Sunday, December 23, 2007

Bath Day

When Mom came to live with us it soon became apparent that she needed help with bathing. She was resentful of my bumbling efforts to help because she did not remember that she had stopped showering on her own. I really couldn’t blame her because from her perspective it must have seemed that I had taken bossiness to the extreme by giving her directions on what to do with a washcloth. But the fact remained that we had installed a brand new handicapped accessible shower that was not being used.

Then, Mom fell and broke her shoulder and this proved to be a blessing in disguise. She understood that her injury provided a valid reason for me to be invading her personal space, and so the transition to accepting help with the bathing process was facilitated. By the time she had healed our shower day rituals had become routine, and she no longer felt that something unusual or downright weird was happening when her daughter offered to help her to the shower stall.

I’ve recorded here some of the bath day strategies that I have learned through trial and error. They are not meant to be specific instructions for any other caregiver and patient. I’ve purposely avoided recording actual procedures because, 1) I don’t know what I’m doing, never having received training for How to Bathe Someone Else, and, 2) I don’t want you to drop your loved one on the bathroom floor and then to blame me. My intention is to provide help for you to transition emotionally to the role of cleanliness supervisor for your loved one and to provide a few helpful hints that I’ve discovered on my own. Please take any actual plans of action to your health care provider for approval and for goodness sake don’t try, by yourself, to bathe someone who has poor balance or is in danger of falling—wet surfaces are slippery, people!! Consult a health care professional for specific safety procedures. You can also contact your local counsel on aging for a list of professionals who can bathe your loved one.

If you end up being the designated bath day facilitator, your attitude should be cheerful and matter-of-fact. A strategy that works with my mom is for me to act as though we’d agreed earlier that bathing was a good idea—or that perhaps even that it was her idea! I don’t know whether this is typical of most Alzheimer’s patients who are in the mid-stages of the disease, but my mother has accepted the fact that she has trouble remembering and is adept at reading the ‘signals’ others send to her in her present moment. If I am apologetic, my mother reacts with irritation to the whole procedure of bathing because she is responding to my signals that she is somehow being wronged. But if I say, “Mom, you asked about a bath today and I can help you with that now,” she is happy. I am performing a service for her that she’s requested. It gives her a sense of dignity and control. Of course, this can backfire. She might decide that since it was her idea in the first place, that she then has the option of changing her mind. At that point I have to gently overrule her saying, “Oh but Mom I have time now to help you and I won’t later, and I really want you to get cleaned up like you wanted.” This is done in love and not in order to manipulate. I help my mother to feel and to react in the way that I know that her pre-Alzheimer’s mind would have very much wanted to do.
Here are the aforementioned “helpful hints”:
  • Medicare will pay for periodic trips to the podiatrist for foot care for the elderly. Check this out. I do Mom’s nails at home at the end of her bath time when the nails are softened and easier to cut, but this is not recommended, especially if your loved one has circulation problems or diabetes.
  • During bath time, verbal directions may work for a patient in the early to mid-stages of Alzheimer’s. I can talk my mom through the process of bathing without having to take over the entire procedure for her.
  • I become queasy when exposed to normal body odors that originate from some source other than MY body. This is not a stellar trait for a caretaker. If you are like me, use cold water to rinse washcloths that have been used where the sun don’t shine. The steam from a hot water rinse brings odors straight to your olfactory system.
  • My mother compulsively picks open places into her skin with her fingernails, especially on her face, earlobes, and upper back. Our nurse practitioner tells me that this isn’t uncommon for Alzheimer’s patients. It is important to cover these areas with antibiotic ointment and Band-Aids and to change the bandages daily. Consult your health care professional for a description of the signs of infection, and take your loved one to the doctor immediately if any of these symptoms develop.
No one wants to become the child who is in charge of bathing her parent. In our so-far-easy experience with Alzheimer’s disease, bathing my mom has been the issue that has caused me the most angst by far. My comfort to others who are facing this unpleasant assignment of bathing an Alzheimer’s patient is simple but powerfully true; God is with you as He has been with us.

Scripture: In all their troubles, he was troubled too. He didn't send someone else to help them. He did it himself, in person. Out of his own love and pity, He redeemed them. He rescued them and carried them along for a long, long time.
Isaiah 63:9 The Message

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