How to support a person with dementia to wash, bathe and shower

When washing or bathing becomes difficult, the following products and equipment can help:

• grab rails, which can be attached to the wall near the shower, bath or toilet
• inflatable hair-wash basins, to help if the person is in a wheelchair or bed
• non-slip mats for the bath or shower
• seats to go in the bath or shower if the person would prefer to sit or is unsteady on their feet
• bath boards and powered bath seats that can help a person get in and out of the bath.

The right equipment can help the person be more independent and more relaxed when they are washing, showering or bathing.

An occupational therapist can give you more information about available products. You can contact them through your local social services, the GP or a health professional.

Larger changes, such as installing a walk-in shower or wet room, might mean the person can stay independent for longer. Involve them as much as possible in decisions about any changes that need to be made to the bathroom.

Looking after skin and nails is an important part of personal hygiene. As we get older, our skin becomes thinner and drier. Dry, irritated skin may lead to discomfort.

While the person is undressed, try to check for any changes to the skin, redness or sore areas. Mention any concerns to the GP or another health professional. After showering or bathing:

• make sure the person is thoroughly dried, especially in the skin folds. This will prevent the skin from becoming chafed.
• use the towel to pat skin dry, rather than rubbing
• take the opportunity to apply moisturiser to their skin.

Support them to keep their toenails and fingernails clean and tidy. Trimming nails after a bath or shower can be easier, as nails are softer. If this isn’t possible, soak the fingers or toes in lukewarm water for a few minutes before trimming. 

This is also an opportunity to routinely check for marks or spots which might indicate a foot problem, such as calluses. You can also check for signs of fungal nail infections.

Someone with dementia may not wash their hands or brush their teeth as often as they should. Try to work out likely reasons for this. For example, if they forget, reminders above the sink might prompt them. If they are struggling with the task, talk them through washing their hands or brushing their teeth one step at a time.

Take handwashing easy and pleasurable. You could do this by asking the person to choose their favourite soap and scent. If they prefer a bar of soap, use one that is a different colour to the sink so they can easily see it. Using a moisturising hand cream after handwashing can help keep their skin in good condition.

The person may need prompting or reminding to brush their teeth. Towards the later stages, you may need to help them or do it for them. Teeth or dentures need to be cleaned twice a day to maintain oral health. 

Many people enjoy the feeling of having their hair washed and feel better when it is done. Others don’t enjoy it at all. Some people with dementia can find it distressing and confusing.

If possible, try to wash the person’s hair at least once a week.

The following tips may be helpful:

• Reduce the amount of water on the person’s face by using a handheld shower attachment or large plastic jug. You can use a hair-wash shield to help with this.
• Respect their preference for certain hair care products. This could be a particular brand, scent of conditioner or hair spray. They may also cover their hair or wear a turban. If so, ask them how they like to wear these.
• Suggest a shampoo that will not cause stinging if it gives them discomfort in their eyes. Look for shampoos that are labelled as being ‘non-stinging’, ‘tear-free’ or ‘gentle’. If possible, try to match the scent of any new products to ones they are already familiar with.
• Consider other shampoo options if needed. This can include a ‘no rinse’ shampoo that can clean the hair without using water. You could also try using a dry shampoo.
• Be aware that hairdryers can be distressing for some people with dementia. This can be due to the noise and the sensation of hot air blowing. Ask them if they prefer their hair to be towel dried instead.
• If they prefer to have their hair washed by a hairdresser, arrange regular trips to the salon or find a hairdresser who will come to the house. This may be a time when you can have your hair cut too.

In the early stages of dementia, a person may need to be reminded to shave. As their dementia progresses, it is likely they will need more help.

If they use a straight-edge or double-edge razor, they may need help much earlier than if they use a cartridge-style razor. If they begin to cut themselves with any type of razor, it’s important to supervise or help them to shave if you can.

Some razor blade manufacturers sell razors specifically for carers to use on another person. These include a built-in safety comb and specially designed handle.

If the person uses an electric shaver, they will be able to shave independently for a longer time. If they use tweezers to remove hair, an electric trimmer can remove hair much more easily.

They can continue using wax, hair removal creams and devices such as epilators for as long as they can safely do so. But they may need support. 

If using hot wax becomes too unsafe, cold wax strips can be used instead. If they usually go to a salon for hair removal, this should continue as long as they feel comfortable and are safe to do so.

Balancing independence and safety

It can be a challenge to balance the person’s independence with changes that need to be made for their comfort and safety. 

Try to support their choices as much as possible. Only make decisions yourself that help keep them safe and calm and reduce any distress for them. 

It’s important that the person cleans themselves properly after using the toilet. Using the toilet is a very private matter, so it’s best to approach this tactfully. If you realise that they need support, ask them if they would like help. 

If they prefer to do things themselves, you may need to gently remind them what they need to do.

If they need some support, the following can be helpful to consider:

• Ask them if they want you to stay outside the toilet or be in there with them in case they need help.
• Be mindful that they may prefer to use a bidet rather than toilet paper or use a preferred hand to clean themselves.
• If you are helping them, wipe from front to back (which helps to prevent infection), rather than back to front.
• Consider using moist toilet tissues, as they clean better than dry toilet paper. They are available from most chemists and supermarkets and can be useful to keep around in case the person has an accident.
• Remind them to wash their hands after they have used the toilet. If you have helped them, you could wash your hands together.

Try to talk positively and be sensitive towards the person when helping them to use the toilet. Reassure them that, despite it being a very personal activity, you are happy to help.

Incontinence

Some people with dementia may start to have problems getting to the toilet in time or controlling their bladder or bowels. If this happens, it can be a sensitive issue for both of you. 

If the person has an accident, try to support them with any embarrassment they might feel. You can do this by being calm and reassuring. A matter-of-fact approach can work well.