By Jane Verity ©dementiacareinternational.com
Here are some new ideas on non-intrusive ways to assist the person with dementia who no longer wants to have a shower. There can be many reasons why the person may not wish to have a shower. It is important to keep in mind that there is always a strong, personal, meaningful reason behind the refusal. By finding out what lies behind the response, it is possible to work around the underlying issue.
The most successful solutions are the ones you come up with intuitively when you know the individual person. To find the best solution, use your intuition and intimate knowledge about the person and combine these with your creativity. Be prepared for trial and error.
Remember; you can not change the person with dementia, you can only change the way you deal with the situation and your own responses.
10 Scenarios & Solutions
1. Living in the Past
The person may be living in memories of their childhood. In the past, it was not necessarily the custom to have a daily shower. Bathing was often a weekly or fortnightly family event where the bathtub was filled and the whole family took turns using the same water. Older people may still hear their parents’ voices ringing in their ears, saying, ‘It is unhealthy for the body to have more than one bath a week!’
Solution: Trial a bath instead of a shower. You may find this works, even if only once a week or fortnightly. On days between baths, you can assist the person to have a sponge bath; helping him or her to use a face washer in places that can’t be reached.
2. Feeling the Cold
The person may suffer from reduced circulation, which makes them more vulnerable to the cold and makes the prospect of taking off clothes daunting.
Solution: Install a ceiling heater and switch it on well before the person has a shower or bath. Let the hot water run to heat the shower base. Use a thick bathmat with rubber backing on the floor. Warm a bath towel so the person can be wrapt in this both when first undressed and again when stepping out of the shower. Place a towel on the bath stool or the toilet so that it is warm and soft for the person to sit on while being dried and dressed.
3. Loss of Abstract Thinking
The person may have lost the ability to comprehend that the face reflected in the mirror is him or herself. Instead, the person may experience the bathroom mirror as a window that other people are looking through. This thought can generate a strong feeling of discomfort or even fear of being exposed to other people watching while the person is undressing or showering.
Solution: Remove or cover the mirror to make the bathroom a safe and private place.
4. Fear of Theft
The person may have a fear of losing his or her clothes or that if they take them off the clothes may be stolen.
Solution: Bring fresh clothing into the bathroom and place it where the person can see it at all times. Also bring in a coat hanger where clothes that are taken off can be carefully hung. Showing respect for a person’s clothes can be experienced as showing respect for the person.
5. Misinterpretation
The person may tune into your own stress as anger and therefore be unwilling to co-operate. Your body language sends the same signals when you are stressed as when you are angry. Your muscles tense up, breathing becomes shallow and rapid, your jaw tightens and your facial expressions become rigid and tense.
Solution: Take a deep breath. Pull your shoulders up, and then relax them. Think of something pleasant that helps you feel relaxed and brings a happy expression to your face. It could be a favourite piece of music, some lovely words from a dear friend, a holiday, or whatever works best for you.
6. Wrong Time of Day
The person may not like to have a bath or shower at a particular time of day.
Solution: Follow the person’s daily rhythm. Some people have been used to bathing or showering at night time after a long day’s work before going to bed. Others refuse to shower or bathe late in the day or evening as they find it more natural to wash in the morning and start the new day afresh.
7. Feel No Need to Shower
The person may not feel dirty or be aware of any unpleasant odour. The memory of a last bath or shower may have been forgotten and the person may not believe there is any need to wash.
Solution: Find or create a reason to shower. Going out can sometimes act as an incentive to having a bath to look one’s best. Try dancing with the person until he or she feels warm. Then suggest, ‘How about a nice refreshing shower after all this hard work?’
8. Heightened Sensitivity
The person may have increased skin sensitivity. In this case, water spray from the shower rose can feel like pointy needles when it hits skin.
Solution: Try a bath or use a handheld shower with a soft spray. Avoid using the handheld shower to rinse the person’s face or hair as this can be extremely frightening. Instead, offer a face washer to clean the face and either wash hair at the hairdresser or in the old-fashioned way over a sink. Use a jug to pour warm water over the scalp to rinse off the shampoo.
9. Lack of Ability
The person may no longer understand or be able to take a bath or a shower independently. Rather than admit this ability is lost, the painful reality is avoided by the person saying, ‘I don’t feel like a shower right now.’
Solution: Assist the person – in the gentlest way – to experience success when showering. Support the person in doing as much as possible independently and only help where absolutely needed. Offer encouragement and hand one object at a time, such as the face washer first, then the soap – not both at the same time.
10. Taking Language Literally
The person may have heard you say, ‘It’s time we have a shower or bath,’ and taken what you said literally. The person could be waiting for you to get undressed first.
Solution: Avoid using the word we. Instead use short clear communication with a warm, firm tone of voice. This could be as simple as saying, ‘Charles, Come.’
Helpful Hints to Keep in Mind
- Let the person test the temperature of the water before entering a bath or shower, or having hair washed. Check first whether the person has retained the sense of temperature; otherwise you will need to check the temperature to prevent scolding.
- Music and singing can be used successfully to set the atmosphere for a pleasant experience.
- Ensure colour contrast to make it easy for the person to find what he or she needs, such as a coloured soap on a white background.
Summary
When a person refuses to take a bath or a shower, you have three choices:
- Find out what is the real reason for the refusal and act accordingly.
- Find out if there is a time of day when it is easier for the person to feel comfortable showering or bathing.
- If nothing seems to work at that moment, drop it and try again at a different time.
Remember, the best solutions are the ones you come up with intuitively.
For further reading – Click topic
- 10 Successful Solutions for the Shower Challenge – Jane Verity (Nine scenarios & their possible solutions, plus learn 3 helpful hints towards successful bath & shower times.)
- A Positive Approach to Challenging Behaviour – Jane Verity (Understand cause & effect; learn how to work with the need rather than against it & discover successful strategies for preventing challenging behaviour)
- Reducing Anxiety and Agitation with Aromatherapy – E. Joy Bowles BSc. (How aromatherapy appears to be providing an alternative to the use of anti-psychotic & sedative drugs.)
- How can Aromatherapy Help People with Dementia? – E. Joy Bowles BSc. (How the ‘sense of smell is non-verbal and can get through” to emotions when words fail’; the use of smells can help orient people with dementia to time & space; tips for choosing & using the right oils to lessen anxiety, agitation and depression.)
- Turning Hassles into Highs – Jane Verity (Simple strategies to turn negative experiences into highs plus two keys to how these techniques work.)
- Ribbons turn Around Challenging Shower Experience – Community story – (How one professional care discovered successful showering through the magic of colour.)
- Creative Thinking Solves Toilet Challenge – Community story – (A professional carer’s tip to solving the challenge of a resident going to the toilet plus a fantastic question to ask when seeking constructive solutions to challenging behaviours.)