Setting the stage for bathing
Let's face it, giving your dad a bath isn't an easy thing for you or for him. Bathing is one of the most intimate kinds of personal care, second maybe only to diaper changing. You're likely to feel awkward, embarrassed, and self-conscious. Your dad feels all of these emotions, too, as well as helpless and vulnerable. Expect these feelings to be heightened if you're a daughter.
If you can afford to hire someone to provide this level of care, that's a big help. But for many families this expense is way outside the budget, especially if he needs help for months or years. So it falls to you.
Fortunately, there's a positive side to the job. Most people feel better when they're clean, revived, and refreshed. It's uplifting. To give this sensation to another person, especially to your parent, is rewarding. And it really does get easier with time as you learn routines that work for you.
"This is a trial and error kind of thing," says Jennifer Serafin, a geriatric nurse practitioner (GNP) for the Jewish Home for the Aged in San Francisco. "The first couple of times it might be awful. You may get more water over you than your parent. You're not a failure. Give yourself a break."
Your dad doesn't need a full head-to-toe body scrub daily, and in fact it can damage older skin, which tends to be dry and sensitive. Two or three times a week should be enough. But daily cleaning of the private areas and under skin folds is recommended. Briefer daily cleaning can be done with wipes or a warm washcloth. For efficiency, use bath time to shampoo your dad's hair, clean his teeth, and check his nails -- a sort of one-stop shop of grooming.
Back to TopThe importance of communicating with your parent about bathing
One of the most powerful tools for making the bathing process go smoothly is communication. Touch base with your dad about the task. Ask about his preferences. Check in about his fears. This will help him feel respected and included at a time when he's losing a huge chunk of independence. Being unable to bathe oneself is a significant loss and can be depressing.
Be aware that this discussion can be awkward. Bathing is an extremely sensitive topic. No one likes to depend on someone else, let alone on their own child, for cleanliness. And when the child is of the opposite sex, it's doubly difficult. Expect your father to be unusually shy, antsy, irritable, or even resistant to the whole idea. People with dementia or Alzheimer's may even get combative because they're so terrified and confused.
Before and during the bath, be as nonchalant as you can. Take an almost businesslike tone, discussing bathing as if it's a necessary medical procedure rather than a personal experience. Lay out the game plan briefly. Confer and run through the realities. "I know you'd like to take a shower by yourself, but the truth is you can't stand up well right now." "I know you'd prefer to wait a few days, but the doctor said you should bathe today."
Give your dad as much independence as he's capable of. Simply handing him a washcloth goes a long way. "It gives him a sense of entitlement and occupies him so he's not as concerned about what you're doing," says Serafin.
It also helps to stick to familiar routines as much as possible. If your dad likes a certain kind of soap, use it. If he always showers in the mornings, aim for the same timing. "You try and do everything he'd do if he weren't sick. You want to make him feel like he's a whole person and not being forgotten," says Lisa Balestreri, a registered nurse and the owner of Complete Nursing Solutions, a home healthcare service in El Sobrante, California
Back to TopThree main bathing options: the shower, the tub, or a bed bath
To get started, you'll need to decide what bathing method your dad needs. The three main options are the shower, the tub, or a bed bath.
What works best for your dad will depend on his health, mobility, mental state, and strength. Consult with his medical team to come up with a plan. Get all the input you can to make your job easier. It can be very helpful to hire a home health nurse for a onetime bathing crash course.
Consider his balance and ability to stand; any joint stiffness and pain he experiences when bending, sitting, or reaching; whether he has sufficient fine motor skills to use soap or a washcloth; his sensitivity to water temperature, which can decrease with age; the presence of sores or wounds; and his mental state. People with Alzheimer's or dementia can experience severe anxiety around taking their clothes off or getting wet. Alzheimer's can also affect depth perception, making people fear the bathtub, thinking it's a void.
"In every situation, you need to evaluate before you do anything. It's really pretty easy to do," says Balestreri. "Sometimes it's a day-by-day thing, and by the end of the week you have all the body parts clean. You never want to force it."
If your father's in pretty good shape, he may be able to shower largely by himself with you there as a kind of spotter. Stay on the sidelines to allow him privacy and independence, but within easy reach in case of an emergency. Bring a newspaper or book, but be on the alert. If he protests, explain that it's better to be safe than sorry, and you're there "just in case." Don't let him talk you out of staying. Bathing accidents are all too common for elderly people, and most are preventable.
If your father is extremely frail, he may need to be bathed in bed, a process called a bed or sponge bath. There are different techniques, but the basics involve washing and rinsing with washcloths.
For certain weak elders, sitting in the tub or on a shower seat is the most comfortable and practical way to bathe. The shower is preferable, as it's much easier to get in and out of than a tub.
Back to TopAdvance preparation: bathing supplies and equipment to make your job easier
With any method, a little advance planning is essential. The supplies and equipment you'll need will depend on your dad's situation.
Although you can go all out and remodel the bathroom for a senior, this isn't practical -- or affordable -- for many families. A few less ambitious steps can go a long way toward creating safety and comfort.
Bathrooms are wet, slippery places; for a frail parent, they're a hazard zone. Bathing is also a temperature-sensitive activity. We all know the "ouch" of stepping into a too-hot shower, or the "brrr" of being naked in a chilly room.
Make sure the room temperature is warm before starting. Have plenty of dry bath towels and washcloths on hand. Check the water temperature yourself, even if your parent is able to work the faucets. The ability to judge hot or cold by touch declines with age.
Remove loose throw rugs that create a tripping hazard. The same goes for electrical appliances with loose cords, like hair dryers or shavers. Gather up stray soap bars, small bottles, and brushes that may get underfoot. Wiggle the towel and shower curtain bars; if any are loose, as they often are, it's best to remove them altogether rather than risk your dad yanking one off and falling. Some families remove sliding-glass shower doors, which can be perilous in a slip or fall.
Keep necessary supplies like soap, shampoos, and washcloths in a handy, accessible place, such as a plastic basket. A couple of soap pointers: baby soaps and shampoos work as well for the elderly as for the young. They rinse off easily, don't sting the eyes, and are gentle on sensitive skin. No-rinse soaps and shampoos are helpful for people with a strong aversion to water, a trait of some people with Alzheimer's and dementia. But they leave a residue, so you'll still need to rinse now and then.
Handy and life-saving equipment essentials include grab bars, which you can install wherever they're needed; a shower or tub chair; and a rubber hose that attaches to the shower nozzle or tub faucet. A hose allows you to direct the flow of water as needed, and is less irritating than an overhead spray. If your only option is a tub, you may need a "transfer" bench, which allows your dad to swivel or pivot his way inside. You'll find all of these items at medical or hospital supply stores, with options to fit different budgets.
Back to TopThe nitty-gritty of washing your dad -- one body part at a time
Once your dad is seated, soap and rinse one section of the body at time with a washcloth. Save the privates, or perineal areas, for last. Start with the neck and shoulders, then wash the arms and hands, moving down the body to the hips, legs, and feet. Clean between any folds of skin where bacteria tend to bloom, a particular issue if your dad is overweight.
The last section to wash is the privates. The modesty issue can be ultrasensitive for you and your dad, and even more so if you're a daughter. A few ways to ease this awkwardness: place a towel over your dad's lap in the bath seat, or, if he's standing, keep a wrapped towel around his waist. Lift it only when you're washing underneath. Avert your eyes as much as you can. Do the front crotch area first. Wash under his penis and testicles. A quick one-two will do the trick; you don't need to scrub.
The rear end can be tricky because you'll need to reach under. Have your dad lean forward as much as he can. You'll want to give his rectal area a thorough soap and rinse, since, as much as you may not like thinking about these things, elderly people aren't always efficient at wiping after using the toilet. Do this as fast as you can, chatting about sports or the stock market as a distraction.
Speaking of things you may not like to think about when bathing your dad, it's possible he'll get an erection. This happens more with Alzheimer's or dementia patients who are simply responding to being touched and have no sense of the context. It's less common among family members. Keep in mind, though, that if it happens, that's life, and it's nothing you or your dad did wrong. Keep the towel over his lap and move to a different body area. If your dad is drawing attention to it, tell him sternly it isn't appropriate. Skip the genitals this day or, if the erection goes away, return to the area for a quick wash.
Be quick, be matter-of-fact, and explain as you go. "Just the fact that he can't do it for himself can be very degrading and humiliating. If you explain and tell him what's happening, it gives him a sense of control. You try to take the fear level down," says Balestreri.
Back to TopThe calming power of distractions, music, TV, and your voice
A few other things can enhance the bathing experience. Call these pleasurable distractions. Does your dad have a favorite singer, type of music, talk radio host, or television show? Try putting one of these on in the background. Friendly conversation or just hearing you talk can also help. Chat about sports, the weather, or the goings-on of relatives. Distractions are especially helpful when you're washing private areas or tickly spots. There's no getting around the fact that bathing is an extremely intimate experience. But you can downplay the intimacy, which in turn can make you more relaxed.
Finally, some people with Alzheimer's and dementia are terrified of water and of being naked, adding up to a nightmarish bathing situation. They violently resist bathing. If you're at your wits' end, talk to your dad's doctor. He might recommend antianxiety medications, which can reduce your dad's stress.
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