Alzheimer’s and the Shower

The dreaded shower it is a problem for the majority of Alzheimer's caregivers. Often a big problem.
By Bob DeMarco

Sometimes I decide to write an article because it seems to me the issue is very broad and we can all benefit from a discussion of the topic.

This happened in February 2010. I wrote about the "shower". After writing that article I really started working hard on the shower. As a result, I can now say that the shower is rarely a problem. I successfully incorporated the shower into our day in a way that makes it happen - with ease of effort.

Now I know some of you are going to laugh. I believe the Alzheimer's patient should take a shower every day. I think if you do it every day it is easier. In other words, it becomes part of the routine of the day, a habit. I can visualize many of you thinking, “This guy is nuts.”

I know that many of you think once or twice a week is good enough. Well, I don't disagree with you. However, I believe it could be harder to get an Alzheimer's patient to take a shower every once in a while, than it is to get them to take one "like clockwork".
Another issue that comes up is me, the man, giving my mother a shower. It is not a problem for me. You just have to think of your mother as some kind of giant baby. It works.

Dotty gets a least five showers a week. Sometimes she is not feeling well and on those days I let her "slide". Almost every single day my mother will resist when it comes time to take a shower. When she occasionally says something other than NO, I look to the heavens as if it is a reward.

Here are some shower guidelines:

1. Provide constant positive reinforcement. Talk about how great it feels.  I always reinforce how great it feels to be nice and clean. This might be around 8 or 9 in the morning. This is how I start to set the stage for what is coming later in the day -- Dotty's shower.

2.  Establish a consistent pattern. I am convinced that trying to do the same thing, at the same time, every day is very helpful in Alzheimer's care giving.

3.  Try and make sure the person is in some bright light before and during the period directly before her shower. It helps if it is sunny outside. Bright like affects my mother's overall behavior. Of this I am certain. Bright light, bright mom.

4.  Choose the best time for the person.  My mother usually gets her shower around 3 - 4 in the afternoon. I gave up trying to do it in the morning. Why? Because it was easier for me to establish the "morning pattern" and then slot the shower into the late afternoon.

5. Ease into it.  Right before shower time, I start talking to my mother. About the weather, or what is going on in the world, or whatever could be on my mind at the time. Communication and dialog. I don't sneak up on her and tell her she needs a shower, or has to take a shower.

6.  Expect NO.  No matter what, when I say time to take a shower mom almost always says the same thing. NO. Of course there are variations on this theme. I don't need a shower. I already took a shower.

KEEP IT SIMPLE.  Here is one simple way to get someone suffering from Alzheimer's to take a shower.  Let's call this Pavlov's dog and the shower.

I start out like this. “Mom it’s time to take a shower”. Sometimes I sit down and pat her hand after she says no, and discuss the merits of being clean.

How wonderful it is going to feel, how great she is going to look

Then I fire in the zinger. Okay mom let’s 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 get mom up for the shower, I hold her hand and walk her toward the bathroom. We get her watch off.

I think you might be surprised to learn this. Turn on the shower while the person is still dressed.  Help her undress. Lay out all her clothes. If she needs little assistance, like my mom, I close the bathroom door, but I leave a crack so I can peak in.

I check in on her a couple times and assist if needed.

When my mother comes out of the shower, I usually help her dry her back and feet.  If needed, I assist with dressing.

Like so many folks with Alzheimer’s, my mom is afraid of water.

Mom won't stand directly under the water when she gets in the shower. I have the showerhead set so there is just enough room for her to squeeze in the side.  I think water is invisible to Alzheimer's patients. This might be why it is so disconcerting. I know water makes my mother feel dizzy. If possible a hand held showerhead works wonders.  It gives the person more control and is much less scary.

No doubt water disturbs many people that suffer from Alzheimer's.

So my advice. Don't get bent out of shape about the simple fact that your loved one doesn't want to take a shower or bath. Accept it. Try and learn how to laugh about it.

Try to come up with a way to positively reinforce the bath experience. Try the snack approach. Or, include something the person likes to do as an end game. I bet ice cream or chocolate works. Here is the model. Shower leads to snack. Shower leads to ice cream. Shower leads to [you fill in the blank.] The shower should lead to something. Something that is wanted. Something pleasing.

Did you ever consider that if you get uptight you are making them uptight. Make it fun. When they stiffen up about taking the bath or shower, turn the conversation into something that loosens them up. Hold their hand. You will feel the tightness go out of them. Then proceed.

In Alzheimer's World NO is the most common word in the dictionary. But, NO does not always mean no. It might mean, I don't like that so you have to convince me slowly that is it s good thing. I can be convinced something is good when a person is smiling at me.

Cleanliness is next to Godliness. Makes sense doesn't it? Allow the spirit within you to be your guide.

Don't worry, you can do it. Be patient. Start looking forward to the day when you can laugh about it. ■

It should be any time now.

Bob DeMarco is the Founder of the Alzheimer's Reading Room and was an Alzheimer's caregiver for his mother Dotty for 8 years. Dotty died in May 2012. Sympathy emails from those of us all over the world who felt like we knew Dotty too, caused Bob’s Alzheimer’s website to crash for days.

Bob lives in Delray Beach, FL.