“Mom, how do I say this… You need a shower.”
A painfully awkward subject for all parties involved, and the worst role reversal situation you could imagine for your family. The children find themselves trying to find a “nice” way to direct their parents to bathe, brush their teeth, change out of dirty clothes, and have better toileting hygiene, while their parents are trying to deal with receiving this information from their children… their babies! How do families manage this new dynamic? Some parent/child relationships can’t tolerate this level of openness and vulnerability.
Many of the elders we’ve worked with through the years are not in the habit of bathing or showering on a daily basis. Children of the Great Depression Era had a bath once a week “whether they needed it or not.” For adults whose bathroom habits are intact, this isn’t a problem. However, when effective toileting hygiene is compromised, more frequent bathing is a must. Keeping skin clean and free from bacteria free is not only an aesthetic concern, but it is also a health issue. The urinary tract must be kept clear to prevent infection and avoid skin irritations that can become infected. Infections can quickly evolve into wounds that are very difficult to heal.
Broaching the Subject
If your family fits into the “this isn’t the way we communicate” camp, you aren’t alone. Discomfort attempting to cross these privacy boundaries is common. If you can’t be the messenger, the question remains: who can?
Start with a discreet phone call to the elder’s primary care provider to discuss the issue, and perhaps schedule a “wellness visit” at their office. Medical professionals are used to diving into the deeply personal aspects of life. Getting the senior into an examination gown and performing a skin check gives the clinician a good opportunity to assess the situation. The need for regular hygiene can be addressed on a “medical basis,” which sometimes makes it less embarrassing and easier to hear.
When memory loss is a factor and going to the physician’s office for this kind of exam will not be remembered, your family can craft a different approach. If your elder has Home Care, Visiting Nurses, Hospice, or Case Management, bring your concerns to them and help them understand your loved one’s hesitancy. Bathing, especially when help is needed, often involves nudity and exposure; the idea of being so vulnerable can be intimidating and cause anxiety for elders.
Many elders find that not being able to control the shower water is upsetting. Others may feel extra vulnerable in the shower and have a fear of falling. Does your elder keep the house very warm? Showering and bathing may cause them to feel very cold. There are techniques for stress and fear reduction. Sometimes, it might just mean getting creative and singing their favorite song to help ease their anxiety.
How can you reduce the negative experience associated with bathing?
Install a hand-held shower head.
Provide a shower bench with a back and big, sturdy rubber feet.
Make sure the outside tub mat has a non-stick backing.
Run the warm water a few minutes early to warm up the bathroom.
Put a small towel on the shower seat and run warm water over it to make the bench seat more comfortable.
Set up is everything: place all products within reach before they get started.
Standby within earshot and check in frequently.
If direct care is needed, provide a “privacy towel” to cover the front of the elder’s body.
Be ready with a dry towel to help them cover up as soon as the shower is over.
Don’t Forget About Oral Hygiene
Often, deteriorating oral hygiene is not as easy to detect. The sad truth is that oral hygiene is lacking in most elders’ health care plans. Increasing their dental cleaning schedule to every three months is recommended. Often, electric toothbrushes are effective, but they can be overstimulating to an elder with cognitive impairment. If your elder has sensitive teeth, or dental pain, substituting a “toothette,” or dental swab, may decrease the pain, and remove a barrier to their necessary daily oral care. Institute twice a day use of a non-alcohol mouthwash to reduce oral bacteria.
Employ the Laundry Fairy!
Another obstacle children find themselves struggling with is how to tell their parents that their clothes are dirty. Many elders wear the same few outfits over, and over, and over. As a family, you can try to solve this issue by purchasing duplicates of their favorite outfits, so there is always a “clean replacement.” That may work, but if you have already tried many light reminders to put their dirty clothes in the laundry and that has not been successful, there is little left to do. Unfortunately, there is no easy answer to this one, and your best bet may be to have a caregiver or family member launder their dirty clothes on a regular basis.
Unfortunately, there is no easy solution to the dirty clothes dilemma. Try having a caregiver or family member on hand when the clothes are removed to quickly get them out of sight. Your elder might dispute the need for laundering, so it might be advantageous to not get into a discussion about it. Just remove the dirties and return them clean. In other words, employ the Laundry Fairy!
It’s okay to ask for help.
These conversations are difficult for everyone involved. If you find that despite your best efforts, your family needs help navigating how to address your elder’s hygiene, please reach out to Aberdeen Home Care for customized case management of these complex and difficult issues.
Written by Joanne MacInnis, RN and Certified Dementia Practitioner.
Originally published in the Manchester Cricket Newspaper, June 2018.