Bathing your mom: getting past the awkwardness
Let's face it, giving your mom a bath isn't an easy thing for you or for her. Bathing is one of the most intimate kinds of personal care, second maybe only to changing an incontinent parent’s diaper. You're likely to feel awkward, embarrassed, and self-conscious. Your mom feels all of these emotions, too, as well as helpless and vulnerable. Expect these feelings to be heightened if you're a son.
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 family budget, especially if she 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 mom 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 mom's hair , clean her teeth , and check her nails -- a sort of one-stop shop of grooming.
Communicating with your mom about bathing
One of the most powerful tools for making the bathing process go smoothly is communication. Touch base with your mom about the task. Ask about her preferences. Check in about her fears. This will help her feel respected and included at a time when she'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 mother 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 mom as much independence as she's capable of. Simply handing her a washcloth goes a long way. "It gives her a sense of entitlement and occupies her so she'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 mom likes a certain kind of soap, use it. If she always showers in the mornings, aim for the same timing. "You try and do everything she'd do if she weren't sick. You want to make her feel like she'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.
Three ways to bathe your mom: the shower, the tub, or a bed bath
To get started, you'll need to decide what bathing method your mom needs. The three main options are the shower, the tub, or a
What works best for your mom will depend on her health, mobility, mental state, and strength. Consult with her 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 her balance and ability to stand; any joint stiffness and pain she experiences when bending, sitting, or reaching; whether she has sufficient fine motor skills to use soap or a washcloth; her sensitivity to water temperature, which can decrease with age; the presence of sores or wounds; and her mental state. People with Alzheimer's or other forms of 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 mom's in pretty good shape, she may be able to shower largely by herself with you there as a kind of spotter. Stay on the sidelines to allow he r privacy and independence, but within easy reach in case of an emergency. Bring a newspaper or book, but be on the alert. If she protests, explain that it's better to be safe than sorry, and you're there "just in case." Don't let her talk you out of staying. Bathing accidents are all too common for elderly people, and most are preventable.
If your mother is extremely frail, she 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 other 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.
Advance preparation: bathing supplies and equipment to make bathing your mom easier
With any method, a little advance planning is essential. The supplies and equipment you'll need will depend on your mom'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. Wig gle 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 mom 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 other forms of 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 mom to swivel or pivot her way inside. You'll find all of these items at medical or hospital supply stores, with options to fit different budgets.
The techniques of washing your mom, one body part at a time
Once your mom 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 mom is overweight. Lift her breasts to wash under them.
The last section to wash is the privates. The modesty issue can be ultrasensitive for you and your mom, and even more so if you're a son. A few ways to ease this awkwardness: place a towel over your mom's lap in the bath seat, or, if she's standing, keep a wrapped towel around her waist. Lift it only when you're washing underneath. Avert your eyes as much as you can. Do the front crotch area first. A quick one-two of the outer vagina 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 mom lean forward as much as she can. You'll want to give her 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 relatives or world news as a distraction.
Be quick, be matter-of-fact, and explain as you go. "Just the fact that she can't do it for herself can be very degrading and humiliating. If you explain and tell her what's happening, it gives her a sense of control. You try to take the fear level down," says Ba
A few other things enhance the bathing experience. Call these pleasurable distractions. Does your mom 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 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 other forms of 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 mom's doctor. He might recommend antianxiety medications, which can reduce her stress.