Saturday, January 21, 2012

Showering an Elderly Person - a Step by Step Guide

Showering an elderly person can be challenging when it's something you're not used to. I learned "on the job", because the training for this was very brief. Keep them safe; yep, I get that. Keep them feeling dignified. Gotcha. But... HOW do you do it?

It will be different if you are dealing with someone with Dementia. The person who does not have Dementia already realizes what is going to happen. In that case, what you say AND how you go about your duties will make or break the situation. If the person has Dementia, both tell them, and illustrate with body motions, what you are about to do. 

First, gather all of your supplies. There's nothing worse than looking like a novice (even if you are one!) by getting all ready to do and finding out you forgot the shampoo. 

You'll want

  • Three washcloths. One for you to use on their face, back, etc. One for them to use on their front and as much of their body as they can/will reach. One for you or them to use on their private area.
  • Three towels. I use three - you may think that's a bit much. I put two full size bath towels and one hand towel into the dryer for 30 minutes during the shower. The hand towel is for their head/hair. One bath towel is for their back, and one for their front. On a particularly cold day, I've used three bath towels, and wrapped my client's legs in the third one. She loved this, by the way.
  • Two extra hand towels
  • Body wash or soap
  • Shampoo
  • Conditioner, if using
  • Lotion or cream
Grab an extra hand towel or small bath towel, and help guide the elder into the shower with this. I do this in part for privacy/dignity, an in part because I wash my hands so much they're always ice cold. You will use this same towel to dry their hands, and the hand rails in the shower, when you ask them to stand for washing the bottom areas. 

Guide your elderly to the toilet just before the shower. It's easier to get undressed there, and you really don't want them to perform potty duty in the shower if you can help it. By the way - if that happens - it's okay! Let it go! I literally will say "Let 'er rip! You're in a great place for it!" There is NO sense in trying to stop that. Warm water tends to bring on the urge, anyway. It's best to laugh about it.

Test the temperature of the water on your inner wrist, prior to having them step into the shower, or pivot onto the shower bench. NEVER have an elder step into a shower stream which has not been well tested. I love hand-held showers and have been fortunate to have them everywhere I have worked. The exception to this made it very awkward to assist with a shower. 

I place a towel on the shower seat, or at least warm the seat with hot water prior to the elder sitting on it. Small things mean a lot! 

Wash the face, first - their eyes closed. You will want to use water, only, or very mild face wash. Dry their face, then let them hold that hand towel over their eyes while you wash their hair. Encourage them to tip their head back as you do this. Work quickly, but don't forget how wonderful a scalp massage feels. Many elderly are starved for touch, and this is a healthy and soul-lifting way to fill that void. 

If the person is able, have them hold the hand-held shower. One of my clients loves this, and sometimes threatens to give ME a shower, too!

Soap up the face wash cloth, and hand it to them to wash as much of their body as they can. Make a "mitt" out of your wash cloth, and soap it up. You'll wash their back in gentle circular motions, listening and watching for clues. Do they want you to be more vigorous? Should you be extra gentle? Work on the back, underarms, arms, torso, legs and feet. Then, after rinsing completely (feel the skin - make SURE the soap is gone) wipe the hand rails dry, and dry the elder's hands. Ask them to stand, carefully. That's when you will either assist them in washing, or will wash, the bottom half. Front first, back last. Rinse VERY well. Do this professionally and quickly, as if you do it every day. 

Have them sit again, carefully, turn off the water, and run for the hot towels! IMPORTANT: If the elder is unsteady, or cannot be left alone, you will have brought the hot towels into the bathroom prior to the shower, wrapped inside another towel, a blanket, or pillow case to remain warm. Place one bath towel around the front of them, one around the back, and a hot hand towel on their head. Be ready to receive an expression of pleasure. This moment can be savored - no need to rush. I give a shoulder massage through the hot towel. I also give a scalp massage while drying the hair. Press the towel into the skin gently. Get that skin as dry as you possibly can, to avoid skin breakdown.

Uncovering a little area at a time, apply skin lotion or cream. During the entire process you are checking the skin for breakdown, unusual bruising, cuts, etc. Apply any prescribed skin medications at this time. I leave the client on the shower bench and dress their top half, with the bottom half covered in the warm towel. I also brush/comb the hair at this time, after dressing their top half. This method is the most dignified, and does not leave them feeling exposed or vulnerable. 

Make sure the handrails are dry when you have them stand again. If your elder is using a pivotal transfer onto a shower bench, that part of the routine will obviously be different. 

Assist them in standing, and then dry dry dry the bottom half and back of legs. Apply lotions/medications, then walk to the toilet for the rest of the dressing routine. That's where you'll put on fresh adult underwear, socks, pants, shoes. Spend a moment to apply lotion to their hands, and smile at them as you do so. This, when they are dressed and finished, will help them understand that you are serving them willingly. Especially if they have Dementia, this will go a long way in promoting a feeling of wellbeing. 

You will get them safely to the next place they are going, before returning to the bathroom to clean up. If you are in an assisted living facility, you may have to attend to this right away, and sterilize the shower for the next client. 

If you are assisting a lady, ask if she would like any makeup or perfume. My two lady clients enjoy a little blush and lipstick. One client likes me to shave her chin each time I shower her. 

Smile. It's an honor to be trusted with this assignment, and they need to know that.

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  2. Very helpful. Thank you

  3. Very informative and nice personal touch on the small details and tips.....

  4. After only just becoming a carer I gave a shower to a resident for the first time a few weeks ago, and unfortunately I didn't manage to do it this well. I wish I had read this before as it was extremely detailed and helpful and will definitely be putting it into practice next time :)

    1. It's been a year - are you still caregiving? Wondering how it's going.

  5. Thank you SO MUCH for this. Never covered in training, and have been struggling for a couple of weeks before finding this. Might be worth mentioning if you are doing Home Care to make sure you let the family know how many towels/flannels to leave in the bathroom for you to use... as things will not always be left as you might need them to be. Thanks so much!

  6. Great tips and I love the idea about the warm towels. Only thing is that you shouldn't leave an elderly person alone to run for the towels. They may get up and slip in the shower. Usually you don't have someone else that. Can get the towels for you from the dryer.. .if you do then have them bring the towels or stay with the person while you run for the towels. Thanks for the great tips :-)

    1. Thank you. The only client whom I "left" to grab the towels was a fully mentally alert lady securely seated on a shower chair. Otherwise the hot towels can be brought into the bathroom and wrapped up in themselves to be kept warm. No falls on my shifts - ever! :-) Thank you for commenting.

  7. this has been a great insite, never coverd in training in theory but when in prac everyone does things in a different way

    1. So true. I just remember my first shift with a woman who had Dementia. I had this horrible sinking feeling of - "what do I do?" I wanted others not to have that same experience.

  8. Thank you so much! I will be bathing my father for the first time since becoming his carer and want to preserve safety and dignity. Your clear steps will help me be successful.

    1. Parents are tricky. It's tough to "reverse roles" like that. Using the towel as a "shield" will probably bring him comfort and dignity. You'll get used to each other in that new function and it will become as normal as fixing lunch. Meanwhile, I applaud you for being so loving and giving. Feel free to communicate with me if there is anything I might give you "un-biased" input on! Ruth 425-802-2763

  9. You seem like such a sweetheart. I am a funeral director. We "adopted" an elderly woman after her Mother and Husband passed away. Now she is starting to decline and we moved her into the owner's house but with the owner being a guy she doesn't feel comfortable with him showering her so I get the task. These tips help a lot! I've bathed many people but they were not living people :) Thank you for taking the time to write this.

    1. I so appreciate comments like these. I love my "job". One of my Dementia clients was concerned that I might not continue to be an in home caregiver much longer. I told him that I AM a caregiver; it's not just what I do.

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  12. My husband's mobility has changed quickly from being an avid hiker to barely walking unassisted to cane to walker and now to wheelchair. He was diagnosed with brain cancer just months ago. I am in the sharpest learning curve of my life - going to use your methods - i like the idea of looking at it as a way to show love and respect to my husband. I may be approaching the end days ~not sure~I don't get a do-over. You are a godsend!

    1. I'm not sure how this works - as to whether or not you can see my reply. I sincerely would love to speak with you. I want to encourage you in any way I can. Being a "stranger" it won't matter what you say! Would you please call me, if you feel that would be of help? 425-802-2763 is my number. If you leave me a message here, I also get it in my email. What a challenging road you have ahead. You are showing love and respect to your husband who is needing that so much. It's proof positive OF love. This is love. I'd really like to be a friend through this if that is something that would help.

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  44. Thank you very much for your wonderful a new caregiver, the training I received lacked this vital information, as well as the basic info on how to clean the patient after thankful that I found your site!

  45. You are so welcome. Please feel free to call me if you have any questions. Ruth at 425-802-2763 (We live in the country, so texts are actually more reliable!) Best of luck to you. You are providing a very valuable service.

  46. Ruth - you helped me so much with your "how to shower an elderly person". For the first time I had to give my 91 yr old difficult mother a shower. With your advice it was a calm and compassionate experience - now I won't dread it in the future. I keep having more and more caregiving tasks for my Mom, but showering will be a piece of cake thanks to you!

  47. I'm so glad you found the instructions helpful. I remember that first shower I had to do, and how lost I felt. Nobody offered any training on this whatsoever! And, while a simple shower seems like a normal thing, it's just NOT comfortable at first. Feel free to call me any time if you need a listening ear and a "stranger" who won't judge! :-) 425-802-2763


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