Part 7: Bathing, Hygiene, Mouthcare

(Text Used from CTDSSMAPS Training (9/23/2020). 

13. BATHING

 

Safety

The bathroom is one of the most dangerous places in the home, especially for older adults. Each year numerous individuals slip or fall causing serious injuries. Older adults are at greater risk of injury because some medications they take can cause dizziness or low blood pressure and they may have difficulty standing or walking. Surfaces in the bathroom (metal, cold tile and porcelain) are slippery when wet and have no cushion when a person falls. 

 

If the person does not have the right equipment to give a safe shower, ask your supervisor to contact the care manager to request a physical therapy evaluation. 

 

General Tips for Bathing

  • Encourage the person to bathe herself/himself as much as possible. 

  • If bathing is difficult, do it only as often as in the plan of care.

  • Make sure that the hands, face, and genital area are washed every day.

  • Have all supplies ready before starting a bath. Keep the room comfortably warm.

  • Respect the person’s privacy. Keep her/him covered when possible.

  • Wear gloves.

 

Safety is important when giving a shower. If a shower chair is used, check it to make sure it’s sturdy.  Adjust the height as needed. Put a bath mat or towel on the floor outside of the shower to prevent the person from slipping on a wet floor when she/he steps out of the shower.

 

Always stay with the person while she/he is in the shower.

 

If the person becomes dizzy during a shower, turn off the water. If the person is standing, have her/him sit down and lower the head as much as possible. Cover the person with a dry bath towel.

 

During the shower, look at the person’s skin for areas of redness, rashes, rough areas or tenderness. Look at the person’s feet to see if there are any sores, blisters or redness. Report this information to your supervisor.

 

 

Procedures for a Shower:

1. Get everything you will need.

2. Make sure that the bathroom is warm.

3. Make sure the shower chair is clean. Clean the chair if necessary.

4. Place a nonskid mat in shower stall if the person is standing during shower.

5. Explain what you are going to do. This is very important for persons with dementia.

6. Wash your hands and put on gloves.

7. Ask the person if she/he needs to go to the bathroom. It may be easier to undress the person on the toilet.

8. If the person wants to undress in her/his room, assist the person to undress and put on robe and slippers.

9. If the person cannot walk, take the person by wheelchair to the bathroom.

10. Transfer the person to the shower chair.

11. Turn on the shower and adjust water temperature. Direct water spray away from the person while adjusting. Flow rate should be gentle. Check water temperature on an inner surface of your forearm. NEVER have a person step into a shower before the water temperature has been tested.

12. Help the person to wash as needed. If the person can’t help, start with the eyes then wash face, ears, neck, arms, hands, chest, abdomen, and back. Ask the person if she/he wants soap used on the face.

13. Rinse with warm water.

14. Wash legs, feet, genital area and in between toes. Wash genital area from front to back. NOTE: Wash female genital area from front of chair; wash anal area from under the chair. Rinse well with warm water; discard washcloth in a laundry basket.

15. Turn off shower and cover the person with a towel; place towel around hair if wet.

16. Assist the person out of shower.

17. Remove and dispose of gloves.

18. Uncover the person one area at a time and pat dry. CAUTION: Once a towel has been used to dry any area below the waist, it should not be used on other areas.

19. Apply non-talcum powder, lotion, and deodorant if the person wants the person. During the entire process, check the skin for breakdown, unusual bruising, cuts, or anything unusual.

20. Assist with dressing.

21. Help the person to a comfortable place and assist with any personal care such as shaving and hair care. 

22. Do not cut fingernails or toe nails.  If the nails are a problem, report it to your supervisor.

23. Return to bathroom, remove soiled articles, and clean the shower chair.

24. Wash your hands.

25. Report anything unusual to your supervisor.

 

Bathing Persons with Dementia, Alzheimer’s disease or Cognitive Deficits

Bathing may be difficult when bathing persons with Alzheimer’s disease, dementia, or other cognitive impairments. Cognitive impairment is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life.   Some persons may refuse to bathe. If the person continues to refuse, it is probably because the person is afraid of something about taking a bath or shower.  Individuals with dementia, Alzheimer’s disease and cognitive impairment may not be able to tell you what is bothering them.

 

Tips:

Daily routine

Establish a regular daily schedule that includes bathing at the same time every day.  It becomes a normal part of their day, like eating or sleeping.  A predictable daily routine reduces stress and anxiety.

 

Comfortable and Warm Bathroom

Many older adults don’t like bathing because they are afraid of being cold. Older adults feel cold more easily than a younger person. 

 

Avoid Arguments

Don’t argue about bathing. Keep sentences short and simple. Make eye contact, and smile. Extend your hand so they’ll take it, get up, and let you escort the person toward the bathroom.  Talk about something positive or rewarding to change the focus. Ask about their favorite things like music, TV shows and movies. Ask the person about their children or grandchildren. Find out what makes the person happy.  Have this conversation in advance to be prepared with positive topics.  Do this often so that when the person takes a shower, they think of positive things that they enjoy.

 

 

 

 

Calming

It is best if the atmosphere is calm. Use calm, soothing tone of voice, or play soothing music they like. When the water is warm, slowly spray water on body parts to give the person time to adjust to the feeling.

 

No Surprises

There are many steps to bathing which may be upsetting to someone with dementia, Alzheimer’s’ Disease or cognitive disability.  Let the person know what’s going to happen and talk the person through it to avoid fear or anxiety.

 

If the person really does not want to bathe or shower, do not force the person.  Wait for several hours or the next day. Report this to your supervisor. 

 

If the person is incontinent, try to wash the urine or feces from the area.  Explain that you’re doing it so the area won’t be sore and painful.

 

How to Give a Bed Bath

Supplies

  • Water basin and washcloths

  • Bath towels

  • Soap, lotion, and deodorant

  • Lightweight blanket

  • Clean clothes

 

Preparation

  • Close the windows and turn up the heat to keep the room warm.

  • Fill the water basin with warm water and check the water temperature.

  • Place towels under the person to keep the bed dry.

  • Cover the person with a blanket or towel. Use the blanket or towel to keep the person warm.

 

Process

  • Make sure the person cannot fall out of bed.

  • With soap and water, wash and dry the face, neck, and ears.

  • Wash one side of the body from top to bottom and repeat on the other side. Start by washing the shoulder, upper body, arm, and hand then the hip, legs, and feet.  Rinse the soap off of each area and pat dry. Check for redness and sores during the bed bath.

  • The genital area is the last area to be washed. For women, wash the genital area from front to back. For men, make sure you wash around the testicles.  Roll the person to the side to clean the buttocks.

  • Apply lotion to the arms, legs, feet, or other dry skin areas.

  • Remove all dirty washcloths and towels and help the person dress.

  • Clean the water basin.

  • Report any skin changes, like redness, to your supervisor.

 

 

14.  WASHING HAIR

 

If the person is able to wash his/her own hair, it is okay if the person would like to do it for himself/herself.

 

How often to wash

Ask the person if they would like to wash their hair. Pay attention to the how the hair looks, how it smells, and if it seems dirty. If you see redness, a lot of dandruff or have concerns about lice, report this to your supervisor.

 

If the person does not like having the hair washed, once every week or every two weeks is okay. Brush or comb the hair daily.

 

Dry shampoo can be used in between.

 

Sitting the Bathtub

Have plenty of clean, dry towels available. Use a cup or shower hose to direct the water away from the face. Many people do not like water in the face. Water in the face may be more upsetting for anyone who is not healthy, has dementia, Alzheimer's disease or a cognitive deficit. Make sure you test the water temperature first and rinse the hair.  Shampoo the hair and rinse.  Dry the hair with the towels. Comb or brush the hair.

 

Standing in the shower

If the person you're caring for is able to stand in the shower, make sure the person is steady and is able to stand long enough to shampoo the hair. The person needs good balance to do this. If the person is not steady, offer to help and make sure a tub chair or a shower chair is available. Do not leave the person alone.

 

Sitting at the sink

If the person does not want to have her/his hair washed in the tub or shower, you can ask if the bathroom or kitchen sink would be okay. Bring the supplies to the sink.  You should have either a kitchen hose or a cup. You will need shampoo and plenty of towels.

 

The person can either face toward the sink and lean the head forward over the sink or sit facing away from the sink and lean the head back over the sink. Leaning back is the best way to keep water out of the person’s face. Make sure you test the water for temperature. Rinse the hair with a cup of water or a small sink hose, shampoo and rinse. Cushion the neck well with towels. Dry the hair well with towels to prevent a lot of water dripping on the floor.  Comb or brush the hair.  Wipe up water that has dripped on the floor.

 

 

15.  HOW TO WASH HAIR IN BED

 

Before you get started, make sure you have all the supplies you need.

 

Supplies

  • Garbage bags or other waterproof cover and towels to line the bed and keep it dry

  • Washcloth

  • Towels

  • Shampoo

  • Basin of warm water

  • Cup or pitcher for pouring water

  • Bucket, large bowl or pot to drain dirty water

  • ÛÛÛ Inflatable Hair Wash Basins/Portable Shampoo Tray (if available, see pictures below)

 

Washing the hair

  • Make sure the area around the bed is clear and the room temperature is warm.

  • Wash your hands and put on gloves.

  • Remove the pillows from under the person’s head.

  • If possible, elevate the head and put something under the head to collect the water.  See examples below.  Use one of those devices if they have one.

  • Place a plastic sheet or garbage bag under the person’s head and put   towels around the person’s shoulders.  The edge of the trash bag should drip into the bucket or bowl.

  • Explain what you are going to do.

  • Fold the sheet, blanket and bedspread down to the waist.

  • Cover the upper part of the body with a towel.

  • Put a bucket, large pot or large bowl on the floor to catch the running water and put a sheet or towel underneath.

  • Put the clean water basin next to the bed.

  • Gently lift the person’s head and place a towel underneath the patient’s neck.

  • Fill the basin with warm water. Check the temperature of the water.

  • For short hair, you can rub a wet washcloth over the head until the hair is thoroughly wet. For longer hair, fill a cup or pitcher with water from the basin, carefully wet the person’s hair and make sure the water drains into the bucket/bowl or pot.

  • Put a washcloth over the person’s eyes.

  • Shampoo the person’s hair using a small amount of shampoo.

  • Rinse the hair thoroughly. Start at the top of the head and go down to the bottom of the head.

  • Squeeze excess water from the hair into the bucket/bowl or pot.

  • Gently rub hair dry with a towel. Dry the person’s face.

  • Comb or brush the person’s hair.

  • Change the sheets if they are wet and clothes if they are wet.

  • Pour the water down the sink or tub.

  • Put the supplies away.

  • Remove your gloves.

 

 

Examples of Inflatable Hair Wash Basins/Portable Shampoo Trays

 

 

 

   

        

 

16.  MOUTH CARE

 

Good mouth care is very important to prevent cavities, bleeding gums, gum infections and pain. A healthy mouth is important for general health. Healthy teeth and gums allow people to eat, speak and socialize without being embarrassed. Toothaches and gum infections can make it even harder to function for elderly people, people with dementia or cognitive impairment.  Mouth and gum infections can lead to other health problems like heart disease, stroke and pneumonia.

 

Brushing Teeth

  • Wash your hands and put on gloves.

  • Set up the supplies such as the toothbrush, mouth swabs, mouthwash, cup or bowl or basin.

  • Place supplies on the sink. If the person cannot brush at the sink, place a bowl or basin on a tray with paper towels under the bowl or basin.  If there is no tray, use the kitchen table or other safe surface.

  • Wash the toothbrush in the sink.  Put a small amount of toothpaste on the brush.

  • Brush the teeth softly. Brush the outside of the teeth, then the inside of the teeth.

  • Softly brush the upper teeth by brushing at the top of the gums and moving downward. The reason for this is because it moves the plaque away from the gums. For lower teeth, brush upward away from the gums.

  • Lightly brush the tongue.

  • After you are finished brushing, have the person rinse with water and spit into the sink or the bowl or basin.

  • After you are done, rinse out the toothbrush and put away the supplies.

  • Remove the gloves and wash your hands.

 

Dentures

  • Wash your hands and put on gloves.

  • Put dentures in a water-filled container.

  • Brush dentures thoroughly.

  • Ask the person to rinse mouth with an alcohol-free mouthwash if they want to.

  • Put the dentures in the person’s mouth.

  • Rinse out the denture container.

  • If the person does not want to wear the dentures, put the dentures in the denture container with water.

  • Remove gloves and wash your hands.

 

If you see any redness, bleeding or sores, report this to your supervisor.

 

Mouth Care for Persons with Dementia, Alzheimer’s Disease or Cognitive Impairment

  • Slowly walk toward the person, smile and look into the person’s eyes.

  • Tell the person what you are going to do and why you’re doing it.

  • Speak slowly and clearly.  Be patient and repeat what you said if necessary.

  • Ask the person if it’s okay before starting.

  • Be positive and encouraging.

  • Only do as much as you can do if the person becomes upset.

 

Person Refuses Mouth Care

  • Try to find out why the person does not want mouth care like being afraid or mouth pain.

  • If the mouth is painful, look for broken teeth, redness or sores in the mouth.  Tell your supervisor if you see this.

  • If the person is afraid, play music the person enjoys, say things that are calming.

  • Try talking about something the person enjoys, the weather or other positive topic.

  • Try to do mouth care around the same time every day.

  • Tell the person all of the good things about mouth care like getting the food out of the teeth, their mouth will feel better, their smile will be brighter.

  • If the person refuses, try again at another time.

 

 

17.  DRESSING

 

  • Before you assist with dressing, wash your hands carefully to avoid spreading germs.

  • Make sure that a clean set of clothes is ready to wear. 

  • Greet the person and explain that you want to help the person get dressed or change clothes.

  • The person may need you to dress her/him completely.  If possible, you can help the person to dress herself/himself. 

  • Remember not to pull, push or handle the person roughly.

  • Assist the person to remove clothes if needed.  Let the person do as much as possible without your help. 

  • Put the clean clothes in a place they can be reached easily.

  • Make sure the person does not get too tired or dizzy.  If necessary, help the person sit or lie down.

  • Put dirty clothes in the laundry basket or hamper to be washed. 

  • Wash your hands again. 

 

Suggestions

Avoid having too many choices of clothing items so the person will not be overwhelmed or confused when trying to pick out something to wear.

 

Try:

  • Simple and comfortable clothing.

  • Clothing with elastic or Velcro fasteners.

 

For more information:

http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/TipsforDailyLiving/Tips-for-Dressing_UCM_310116_Article.jsp

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