Getting an Alzheimer’s patient to shower can be difficult. In order to accomplish this mission you will need to learn how to be a guide, and how to use positive reinforcement. You will also need to understand you are dealing with an adult living with dementia, not a child.
My mother usually resisted when I asked her to take a shower – for years. When she occasionally said something other than NO, I looked to the heavens as if it was a reward.
It took me quite a long time to figure out what to do and how to properly motivate her so that she would take the shower without resistance.
Step one, constant positive reinforcement about the positive effects of being clean.
My mother would usually take her shower around 3 in the afternoon. I gave up trying to get her to take her show in the morning because she wouldn’t do it, and I had too much to do with her to get the day going well.
Nevertheless, I started setting the stage for the shower early in the morning and throughout the day prior to the time of her taking her shower.
I would take my shower and then come out with my head still wet and my face clean shaven and start extolling how great it felt to be clean.
I would get my mother to touch my face and show her how smooth it was. As she was touching my face I would say – smooth a few times. Eventually she would say smooth, or “smooth as a baby’s *ss”. This would give both of us a good laugh.
I would also get her to touch my wet hair. Then I would say – clean. I would say clean a few times as she touched it.
I would then tell her how great it felt to be clean. Positive reinforcement about the virtues of being all nice and clean.
All of this was designed to set the stage for Dotty’s shower that was coming later in the day.
I tried to do the same thing, or a similar thing each day. I was trying to set a pattern leading up to the shower, and then a specific pattern when it came time to take the shower.
Establishing patterns is one of the only ways I discovered that worked when it came to establishing consistent behavior with someone living with Alzheimer’s disease. I am convinced that trying to do the same thing, at the same time, every day is very helpful in Alzheimer’s caregiving.
Step two. Prior to the shower I tried to make sure my mother was sitting in bright light. Sitting her next to a window in the kitchen usually did the trick. I learned that bright light can be mood altering when used effectively with dementia patients.
Put it this way – bright light, bright mom.
Before shower time, I always talked to and engaged my mother. I would resist the temptation to sneak up on my mother and then announce – time to take a shower. This doesn’t work, and it never worked for me.
Singing can be a good way of engaging a dementia patient and getting their attention. I learned my mother was always willing to sing Shine on Harvest Moon. It became even easier after we obtained our repeat parrot Harvey. Now the three of us could sing together. This usually delighted Dotty. Want to see Dotty sing and talk to Harvey? Go here.
I understand that Alzheimer’s patients often say NO when asked to take a shower. Sometimes my mother would say, “I already took my shower”. This was amusing because she was still sitting in her pajamas.
Rule number one. Never correct an Alzheimer’s patient if they say they already took their shower. Rule number two, never try to explain to them the importance of taking a shower – like good hygiene. Ever hear the saying “loose lips sink ships”? Well, explanations and lots of words will sink your caregiving effort every time.
Step three. When it comes time to take the shower think of yourself as a guide. You are going to guide your loved one to the shower by taking their hand. Of course, you will already have given them a nice smile, and received a nice smile back before you start to take action.
The weapons in your caregiver arsenal. The smile. Your hand. And the most important of them all – Positive reinforcement.
Here is one simple way to get someone suffering from Alzheimer’s to take a shower in my opinion. I learned this as a freshman in college in Psychology 101. Let’s call this Pavlov’s dog and the shower.
The zinger. The shower must always lead to something the dementia patient wants or enjoys. In the case of Pavlov’s dogs they rang a bell when the dogs would eat. Eventually, they would just ring the bell and the dogs would salivate. This is known as a conditioned response.
I fire in the zinger.
Okay mom lets do this. After you take your shower you will get a nice snack. I usually say potato chips because they are her favorites. Positive reinforcement before the shower, BIG positive enforcement after the shower. For many of you, ice cream or chocolate should do the trick.
When I got mom up for the shower, I hold her hand and walk her toward the bathroom. We get her watch off. The only time mom takes that watch off is when she goes in the shower. She wears her watch to bed and won’t allow me to take it off. She has other watches. One looks like a bracelet, so sometimes she has a watch on each wrist. When I was dumb, I use to try and get her to take one watch off. Then I got smart and learned how to laugh. If mom wants to wear 4 watches fine by me, and if it will help with the shower she can wear 6.
I think you might be surprised to learn this. I take off mom’s robe. She still has her pajamas on. I turn on the shower. I put her clean bra and panties on the sink (the first part of the change of cloths). I put her towel on the sink. I hand her the wash cloth. I tell her to make sure she gets all the stinky parts. Then I close the bathroom door, but I leave a crack so I can peak in. We have a glass shower. She gets in. I check to see how she is doing. It varies. Most of the time, good enough. She does gets the stinky parts. She is not good at getting her legs and feet. I take care of that once or twice a week. Note: as the disease progressed I had to give Dotty her shower, but I used the same approach to get her to the shower.
Two points here. One, mom gets the positive reinforcement after every shower. Two, I am involved with mom all the way. I don’t say you need a shower and then wait for her to go take the shower. I assist her right up to the door of the shower.
You have to be actively involved with a person suffering from Alzheimer’s in everything they do. Once you get the hang of being actively involved you will find, learn, that it gets easier to guide your loved one and get them to do what you would like them to do.
Resist the temptation to be a parent. You are dealing with an adult with dementia, not a child.
Resist the temptation to be the boss. Instead be a guide and lead with a smile and your hand, palm turned up. Offer your hand to your loved one.
Always think positive and endeavor to find new and better ways to introduce positive reinforcement into the equation.
If you want your loved one to take a shower every day establish a pattern. Make sure the communication and activity leading up to the shower are positive and that you are engaged with the patient before guiding them.
After the shower be so happy you can’t see straight. Extol the virtues of being clean and how wonderful it feels.
Make sure the immediate aftermath of the shower is positive. Like potato chips, or ice cream, or a trip out the door (this really worked well for me).
Don’t worry about being so happy you can’t see straight. Once you get this technique down you will be so happy you won’t believe what it feels like.
Don’t worry, you can do it. Might take some practice and patience, but it will happen.
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Kevin Tagarao is 1Heart Caregiver Services' Vice President of Operations.