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How Family Caregivers Can Help When Personal Hygiene Is a Problem

Assisting a loved one with showering, toileting and other intimate tasks takes finesse, know-how

spinner image caregiver washing foot of woman in bedroom
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Pamela Toto’s 102-year-old client had a problem: She was able to live alone, with help from her son, but getting in and out of her shower, where she had a chair and a handheld nozzle, was too difficult.

So, Toto, an occupational therapist, showed the son how to safely help his mother into her shower chair.

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But, Toto says, “they didn’t do it.” She learned why in a talk with the son: “He said, ‘I do everything for my mom, but I just don’t want to see her naked.” Toto helped the pair find a solution: a wrap-around towel robe the woman already had that she could wear on the way into and out of the shower.  

It was a good illustration, Toto says, of the challenges, both practical and emotional, that caregivers and care recipients face when someone needs help with showering, using the toilet or other intimate hygiene tasks.  

“It’s hard to ask for help in those areas, and it’s also hard for care partners to give help in those areas,” says Toto, who is a professor of occupational therapy at the University of Pittsburgh.

She and other experts say there are ways to make such tasks easier.

Notice changes and think about causes

For some people, the need for hygiene help arrives suddenly, with a stroke, a fall or other crisis. But many older adults gradually become less adept or attentive to personal care, Toto says.

Not every change is a problem, says Heather Young, a nursing professor and dean emerita at the University of California, Davis. “Having a shower every day or every other day is not a necessity,” she says, especially for many older adults who aren’t working up a sweat. Also, she says, “Someone who has always been fastidious about their hygiene is very different from someone who’s always sort of neglected it.”

However, if you notice a change, it’s a good time to start a conversation, says AARP family caregiving expert Amy Goyer. For example, she says, you might say: “I’ve noticed that you aren’t showering as frequently. Is that because you don’t feel safe in the shower? Can we put up some grab bars to make it more comfortable? Is it because it’s cold in there? Because we can put in a heater.”

Sometimes, the challenges are greater. Michele Merfeld Hale, 66, of Columbia, Missouri, cares for her husband Larry, 88, who has vascular dementia and often resists showering. “The sad thing is, he was one of the most hygienic men I ever knew,” she says. “So, it pains me when he doesn’t want to shower.” But Hale has learned that her husband is afraid of falling and dislikes water on his head. So, now she uses no-rinse shampoo and body wash to make the process quicker and more comfortable.

Make the bathroom better

Many problems can be prevented or eased by making a bathroom safer and more inviting, Toto says. You can turn down a water heater to prevent scalding, improve lighting, add grab bars, attach a handheld shower hose and add a nonskid tub mat without spending much, she says.

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Goyer says you can’t have too many grab bars, to prevent falls and to help people with mobility challenges stand, sit and make other transitions.

If you do have money for bigger renovations, a curbless shower is ideal, she says.

Try problem-solving products

Simple products sometimes make a big difference. For example, Young recommends spray conditioners to ease hair-combing. Some people with dementia find minty toothpastes overwhelming, she says, so a fruit-flavored children’s brand works better.

The right bathroom equipment also matters. If a toilet doesn’t have a high enough seat (17 to 19 inches), many people benefit from an added raised seat with rails. Some bedside commodes can be repurposed this way.

And a bidet seat, attached to a standard toilet, can be a “miracle,” Young says. These devices spray the bottom clean. Many can adjust water temperatures and pressures.

In the shower, a chair with a removable center can help caregivers reach hard-to-clean areas, Goyer says.

Balance safety with independence

Sometimes, caregivers take over hygiene tasks for impaired older adults in the name of safety or effectiveness, Toto and Young say. But, whenever possible, “guiding and supporting rather than taking over for them,” is best, Young says.

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For example, someone who needs help in the shower may be able to wash their genital and anal areas if the caregiver hands them a soapy washcloth.  

The less people do for themselves, the less they are able to do over time, Toto and Young say.

Protect yourself, physically and mentally

“There’s a lot of squatting and bending over involved in this kind of personal care,” and caregivers can get injured, says Goyer, who has cared for multiple family members. She says she took up Pilates to strengthen her core muscles and wore a back brace when she was caring for her late father, who had Alzheimer’s disease.

Dealing with urine and feces also can be emotionally trying, Goyer says. Sometimes, it helps “to look at is as if I’m performing a medical task, like I’m a professional … it doesn't mean I have to become hardened and not feel emotions. It’s just that there’s a need and I’m meeting the need.”

Know when to ask for help

If you are an exhausted caregiver or can’t solve a problem, “don’t wait until you are in a dire situation to ask for help,” Young says.

Some primary care practices have nurses who can offer advice, Young says. A doctor also can make a referral to an occupational therapist who works with people at home, Toto says. If you are ready to consider home health aides, your Area Agency on Aging can help find providers, Goyer says. Some will know about free or reduced-cost options or alternatives, such as adult daycares that offer bathing services.

Hale says she recently hired an aide to help with her husband’s personal care. She gives herself credit for doing so well on her own for so long: “I’m thankful that I’m a fairly creative person and a good problem solver.”

What to Know About Incontinence Products

If you are new to the world of incontinence products, it can be overwhelming, says nursing professor Heather Young. The supermarket aisle for absorbent pads and adult briefs “now is longer than the feminine hygiene aisle,” she says.

A few tips:

  • They aren’t always the solution. Occupational therapist Pamela Toto had one client who kept urinating in his pants — because, as it turned out, the jeans he’d worn all his life took too long to unfasten. A switch to sweatpants solved his problem. 
  • Best options vary. “It’s important to use the least amount of products you need,” Young says. “If someone has slight leaks when they cough, they don’t need a massive pad.” But sometimes, a maximal approach is needed. AARP caregiving expert Amy Goyer says her late father needed a brief stuffed with pads on all sides — a “Michelin Man” look — to stay dry at night. 
  • Bargain shopping is worthwhile. Savvy caregivers stock up at big box discount stores or look for bargains online, Goyer says. Washable padded underwear works for some people, but it also is much pricier than regular underwear, says caregiver Michele Merfeld Hale of Columbia, Missouri.

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