What to Do When a Senior Refuses to Bathe and Change Their Clothes

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The issue of elders who were once reasonably clean adults refusing to take showers and wear fresh clothes is one that is far more common than most people think. To remedy this often-malodorous situation, it is crucial to first understand why a loved one is not bathing and/or changing their clothes regularly. There are many possible culprits and often several of them combine to form the perfect unhygienic storm. Getting to the root of their avoidance is the best way to devise a successful strategy for cleaning up their act.

Why Seniors “Let Themselves Go”

Depression

If a loved one who used to wear makeup, bathe regularly, or refuse to don a wrinkled shirt suddenly stops taking care of themselves, it’s wise to rule out depression first. A simple checkup with a doctor is a good idea, especially if low energy seems to be part of this change in behavior or they just don’t seem to be interested in much of anything anymore. Depression isn’t always obvious to an observer, especially in seniors, so be aware of the warning signs to look out for.

Control

As people age, they lose more and more control over their lives. One thing that seniors tend to keep a tight grip on for as long as possible is their own personal hygiene. Caregivers and family members can nag all they want, but the more you pester them, the more they resist. They may react with a remark like, “This younger generation is trying to take over everything. Well, they aren’t telling me when to shower, that’s for sure!”

Dulling Senses

Your nose may easily pick up on the odors of urine, old sweat and feces, but our elders may not even notice these stomach-turning scents. They are especially “nose blind” to their own smell and that of their home. This is because their senses are not as acute as they once were. With the aging process comes a weakening of the senses, especially one’s sense of smell. Many seniors begin showering and changing less frequently because it is harder for them to notice the tell-tale scent of body odor or the stains on their clothing that indicate it’s time for a wash-up and a load of laundry.

Boredom

Sadly, for many seniors, their days aren’t marked with tons of activities as they were when they were younger. If there isn’t something special about Wednesday, well, it might as well be Tuesday or Thursday. It can be easy to simply lose track of time and not realize how long it’s been since they showered. (This can be compounded by actual memory loss, but more about that in a moment.) Furthermore, if there isn’t company coming over or an outing coming up, then what’s the point of exerting the energy to get all gussied up and just sit around the house?

Fear and Discomfort

The bathroom can be a scary place for many seniors. After all, it is entirely composed of slick, hard and often monochromatic surfaces—the perfect setting for a fall. Taking a shower or a bath was once a regular part of their routine that they didn’t think twice about. But now, this basic act carries significant risks. The possibility of a bruised ego, a broken hip, or even a permanent change in mobility is enough to deter anyone from stepping into the tub.

Discomfort is another very common culprit. Seniors get cold much more easily. They may tire out quickly and lose the sense of balance and range of motion they once had. If someone must help them bathe, there is a loss of dignity involved. Joint pain and lower energy levels can make doing laundry and changing clothes a real hassle.

Cognitive Impairment

Poor personal hygiene is an incredibly common symptom of Alzheimer’s disease and other types of dementia. Getting a resistant elder with all their faculties to bathe is difficult enough, but when dementia is part of the equation, it can seem downright impossible. Conditions that cause cognitive impairment are often accompanied by depression, difficult behavioral changes, sensitivity to stimuli and an inability to keep track of time. When these things combine, it can cause a loved one to refuse to bathe or mistakenly think that they have already bathed for days, weeks or months on end.

Fear and discomfort are often magnified by dementia as well. A loved one may not understand why there is water running on them or become afraid of it. They may hallucinate that the shower drain will suck them down. When it comes to bathing, dementia patients just don’t understand what you are trying to “do to them.” It can be a traumatic experience.

Furthermore, we take daily bathing for granted in this country, but when our elders were growing up, a weekly bath was likely the norm. Your loved one probably adopted more frequent bathing habits as they grew in popularity, but damage to their brain may cause old habits to reemerge. A weekly shower may sound like a godsend for some caregivers, but it’s difficult for dementia patients to actually stick to this schedule when they cannot recall when their last bath day was.

A Caregiver’s Experience with Personal Hygiene Issues

When my mother-in-law was still living independently in her apartment, she began forgetting to bathe and change her clothes. She would look me in the eye and say she had, because she truly believed she had. Some of this was due to her memory issues. She thought she must have taken a bath at some point, so she said she did. However, I believe fear was a contributor as well.

Finding a workable solution to this problem proved difficult. My mother-in-law was an exceptionally modest woman, even for her generation. I knew that she didn’t want a family member helping her take a bath; It was far too intimate. So, we decided to hire a professional caregiver through an in-home care company to come to her apartment and give her a bath on a regular basis.

On the first bath visit, she reluctantly let “the girl” give her a shower. To help ease her mind, I stayed in the apartment but waited in another room. On the second bath visit, a different caregiver showed up and my mother-in-law refused to let this woman in the house. She slammed the door and that was that. From there, bath visits were touch and go. Some days she would concede and others she would flat out refuse.

Her apprehension is completely understandable. I wouldn’t want a stranger coming to my home to bathe me, especially if it is a new person each time. But caregivers need to do something to help their loved ones maintain their personal hygiene. The health implications of not doing so can be great. Urinary tract infections and nasty skin conditions can present serious setbacks for an aging loved one.

How to Convince a Loved One to Bathe and Wear Fresh Clothing

There are many different approaches you can try once you’ve figured out why a loved one isn’t taking proper care of themselves. It can take some trial and error to find what works best for you both, but it is crucial to put in the time and effort.

Use Their Doctor as a Resource

In some cases, a loved one’s doctor can be a powerful ally. For example, a doctor can help determine if depression is a factor and whether antidepressants may lift their spirits and give them more energy, thereby helping to resolve the self-care issue. A renewed interest in life may make a senior more aware of needing (or wanting) a shower or bath and clean clothes. Medical professionals can also rule out other factors that may be affecting their ability and/or willingness to care for themselves and recommend next steps. Keep in mind that our elders often place doctors on a pedestal and may take their “official” recommendations more seriously than our pleading and nagging.

Overcoming the Power Struggle

If you find yourself in a power struggle with an elder who refuses to be “bossed around,” a little well-intended trickery can come in handy. See if you can get a close friend to call and extend an invitation out to lunch or some other gathering that requires a bit of primping. A reason to get cleaned up for someone besides family can sometimes do the trick. Bribery may seem childish, but the promise of a special treat, such as dinner at their favorite restaurant on their weekly bath day, can also be a powerful motivator.

Use the Right Equipment to Maximize Comfort

Specially designed bath aids and products can be a game changer as well. For example, if you can still get a loved one in the shower, but they aren’t steady on their feet or tire easily, there are many types of shower chairs available. This is a wise choice for anyone who is getting older, because it can significantly decrease the risk of falling. A hand-held shower head can be useful for bathing a loved one who is afraid of or overwhelmed by water. It allows them (or a helper) to direct the stream only where they want it and when. Grab bars are another must-have for those who are afraid of falling. Simply having extra points of support can help a senior navigate getting into and out of the shower safely and confidently.

Read: Bathing & Hygiene Top Tips: Promoting Comfort and Cooperation

Framing Is Important

The way you talk about and approach bathing and changing clothing can be very influential. If your loved one requires help in the shower and once enjoyed getting pampered, try referring to bath days as “spa days.” Use a scented body wash and their favorite lotion afterwards to help them focus on the enjoyable aspects and how good they feel afterwards rather than the process itself.

Be gentle when pointing out body odor or soiled clothing. In some cases, a senior simply may not notice and is likely to be embarrassed once it’s brought to their attention. If indifference is the issue, keep in mind that too much nagging is still counterproductive. Caregivers are often beyond frustrated by their loved ones’ apathy regarding their own appearance, but try not to let it show.

While it may not be successful for everyone, positive reinforcement can be helpful. On the rare occasions that you can get them to take a cat bath or put on a fresh shirt, lay on the compliments. Tell them how good they smell and how polished they look. Most elders love getting attention. Again, it may seem elementary, but rewarding their behavior is very important.

Tread Softly with Loved Ones Who Have Dementia

Dementia care is unlike any other kind of caregiving, and beyond that, it is unique to each family. Some patients merely require reminders and prompting when it comes to bathing and dressing, but others may become agitated or combative at the mere mention of a shower. Furthermore, one never knows when a new behavior or fear may develop or go away. The key is to proceed slowly and gently and schedule difficult tasks at the time of day when your loved one is most cooperative.

Don’t insist on a full shower/bath and outfit change all at once. Breaking a task down into smaller pieces over a longer period can make it easier on both of you. Begin with just asking to wipe off your loved one’s face. If they are receptive, gradually move to cleaning their under arms and other parts of the body, all while talking to them and telling them what you are doing as you go. Be soothing. If they fight it or say stop, then stop. You can always try again later. These little victories can function as a stopgap between full baths or showers.

Bring in a Third Party to Help

While hiring a professional to come in and help my mother-in-law bathe wasn’t totally successful, for many families, these bathing visits are a blessing. Most seniors are wholly opposed to the idea at first, but for some, having a stranger assist them is less embarrassing than having a son or daughter do it. Furthermore, in-home caregivers are trained to help people of all physical and cognitive abilities. They know how to knock a shower or bath out quickly, thoroughly and respectfully, all while taking a client’s comfort into consideration. It’s true that some home care companies are better than others about consistently sending the same aides, which is why it is important to do your research before hiring.

Read: How to Select a Home Care Company

Consider Long-Term Care Options

Eventually my mother-in-law’s condition worsened, and she began forgetting about other care needs in addition to bathing. The family saw to her care as best as we could, but the truth was that she could no longer live independently. We were fortunate to find an opening at a nearby nursing home, and she adapted very well. My mother-in-law grew comfortable with the staff and her new routine and bathing was never a problem again.

At some point, many caregivers must face the fact that their loved one is not going to regain their physical or mental abilities. It may become dangerous for them to continue living independently, or it may be unrealistic to think that one or even two people can meet their increasing care needs. Placement in an assisted living facility, memory care unit or nursing home is a difficult move to make, but many seniors thrive in these environments. Just as a loved one may be more compliant with their doctor or a professional caregiver compared to a family member, staff at a senior living facility may be more successful when it comes to encouraging proper hygiene, getting them to eat, administering medications without hassle, etc.

Compromise Is Key

The hygiene issue is one of many instances in caregiving where compromise is essential. The thing to remember about cleanliness is that you may have to lower your standards. It’s a difficult and undesirable adjustment, especially if you and your loved one live together.

Caregiving and aging are not glamorous, and there are some changes, such as incontinence, that both parties must simply learn to deal with as best as they can. Do not expect or insist on a pristine appearance. It’s often not realistic and will only lead to more frustration and tension between you. It can be embarrassing to take a loved one to a doctor’s appointment or on an outing looking disheveled and smelling dirty, but do your best to encourage and help your loved one look nice and stay clean. If your current approach isn’t working, then it’s time to consider trying something new.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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182 Comments

Wow this has been a great concern of mine. I would try to have 'beauty parlor' day from head to toe! I tried to prepare her ahead of time, to no avail. The only success would be if she had an appointment to go to. Months would go by.

She will walk around the house, going inside and out, as if she is on a mission, which she is, avoiding the bath.

Once it begins to get dark, I know that the bath is not going to happen at night. She gets sun~downers, at times.

These five months, in which I have been sole caregiver to my mom, I have learned much, I see her eyes cloud over and she is so far away. I will say, hey momma, where'd ya go? She would turn and laugh and just say, somewhere.

When we do accomplish the beauty parlor day, she is voices with passion, how much she appreciates it, and then she will apologize and it is then that I feel her humiliation, to which she is fighting, but it is still apparent. I tell her how much I appreciated all the times she bathe me and washing and setting my hair, so turn about fare play! She gives me that beautiful smile and says, I love you.

This article confirmed my thoughts about this topic and with this I can know more about approaching this task. Thank you for sharing.
People with Dementia often have depth perception and vision changes and often there is a lot of white and soft colors in the bathroom and folks can't tell where the edges of tubs, showers or toilets are! A simple technique is to outline the tub, shower lip or toilet with black or blue masking tape so that a person can see where they are going!
One thing that is probably true for all elderly is they don't like to bathe because they get cold. On top of being cold, it may be very painful to move all those extremities. If they already are compromised and weak, with lung disease, or heart disease, they get so short of breath they become very uncomfortable. One way to be successful in bathing is to try to do different parts of the task everyday. One day, its just a nice foot soak, an maybe the lower part of their legs, and apply lotion, another day, soak the the hands, clean the nails, clip the nails, and wash their arms. One day just wash their back, and give them a nice back rub. For daily cleansing, see if they will let you wash their privates when they are already sitting on the toilet. Have some warm soapy water ready to pour and a few washcloths. Washing the face, try to give them a nice warm wash cloth so it feels good to the touch. Don't push at them because it just becomes a war time and in all honesty they really are't that dirty, nor are they really sweating up a storm. Put on their favorite music if you can , and try to have a good time.