Walk-in shower or walk-in tub for elderly with dementia?

I didn't individually mark any of the newer posts as "helpful" but I did read every single one and to all of you who answered my shower v. tub question: thank you! Shower it is! Your explanations really helped me see why this is the best option. And I so appreciate all the other showering tips you all provided. Thanks again. <3

I would search out a memory care facility who has the right license where your MIL can age in place. Different licenses allow these places to provide more care without your loved one having to go into a nursing home. Hospice can be a big help if she is at your home or in memory care. All Hospice care will be covered under her insurance. She does not have to be on her death bed to use Hospice. Talk her primary care physician about Hospice as it’s best if they do the referral.

My mom is 88 with severe dementia and its in her best interest to be in a memory care facility with professionals around her.

Hope this helps

CountryMouse & Grandma1954 are beyond spot on!

I’ll vote for a shower to be done and you have them build one that is totally walk in for 2. As far as design, look at ADA compliant gym individual showers for ideas. These tend to rectangular with 1 of the long walls being only a 2/3 wall and lower height with the other 1/3 open with a channel (like a French drain) all around at the bottom to capture water from going out. Walls will have 2 sets of grabs bars at different heights on each side and the floor is somewhat raked (like that done for ballet) to the far wall. 2 shower heads w 1 with a moveable arm/head.

Mom gets an adjustable Geri shower chair, these are heavy plastic open design and slunk down in the molded seat so she can’t slip out or shift forward. Some have grab bars atop the arm rests which if she still has upper body strength she can help you help her to get in or lift and get out. To bathe, You get her undressed and transferred into the Geri chair and wheel her into the shower. Makes bathing, hair washing, way way easier. Drape a big towel over the chair after shower over so she stays warm & seated while move her into the regular part of the bathroom and you dry her off and put on shoes, etc.

My moms NH had a big shower set up like this and it was amazing to watch the aides in action give mom a shower. The bathing room was heated too. Another plus with a Geri bathing chair is they can be cleaned and sanitized.

I believe a 'walk-in tub' would be for therapeutic reasons only - not for hygiene. We have
a walk-shower (no curb) with a bench seat and we use a commode in there. Just this morning my husband managed to have a 's*&t storm' - much easier to deal with in a shower and the commode. I still had a santitize the shower but having had feces all over the shower, we found that sitting on the commode (with bucket when episodes are iminent) was a much safer option. We have decided the commode is also more stable than the shower chair - so we have him use the commode as a shower chair also.

Now, on the other hand, my husband does wish to sit and soak at times for therpeutic reasons. So we are entertaining putting a walk-in tub (somewhere - haven't figured out that part yet) But the shower stays.

It isn't messy and uncomfortable to help a person have a shower, not at all - just make sure you have a shower commode - i.e. a waterproof one so that you can literally wheel her into position - and a shower with a head that you can take off the wall and use to rinse her thoroughly. If you go for the bath you'll have much bigger problems with moving and handling as her mobility declines.

As you're having a whole new bathroom put in I can give you my personal wish list!

GOOD HEATING. A decent sized towel rail that also gets the room properly warm. Put it on the wall away from the shower so it doesn't get wet, but within reach so you don't need three hands or extendable arms to grab a towel when she gets shampoo in her eyes.
Non-slip flooring which must be easy to clean and dry and pleasant under foot - there are plenty on the market, but consider how you're going to maintain it and also how it will feel on her toes when they're bare and wet.
Looking at the shower wall - somewhere to put soap, shampoo, brushes and sponge when in use, such as a built in ledge. No grouting or tiling, avoid anything that can gather sludge, hair or mould.
Other walls - shelf storage and a bin. Otherwise the basin and shower will soon be cluttered with denture pots, toiletries, creams, boxes and goodness knows what, and plastic bottles are much more breakable when they drop on the floor than you'd think.
Good lighting. You need to be able to check skin integrity without having to bend down and peer at bits of her.
Good ventilation. Especially if either of you wears glasses.
Give serious thought to a bidet function on the toilet. Worth every penny both in terms of labour-saving and quality of outcome - they wash and dry a person's undercarriage really well without her getting upset or anyone else having to lift a finger (except to press Start).
No sharp corners. On *anything.*
No designer gadgets. A mixer tap (faucet, I mean, do I?) on the handbasin is a good idea but avoid space-age aesthetics or hidden controls. Hot should say Hot, Cold should say Cold, you shouldn't need a master's degree to let the water out.
Please make sure the handbasin is tall and deep enough to get a bedpan and/or the bucket from a commode under the tap (unless you have a separate sluice somewhere, not many family houses have) - not for emptying, obviously, but for 3 x filling to rinse, disinfecting, 1 x filling to remove disinfectant. The contents go down the lavatory pan, of course, but if you can't get the pan or bucket under the tap to fill it it's extremely irritating. I get very sick of dainty little dolly's handbasins that some numpty designer thinks anyone can actually wash anything at.

As MIL is currently able to stand and walk with support, it would be good to encourage that by having grab rails so that she can engage fully in showering herself and stand safely - but you are now in the realms of OT assessment and recommendations. Which it would be sensible to get anyway.

If you are redoing a bathroom..
I would opt for a walk in shower with NO threshold. Also called a zero entrance shower.
the reason for this is it will be easier to roll a shower wheelchair in if and when she needs it.
It will be easy to walk in with a walker.
If necessary it will be easier to get equipment in like a Sit to Stand or a Hoyer Lift.
The bathroom that I have in the house that is "handicap accessible" is large enough to get a wheelchair into as well as being able to turn it around so you can place it over the toilet. (shower wheelchair has an open bottom so that it can be placed over the toilet rather than emptying a basin that can also be slid into place.) 2 people can comfortably bathe and care for a person in the room and have space to do what needs to be done.
Place grab bars wherever you can think that she might need them.
There are companies that will come in and assess the room and give recommendations on how to make it safe and functional.
And if possible an ADA height toilet with an elongated bowl rather than a round one.

My solution for bathing a 97 yr old mobile impaired who with effort can transfer herself from bed to wheelchair was to finally keep our bathtub as is.

I purchased a Carousel Sliding Transfer Bench with Swivel Seat by Platinum Health, plus with a 32-inch Horizontal Extended Rails.  Also, have safety rails on all three sides of the bathtub.

Turn on the bathroom ceiling heater. If you don’t have a ceiling heater use a plug in heater in a safe location.

Wheelchair her into the bathroom. She transfer to the sliding seat on the outside of the tub.  Once in the seat, I slide her into the center of the tub.

Control the hand-held shower water stream to low and soft to avoid frightening her. Also, with the control hand-held shower I control the direction the water flows. Use the shower curtains for front and for back to avoid getting drenched.  

She uses the safety rails to raise herself so the most odor parts get washed. The ceiling heat keeps the room warm, no problem.

With the ceiling heat on, I sweat, but that’s okay, the job gets done.

My dad had friends who put in walk in tubs and all quickly grew to hate them. They had to sit and wait for the tub to fill, cold and unclothed. After the bath, the reverse was true, sitting there wet and cold waiting for the tub to drain. We put in a walk in shower for my dad, he had great success with it, there was a seat and no wait for warm water or for getting out

I agree it can be messy and uncomfortable at times to assist in a shower but not too much once you get the hang of it, IMO. If she's in memory care and needs that level of assistance, I don't see much difference between assisting in a shower that's "tricked out" for her or assisting in a walk-in tub.

Either way, I think a handheld extension and multiple support rails -- and a heated floor if the expense is no object -- would help make her safer and more comfortable in either case.

My grandmother liked a small amount of warm water in the bottom, or in a basin, to keep her feet warm. I think she would have liked a walk-in tub but she was also fearful of things, so not sure how she'd feel sitting in water up to her chest. Can you try out a walk-in tub with your mom?

Walk-in tubs take forever to fill and to empty. It would probably be easier and less expensive to get a chair in the shower and a bidet attachment to the toilet for her hygiene needs.

silvie: I would opt for whatever product makes her the most comfortable, knowing that this plan may indeed be a temporary one. You deserve much credit for the plan of bringing your mother into your home for care by you.

Shower all the way.

We remodeled the bathroom in my parents' house from a 9-year-old tub to a large shower with a handheld sprayer. We also put in a bathtub faucet about a foot above the floor so it could be used to wash feet or fill a bucket easily if needed. There was plenty of room for a walker and a shower chair to get in there, and honestly, I wouldn't have been a wet mess if I'd had to get in to help my mom shower. It would have been much easier to clean her "bits" than trying to lean over a walk-in tub.

Unfortunately, my dad died and my mother was in a nursing home before we were ever able to use that shower. We went from beginning the remodel, to my previously-healthy dad dying, to my mom having to go into a nursing home all in a span of six months, so know that things can change very, very quickly. Your mom has already been in a nursing home, so know that most of us see this plan of yours as probably not really feasible for any period of time. I do wish you luck, though.

Three years later, it sits there unused, but it's an asset to that house and not an obvious handicapped bathroom, so we'll do fine when we sell the house this spring.

You speak of a nursing home and your home. Please, please, do NOT bring her home. She may be fine right now but she is old wi th problems and odds are she will get worse and need more help and have more behavioral and personality issues. Don't be a fool. Put her into a nursing home before she damages you. But if you insist, I say the chair in the shower.

My wife and I spent the last ten years of her life coping with Alzheimers Disease. I wonder if the memory care facility can't help her anymore then maybe she might be eligible for hospice. When my wife could no longer eat without help, dress herself, walk without help, go to the bathroom by herself, bathe her self, converse with other people then she became eligible for hospice. She stayed in our home right up to the last day of her life. This is what we wanted. Hospice nurses came to our home twice a week to bathe her. When she could sit on a shower stool they bathed her that way. When she could no longer get out of bed they bathed her in the bed. They did an excellent job. My wife was comfortable every time. They did not make a mess and my wife got her hair washed each time. She was clean and pretty. I loved how they took care of her. Maybe it is that time for your loved one.

Have you considered a bath lift with a handheld shower head? The lift rises to the level of the edge of the tub, the flaps 'fall out' to create a surface to slide out into the seat. The hand controls for the lift are rechargeable and the lift seat reclines as it lowers. The shower head can mount up in the normal place of a shower head, but removes easily to be used across the tub for washing. Falls are out of the question this way (except once out of the tub), and it makes bathing and washing of hair very easy. [NOTE] prices vary on units - the one we wanted was around $900, but my mother (just passed on Saturday) would not make up her mind. I finally went back online to buy it, and the price jumped up to high $4000 range and would have been almost $5000 with tax! The home health care nurse said this happens now and then, just wait and watch the price. I wound up getting it for only $600, delivered, when it dropped again! Also, watch the lift weight; there were some that looked identical until you read the fine print and the 'cheaper' one would not lift but half the weight of better models.

Get the shower.

Imagine the walk-in bathtub filled with water and the patient poops in it. Not firm poop that stays together due to roughage and fiber in the diet. No, runny poop like a baby. The bathtub water turns yellow and the dissolved poop is all over her body. YUCK!

In the shower the poop goes to the floor and the patient remains clean.

My dad would poop in the shower all the time (he was incontinent). A bathtub would have been disgusting.

Look for a contractor that is “Certified Aging in Place” Specialist. (CAP). They have the expertise to help you create a design that will be most convenient and safe for both of you.

If cost is not a determining factor, I would do a bathtub and a shower. While she is able to walk, she is going to get cleaner in all the important spots if she can get all the way into the water with the jets moving water around. She will be warm in the water as she bathes. If you happen to have her in the home even after she can no longer walk, then rolling her into the shower will be necessary. Plus your home will be equipped for you later on - whether walking or not.

Sitting on a shower chair being hosed off is very cold for the person being bathed. And yes, a certain amt of water gets on the helper, too. To me, it's a miserable way to take a bath. Not to mention, to really clean the private parts, the person needs to stand for a period of time - even with the safety bars, strength is an issue to avoid falls.

I installed a lift chair for my mom (w/existing tub). Chair comes over edge of tub for her to sit on, then I activate it to lift up - turn to be over bath water - then lower to bottom of tub. She was so happy to be able to get into a warm bath and soak/have the jets in tub running. I raise her up a little when done, use shower sprayer to rinse her off and wash her hair - it minimizes the amount of time she is in the cooler air and not surrounded by warm water. I'm not having to stand there and wash every nook and cranny - she can do it.

I personally hate the thought of sitting on a shower chair being hosed off. You only feel warm when the water is all around your body...instead of just certain parts being sprayed. For me, that would be torture because I'm usually cold any way.

I'd have to say go with the walk-in shower. They have plenty of space so it won't be too messy or uncomfortable for either of you. Things gets messy and hard when there isn't a walk-in showering area and someone is trying to shower a handicapped person in a stand-up shower or in the bathtub. You'll be just fine getting a walk-in shower.

Shower works best and definitely a hand held shower head.

With a walk-in tub you need to remember that you have to wait for water to go out before door is opened and she comes out. Could cause some water issues. We put in a walk-in shower and I do not regret spending the money. It turned out better than I expected and is working well now for hubby. There is an amazingly large seat. I had the hand held shower part put separately on the wall with its own water control on/off. Other shower head was lowered because original one was up too high. It also has its own control. Another seat could go in on the floor that swivels if loved one needs that. Well worth the cost!

I’ve been through a lot of stages of disability. In my opinion, a tub is limiting both for the person with needs and others. A roll-in shower allows many options long-term. The most important advantage of a shower is space. A person can wash or be washed in a shower. Don’t opt for a built in or fold down seat, the positioning of those is rarely an advantage; instead use whatever moveable shower chair works best for the present needs. Do include plenty of grab bars and a lower hand held spray nozzle. A ceiling light in the shower is helpful, and a ceiling heater in the bathroom affords much comfort. Hope whatever choices you make work well.

My shower entrance was large enough that moms walker went into shower with her...she needed it to get in and out and down and up from chair. Once in she managed cleaning self and shampooing hair . None of it was easy but it worked .

I'll address in a general way some of the issues people brought up. Of course, I have thought long and hard about this. At the MC place where she is currently, they are legally not able to bathe her or help her eat, but really, she just needs a little assistance in those regards, and it seems a shame, to me, that she has to go to a nursing home for those reasons- so I offered to do this. She may well end up in the NH as time goes on, but for now I'm happy to try caring for her here. If it doesn't work for whatever reason- there is still the NH option. I have a spacious home that has 3 full bathrooms, one on each floor, and those will remain as they are. She will be in two nice rooms in the walk-out basement- which have been unused- and her bathroom will be a new build, just an extra bathroom. I am not concerned about resale value. With three others, I doubt it will matter. She will be monitored closely and when someone is not with her, she will be in a safe, secured area and not free to roam the entire house or go outside on her own. I will have help. She is not in the least a difficult person. Thank you all for your concerns. And, special thanks to those who helped me with the shower info. I have a much clearer picture of what I need to do in that regard.

I have both. I like the shower. I got a new walk-in tub about a few months ago. I didn't like my old one because of having to sit there waiting for it to fill and drain. I have a new model that is three or four times faster filling draining. I love it. I get the one by Kohler. My contractor recommended.

I have a walk in shower in my master bath. When my husband was still alive, he used it daily. But when he was getting more unsteady on his feet, I took him in there every other day to help him shower. He would sit on the shower bench and I would stand outside the shower and help wash the areas that he couldn't reach or forgot. I sometimes got a little wet, but nothing major. It actually worked out quite well, and I didn't have to worry about him falling. Just make sure you have a good slip proof mat under the shower chair, and grab bars where needed.
And for the in-between shower days you can use the extra large body wipes. and waterless shampoo and conditioner caps if needed. They both work really well. you can order both from Amazon or Walmart.com
I wish you the best as you will certainly have your hands full. I really hope you're thinking long and hard before making the decision to bring her into your home.

If the people at MC feel that she is too much for them, why do you feel you can take this on? She must be ready for the next level of care or believe me they would keep her. It is not easy to care for someone with a Dementia, the reason she cannot follow directions. There is no rhyme or reason to the desease. And very unpredictable. Before I would remodel my house, I would make sure that you are able to do the job. You are a Senior too.

Putting in a walk in tub is very expensive. We had a walk in shower. Mom used a shower bench. I installed a handheld shower head. I kept the room warm with small heater. I would wet her down and turn off the shower. Then soap her down and rinse. Have a towel nearby and dress her as much as I could. Bathroom was small. I eventually placed Mom in an AL and eventually LTC. At 68 I could not do the showering and the toileting. And the accidents. One being a "blow out" that took 3 hrs of cleaning up. The bathroom first because she needed a shower. I had a small table outside her bathroom door. I caught her using it as the toilet.

I hope your husband is going to be helping in her care. You will have sleepless nights because she is roaming or trying to get out of the house. Just as you sit down, she will want something. Its like having a toddler again.

I do suggest that you try a commode over the toilet. There are splash guards that take the place of the bucket. This will give MIL the arms and legs for stability.

Good Luck if you go ahead with this. If you find that her care is beyond you, please don't feel guilty. I personally could not do it because of the unpredictability. I like knowing what comes next. I like organization. Don't do well when a ball in thrown into the mix.

Was she ever a bath taker? If she was, it might be a great thing to have for her. I know people that are soakers and a nice long, hot bath is what makes their day.

If she was not, then it won't be worth putting an expensive walk-in tub in.

How much space do you have for the shower/tub? Because there are some really great shower configurations for ease of access and assistance. A good contractor should be able to help you with the ideas.

I, highly recommend, heat lamps for the area, showers are cold and need to be heated up before she gets in and when she gets out.

Do a Google search for wheelchair accessible showers, it will give you some ideas.

A higher toilet with an attached bidet would be terrific . Also sturdy grab bars for support. As she gets old/weaker, a sponge bath on the toilet is often quicker/easier to tolerate, and a bidet will make incontinence care much easier.
Contact your local aging service program - the Senior center, Board of health, county social services can tell you who to call. See if she will be eligible for help with bathing, as it is much easier to let a trained aide to help with the shower or bath. Also, that person can show you how to help her.
There are plenty of businesses that offer home safety services for elders - ramps, rails, bathrooms, etc. They will have ideas...

Don't eliminate the no rinse products, such as those used in rehab and care centers, as well as hospitals.   

A former poster offered good insights into bathing:  make it a pleasant ritual, with her favorite music, a treat before or after (flowers, or the music) and guide the experience into something positive, as well as one that's more safe.

If you do stick with the shower remodel, make sure you find a carpenter (and ONLY a carpenter) to install grab bars, on all sides, at low and medium high levels.   They're lifesavers.