Teepa Snow, Dementia Expert, with Bathing Tips for Caregivers of those with Alzheimers

Why is Bathing Such a Problem ? & How to Help! TeepaSnow.com © 2010 Teepa Snow . All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA. .

Why Is Personal Hygiene a Problem?
Physical Health issues
Psychological Health Issues
Social issues
Family concerns
Regulator issues
Caregiver stress
Others…

With Dementia…
Problems with hygiene frequently are an indicator of…
A need for closer supervision and assistance needed with other ‘complex’ task completion – toileting, OTC meds, diet restrictions…
The beginning of loss of ability to organize time during a week or day – more down time
A need for more structure and guidance in how the day goes – appointments & activities

Common Issues
No sense that bathing is needed
Sense that bathing has already happened
Need for privacy
No sense that assistance is needed
Dislike of the space – size, temperature, look, echo, emotional memory, wet/slippery surfaces
Dislike of caregivers – personal or general
Fear of… falling, water, experience, cold
No understanding of what is happening

THE GOAL IS…???
Getting CLEAN – NOT –
Taking a bath
Taking a shower
Having a traumatic experience
Keeping everyone safe – NOT –
Hurting the person – physically & emotionally
Hurting the helper – physically & emotionally

SIX Pieces to the Puzzle
Personal history and preferences
Level of dementia
Other conditions & sensory losses
Environmental conditions
Care partner approach and behaviors
What happened – full day & all players

If it is A PROBLEM…
Describe the behavior – OBJECTIVELY & SPECIFICALLY!!!
WHO?
WHAT?
WHERE?
WHEN?
WHAT helps… WHAT makes it worse?
Frequency & Intensity?

BEFORE YOU EVEN START… For EACH PERSON…
Get a ‘getting clean’ history & preferences…
How have they been getting clean?
History of hygiene practices
How frequently did they get clean?
What about hair?
Where did they do get clean?
When did they get clean?
Temperature sensitivity?
Privacy issues?
Gender issues? Racial issues?

Before You Even Start…
Check on medical, physical, psychological, & sensory status and conditions
Pain - Stiffness
Mobility - Contractures
Sensation - Fear of others
Vision - Need for control
Hearing - Body fat
Balance - Circulation

Level of Dementia
Diamonds – Using OLD Routines and Habits
Emeralds – Just Get It Done & I Can Do IT! or
I already did it!
Ambers – Its Not a Task Its an EXPERIENCE – Busy hands & If I don’t like it I leave or hit
Rubies – Got to GO or Out Like a Light –
gross movement – sensitive spots
Pearls – Stuck in Glue – Immobile & Reflexive
stiff and tight – hard to get to & low weight

Uses Routines & Old Habits to function
Can complete personal care in ‘familiar place’
Follows simple prompted schedules - mostly
Misplaces things and can’t find them
‘ Resents takeover’ or bossiness
Notices other people’s mis-behavior & mistakes
Territorial – refusals!
Varies in lack of self-awareness
Level 5 - Diamond

Personal Care Issues
IADLs
Money management
Transportation - Driving
Cooking
Home maintenance & safety
Caring for someone else
Pet maintenance
Med administration
Unfamiliar settings or situations
Hospital stay
Housing change
Change in family
Change in support system
MD visits
New diagnoses
Traveling or vacations

Help?
Apologize! - “I’m SORRY!” – “I didn’t mean to…”
Friendly NOT bossy
“ Let’s try” – temporary…
Share responsibility not take over
Use as many ‘old habits’ as possible
Give up being ‘RIGHT’
Go with the FLOW
Give other ‘job’ when taking away another

Level 4 – Emerald
Limited awareness of time sensitive needs
Needs some “HELP” – not doing for or to
Wants the familiar … hard to find it
Asks a lot about “What…? Where…?”
Increasing mistakes and errors
Likes to ‘stay busy’ with familiar tasks
Fears being seen as ‘incompetent’

Personal Care Issues
Doesn’t do care routinely – thinks did
Makes mistakes in sequence – unaware
Repeats some care routines over & over
Resists or refuses help
Gets lost – can’t find where to do care
Limited awareness of ‘real needs’ –
Hunger, thirst, voiding, bathing, grooming…
Has other ‘stuff’ to do…

How to Help
Learn about “SO WHAT!”… is it worth it?
Provide ‘subtle’ supervision for care
Provide visual prompts to do
Gestures, objects, set-up, samples, show
Hide visual cues to ‘stop’/prevent
Put away, move out of range, leave
Use the environment to cue – SHOW
Use ‘normal’, humor, friendliness, support

What NOT to DO…
DO NOT point out errors – or focus on ‘wrong’
DO NOT offer – physical assist 1 st
DO NOT offer “Let me HELP you”
DO NOT try to ‘go back and fix it…
DO NOT continue arguing about ‘reality’
DO NOT treat like children…

Level 3 - Amber
LOTS of touching, handling, mouthing, manipulating
Focus on fingers and mouth
Get into things
All about sensation….
Invade space of others
Do what they like AVOID what they do NOT

How to Help
Provide step-by-step guidance & help
Give demonstration – show
Hand-under-hand guidance after a few repetitions, uses utensils (not always well)
Offer something to handle, manipulate, touch, gather
Limit talking, noise, touch, other activities
SUBSTITUTE don’t SUBTRACT

Level 2 - Ruby
Big movements – walking, rolling, rocking
Hand actions – not fingers
Tends toward movement unless ‘asleep’
Follows gross demonstration & big gestures for actions
Limited visual awareness
Major sensory changes
Major movement skill loses
Fine motor skill lost – mouth & hands

How to Help
Hand under hand
Move with first – then guide
Learn about patterns of ‘needs’
Gradual transitions - go to stop
Use music and rhythms – help get or stop movement
Use touch with care
Combine cuing & do SLOW

Level 1 - Pearl
Immobile – can’t get started
Bed or chair bound
Has more time asleep or unaware
Has many ‘primitive’ reflexes present -Startles easily
May cry out or mumble ‘constantly
Increases vocalizations with distress
Difficult to calm
Knows familiar from unfamiliar
Touch and voice make a difference in behaviors

How to Help
Hand under hand help & care
Check for reflexes – modify help and approach to match needs
Guide movements
Use calm, rhythmic movements and voice
Come in from back of extremities to clean
Stabilize with one hand and work with other

Before you start…
Flow of the Day
TIMING!!!
Routine, habit, patterns
Fit into the rest of the day
Cues and clues
What else is happening?
Time to recover…

Before you start…
Check out the Environment…
Physical
Sound
Lights
Equipment
Surfaces
Temperature
Privacy
Materials

Before You get started
Caregiver Skills
Preparation of the space
Preparation of supplies and equipment
Preparation of self
Approach
Words
Actions
Reactions
THANKS!
BACK OFF!

How can we help… better? It all starts with your approach !

Positive Physical Approach

How you talk…
How you say it…
What you say…
How you respond …

Use empathy & Go with the flow Reality Orientation Telling Lies

How you help…
Sight or Visual cues
Verbal or Auditory cues
Touch or Tactile cues

Hand-Under-Hand Assistance

Believe - People with dementia Are doing The BEST they can!

Courtesy of Life Enrichment Center, Kings Mtn “ It beats a cold creek!”

What shouldn’t we do???
Argue
Make up stuff that is NOT true
Ignore problem behaviors
Try a possible solution only once
Give up
Let them do whatever they want to
Force them to do it

So WHAT should we do??? Remember who has the healthy brain!

www.bathingwithoutabattle.unc.edu Training CD for facilities © 2010 Teepa Snow . All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA .

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Teepa Snow, Dementia Expert, with Bathing Tips for Caregivers of those with Alzheimers

by Home Instead Senior Care of Sonoma County, CA on Mar 27, 2010

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Teepa Snow, Dementia Expert, with Bathing Tips for Caregivers of those with Alzheimers — Presentation Transcript