Tag Archive for: challenging behaviors

helping relative memory loss bathing

Bathing is often the first personal care task that a person with dementia needs help with.

Bathing is often the first personal care task that a person with memory loss needs help with. But helping a relative with memory loss to bathe can be touchy, difficult, and easily lead to aggressive, angry behavior. And why not, when someone needs help with a task he or she has done independently for decades? The loss of privacy and dignity is just one of many triggers that can make bathing very difficult.

That’s why we shared our chapter, “Why won’t she take a bath? Helping your relative with memory loss with bathing”on our website. This blog offers some tips to get you started thinking about bathing. Much more can be found in the online chapter and in our book, Coping with Behavior Change in Dementia: A Family Caregiver’s Guide.

What’s the problem?

To start, approach the bathing problem by putting on your behavior detective hat. Ask yourself questions about the possible physical, cognitive, medical and emotional causes of your relative’s bathing problems:

  • She may have forgotten when she took her last bath.
  • She may be in pain: joint pain, for example, can make it difficult to get to the bathroom, and in and out of the shower.
  • She may be tired: not sleeping well, or asked to bathe when she is tired.
  • She may be depressed: often people who are depressed do not see the need to take a bath or may not have the energy to take a shower.
  • She may be afraid of falling, or getting in and out of the bath or shower.
  • She may be asked to bathe at a time that is not familiar to her.
  • Water might not feel good on her skin; having water come over her head and face may be frightening.
  • She may not remember how to do all the steps in bathing: wet the washcloth, put soap on the washcloth, etc.

“Why won’t she take a bath? Helping your relative with memory loss with bathing” offers strategies for each of these situations.

Talking about bathing

  • Watch your tone of voice. In particular, avoid sounding bossy! Without meaning to, care partners often sound bossy, especially when they are tired or frustrated. This tends to breed resentment and resistance to being told what to do.
  • Think about how you are going to approach this conversation ahead of time. How can you use a hook or reward? Can you mention an upcoming visit, a trip to church or synagogue, or a dish of ice cream afterwards?
  • During the bath, explain things clearly. If your relative doesn’t understand what is going on, it may increase her fear or anxiety. You may need to give step-by-step instructions.
  • If the answer is “no”, ask your relative why she doesn’t like to bathe. If she is upset, in pain, or fearful, she may be able to tell you the reason herself.

Strategies for ensuring privacy

  • Try to give your relative as much control as possible over the decision and the process. Instead of asking, “would you like to take your bath now?” try, “would you like your bath now, before you get dressed, or tonight before bed?
  • Try to schedule bathing at the same time she is used to —but pay attention to fatigue levels. If she has always bathed at night but is now exhausted or more confused by early evening, you might try a different time of day.
  • Drape a towel over your relative’s shoulders or lap. Some families have the person shower in her underwear or bathing suit to protect modesty.

Pay attention to the environment

  • Try to make the bathroom as comfortable, warm and inviting as possible before the bath begins.
  • Use non-slip washable bathmats inside and outside of the tub or shower.
  • Use towels and other bathing supplies with colors that contrast with the bathing area. A white bathtub, white washcloth and white bar of soap may all blend in together, making it hard for your relative to locate the washcloth and soap.

Putting it all together

Joan McCay hated having anyone assist her with bathing and became quite angry whenever it was attempted. Her daughter Alice began to think about the whole bathing experience from “setting the stage” for a bath to sharing a pleasant experience with her mother after the bath was finished. She decided to try a new approach. First, Alice got the bathroom ready and turned on the heater. Then she and her mother looked at a favorite photo album together. Next Alice said, “Mom, the shower is ready. Let me help you off with your shirt and give you a hand into the shower so you don’t slip.” Joan started to get angry and Alice replied, “Mom, John is coming to visit later and I know you want to look nice. I’ll help you.” After she had her mom seated in the shower, Alice used the handheld sprayer to help her get the water the right temperature. Then she put a towel around her shoulders, gave her mother the washcloth and had her wash while Alice held the sprayer the way her mother wanted it. When Joan was dressed again, Alice had a snack waiting for her. Although there were some tense moments, the bathing process went smoothly. Alice practiced remaining calm and ignoring angry outbursts.

If your relative particularly dislikes receiving help from a family member, consider hiring a home health aide to assist with bathing. If you do, you might want to have the aide help with other things as well, such as changing beds or laundry. You might not want to introduce bathing until your relative has established a relationship with the aide.

Beth Spencer and Laurie White


writing the red bookOur “red book” on coping with behavior change in dementia was published in the early 1980s—a time when people who cared for someone with memory loss had few resources.

Unfortunately, when these energetic, courageous and wise folks faced repetitive actions, agitation, incontinence, sleep problems, and other behavior changes in their relatives, the primary recommendation from professionals was medication. It was almost a knee-jerk response: Problem, medication. Another problem, increase the dosage. And so on.

While medications were sometimes necessary, we viewed them as a last resort.  Side effects could be serious, and sometimes medications could make care even more difficult.

We always recommended that caregivers and professionals try non-pharmacological approaches first, because we had seen so many instances in which using strategies other than medication actually made care easier. We recommended that caregivers use systematic problem-solving to analyze the situation (we call it becoming a behavior detective), understand what is causing the distressing behavior and develop responses that target the underlying causes.

For example, a nursing home resident was being sedated because of his agitation in the middle of the afternoon.  He would pace the halls, knock on doors and generally appeared very worried.  Medication made him drowsy and much more confused and he started falling. His family requested that the medication be stopped. When staff and family investigated possible causes of the behavior, they found that he was hungry and tired by midafternoon.  A light snack and encouragement to rest in his recliner calmed him and most of the agitation disappeared.

In the 1980s this approach was rare.  With funding from the State of Michigan, we worked with our colleague Anne Robinson to develop Understanding Difficult Behaviors, a manual to help families understand possible causes of common behavior changes at various stages of memory loss, so they could respond more effectively without resorting to medication.  Over the years it became known as “the red book” and was used by thousands of professional and family caregivers throughout the world.

After 26 years in print, a new “red book” was created by Beth Spencer and Laurie White aimed particularly at family caregivers, though many staff and facilities are using it as well.  Coping with Behavior Change in Dementia: A Family Caregiver’s Guide is still red, and it contains many more case examples and additional behaviors and strategies.  Coping includes new sections on physical intimacy and sexual behaviors, challenges and strategies for mouth care in people with dementia as well as a glossary, an updated introduction to dementia and an extensive resource list.  We’re pleased that one of our readers calls it “a ‘must have’ book and guide for anyone facing dementia as a caretaker” and we hope that you too will find it a useful resource for your family.

Beth Spencer and Laurie White