Thursday, October 23, 2014

Saturday, April 25, 2009 shirlee, Community Member, asks

Q: can someone please tell me how to handle the bathing?

my mom is in the middle stage. she will be 80 in a couple of more months. she is on arcipet,& namenda. she has lorazepam as needed for agitiation. i only use the lorazepam when it is absolutely necessary. most days she will let me or the staff give her a sink bath. then there is those days when she will not. like today. she still has on her depend since yesterday morning. she flat out refuse to bathe. today i have tried every technique in the book. as a result of her not bathing i can not take her out. i am sooooo frustrated. i have help three days a week for 4hrs each day. but i am feeling like that is not enough. any suggestion will be appreciated. thanks shirley in n.c.
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Answers (4)
Christine Kennard, Health Pro
4/27/09 1:44pm

Hi There

 

It is very hard to cope with uncooperative behavior. You want to help them eat, drink, bath, change their clothes and they just refuse. It can be so frustrating. Can I first give you a bit of a pat on the back! Well done for not using lorazepam too often. It can be a great drug but can also cause a lot of problems if overused.

 

Here are a few suggestions that may help with bathing. You may have tried them already.

*See if she will take a bath at different times of the day. People with Alzheimer's are often at their best, less confused, therefore more cooperative, in the morning, but this is not always so.

*Try giving her rewards for cooperation-i.e. verbal praise, giving her some food or drink she likes before and after her bath.

*Let her choose lotions to put in the bath.

*Always use simple instructions, never shout, smile, chat in a friendly calming way. Gently lead them to the bathroom.

*Be flexible, if she does not want a bath go away and try later. Like all of us all, moods change.

 

Write a care plan that will record what works and what does not. Consistency is very important for people with dementia and for staff to provide the best care possible. Caregiving is frustrating at times

 

Christine

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NC, Community Member
4/25/09 5:47pm

I am not the one that bathed my father-in-law but I get some clues from the caregivers who do it. the change of the underwear does not have to go with the bath. You can change her every morning. If you don't change it, she could have diaper rash and it is not good for Alzheimer's patient as she would scratch it all the time. Usually some people go to bed at night and take a shower in the morning. If she has the same habit, it is better to change her underwear in the moring while she was being dressed when she just got up. Also call it underwear in front of her as she would not like to know it is diaper!

Our trick to give my FIL bath is to do it when he just got up every Saturday or Sunday. Before he is dressed, the caregiver would get the shower ready and put him on the bath bench. Also, you need to buy bath bench that is a longer one so she can get into the tub easily and she can sit on the bench.

Since my FIL is still alert, the caregiver would need to sort of ask him or tell him it is time to take a shower if he is ready. In a way, he needs to approve of it. This way he only takes a shower once a week in the winter and 2 or 3 times per week in the warm weather. They also apply lotion on his skin.

The routine is important and he does not want anyone to wash him - it is embarrassing, you know.

 

Hope this helps,

Nina

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AFA Social Services, Health Guide
4/28/09 10:29am

Dear Shirley,   Bathing can be difficult for individuals with Alzheimer's disease but there are ways to make the process easier. It is important to "set up the scene" in advance to make showering seem less intimidating. For example, if your mother thinks that another person might be in the room while seeing her own refection, you should consider covering up the mirror. You can also dim the lights, play soft music, and turn on the hot water in advance to warm up the room. You also must consider privacy issues, as it is possible your mother feels uncomfortable being exposed. When in the shower, it can be helpful to wash one body part at a time, while keeping the rest covered to preserve her dignity. It is a good idea to use a handheld shower head as this can also prevent water from splashing directly into her face (which can be very frightening to a person with this illness). Also, try engaging her with activities and discussion throughout the process. Allow her to take part in the process by encouraging her to wash herself. You can use her favorite scents in the tub that could help spark memories from the past. Here is an example of a conversation you can have:   You: Mom, I want you to know that I bought this great bath soap for you. What do you think of the smell? Mom: Smells like cake. You: It sure does smell like cake! I know you love cake. It's your favorite. Mom: Yes. You: (While washing her) Do you remember the time you baked that delicious cake for the bake sale? It was the one with the vanilla icing. Mom: Oh yes, it won first prize! You: (Pass the sponge to her) Yes it did, and it one of the best I ever tasted. I love this soap because it reminds me so much of your icing. I want to wash my hands with it now. Why don't you join me?   Just remember to always be positive, patient, and go at her pace. If you have exhausted all these options and she continues to refuse, you may have to consider giving her sponge baths as an alternative.

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SlappedAround, Community Member
12/29/09 9:16pm

My Mother in law has had Alzheimer's for more than 15 years now. My husband and I are caring for both her and her husband and have been for the past 8+ years. In the past 3 months she has become combative and absolutely refuses to bath or shower. She is incontinent so needs to be washed daily. I've always been able to easily shower her at least from the waist down as needed. But now, just the mention of the word shower or "wash" turns her into someone I don't recognize! When her depends are full of number one AND number two, it is an all out struggle to get them off her because she wants to try and clean it up with Kleenex or tp (and even her bare hands) and keep them on. I have tried everything in the book which has worked for years, but IT DOES NOT WORK ANY MORE!!!!!!!!!!!!!!!!!! So when simple psychology is no longer affective, is this why the care center bathrooms are just one big shower, so that if they won't get in the shower the shower will come to them?? There really is a point where you have to wash them regardless of their mood! I want to know how this is handled professionally, THE TRUTH! You can't just leave them in their mess until they reboot! I've raised 5 children and I have 16 grandchildren and when they poop their pants they get changed and cleaned up for their own good and for the good of those around them. So today when my Mother in law refused to clean herself or let me clean herself, I threw towels on the floor, warmed up the shower water and when she finally stood up from the toilet I hosed her bottom down while she slapped me around and cursed at me. Five minutes after this episode when she was dried and redressed, she couldn't remember one second of that experience. I can take being slapped around if it means saving her from diaper rash and smelling bad! It would be nice to know that there are others facing this turning point in Alzheimer's care. I love my Mother in law, I hate the disease.

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Christine Kennard, Health Pro
12/30/09 8:52am

Sounds as though you did really well to me. You are right, there are times when you cannot wait for someone to 're-boot' as you call it. You cannot leave someone for long periods of time if it means that their skin may break down because of fecal incontinence. Caregivers to people with advanced Alzheimer's have to decide when a situation has become intolerable.

 

I still believe caregivers need to be flexable. I have had many slaps too! It is a horrible disease. Your Mother in law is very lucky to have someone that loves her to care for her.

 

Christine

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Carol Bradley Bursack, Health Guide
12/30/09 11:09am

You really are devoted. Many of us have had similar situations. Some people can take more than others, and you seem to be exceptionally strong. It's so awful seeing someone we love change so much and not be aware. As Christine says, she is very lucky to have you.

Carol

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SlappedAround, Community Member
12/30/09 2:18pm

Thank you Carol!

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SlappedAround, Community Member
12/30/09 2:29pm

Thank you Christine. This forum is great therapy. Wonderful comments and help from all sources, especially those who have dealt with this first hand. I just found that no one really talks about the hard times or how terrible it is to have to use any kind of forced control to handle a situation. I was up most of the night worrying about how I would handle her today knowing that I was going to have to clean her up for a doctors appointment. It turned out to be uneventful, just a "normal" Alzheimers shower, curl the hair, get dressed morning. Thank God for this moment, and this day, and I'll try not to think about tomorrow!

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AFA Social Services, Health Guide
12/30/09 1:31pm

<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--> <!-- /* Font Definitions */ @font-face {font-family:"Arial Narrow"; panose-1:2 11 5 6 2 2 2 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:647 0 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Arial Narrow"; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} span.EmailStyle15 {mso-style-type:personal; mso-style-noshow:yes; mso-ansi-font-size:12.0pt; mso-bidi-font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:"Times New Roman"; mso-hansi-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman"; color:black; font-weight:normal; font-style:normal; text-decoration:none; text-underline:none; text-decoration:none; text-line-through:none;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]-->If you are seeing changes in your mother-in-law, it is imperative that you bring her to her primary care physician right away. The doctor will provide a series of tests that may explain the reasons behind her combative behaviors.  Conditions such as a urinary tract infection, dehydration or medication side effects can exacerbate symptoms of Alzheimer’s disease--and doctors may be able to effectively treat these symptoms. If there are no underlying conditions, and her behaviors are just a natural progression of the illness, the doctor may issue medications to treat these symptoms which may provide emotional comfort to your mother-in-law, and might also make caring for her a bit easier.

You stated that mentioning the words “shower” or “wash” turns your mother-in-law into someone you don’t recognize. If you find that she is having a negative reaction to the words you are using, you may want to be careful about not “prepping” her verbally prior to the washing. It may be that she is experiencing some form of fear or anxiety, and acting out aggressively even prior to the actual event. Simply setting up the scene and gently preparing her for the shower without alerting her beforehand may be a better approach at this stage in her illness. Try using this time to talk about more pleasant topics, such as the next meal you will share together, or an earlier memory that has offered her comfort in the past.

You asked about showering techniques used in care facilities. Although every facility is different, many care facilities offer showers only 2-3 times a week, which makes it less anxiety-provoking for the resident who dislikes or fears bathing. Some individuals who are unable to ambulate on their own or are combative during bathing are seated in a rolling chair specially designed for the shower. This can make it easier to bring the person into the shower area from wherever they are. Other individuals may require baths, as they are more comforted while immersed in warm water, or by the look/feel/smell of bubbles. Generally, a good rule to go by is maintaining an individual’s health while upholding their dignity and right to quality of life. If your mother-in-law needs to be bathed to avoid skin breakdown or infection, it is necessary to do so by any means possible. However, if her health is not at risk, and she prefers not to shower for a longer time than you would feel comfortable with, you might want to pick your battles and decide what is more important.

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SlappedAround, Community Member
12/30/09 2:17pm

Thank you so much for your support, I needed this terribly! I do have a medical background and am aware of her medical conditions and needs. We had put her and her husband in a care facility this past September and you are right, they only scheduled a shower 2 to 3 times a week, not when she needed it. She ended up with such a terrible rash that I felt I had no choice but to bring them back home. The facility would call over every little incident or inability to manage her so I ended up driving back and forth so often it became rediculous. I don't know why I thought these people had some kind of "magic touch" that I was unaware of!!!  I try not to use the words "shower" or "wash", and have done exactly what you mentioned as far as just naturally easing her into cleaning up when she has to use the toilet so that the transition is easy, but I never know when that trigger is going to go off. I'm taking her in to the neurologist today to see if he has any suggestions and to make sure she is healthy and not fighting an infection that I'm unaware of. I appreciate your statement about picking your battles, very well said, which is why I was surprised that the care facility would let her get so bad. But then again this world has become so sue happy that I'm sure they are fearful of even the slightest confrontation or use of force even when necessary.

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AFA Social Services, Health Guide
12/30/09 3:59pm

Glad to be of assistance!

 

Please do not hesitate to contact the AFA in the future if you need further assistance, referrals or support. We are always happy to help! You can call us at (866) 232-8484 Monday-Friday, 9am-5pm ET.

 

Best to you and your family.

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Christine Kennard, Health Pro
12/30/09 12:12pm

Hi Shirlee

 

This sharepost that I wrote about aggression in Alzheimer's may be helpful to you. It is very stressful to cope with. Click on the link Aggression in Alzheimer's Disease

 

Hope it gives you some ideas

 

Christine

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Carol Bradley Bursack, Health Guide
12/30/09 2:38pm

Excellent response and article, Christine.

Thanks!

Carol

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By shirlee, Community Member— Last Modified: 02/07/13, First Published: 04/25/09