November 1, 2016
Seniors—especially those with Alzheimer’s disease or a related dementia—may resist bathing for a variety of reasons. They may think they have already bathed on a given day when they have not. Altered sensation may make the shower spray feel painful or cold or too hot. When they get into the water, they may feel like they’re drowning.
Resistance from the senior could lead to clashes of will between the caregiver and senior, which can cause stress for all the parties involved.
We believe there’s a constructive way to handle this. Our case study this month features the story of Reta, a senior with advanced Alzheimer’s disease who exhibited intractable behavior when it came to bathing. Although Reta lived in a care facility, the lessons learned from the case study can translate easily to family caregiving at home, as well.
Reta was an older adult with stage three Alzheimer’s disease who lived in a small care facility. The professional caregiving staff began to notice difficult-to-manage behavioral changes as Reta’s Alzheimer’s advanced. Notably, she began to refuse bathing and personal care. She also exhibited anxiety and agitation and started to refuse food at mealtimes.
Because of these difficulties, the facility appealed to the family to provide care support for Reta. The family responded by hiring Home Instead Senior Care® to create a personalized care solution for Reta. Using a step-by-step process, the Home Instead CAREGiver℠ team was able not only to get Reta bathing regularly but to calm her anxiety and agitation.
Step One: Consider the Bigger Picture
The Home Instead Senior Care team realized issues like bath time refusals do not exist in a vacuum. While people with dementia can act irrationally sometimes, their behavior usually is motivated by a very real trigger.
Armed with this knowledge, the team did not begin their problem-solving quest by focusing on Reta’s bath time refusals. Instead, they took a broader perspective by using an Alzheimer’s care technique called Capturing Life’s Journey®. This approach begins by taking a thorough personal history of the individual receiving care. When the team used this technique with Reta and her family, they identified three facts that could be triggering her bath time refusal:
- She never liked water or showers
- She was always a very orderly person
- She was very particular about her habits
Step Two: Compare Current Behavior with Personal History
After identifying three key personality traits that could be driving Reta’s current behavior, the Home Instead Senior Care team compared the problematic behavior to these characteristics. They found that Reta rose early and got dressed to "go to work” each morning, in keeping with her lifelong habit of being a very orderly person. Understandably, then, she would become agitated when a caregiver subsequently asked her to take off her work clothes and get into the shower because this care pattern did not match her particular habits. Furthermore, Reta certainly did not want to disrupt her habits in order to enter an environment she hated: the shower.
Step Three: Adapt Care to the Individual
With the bigger picture about Reta’s bath time refusals becoming clearer, the Home Instead Senior Care team formulated a revised care plan for Reta that took into account her individual world view. Instead of requiring her to comply with an arbitrary care schedule that disrupted her habits, Home Instead Senior Care sent CAREGivers to Reta at 6:30 a.m. each day to be there when she awoke. By arriving so early, CAREGivers could intervene early in Reta’s day to redirect her habit away from immediately dressing “to go to work” and toward taking a sponge bath before dressing.
This method honored Reta’s lifelong dedication to orderliness while also facilitating better personal hygiene. And starting with a goal of taking a sponge bath instead of a shower allowed the CAREGivers to foster a personal connection and reinforce to Reta that her wishes to avoid the shower spray were being honored.
Personalized Care Can Solve Bathing and Behavioral Problems
After the care plan was adapted to better serve Reta’s unique personality traits, her family and the care staff saw a marked improvement in Reta’s behavior. Over the course of six weeks, she gradually allowed her caregivers to give her a shower, and she also began eating without anxiety again.
This case study illustrates the benefits of personalized care for people with Alzheimer’s disease or a related dementia. Too often, these individuals are asked to adapt to rigid care schedules when, in fact, they have lost the coping skills required for such adaptation. Feeling overwhelmed or powerless, they may act out with undesirable behaviors like bath time refusals, agitation and anxiety.
A better approach to consider, as illustrated by Reta’s story, is to adapt the care plan to suit the individual’s values and temperament. Best of all, this type of personalized care can be delivered to a senior living at home or in a care facility.
Family caregivers often cite bath time resistance as a key challenge in providing care to a senior loved one. When your clients ask for help overcoming this type of issue, please share this case study and refer them to Home Instead Senior Care for assistance. Helping to resolve these types of care stressors benefits both the senior and the family, allowing them to focus on their loving relationship instead of feeling constantly embattled.
Get helpful tips and articles like these delivered to your email.