Three little words that may completely change the mind of a loved one refusing to bathe.

• • • Discover
    • Validate
    • Resolve

In Generating positive bathing responses you can find helpful tips that encourage loved ones to “make the right choice and get in there and bathe.”  Now let’s look at some of the reasons behind why they may not want to, tempered with plausible solutions.

1)  Refusing to bathe because bathroom too noisy – echoes

THEIR FEAR IS: “Who will hear my cries for help above all this racket if I need assistance?”

SOLUTION: Talk softly and succinctly,  “Your shirt and pants are on the counter.”  Use closed-ended (yes/no) questions, “Water temp okay?”

….Your body language should resonate calmness while reflecting an “all is well” facial expression with soothing, nurturing vocal intonations when speaking.   

….Eliminate any music regardless of whether it’s their favorite soothing songs or how quietly it may be playing in the background.  It isn’t soothing to them here because their senses are already overstimulated.  

2)  Refusing to bathe because bathroom is dimly light to their tired eyes

THEIR FEAR IS: “I’m frightened because I can’t see what’s going on very well.  I don’t feel safe to move around.”  

SOLUTION: Make sure lighting is bright, clearly defining their environment, eliminating shadows. 

….Install grab bars in bathing area. 

….Less is more.  Keep their bathroom simple with clean countertops and few if any chotskies.  This helps eliminate overstimulation.

3)  Refusing to bathe because water splashes in their face

THEIR FEAR IS:  “I’m frightened because I can’t see or breathe.  What if I start falling?  I won’t see anything to grab on to and then I might fall and die.”

SOLUTION: Replace showerhead with a detachable one which also helps to eliminate echoing.

….Loved ones sense they are a high risk for falls.  Just telling them, “You’re fine,” doesn’t calm their fears; they need lots of reassurance.

4)  Refusing to bathe due to diminishing depth perception  

THEIR FEAR IS: “I’m lost in this giant abyss!  I don’t know what I’m doing!  Why am I here in this unknown place?  NOBODY knows where I am!” 

SOLUTION: Buy a contrasting bathtub mat which will add dimension to the shower area while soaking up echoing sounds.

….Tub and shower walls are often monochromatic, confusing loved ones as to where they are.  They have already “forgotten” they were about to take a shower.  Now they’re in an unknown abyss.  The confusion raises “fight or flight” issues, making everything catastrophic and instantly confusing.  

….They are naked which heightens their sense of vulnerability to the unknown.

5)  Refusing to bathe due to diminished recall abilities

THEIR FEAR IS: “I don’t know what I’m doing!  I can’t tell if I’m safe or not!”  Their logic proclaims, “Showering isn’t vital for my survival!”

SOLUTION:  Find and use the bath time terminology they previously used prior to the onset of dementia as it will direct the brain to release “feel good” chemicals from their past.  

….Keep reminding them, “You’re doing great with your shower, almost done, I’m here if you need me while you shower,”  This grounds them in what they are there for.  It also reminds them you know they are there and that the shower is almost over.

6)  Refusing to bathe due to fearing they may slip and fall

THEIR FEAR IS: “I’ll fall and die in there.”

SOLUTION: Buy a shower chair (if they still like to shop take them with you and have them help pick one out).  

….Make sure they shower at their own pace.

As with all humans if they perceive danger, they will not freely cross its path.  They will resist.

Helpful tips

1. Hire a caregiver to shower your loved one.  If it goes well, let the company know you only want that person as resistance can rebuild itself because every caregiver has their own way of showering people.
2. Ask yourself, “Is it your standard or their standard for cleanliness?”  This population grew up showering once a week.  Because they are now cognitively living more in the past, you might find following their old routine to be highly beneficial, sort of catching that old rhythm again.
3. Daily perineal (peri) care, which they may still be able to do on their own if instructed, may resolve a lot of issues.  This sometimes turns out to be a very helpful compromise.

One clever woman’s story

I read online about a woman whose father absolutely refused to shower.  She started taking him once a week to a care facility for daycare to “partake in their activities.”  

Really she had set it up to have the facility shower her father, using daycare activities as the reason.  The first shower dad was obliging but the following week he became more resistant.

The caregiver explained, “If we don’t shower you, we won’t get paid.”  Dad didn’t want this young lady to not get paid so he compliantly allowed the showers.  

A family comes together with bathing solutions

A nurse shared with me a great resolution she experienced with her own mother who kicked, scratched, screamed, and forcefully fought her way through each shower.  One of the granddaughters suggested they buy grandma a baby doll she could interact with while getting bathed herself.

Not only were grandma’s hands kept busy during shower time they found, her “I hate to shower” thoughts were redirected in a more positive direction which completely eliminated unwanted behaviors.  She was able to recapture a sense of her own ability to contribute to her community which strengthened her own psychosocial wellbeing.

You may want to read “Attachment Theory” regarding Plan “B” to learn more as to why the loved one’s first response to bathing may be so negative.  It also explains the importance of being “that one that will cause me to survive” person to your loved one.

Psychosocial Encouragement

• Work diligently on becoming “that one that will cause me to survive” caregiver to the loved.
• You remain calm during bath time so they will remain calm.  They will follow your lead.
• Warm the towel in the dryer for a few minutes while they are showering.