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Case Study: Overcoming Bathing Resistance

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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.

Meet Reta

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® 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 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 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 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 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 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.

Last revised: November 1, 2016

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Thoughts and stories from others
  1. December 12, 2016 at 5:26 pm | Posted by Carol

    The nursing home bathing routine for my mom was excruciating! Oh, how we would have benefitted from these caring professionals and their willingness to understand the person and not simply the procedures.


  2. December 2, 2016 at 9:38 am | Posted by Joyce Beedle

    The use of a "No Rinse" bathing product to Reta's hygiene routine would be massively beneficial. Use of this product reduces overall time needed but more importantly it is better for fragile older skin. It can be used for sponge bath as well as in the shower or bath, and for clean up of incontinence accidents. Numerous products are available; in smaller communities the products may need to be ordered through a pharmacy or medical supply store. Perhaps an article in your next newsletter could provide details about this underutilized resource which not only helps with resistive care situations but can be used routinely to provide better skin care.


  3. November 29, 2016 at 10:31 am | Posted by Richard Apple

    Excellent case study. We would make great strides in caring for individuals with Alzheimer's disease and other dementias if this type of approach was the foundation for training all care providers. The specific strategies will vary for each individual but the approach is essential. When you think about it, the lack of respect for the individual built into the one routine fits all approach combined with the quick reliance on "medication" to mute the person's resistance is a core problem.


  4. November 3, 2016 at 1:32 pm | Posted by Deb Russo

    excellent! Many helpful interventions thanks Deb Russo


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