you can email me and tell me, and I’ll make sure they are covered in the next edition and online on my website at www.juneandrews.net.
Bathing is a tricky issue for carers of older people. It is vital to let a person do as much as possible for as long as possible but a time might come when an old and frail person needs your help. Keeping a person clean is not just about hygiene but also about upholding their dignity while maintaining the health of their skin, teeth, hair and nails. The challenges of this kind of intimate care might put some people off. But if you’re going to do it, here are some ideas.
How often do you have to do it? Remember, this is mainly about an older person who cannot or will not attend to their own hygiene.You normally don’t need to provide a bath or a shower more than twice a week, but aim for that at least. Every day they should be helped to wash their face, and “down below”, front and back. And of course, it’s impossible to repeat too often the need to help everyone to wash their hands every time after they use the toilet and always before eating.
If the person can wash themselves but is frail or disorganised, a major challenge is to assess the bathroom for safety. Make sure it is difficult for the person to lock themselves in – you may have to get into that bathroom if they suffer a fall or other accident. Asking yourself a ‘What if?’ set of questions is a risk assessment. All of life has some risks, and so you must accept a level of risk if the person is fiercely independent. There are some things you can easily do. For example, use the central control thermostat to fix the hot water temperature at the central boiler and reduce the risk of scalding accidents. There is further guidance about general safety later in this A to Z series and in my book under ‘Home adaptations’ including advice on flooring, steps, stools and rails.
Sometimes the person is very pleased to be given a hand, but it is a real problem if they resist taking a bath or shower. It just seems like too much work for them and too much fuss. Remember that many older people may have been brought up on far fewer baths than we have now. It is not worth making it a battleground. Don’t feel pressurised by what others might think.
Begin by assembling everything that you need, including towels and the clothing that they will be putting on after the bath. Having a bath can be more luxurious than a shower, but it is sometimes hard to get someone in and out of the bath if they have arthritis or other mobility problems. You can buy a side entry bath, but more commonly people make do with a shower because it is less expensive and disruptive. If you’re helping the person to shower it is easier and safer if they will sit down on a specially designed shower stool. You can get a folding one fitted to the wall of the shower. Wearing shower shoes with grips to prevent slipping makes it even safer. Particularly if the person has dementia or is nervous, they may be alarmed by feeling shower water coming down on their head and a detachable showerhead that you can use to spray water gently around their body is much less stressful. If the person gets stressed they won’t co-operate, and it is more likely that there will be a fall or other problem. The website bathingwithoutabattle.unc.edu offers tips on bathing equipment and technique. See the listing in Useful Contacts and Resources in the ‘Information about caring’ section of the book.
Explanation is important, and lots of encouragement. You can buy a towelling modesty garment that is open at the back which the person continues to wear even when they’re under the water, so their nakedness is never exposed throughout the process. It can be left behind in the shower cubicle or bath when they step into a dry towelling robe or large bath towel to get dry. A seat or recliner in the bath can help the person to feel secure. Bath time can be a relaxing and pleasant experience, enhanced by having some nice music playing. Or it can be a battleground.
When a confused person resists being washed, they may be usefully distracted if you give them something to hold. If they are clutching a washcloth or a sponge they are less likely to use their hands to try and push away the other cloth that you are using to wash them down.
If bathing in the bathroom is too difficult, it is possible to give someone a perfectly good wash in bed or in their chair. By putting a towel under each limb in turn you can give the person a rubdown with a soapy flannel and use another one to rinse. Some of the products which you will see for sale for people who are going to music festivals or camping can be put to good use in the circumstances. They are available online or from large chemists and they include large body wet wipes and ‘no rinse’ body wash foam. You squirt the foam on and rub it off with a towel. Just like that. Clean and smelling good. The person can use it themselves to stay independent for longer.
Never miss the hands and mouth. Make sure hands are washed before food and after the toilet, and keep nails trimmed and clean. Clean teeth twice a day. There will be more advice later in this A to Z series soon under the heading ‘Mouth care’. Get advice about toenails as they may be best left to a podiatrist. If it is possible to get genitals and bottom cleaned each day, that’s going to make life nicer for everyone, even if a bath or shower is not possible. If you reach the stage where this is not going to happen, that’s when you might have to consider getting outside help.
For hair, you can buy a product which looks like a shower cap. These no-rinse shampoo caps are full of ‘no-rinse’ shampoo and you put the hat on the person’s head and massage the hair. When you take it off you can towel-dry the hair – a really simple way to get clean, fresh-smelling hair. Washing the hair over the sink is easier than in the bath or shower, but the cap is even simpler and it can be therapeutic massaging someone’s head for five to ten minutes. Or you can take the person to a hairdresser, and if they’re familiar with the salon they will find it entertaining or even comforting. Many hairdressers will work in a person’s home and that’s even easier. Talk to your local hairdresser. Or, in the case of gents, their barber.
There is much more about bathing and personal hygiene in Carers and Caring: The One-Stop Guide: How to care for older relatives and friends - with tips for managing finances and accessing the right support available from all good bookshops from May 2022 and available for pre-order
Three hints:
1. Safety first
2. Use products to keep life simple
3. Don’t let bathing cause a battle; dirt isn’t all bad
