As bathing or showering sometimes becomes problematic as dementia progresses, it is a really good idea for care partners to learn about alternative bathing techniques. Did you know that there is no law that says we have to get someone into a bathtub or a shower in order to get them clean? It’s true!

If you do not have a good trusting relationship with the person who you are trying to help bathe or shower, it will be doubly difficult to assist them. I mean, how many people in the world right now do YOU trust with your naked body? That’s a pretty big deal. And once people are living with dementia, or simply have reached a certain age, it might feel downright embarrassing to mother to consider being bathed by their daughter, someone THEY used to bathe! Or for a man to accept shower assistance from his son or daughter, or his younger sister. Sometimes it can work out just fine, but other times, bathing becomes a struggle and a seemingly insurmountable challenge.

The following descriptions of alternative bathing techniques are taken directly from the website “Bathing without a Battle”: https://bathingwithoutabattle.unc.edu/bathing-techniques

1. THE TOWEL BATH: This is a variation on a typical “bed bath”, which you may have heard of. Bed baths are a good choice for persons who are frail, non-ambulatory, considerably overweight, or who experience pain on transfer. It is possible to wash people adequately in the bed and it is often much less stressful. It is usually done with a basin of water, soap, washcloths, and rinsing off the soap.

A variation on this method is the TOWEL BATH. Here, a person is covered with a large, warm, moist towel containing a no-rinse soap solution, and is washed and massaged through the towel.

(The website mentioned will give you more details on the equipment needed, how to prepare the person, how to prepare the “bath” in a big plastic bag, and will lead you through the TOWEL BATH process, step by step. It is a bit futzy, I must say - having a team of two trusted people to help with the process would be ideal, I think.)

2. THE RECLINER BATH

Some home health aides have reported giving very successful baths while the person is resting in the recliner chair. This works particularly well for persons who are extremely fatigued by chronic or terminal illnesses.

Equipment Needed:

• Basin of water, preferably with a no-rinse soap

• Towels

• Incontinence pads

Pad each body part being washed with a towel and incontinence pad if available. Proceed with uncovering and washing body parts one at a time.

3. THE TOILET OR COMMODE BATH: This method was useful for an easily agitated nursing home resident. Mrs. Harrington greatly disliked being moved or touched and fought through attempts to carefully shower her or bathe her in bed. She was often incontinent of stool during her AM shower or bath. So, the caregiver, Marie, first placed her on the toilet, allowed her private time to have a bowel movement, then washed and dressed her upper torso while she sat there. Marie then washed her legs, and lastly had her stand with assistance and washed her peri area and bottom just prior to transferring her to her wheelchair, ready for the day. Her thin hair was washed at the bathroom sink using wet washcloths to wet and rinse her hair.

4. THE SINGING BATH: For another most complex person, we did the singing, sitting, in- room bath. Miss Florence was infamous for refusing her shower and for fighting when she was forced to shower. Estelle, the nursing assistant who worked with her, discovered that she liked to sing, and her favorite tunes were “Jesus Loves Me” and “ Happy Birthday”. If Estelle waited until she felt Miss Florence was in a good mood, sang with her, did part of bath while she was lying in bed and part as she began to get up out of bed (following Miss Florence’s lead), she was able to wash her entire body. Her hair was done using an in-bed basin on another day. Interestingly, the family reported that Miss Florence had been refusing to get in the shower or tub for ten years prior to coming into the care facility.

5. THE SEVEN DAY BATH: A family reported good luck in keeping their father, Mr. Simmons, clean by dividing the body into seven parts and washing one each day. He disliked bathing or washing but could tolerate short episodes better than longer, more overwhelming ones.

6. THE UNDER-THE-CLOTHES BATH: Grace disliked the shower or tub but did well when encouraged verbally and physically to wash herself in her room. One day her caregiver, Margaret, arrived to find that Grace had been up all night, which was unusual because she preferred to stay in bed most of the morning. She had had a rough, agitated night and her body odor smelled of perspiration and urination. A urinary tract infection was suspected and later confirmed and treated. It was the usual day for Grace to get her in-bed bath. Margaret considered just postponing it but thought she would try to freshen her up and help her feel better. She washed what she could while Grace was sitting in the wheelchair, gently talking to her about her favorite subjects. She continued this approach and asked permission to reach into Grace’s dress to wash her underarms and breast areas and then the genital area. When Grace refused or started to become angry or upset, she stopped. It wasn’t a complete bath, but the priority areas were cleaned, and Margaret avoided a big battle at a time when Grace would be easily distressed.

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Here’s hoping these examples will encourage you not to despair, and to try something differently to ultimately make life easier both for yourself and for the person you care for.

Many thanks to https://bathingwithoutabattle.unc.edu/bathing-techniques for these ideas, and all the research that went into them.

---Marysue Moses, Ebenezer Dimensions Program Coordinator