“Mom, you gotta get a shower.” “Why?” “Because hygiene, and you smell like you’re Oscar the Grouch’s roommate in the same can.” *Mom giggles* “No.” “Mom, it’s been almost a week. You gotta get a shower. We have to take care of our bodies.” “No. I’m fine.” Meanwhile, she practically has a cloud of stink around her like a Peanuts character because we’re on day 4 of refusing to bathe.
Sound familiar?
Here’s my solution that has worked for my mom, and probably could work with other people who have mild to moderate dementia. I want to preface this with the fact that I started doing this particular process really early on in her dementia because I wanted to hardwire as much as I could, but you may not be in that sort of place. It theoretically should still work for you, though, because at the heart of things you’re taking out steps and activating the cue-reward cycle.
First- you schedule it. This requires that they still recognize what “Tuesday” means, and if they don’t, then this isn’t going to help you. If it’s on the big fridge calendar that today is Shower Day….then today is shower day. I also make sure that the words for different specific tasks are always in the same color. Shower Day is blue like water. The Calendar Method, as I call it, requires that you put an X through every single day so that they know the days before have already happened. Calendar marking is something that most people can relate to even when other things are going because it’s something they often saw teachers and parents do when they were kids, and maybe even did themselves. I often pair it with a reward of some kind, like she gets to have some kind of not-very-healthy food that she loves but can’t have very often because of her co-morbidities. “We’ll get fried chicken after your shower” is the most magical phrase ever uttered in my house, next to “we can go get ice cream.”
Second- you make it safe. It isn’t about safety to your standards but theirs. If they’re always afraid they’re going to fall- grab bars everywhere. Get an extra long shower bench and a detachable shower head. If they think they’re going to drown, make sure that they are well above the water and that the drain works really well. Get a low-flow shower head even, so that the amount of water coming out isn’t overwhelming, and use the gentlest setting you can. Get a very large rubber mat to go in the bottom of the tub, and make sure you wash the tub down afterwards so that there isn’t soap residue on it that could make it even the slightest bit slick. And maybe- you wear a bathing suit and step in first to help them in too. I have a friend that gets her LOWD (loved one with dementia) to get a shower by getting them to “come play in the sprinkler”. She puts on a bathing suit, she gets in, they come in too, and she is able to very quickly get them clean while they’re enjoying the “sprinkler”. She’s superhuman, though, and if you can’t rally for that- don’t feel bad. This is a tough gig.
Third- you make it warm and you remove as many steps as possible that they have to take. Hygiene is a lot of processes. You have to figure out where the towels are, figure out which ones will work the best for you (even if they’re all the same because vision is greatly affected by dementia), figure out what you’re going to wash with, figure out how to turn on the water, and then regulate the temperature of said water. Then, you have to figure out how to navigate getting clothes off, getting into the shower itself, and then how to load soap onto your cloth and then apply it correctly. Furthermore- you have to be able to identify all these steps in the first place and then correctly sequence them. Most people don’t realize that taking a single shower is about a hundred tiny decisions- and it’s just too much for a brain that isn’t typical at all anymore, if it ever was.
Fourth- More than two steps and a few words is too many. The less words you use in directing them, the better. Say “It’s Shower Time!” instead of “okay, Mom, it’s time we go strip down and get a shower.” When it’s time to remove clothing, everyone is a little different. Some will let you remove it with abandon, some will remove it themselves, some will fight you like you insulted their mother. The key is less words. “Let’s take off this shirt.” “Let’s unbutton this.” Things like that. You know the language and dialect that your person speaks better than I do, obviously, so tailor it to them, but make sure that you’re using as few words and gestures as possible so that you don’t overwhelm them. I make it funny to my mom by saying “Time to wash the pits, tits, and bits!” She laughs every single time like it’s the first time she’s heard me say it. If you can inject humor into the longest performance of showering you’ve ever lived through…do it. Do it for you and them.
Fifth- let them do as much as they can, but also assist. Don’t really say a lot about it- just do the things that you can see is clearly going or about to go sideways. Have a “crash plan” for getting them in and out as quickly as possible in case they lose patience fast. Cue up the reward again. “We do this, and then we get chicken.” Mom will endure more of a lot of things if you can remind her what she’s working towards.
Sixth- congratulate them and compliment them. If they associate getting clean with someone making them feel good and getting something they like, they’re going to fight less about it. They may not remember the words you say, but they will remember how they feel about it. It’s really important to meet people where they are on all things, but it’s equally important to remember that they still have some universal human impulses like you- they’re just more pronounced and less inhibited. If it’s always a fight, always negative, and there doesn’t seem to be a point in it for them… honestly, you wouldn’t do it either.
And if all else fails- do a Dark Side Shower. Get a pack of shower body wipes and keep on hand. Throw in that cue-reward sequence. “We can go watch Gunsmoke (for the eleventy-bajillionth time, you’ll think to yourself) if we quick wipe down.”
If your person is in the late stages of the game or just having a really bad day, the shower body wipes are probably going to be the way to go. Introduce yourself if they aren’t sure who you are. Bring a favorite snack with you, if they’re still able to do that on their own- my mother worships at the altar of applesauce in pouches. I bring it with the top already off so she doesn’t have to struggle with it. Then I give her the pouch and wipe her down as I can. It’s not perfect, but it doesn’t have to be- it just needs to be good enough.
Less Steps. Less Words. Less Decisions. More Reward. This is always the way with dementia, but it is especially the way to win in the Shower Arena.
The Dementia Diva 