Dementia Care: Toileting and Bathing

As a family caregiver, you may find helping the person you care for with basic hygiene can deepen your personal connection, but it can also be an emotionally and physically challenging task for caregivers.

Either way, maintaining basic hygiene is vital to their health. A lack of hygiene can cause a multitude of adverse effects, including infections; whereas maintaining proper hygiene can improve morale, promote comfort and health, prevent body and breath odor, and improve skin circulation.

Hygiene and self-care are private, routine tasks we do daily, often without giving them much thought. These tasks are called ADLs or Activities of Daily Living. Unfortunately, the ability to perform ADLs declines in people suffering from memory loss. It starts with thinking challenges and progresses to physical challenges. 

Watch this video to hear experts from the James L. West center for Dementia Care discuss managing hygiene with dementia patients, specifically toileting and bathing. 

Setting them up for success

The goal is to promote dignity and independence. First, create an environment for your care recipient that is safe, friendly, familiar, and functional. Next, create a manageable routine for doing ADLs and do them around the same time and in the same order every day. Also, consider using aids to assist you. 

Challenges with bathing

• Embarrassment, feeling exposed and vulnerable
• Fear of falling or slipping
• Memory loss – “I’ve already bathed!”
  • Sense of time is gone; not aware 3-4 days have passed
• Rebellion
• Depression – lack of caring
• Unfomfortable
  • Bathroom can be cold and uninviting
• Confusion of what is being communicated
  • Changes in senses and unable to understand internal and external signals
  • No is a normal response to something we don’t know or understand
• Afraid of bathing/showering
  • Can’t see the water and just feel water – they may feel hard pressure or stinging
  • The sounds of fan or running water can be upsetting

Tips for Helping with Bathing

• Always communicate dignity, respect, and independence
• Give step-by-step instructions
  • Do with them or “act out” instructions
• Keep it Simple and Enjoyable
  • Music, aromatherapy, “toys” or bubbles to keep hands busy
  • Consider using a portable heater or fan to adjust the room temperature
• Keep it safe – Have everything you need ready!
  • Don’t start the bath and leave to get something
  • Use a shower bench, handheld shower head
• Cover them up with towel and explain step-by-step what you are doing before you reach under the towel to help clean them
• Honor lifelong routines and rituals
• Allow them to wear thier glasses and hearing aids

NOTE – skin care is important! It si easier to prevent chapping and sores than it is to heal it, so apply lotion often. 

How often is bathing needed?

Full baths are only needed 2-3 times a week. Unless there is sweating or incontinence a sponge bath tho clean the face, hands, feet, underarms and private areas may be sufficient. 

Challenges with toileting

• Embarrassment, feeling exposed and vulnerable
• Fear of falling backwards or into a hole
• Physical ailment like constipation, diabetes, prostate problems, infection, too much caffeine, or other foods that excite the bladder
• Problems communicating toileting needs
• Confused about the environment; can’t find a bathroom or know what to do once there.
  • Hides soiled clothes
  • Urinates in other areas of the house (planters, waste basket, closets)
  • Won’t sit on toilet or stay long enough for bowel movement
• Mobility issues
• Might not have the urge “to go” or recognize it too late
• Inability to physically control bladder or bowel function
  • Could be having a hard time getting clothes off in time, bladder infection, forgot where bathroom is located, or result of disease. 

Tips for Helping with Toileting

• Never scold, humiliate, laugh or show frustration
• Easy on/off clothes
• Label the bathroom door with a picture or keep the door open and keep lights on at night
• Proper incontinence products
• Bathroom routine – about every 2 hours
  • Respectfully suggest/ask if they need to go
  • Or take them to the restroom so they see the toilet
• Watch their non-verbal signs – what are their signals
• Don’t decrease fluids – dehydration is common and can be dangerous
  • However, don’t give them too much after dinner
• Keep a toileting diary to pinpoint certain triggers
  • Changes in bathroom behavior (new episodes of incontinence) should be evaluated by doctor to determine if it is just an accident or infection. 
• If they have limited mobility, use a portable commode
• Helping them sit down – 
  • Have their back facing the toilet and hold on to grab bar if available
  • You stand to the side of them and ask them to “Ben our knees, lean head forward”
  • If they are afraid of falling into the hole – put a towel over the hole and pull it away as they start to sit down
• Cover them up with a towel and explain step-by-step what you are doing before you reach under the towel to help clean them
• If they are missing the commode, try a seat cover that is a different color from the floor. 
• What for Urinary Tract Infection
  • Blood or cloudy urine, odor
  • Wash private areas daily with soap and water
  • Increase fluids & fiber (Cranberry pills)
• Clean your loved one up as soon as you realize they are soiled
  • Skin care is extremely important!
  • They may not recognize they are soiled and might start to fidget
  • Always wear goves and wash hands before nad after assistance

Incontinence Products

• Find the right product and find the right fit for each person.
  • Small pads or liners paced in underpants
  • Protective underwear – like pull up cloth underwear
  • Briefs
  • Guards or drip pouches for men
  • Underpads or dry pads can be placed under sheets or furniture
  • Adult wipes and cloths
  • Sip protectant, repair creams, lotions
  • Disposable gloves
• Have your “toileting cart” stocked and easily accessible!
• If outside of home, have a change of clothes and locate the nearest restroom.

General Safety in the Bathroom

• Keep your phone in reach 
• Leave the light on or get an automatic night light
• Remove door locks
• Use no-slip rugs and hang up when it’s not shower time
• Install grab bars in the shower/tub and by toilet
• Shave shower bench in shower
  • And chair or bench in the bathroom for yourself if there is enough space
• Used raised toilet seats
• Declutter! Cute decorations, toiletries, plants, etc. can be confusing and frustrating. 
  • Have only one of each item to choose from and use
    • ex: 1 shampoo bottle, 1 tube of toothpaste. 

We hope this information is helpful to you in the important work you do as a family caregiver.
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