I see this all the time from new caregivers. Cleanliness becomes a big issue with all of us at some point in the caring journey, but we have options. It’s also important to realise that they cannot help it. It’s an issue that comes hand in hand at some point with dementia as an illness.
It’s up to us as family and caregivers, to ensure our loved ones are taken care of well, and that includes hygiene, to a degree. Where it becomes an obstructive daily battle, it is a toxic issue that will only serve to intensify any negative feelings.
People tend to mention it in the terms of lack of hygiene, or their loved one smells, or stuffs dirty clothes in with clean ones and more. Many people think people with dementia are doing it deliberately, and have just become slovenly, lazy or grubby.
It can be very difficult to cope with our own ideas of cleanliness when someone we have been used to smelling squeaky clean, suddenly begins to smell, or refuses to shower or bathe.
This is where we caregivers need to become very subtle and or creative to cope with. Dementia works as a disease does, robbing them of the rational thinking part of their brains as those brain cells die.
Reasons for not showering or bathing.
- they forget, thinking they’ve already done it, or
- they don’t smell what you smell, as their olifactory senses change, or
- behavioural changes affect their inhibitions, or their ability to care about cleanliness, or
- the process of bathing and washing is just too great, or
- any other reason in their new normal that might make no sense to us
The showering process.
When you break it down, there are lots of little and often dangerous steps to bathing and cleanliness.
Lets just take some examples:
- they have to check the water temperature
- run the bath/shower
- remember to turn the taps off if it’s a sink or a bath
- look out towels
- find soap
- deal with the pain of the shower if they have developed sensitive skin
- cope with a fear of drowning if the bath is deep and they have lost sense of perception, which might make a rippling bath seem like a dangerous ocean
- co-ordinate arms and legs while to remembering to stand in a shower
- manipulating soap and washing all the bits, without falling over
- drying themselves with towels, but they still first have to find those towels.
- trying not to fall with slippery feet
- finding clean clothes and not knowing which are clean and which are dirty
- putting on those clothes
- drying hair for women becomes an even bigger challenge with a hairdryer and brush. How to co-ordinate plugging it in, switching it on, holding it up to hair, using a brush in the other hand and not burning their head.
- as above with shaving for men
- fear of falling coming out of the shower
(this is what was bothering my mum and why she refused)
Bathing is actually a very complex process from start to finish, and they are still proud and want independence.
For many, it’s just too much sensory overload and they’ll avoid it like the plague. They don’t want to smell, it’s just that they’re not capable of sustaining the effort it takes to bathe as often as we’d like them to, so if they’ll let us, we have to help.
How we can help.
Arguing usually just makes the situation worse for all, but reminders and help can work with a little creativity. Some days, it’s just not a battle worth fighting, and others they might need incentives for.
- trade. A bath for a visit to their favourite restaurant. Give up dirty clothes for an ice-cream etc
- get everything ready before mentioning a shower or bath
- look out and place everything needed to wash and dry, before you mention the dreaded shower
- offering to help
- remove dirty clothes from the room as soon as they are taken off
- having the bathroom ready with clean towels at all times
- clean clothes laid out
- grab rails in the bath and shower, and on the wall outside the shower, bath, to help them balance on one foot for drying/dressing
- shower stool so they can shower while sitting
- non slip bath step to make the distance to climb in shorter
- non slip mats in the bath and shower
- non slip mat outside the bath and shower
- remove hairs from the plug daily, as if they are prone to delusions, stray hairs could remind them of worms
That’s not working. What now?
There are other ways to get clean. Some things that might work.
- bed baths
- sink washes
- inflatable basins for hair washing on a bed
- wash at a hairdressers or barbers
- go swimming if not incontinent and they can be persuaded
- waterless wash creams, which are wipe on and off
- take over shaving and hair washing/drying
- buy in outside personal assistant care, as close family members may be what is the stumbling block due to modesty. As an adult, I know I wouldn’t like my husband or children washing me daily, and for them, it’s the same
This phase shall pass.
Remember, they wouldn’t have wanted to struggle with this. At some point in the disease, they will likely become more amenable to accepting your help openly, in order to have a better quality life, especially if incontinence becomes an issue.
I would never tell my parents they smell. That’s negative, and will likely foster a negative response in many. Yes, it might work for some, but it damages their self esteem and feelings stick around long after they’ve forgotten what got them upset.
Good luck, this is an emotive issue for many.