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I know I am not a family member, but I do need some suggestions. I am a Long Term Care Ombudsman trying to find suggestions for bathing a long term care Resident who is extremely combative. The caregivers at the facility have tried everything (I've observed), but usually end up getting scratched and hit. They are at their wits end and I am trying to find something that will help them. I have done a great deal of research and given them some suggestions that seem to work for a time or two and then the Resident is right back to being combative. Any suggestions or ideas would be greatly appreciated!

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I too have seen the "storm trooper" approach and it just gets everything off to a bad start.

If the person is getting a shower in a shower room, that's cold and bleak and can make the resident feel very exposed. I think it's similar to driving a car through a car wash.

Try bed baths. Give the resident a heads up several hours ahead of time. "I'll be back around 7pm to give you a nice bed bath before you go to sleep." And do the bed bath closer to bed time when the resident is tired.

It doesn't normally take 2 people to give a bed bath but for the sake of expediency start out with 2 staff members. Keep the body covered except the area being washed. Dry the area then cover it back up.

I hope this helps.
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This is similar to a question posed frequently - the resistance of an elder to being bathed, especially in a shower or tub situation.

First, if the aides are trying to get him/her into a shower or tub, forget it. The anxiety of disrobing in front of strangers and the possibility of falling are too much to battle and traumatizes the resident.

Second, make it a pleasant experience. Skip the bathing for a few days while a few aides he/she likes get to know him/her, chatting a bit, asking nonthreatening questions.

Allow this to happen until the resident is more responsive, and looks forward to this/these aide(s) visits.

Third, when a good rapport has been established, enhance it with music, or something else the resident enjoys (the aides will have to find this out through conversations). When my father was becoming restless as he entered the dying stage, one of the SNF deacons found an all music channel on the tv; we kept it on continually.

The soft and comforting music was so soothing that it relaxed me as well. The photos were all of nature, so the combination was an excellent one to provide calm.

I made up a vase of artificial roses and ivy; my father liked red, so I chose red roses. Just looking at the vase calmed us, as well as other visitors. Flowers can be magical.

Fourth, as the resident becomes more fond of the aide, he/she can ask the resident if she can shave him (assuming it's a male), or comb her hair (if it's a female).

If there are any fragrant lotions, such as lavender, they can be applied sparingly and in nonsensitive or personal areas.

Combine this with a few visits from an Activities Director or Social Worker, asking the resident about his/her interests, family, things that also relax and begin to create familiarity and bonding.

The goal is to make the resident feel closer to the aides through nonthreatening and soothing action, so that when bathing is approached, the resident isn't frightened (unless there's something else going on.)

Fifth, I would start perhaps by washing hair or face, or shaving. If the session is proceeding well, add the arms, and perhaps legs and feet, proceeding with caution before addressing private areas. And use no rinse products, cleaning a small area, drying it, and perhaps patting some organic lotions on. Don't use perfume, the alcohol can be offensive (as it is to me, and gives me headaches).

Finish with a nice chat, maybe browsing a magazine of flowers, natural settings, children, animals...something that's also relaxing and soothing.

These little touches break down barriers. I've seen the difference and the effect. At one hospital and one SNF, the aides came in like stormtroopers, one on one side, another on another, literally trussing my father up like a chicken. I had to keep intervening.

On the other hand, at the best SNF we've been to, the treatment was so much more compassionate, slow, leisurely, engaging in conversation. He told me afterwards he had a really great bath! (It was a no rinse "bath"). The aides shaved him, even trimmed his hair then combed it into a nice style.

Let me know if this works, or if there are any other factors existent in the relationship that complicate it.
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My mother became combative when she had a urinary tract infection. Her’s were chronic so she could be combative for weeks. Still have a scar on my arm. While she was in the hospital with one, nurses came into her room in 3’s for their own safety and she eventually wound up tied to the bed rails for continually ripping out her IV’s. The Resident obviously sees bathing as an invasion of their privacy. As Seniors, (I’m assuming the Resident is one) we were all taught that strangers don’t touch your body without your express permission. Add dementia to the mix and it’s a double whammy at least. If it’s a different group of aides who come in to bathe the Resident, they don’t have the chance to get accustomed to one or two aides bathing them. Would it be possible to have the same aide bathe the Resident? Major Margaret Houlihan said once that giving a successful sponge bath is done by not letting the bathee know they’re being bathed. The whole time she was bathing the soldier she was making small talk. It’s all psychological.
Some people (myself included) just don’t like to be touched. I’d rather do it myself than have someone else do it.

Maybe the staff might tell the Resident they’ll come back when the Resident is ready to be bathed and involve the Resident in the process as well. Nice soap, gentle hands, speed and understanding might all work, too.
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