Showering the Elderly--Part 2 Problem Solving Shower Issues

How do I get my elderly parent to take a shower or bath? If you have have been asking that question lately, then this guide is for you. In Part 1:  

Reasons Why The Elderly Resist Bathing, 


I covered the many issues that may cause a senior to balk on bath day. 


Today, I am offering solutions for all of those issues. These are all techniques that I have used in a professional setting, for private clients, and for my own grandmother, or tips that I have rounded up from other caregivers who have faced the battle of the bath. 

Issue 1.  Alleviating Fear of Injury in the Shower

If being afraid of getting hurt in the shower is your loved one's greatest argument against getting clean, then you have to do anything and everything you can to assure them that they are safe. 

Grab Bars to Prevent Falls

Install as many grab bars as your shower will hold. Don't go for aesthetics here and buy something that blends with the wall. Get something shiny and big that stands out, so that the elderly can see the bars, and know where they are without groping. 


Once they are installed, demonstrate that they are super-sturdy. Pull on them, lean on them. Swing like a monkey. Let your elderly mom or dad see that those bars are not moving even if they put their whole weight on them. 


And the toilet lid? If that is the only place to sit after a shower while drying off, then get a cover for it too. Wet skin doesn't stick to slick plastic very well, and its easy for someone who is weak or who has balance issues to slide right on off into the floor. 

Invest in a Shower Chair

The easiest way to prevent a fall in the shower is by remaining seated. Shower chairs allow a sense of security, while still allowing you to get the job done. 


If you have room, invest in two shower chairs. One for inside the shower, and another for outside. Its a much safer seat than the toilet for drying/dressing/grooming.


 If you have a walk-in shower, then you might look into a chair with wheels, just like hospitals and nursing homes use. This is best for the person that is very unsteady or who has a physical disability. 


Use a Handheld Shower


If you don't have one already, then you need a handheld shower with a long hose. These take  most of the stress out of showering the elderly, because they don't have to move around too much in a confined space. 



Monitor Your Water Temperature


ALWAYS check the temperature of the water before you put your loved one in. Cold water is JUST as bad as hot water. 

Use a bath thermometer that changes color with the water temperature to provide a nice, visual reassurance to the elder who is afraid of being burned. 

Go Tear Free

Most of the people that I showered liked to do as much as possible themselves. Usually, they preferred to wash their own hair. 


Sometimes their physical limitations meant that they couldn't keep the soap out of their eyes. 


The solution is easy, of course. There are tons of tear free shampoos on the market. If you don't like the idea of using "baby" stuff on your elder, just consider this: baby (and children's) shampoos that are tear free are usually hypoallergenic, meaning they are much more gentle on the skin too. 


Since older skin is thinner and can dry out and become irritated easily (something that can aggravate skin picking behavior in those with dementia), then you are actually doing them a huge favor. 

Also: 

• Decorate your tub with slip-proof accessories
• Provide a good non-slip bath mat for outside the tub

Issue 2: Fear of Bathing (Dementia) 

For those in advanced stages of dementia, we always gave each shower like it was the first one they had ever had--explaining everything we were going to do before we did it. 

It really does help to use body language as well as verbal reassurance. Be relaxed, smile, talk to them soothingly as you work. Make the shower as quick as possible if they become agitated. End it immediately if they become physically aggressive. 

Issue 3. Dealing With Embarrassment

When the elderly don't want to shower because they are modest and embarrassed to need help, you have to be very diplomatic. 

You have options, but none of them may be well received at first. If the problem is that you are bathing someone who is the opposite sex, then the first thing to try is finding someone more appropriate to take over shower duty. 


This can be your spouse, a sibling, or your own (older) child (it may cost you an allowance increase). If there is no one in the immediate family who can help, then you might have to be a little more unconventional. 


Do you have a family friend who might be willing to help? Maybe someone who has worked in the medical profession or as a caregiver themselves? Sometimes the elderly will agree to a "stranger" helping them rather than their own close relatives. 


But what if simply can't find a volunteer? Or you can't come up with anyone that mom and dad will trust? If this happens, then you can discuss hiring a home health aide or other professional  to come to your home just for showers. 


You might be surprised to learn that your loved one is absolutely agreeable to that suggestion. Or even more surprised that they suddenly agree to have have YOU do the showers, rather than a nurse or an aide. 


When you ARE the one giving the showers, you can follow these tips to protect your loved one's modesty: 

• Keep them draped in a towel or sheet while showering. Just uncover what you are cleaning at the moment. 

• Make sure that no one else will accidentally barge in during the shower. 

• Don't have multiple people helping with a shower unless it is absolutely necessary for the sake of safety. 

• Seat or position your loved one and yourself so that you are to the side or slightly behind them, rather than facing them. 

• Encourage them to do as much of the cleansing as they can, especially private areas.

• Only discuss their bodies if there is a medical reason (for example: asking whether or not a blemish is tender or where a bruise came from)

• Keep the shower in the bathroom. Don't let them hear you discussing bathing them with anyone else, unless it is with their doctor, for a medical reason. 

Issue 4. Decreased Sense of Smell 

You can't fix a broken sense of smell. But you can discuss the issue with your parent. Whether you should be frank or subtle depends on your parent, on you, and on the level of communication you have in your relationship. 

You don't want to hurt their feelings, belittle them, or make them feel dirty. You just want to communicate that you understand they may not be noticing the issue. 

Ease into their good graces by asking what you can do to make bathing easier or more pleasant for them. The solution may be as easy as implementing some of the other suggestions in this article, such as calendar to remind them of shower days. 

Issue 5: Decreased Sense of Time

For those who lose track of time, use a calendar as a visual aid. Any calendar will work, but a wipe-off board might be best since it large. 

Here you can note which day it is RIGHT NOW, the last shower day, and the next shower day. It might be helpful to note upcoming events on the calendar too, (church, doctor's appointment, holiday, shopping trip) so they can see WHY they need to be clean. 

Issue 6. Fear of Being a Nuisance 

Does your loved one feel as though all of their care needs are a huge inconvenience to you? You may be deny it all day and all night, but your body language may be saying otherwise. 

That doesn't mean you have to act like every task is your dream-come-true, but you should be mindful of your facial expressions and posture during caregiving. If you are rolling your eyes, tightening your lips, sighing too much, slumping your shoulders, or cringing too often, then yes...

They probably feel like they are being a pain in your neck. 

Even if you truly do dread it, slap on a smile and be matter-of-fact. Make the necessary tasks seem like your favorites, and save the sighing for the times when they re-tell your embarrassing childhood stories again. 

Be open too about money, and let them know that baths and laundry are not nearly as expensive as infections, illnesses and hospital stays. 

Issue 7.  Loss of Independence

If your elderly parent is resisting showers to maintain some control over their lives, then maybe you need to give them more choices. 

Maybe you took on the role of caregiver with the idea that you should do everything for your parent because they did everything for you. Some elders eat that up like chocolate. Others, not so much. 

If you are making all the big decisions and all the little ones too, it might help to step back a bit.  If they have more control of their choices, the elderly may not be so stubborn about showers anymore. 

Some non-harmful choices are easy to implement during the day: 

• What do you want to wear today? 
• What would you like for lunch? 
• Would you like to go for a walk or a drive?

If too many choices causes anxiety (sometime this happens in dementia), stick to either/or choices: 

• Would you like the yellow sweater, or the red sweater?
• Would you like chicken or fish?
• Do you want to watch television or listen to the radio?
• Curtains open or closed? 

Getting opinions from the elderly can also make them feel more in control of their lives, as well as part of your home (rather than a guest): 

• Do you think we should re-paint this room?
• What should we plant over there?
• Do you think new chairs would be more comfortable for you to sit on?

Notice how none of these are shower related? Sometimes you have to be sneaky. If you make choices and opinions part of their everyday life, not just for difficult issues, then it becomes a natural part of your relationship. Be consistent: 

• These are things that can be negotiated
• These are things that are firm. 

Otherwise, you could end up in a bad habit of bargaining and pleading over everything, which is exhausting and risky. 

Issue 8. Being Home to Much (Social Isolation)

Basically, if your parent has no reason to bathe, they may decide its not worth the effort. 

You can help this by getting them involved in activities with others. Not only is this good for their emotional health, it might encourage them to be more concerned about their personal health. 

Look around for activities for seniors in your area, but don't force them into something they wouldn't enjoy. (If they have never liked playing games, they probably won't be thrilled with bingo night). 

You can also: 

• Take them to lunch or dinner 
• Take them to see a movie or concert
• Take them to a zoo, museum or art gallery
• Attend small local festivals
• Go with them to attend community events
• Find a group or club they might like to join

Getting them out and about can be fun and reminds them that life is still worth living. 

Issue 9. Depression

Depression in the elderly is a very serious matter, and can manifest itself in different ways. Depression isn't feeling sad some days, or lowering personal standards in a few areas. It may be a total lack of caring altogether about everything. 

If you suspect your loved one has depression, or is at a risk for developing depression, then speak to their doctor immediately. If they ARE diagnosed with depression, work closely with doctors to create a supportive home environment. 

Issue 10. Physical Pain of Fatigue

If going through the motions of taking a shower is physically exhausting or painful for your loved one, you might try: 

• A shower chair

• Doing showers when they are well rested

• Timing showers after their pain medication takes effect

• Bringing in an extra person to help (only if they are comfortable with this) to help support them and get the job done more quickly

• Bathing less often (use sponge baths between full showers)

• Switching to bed baths for all bathing.

Issue 11. Temperature Changes

Obviously, warming up the bathroom will make your loved one more comfortable during their shower. But the promise of a warm bathroom might not be enough. 

The elderly can be sensitive to extreme temperature changes. They might not mind taking the shower, but instead dread the thought of coming back into the cooler air with damp hair and bodies. 

Simply turn the thermostat up a few notches before the shower, so that they whole house feels warmer. According to one of my sweet residents years ago, it wasn't the shower that she hated, it was leaving the warm shower. 

As for water temperature, the thermometer is your best friend. But here is a trick you can try if your loved one insists that the water is never the right temperature: 

Put your hand on the bathtub knob (when you know the temperature is pretty much right) and pretend to turn it. Then ask: 

"Is that better? Or is it still too cool?" 

If they say that it feels much too hot now, even though you didn't turn it, then they may either be unable to gauge the water temperature accurately, or...

They could be just pushing your buttons a little.

If you think that is the case, then just add a comment such as: 

"I think that is as close to perfect as this shower can get. Lets finish up before the water heater runs dry." 

Just make sure you are using a temperature that is neither too hot nor too cold. 

Issue 12. Time of the Day

This is where you can implement one of those personal choices mentioned above. Ask your loved one whether they would prefer their showers in the morning, afternoon or evening. 

If they are unable to communicate what they prefer, experiment with different times of the day. Not just morning, noon, or night. See if they are more cooperative before breakfast, or after they have eaten. Maybe after a refreshing afternoon nap? 

If they have a problem with sundowning, that might be a bad time to try a shower. On the other hand, it relaxes some people. Find what works best for them, then rewrite your schedule around it. In the end you will save everyone a lot of time and frustration. 

Issue 13. Sensitive Skin

We had non-adjustable shower heads in one nursing facility. I swear, the water came out with the same soft pressure as a fire hose, and some of the residents hated it. 

Trick of the trade when you can't adjust your shower spray? Soften the blow by slipping a nylon stocking over the shower head. This diffuses the pressure. 

When you wash the elderly, you need to use a gentle touch. Don't scrub away with an exfoliating mitt. Even if they ask you to scrub harder, you should take care. It is very easy to cause a skin tear or an abrasion could become infected. 

Another ticklish issue about skin...

It can be ticklish. 

Most people won't volunteer the fact that they are ticklish. You learn the hard way, or you ask in advance! People are ticklish in different places too. It may be their feet, their arms, their ribcage...

Where these areas are, you need to use a firm, quick touch, or let them wash those places themselves. 

Issue 14. Increased Sense of Smell

How can you eliminate fragrances and odors from the bathroom that may be causing nausea? First, pin down which odors causes your parent the most discomfort. You may be able to just eliminate that particular scent. 

• Avoid strong cleansers or air fresheners in the room before showers

• Ventilate the room beforehand to remove old perfume and toiletry scents

• Run water for a few minutes to wash out stale or chlorinated water (or let a bath full of water sit until the chlorine smell evaporates somewhat)

• Use fragrance-free soaps, shampoos, and deodorants. 

Issue 15: Childhood Habits

This can be the hardest issue to resolve. You can use some of the suggestions already covered, such as reassuring them that bathing is cheaper than being sick, making sure they get out of the house and socialize when possible, and using calendars to let them see how long it has been since their last bath. 

The good news is that the elderly don't actually need to bathe everyday. Unless they are still very physically active or have a hobby such as gardening that requires getting a little bit dirty, then you can probably compromise on one or two showers a week. 

You can always supplement with "spot cleaning" in between or sponge baths if they are incontinent, and placing more emphasis on hand washing, combed hair, and tidy clothes. 

Bonus Tips: 

• For women, take extra time and turn shower day into spa day, complete with a massage, facial, and manicure

• Keep up a natural flow of conversation to alleviate awkwardness and provide a nice association. (they may love that they have your undivided attention for a few minutes, so listen to their stories, laugh at their jokes, and answer their questions.) 

• Play some music in the bathroom. This can be soothing music or fun music. Whatever the respond to best. This also contributes to a pleasant atmosphere. 

• Have a helper fluff up their towels in the dryer and bring them to the door when you are ready. 

Find A Shower Routine That Works and Stick With It

Once you reach an agreement about showers (how often, time of day, how long, who gives them), stick with it like it is a promise. 

Don't deviate except for absolute emergencies, and you will build up a little extra trust in your relationship with your elderly parent. They know you are serious about them being clean, but they also know you want to do it because it is for their benefit, and you will go above and beyond to make it as nice and safe as possible. And you won't spring any sudden surprises on them. 

Hopefully, this helps resolve some (or all) of the struggles you may be experiencing. If you have any other tips, tricks or advice, please feel free to share it in the comments! 

For new caregivers, check out part three of this series: 

Showering Step-by-Step-A Guide to Showering the Elderly