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How do you encourage and actually get your alzheimer's patient who is being extremely defiant about bathing? How effective is sponge bathing? What can we do to help move this situation in the right direction?

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I don't fight him. We have to bathe together and sometimes that is enough incentive. But I also have Aloe Vesta Cleansing Foam - Perineal Wash - it is foaming and no rinse. Does a great job.

If your patient is a Veteran, the VA will supply 1 bottle per month. This is the same No-Rinse Cleansing Foam given at the hospitals. I also get Betasept (Hibiclens generic) which is pre-surgical scrub and I mix them 50/50 for my hand-washing as it kills pretty much all germs. The VA will provide 2 bottles per month if needed. I put a few drops into the bucket with his washcloths to kill the germs.

Depending on the age of your patient - mine grew up in the depression - some of them grew up using "sink baths" and that is pretty much what you are calling sponge bathing. This is what my DH prefers to do most of the time. He does a good job of it so I don't fight with him. He keeps his nether regions clean. (hence the washrags)  The soap I leave out for him is the 50/50 mixture of Aloe Vesta Cleansing Foam and Betasept.  It gets him clean.
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My dad also responded well to having his clothes on (most of them) to start. Once he is wet, he will let me take them off. We also wrap a velcro towel around his waist for privacy which helps a lot. He likes to hold the shower head himself; I put his hand under it first. Also, he is at a stage where he shouts a lot; when I turn on his music from the '40s, hold his hand and hum or sing, he stops shouting. On hair, when he doesn't want the shower, we use a warm, wet washcloth to wet and wash his hair. Not enough to cause drips but enough to get his hair clean and good smelling.  Also used warming the bathroom A LOT beforehand and the towels warmed in the dryer.  All great tips that worked well for us.  
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Can I just say that hand sanitiser is not always quite as wonderful as we all think it is. After 4 consecutive uses (and by that I mean without washing properly) the sanitiser acts like a culture t bacteria rather than sanitising the area. There is nothing better than washing according to the medics but I do sympathise. Mum likes to soak her feet so I use that time to give her a strip wash if she is having one of those days.

That said don't get into a fight over it, you'll only lose and be more frustrated than ever. Try making sure the room is warm - that is a must - mine feels like a sauna when we are finished and I feel drained buyout hey she is clean!

Warm towels (I warm mine in the tumble drier - quicker , smells nice and get really warm too. I also have a towelling robe that I put round her while I sponge her down. I use hot water so that by the time we finish it is still warm and I wash and dry bits at a time. She is OK with hands and face usually so that isn't a problem, if it is might I suggest you use aqueous cream. Rather than tell her she is having a wash tell her the doc has recommended that you use cream to stop her skin from getting dry. OK it is a lie but I have found it useful when all else fails..... Then I lather Mum in cream and say oops i think I have put too much on mum let me sponge some of it off for you. Always soft low voice always with some soft music in the background and I usually spray lavender room spray in the room before I do anything if she is a bit grumpy - either that or coconut spray they both seem to be calming to her.

One thing I have learned is that if she is having a moment then she doesn't want me to see her more 'personal areas - shoulder to groin so I have been known to use a towel wrap - they fasten with velcro and sponge under that - she stays warm retains her dignity and everything runs a little smoother. As for her undercarriage I make sure when she has a poop that I am there with wet wipes, sponge (actually I use a disposable flannel - they are paper and look like wet wipes so I get away with it) and I wash her thoroughly as I wipe her. If she is angsty about it I say Im sorry mum I don't do this as well as you but I just need to make sure you're clean down there(as I wash it again rinse it again and cream it) Adding for good measure Im going to put some cream on so you don't get sore hun OK? and I get right on with it before she has chance to say NO.

OK I wouldn't pass the carers tests but I am a caregiver not a carer AND IT WORKS FOR ME. Remember that people you may have to lie now and again to get the end result but IMHO? A little lie now and again is worth it for a clean person.

I always rip Mums depends off and I also rip a little at the side of them for a snugger fit - that way to is easy to say oops I ripped a little too far there. It might help if you use a pad inside the depends and just remove and replace that - saves a heap of money and if you want you can apply a swathe of cream to the pad so you know it reaches the right area (I would only do this once a day though usually straight after a wash)

Hope some of those ideas help. In hospital they never fight bathing they do however use the wipes and I have known them use them for certainly 2 weeks.

Just light on the sanitisers especially for you. And remember if you wash your hands with soap and water wash them for at least 25 seconds - sanitisers and soaps both need that type of time to work so it isn't any quicker to use one over the other.
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There is a cool feature here that I noticed. It is the "Search Site" bar in the upper right corner of the page. I typed Bathing, and go a ton of results.

Also, Look for videos online by Teepa Snow. She is sort of a dementia whisperer. She uses kindness and getting inside the person's head to avoid resistance in the first place.
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mmonteros: Many thanks for your suggestions. I will certainly try some of them. I really do appreciate your taking the time to address my issues.

Georgia
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We have had similar experiences with my father who doesn't see the point of his shower and doesn't smell it when he poops! The solutions have been calm conversation, encouraging him to help us, ordering the pants that zip down the sides (making undressing less shocking), wrapping his waist in a towel (he is very modest), covering him with a pancho we fashioned from an oversized towel, sometimes letting him enter the shower clothed (then he wants to take the wet clothes off), also a long bench to make entering the shower/bath easier, letting him hold the shower head, warming up the bathroom before we even start....Hope some of this helps.
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Many thanks for the tips. I certainly will use some of them. I am grateful for this site. My brother is 90. He will not get in the shower. He sponge bathes to his waist everyday. When I ask if he wants a shower or bath. He vehemently says "No." He is very strong physically. Thanks much. Georgia
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Thank you pam, we do have a script for a sedative, will fill it. Tomorrow is my first day of full time care.Mom is a real fighter so good suggestion . Habd sanitizer is now on my list and dry shampoo...imposible to was her hair. I was thinking of music also .thought i read an article somewhere for alzh.patients. mom doesnt know me anymore so thats a tuff one to swallow.
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You start by giving them an anti-anxiety med one hour before bath time. You sit them in a shower chair, robe and panties still on and wash the feet, then the arms, talking softly to distract them, giving them a washcloth or hand towel. As the clothing gets wet, they will want to take it off. Have another warm robe ready.
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I will be taking care of my 95 yr.old mother starting Friday due to incompetent care..who says im competent or qualified lol but this is my mom and I will do my best. I will be checking in on this site for any and all advice I can get. I also have a 93 yr. old father in the home . My moms alizhiemers is quite advanced and we lack the funds for placement.She is afraid of water so bathing is an issue. More advice on that would be appreciated.
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IN answer to the questions of how to bathe a stubborn dementia love one, patients, prayer, keeping one self a breast of new ideas, and having a outlet. There will be good days and bad days. I like the idea of keeping hand sanitizer close by. It helps me tosometimes remember they dont have to live up to my cleaning standards.
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dang nsjmk77,
you sound like quite the thinker. i can imagine a less strategic person having a losing battle with such a patient. about anyone can lead a horse to water but have ya ever tried drowning one? thats where it gets complicated..
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I have a problem with Mom taking a bath. She has been living with me now for 9 months. She will not take a shower, didn't at her house and I don't even try at mine. I help her with a sponge bath. She HATES it and argues with me all the time. It is the last shred of dignity she still remembers. We have gone as long as 12 days between baths and she is in the same clothes 24/7. She never puts on a nightgown anymore, it is easier to just stay in the same clothes. The gerontologist gave her an anti-anxiety med but it doesn't really help. I am titrating it because she is a zombie on it and still doesn't like the bath. I have to try and get her when she is in the bathroom already and has had a messy Depends and I am better able to get her to cooperate. It is a constant battle. I have had to withhold things she likes, like going for a car ride before she will finally let me do it. She is able to walk but has severe arthritis in her knee so it is painful to change clothes. I just try to help her and make it a "no biggy". We are a work in progress, I have succeeded three weeks in a row so far. She won't change her Depends when they are wet and I have to force her to because they stink. I have had to resort to tearing them when she is on the toilet so she cannot pull them back up. She put clean ones on over dirty ones and I had to tear the dirty ones and pull them off. Now she has started taking off the messy dirty ones and sometimes not putting any back on so I have to count the ones I leave out and the ones that go in the trash or the hamper so I know if she is wearing any, otherwise the laundry and cleaning really adds up. When I do get her to bathe or help her change I try to do a good skin assessment; so far no breakdaown but it is a big fear of mine. She also does not like to wash her hands after using the bathroom so if I am right there I insist or I use hand sanitizer before meals or before we go anywhere because she likes to touch people and shake hands and pat children. It is an ongoing battle to keep her clean.
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Is it ok to use the hospital type pre-packaged bathing no rinse bathing towels that you can warm up in the micro-wave, on a daily basis instead of insisting on a shower for the patient. My mother will soon be 92 years old and doesn't like to take a shower. She is ambulatory but has 3rd stage dementia. She says she doesn't smell any order and that is because she has lost her ability to smell anything. Or she will say she has already taken care of her personal hygiene. She lives in a care facility but won't let any of the providers help her do anything, but my sister who lives close by goes in daily to see that she is cleaned and lotion is put on her skin daily. But she still gives my sister a hard time about bathing so she has to do the sponge bath thing, allowing my mom privacy to clean her private areas. What is the best way to handle this.
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Mom has no bladder control so she wakes soaked and smelly. I direct her to the bathroom and stand in the doorway so she cannot "escape". I verbally ask her to take her "night pants" off and put them in the trash(she usually throws them in the toilet and I quickly retrieve them for the covered trash can) I ask her to take her nightie off and hand it to me. I ask her to get in the walk-in handicapped shower. Sometimes she will go right in...other times not...I stand at the doorway and tell her we need to get fresh so we can have breakfast, go outside, see our friends, etc....anything that might interest her. I have stayed at the door up to 25 minutes one day! Patience is required as her language center is not working well nor is her understanding. We get it done first thing in the morning(not early for us)...as we've done it everyday for 5 months she is easier to encourage...before her husband passed away, she was not incontinent and was only showering 1 or 2 times a week and was terrified of the water. Now she enjoys the warmth and me giving her a good wash down! God bless each moment you give to your Hubby!
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I have full empathy and praise for the wonderful careers who not only provide care but are often left on their own to cope with a loved one suffering from dementia .I am not sure what the answer will be as it is different for different people but explaining before doing anything is very important , being gentle , not rushing communicating slowly and clearly and trying to make it a happy experience rather than a struggle is also important , have a favourite song on while attending to his personal needs don't get stressed out even with dementia he can sense it more importantly take care of yourself .Hope this helps.
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I WISH I KNEW. MY HUBBY GRIPS HIS PANTS AND DEPEND WHEN I TRY TO TAKE THEM OFF AND HE CANT DO IT HIMSELF. HE IS STILL VERY STRONG SO I SURE DONT FIGHT WITH HIM. I DO KEEP HIM CLEAN AND BRUSH HIS TEETH EVEN THOUGH HE DONT WANT TO OPEN HIS MOUTH FOR ME.
BY THE TIME HE IS BATHED AND DRESSED I AM READY FOR A LONG NAP...WHICH DOES NOT HAPPEN. I TRY TO TAKE IT ONE DAY AT A TIME.
GOD BLESS YOU.
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