Think about it, from a young age we are taught to do things for ourselves and to largely keep our ablutions private. Why would this change because you have a dementia? Why would it suddenly feel okay to share these personal and intimate matters with anyone - even a loved one?
Personal care is often a real source of anxiety for both carers and those living with dementia. Often as dementia progresses, the need for support around daily living tasks increases which might include washing and dressing.
Maintaining independence, privacy, and routine as much as is possible can help reduce anxiety and stress for everyone in this regard. What follows are a few things that might help with the practicalities but please always remember the importance of dignity and respect when supporting a loved one.
Tip 1: Routines can really help
Incorporate the usual time and location for washing and dressing - keep it familiar
Follow the usual sequence if you can e.g., teeth first then face etc just like the past
Keep to the preferred style of washing as much as possible ie. shower vs bath, and/or integrate a strip wash
Replicate clothing choices.
Tip 2: Encouragement
Use phrases like “it’s time to have a wash” or “the bathroom is ready for you” vs asking as this gives the opportunity to decline
Be flexible and if you are greeted with a “No” then try again later. Use the opportunity if they are going to use the toilet to prompt or maybe before going out, a meal or if visitors are coming to you, say “Let’s get washed before…”
Keep requests super simple and easy to understand with time to complete each one
Take a break if things aren’t going well and try or complete later
If you are able, consider domiciliary home care once a day to complete personal care routines. Sometimes people respond better to someone in a uniform helping with things that they have always kept private.
Tip 3: Washing
Use familiar items e.g., don’t introduce an electric toothbrush if they don’t usually use one
Introduce coloured flannels and towels that are different to the bathroom suite for easier identification and personal for them
Make sure the bathroom is ready, uncluttered, warm, well-lit and well stocked with towels to maintain privacy and importantly dignity
Empower them with a flannel, even if they need you to wash them
Wash hair over the sink with hose or jug if shower or bath is too difficult
Make sure the person gets properly dry especially in skin crease folds to avoid rashes, sores.
Tip 4: Showering:
A shower can cause anxiety or discomfort as some people are very sensitive to the feeling of water hitting the skin. You could try a shower seat and either let your loved one use a handheld shower or a sponge rather than have the shower water directed at the skin.
Tip 5: Toileting
Put a sign with both the symbol and written word on the toilet door so it is easy to find
Sight can often be an issue with dementia so consider a different colour toilet seat to make it more visible
Introduce coloured toilet paper so there’s contrast with your walls
Wipes can be a great alterative and help with cleanliness. Bright containers to hold them can help sustain independence
If getting to the toilet in time is a challenge, consider a commode in the living space – they can be very discreet!
If getting up from the toilet is difficult, consider installing a handrail or a raised toilet seat (a community Occupational Therapist should be able to assess for this)
Introducing night lights or sensor activated lights can be such a help for a person to locate toilet at night
Don’t let worry of or incontinence hold you back from doing things – disposable pads/underwear can create a safety net if there’s not much time to react
If incontinence becomes an ongoing issue affecting quality of life, then speak to your GP for a referral to an incontinence nurse who can look at your personal situation and offer support.
Tip 6: Dressing
Take dirty clothes or night wear away after undressing to encourage fresh clothing the next time
Lay out clothes for the day ahead – better still offer a simple choice
Offer step-by-step dressing prompts or hand items to the person one at a time
Minimise items in the persons wardrobe keep the rest in another room
Introducing loose fitting clothes, elastic waistbands, no buttons, or easy to pull zips can really help, as well as slip on shoes with Velcro fastening rather than laces
Encourage hair, shaving, nails, make up as part of the routine. It makes us all feel better about ourselves!
PRIORITIES:
Keep the person safe
Hand washing before food and after toileting
Wash bottom and genitals daily to prevent infection
Dental care – teeth cleaned twice a day.
Final Thought
Our Wayfinding Team are always here to help but adjusting and educating ourselves is for some the first step on the journey. Offering free advice and guidance for your whole dementia journey, even from before you have a formal diagnosis. The Wayfinders can also sign post to other services we work with to provide holistic, person-centred support.
If you have concerns about your loved one's memory, you can contact our Wayfinders on 01243 888691. They can support you and your loved ones for your whole journey with dementia, from pre-diagnosis to end of life care.