Imagine this scenario:
You wake up and you’re not quite sure where you are. Your room looks sort of familiar and a nice lady brought you some breakfast and opened the window. Then two strangers walk in, say that you need a bath and start trying to take your clothes off. You’re cold and frightened and the strangers don’t seem to understand what you are saying. Then a metal contraption is wheeled in and you are being strapped into it… need I go on? It sounds like a nightmare doesn’t it?
Due to changes in the brain it is not uncommon for a person with dementia to become fearful of what used to be an everyday activity. What is comfortable and understood one day may be scary and unfamiliar the next.
It is so important to find out as much as you can about someone’s life history, routines, habits and preferences right back to their childhood and young adulthood. For someone living in the past, when bath-time was once a week with the whole family sharing the same bath water, a daily shower would be alien and frightening. Some people like a good long soak in the tub with lots of bubbles (that’s me), others like a few inches of water, no bubbles and quick scrub (my other half). It’s important to know.
Bathrooms in care homes can be scary unfamiliar places full of contraptions and shiny surfaces. Mirrors can be confusing, and shiny floors can look like rivers to someone with perceptual difficulties. Anything you can do to make the bathroom look more homely and inviting is worth a try. Ensure the room is warm and free from drafts. Wrapping someone in a soft towel or robe can also reduce feelings of vulnerability. Place a towel on the bath stool or toilet so that it is warm and soft for the person to sit on while getting dried. For someone with increased skin sensitivity the spray from the shower can feel like needles and a “lovely back scrub” can feel like a sports massage! Gentler methods are required here. Try a bath instead, offering a flannel and using a jug to wash hair.
Someone with dementia may have forgotten the sequence of getting washed or how to use the shower controls. Rather than admit this and feeling embarrassed, they may just say they don’t want a shower. It is important to help them in the gentlest way to experience success. Break everything down into simple steps, perhaps handing one object at a time, such as flannel first, then shower gel but not both together. Talk through each step, using sensory techniques to help the person connect to a memory related to the activity, such as using their favourite toiletries, talking about the smell and reminiscing about bath-times from years gone by. Offer encouragement but don’t take over as this may reinforce their lack of independence. It is always less frightening if we are doing something ourselves rather than having it done to us.
There can be many reasons why someone resists bath or shower and it’s up to us to use our experience, skills and knowledge of the person to try to find a solution. We can’t change the person with dementia, all we can do is change the way we respond to situations and be creative in finding solutions.