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Activities of daily living (ADLs) are fundamental skills that are necessary for independent self-care, such as eating, walking, using the toilet, dressing, bathing/showering, and mobility (Edemekong, 2022). ADLs are used to indicate an individual’s functional status and to determine qualifications for medical care, therapy, nursing care, and insurance eligibility. When loved ones need assistance with ADLs, this may require family caregivers to learn how to appropriately support and provide care in a manner that allows their loved one to maintain some independence living at home. This document will address the ADL of bathing/showering and includes recognizing signs your care recipient needs support, how to maintain dignity, and some tips/tools to support your caregiving responsibilities. 

Signs That Your Care Recipient May Need Support with Bathing & Showering

  • They experience physical pain or discomfort limiting the ability to bathe/shower.
    • Can potentially be due to arthritis, a stroke, Parkinson’s disease, injury, surgery, other illnesses, etc.
    • Having difficulty or unable to get in/out of the shower/tub independently.
  • They experience difficulty or require the assistance of another person with washing more than one region of the body while showering, bathing, or sponge bathing.
    • Regions are defined as head and neck, back, front torso, pelvis (including buttocks), arms, and legs (VA, 2023). 
  • They need a reminder to bathe/shower.
    • Changes in memory including cognitive decline or sensory perception (Bursack, 2022). This may include:
      • Forgetting to shower/bathe due to dementia/cognitive impairment
      • Dullness in sense of smell/not noticing their own odor
      • Being unable to stay focused long enough to complete the shower/bath
  • They express distress or discomfort by screaming, crying, resisting, or hitting when it is time to shower/bathe. This can be due to:
    • Loss of interest or motivation in the maintenance of health, diminished well-being, social isolation, or even a fear of falling.

Care Recipient Dignity

caregiver helping with shower

Experiencing difficulty or resistance with bathing/showering can cause frustration for both the caregiver and the care recipient. The goal should be to honor the care recipient’s preferences allowing them to be as independent as possible. Understanding why the care recipient is exhibiting challenging behaviors and where the resistance is coming from can help improve communication. Here are some mindset strategies to consider to maintain care recipient dignity:

  • Honoring the care recipient’s need for privacy.
    • Bathing/showering can be perceived as private and personal activities and can lead to embarrassment or feeling hazukashii and may cause further resistance in accepting assistance. Factors such as the relation to the care recipient, gender, and age can further exacerbate this sentiment. 
      • This may include letting the care recipient remain covered by having them hold a towel in front of their body for warmth and modesty (VA 2017).
  • Communicating clearly with respect and empathy.
    • Understanding that accepting change and help may be especially difficult in our community where the care recipient may not want to be a burden to their adult children, spouses, and/or loved ones and wish to do things by themselves without being reliant on support.
    • When assisting with tasks they cannot complete on their own, communicate with them step by step what you are doing and try to address their concerns.
      • For example, say, “I will be turning the water off now.”
    • Communicate tactfully and sensibly when addressing the care recipient’s body odor, soiled clothing, or unkempt appearance, and refrain from forcing them to bathe.

Overall Safety Considerations for Bathing and Showering

The following tips are for across all levels of care needed to ensure a safe environment. Finding the right tools can help mitigate challenges while assisting with bathing/showering for your care recipient. Doing so can help contribute to both the safety and ease of this task. Adhering to some best practices can also help your care recipient remain independent longer:

bathroom hand rail
  • Remove trip hazards/clutter that may be present.
  • Being sensitive to the care recipient’s skin keeping in mind water temperature, hygiene, and skin conditions.
    • Adjust the water temperature to avoid scalding, using mild water pressure.
    • Be gentle with the care recipient’s skin by avoiding scrubbing and rubbing and instead gently pat the skin with a soft towel to wash and dry. 
      • Be aware of pressure sores that may develop in care recipients who are bed-bound or sitting for long periods, swelling, bruising, rashes, dry skin, or other unusual conditions. 
    • Choose the right products.
      • Avoid using soap, shower gel, and bubble baths that dry out skin, and try to use a soothing cleanser instead.
      • Consider moisturizing lotions for dry and sensitive skin that are dermatologist-recommended, fragrance and paraben-free, non-greasy, with natural ingredients for use after bathing/showering.
  • Consider home modifications if needed, for safer and easier bathing/showering:
    • Grab bars or rails near the toilet, shower, and/or bathtub
    • Temperature control valve for tub and shower
    • Walk-in showers/tubs or curbless showers
    • Adjustable shower head or hose
    • Portable overhead ceiling lift
  • Consider products if needed, for safer and easier bathing/showering:
    • Shower bench
    • Washbasin
    • Non-slip shower/bath mats
    • No rinse bathing wipes
    • Dry shampoo

Additional Assistance

If you need additional assistance with bathing/showering due to discomfort by you or the care recipient or due to greater than physical capability, in-home care may be an option. Additionally, consulting with a physician if your care recipient has skin-related conditions or health concerns that need medical assistance or with a physical or occupational therapist may help you understand proper body mechanics and considerations.

Conclusion

With knowledge, the right tools, and communication strategies that work best for both you and your care recipient, bathing/showering can be a more efficient, safer, and easier process to be navigated with more confidence as you meet your care recipient at their level.

Sources

Bursack, C. B. (2022). What to do when a senior refuses to bathe and change their clothes. Retrieved from https://www.agingcare.com/articles/elderly-parents-who-wont-shower-or-change-clothes-133877.htm 

Callicutt, S. (2024). Tips and tricks on bathing and working with the elderly. Retrieved from https://freedomcare.com/bathing-the-elderly/ 

Edemekong, P.F., Bomgaars, D.L., Sukumaran, S., et al. Activities of Daily Living. [Updated May 2, 2022]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470404/

VA. (2023). TSGLI ADL Standard for Bathing. (n.d.). Retrieved from https://benefits.va.gov/INSURANCE/docs/TSGLI_ADL_Standard_for_Bathing.pdf 

VA. (2017). Bathing, Dressing, and Grooming with Dementia. Retrieved from https://www.dementia.cindrr.research.va.gov/caregiver_topics/activities_daily_living/bathing_dressing_grooming.asp