TUB BATH OR SHOWER

SELF-BATHING:

A bath can be one of the most enjoyable and refreshing activities of the day for many elderly individuals. Frequently, however, bathing does not routinely occur because it involves a great undertaking by the older adult and the caregiver. An option in this case if for the elderly individual to bathe from a wash bowl or sink, and, thus, avoid physical exertion. This type of bathing allows the person to move at a slow pace with time to rest between washing different body areas. Washing from a tub or sink may, at times, be safer for the individual than trying to bathe in a tub or shower alone.

An advantage for the individual in taking a tub bath or shower is the sense of independence which it might foster. Be sure that you, as a caregiver, take into consideration the individual's actual ability to do so before allowing the person to proceed alone. If you are assisting, be sure to allow the person to do as much as possible during the bathing procedures. Another good point to remember is to check the individual for pressure areas, especially if the person is stationary much of the time. Pressure sores can be a serious problem if not cared for immediately. If you should notice any early warning signs, such as reddened areas on the person's skin, try to place the individual in a position which relieves pressure on that area. Also, special mattress covers and materials (sheepskin, for instance) are available which can help relieve pressure.

Take into consideration any grooming aids such as body powder, deodorant, and perfumes which the individual may want to use. Try to provide these, if possible.

Closing of doors, not allowing family members in the bathroom during a bath, and your own sensitivity to privacy issues can assure the elderly individual's comfort while bathing.

The following is a step-by-step process which you can use in assisting an elderly individual with a tub or shower bath. You, as a caregiver, can make bathing relaxing, refreshing, and less of a chore by following these basic procedures. Remember to maintain a light conversational tone with the individual during the procedures. By being aware of the individual's abilities and by applying patience and understanding, bathing can be enjoyable for both of you.

GIVING AND ASSISTING THE PERSON WITH A TUB OR SHOWER BATH:

Prepare the area for bath or shower.

a. Make the room comfortable. Especially notice and adjust the temperature, if necessary.

b. Close the windows to prevent drafts.

c. Close doors and curtains for privacy.

Gather supplies and equipment as listed below.

a. Soap and container,

b. Large bath towel,

c. Small bath towel or bath mat,

d. Washcloth,

e. Safety belt (if necessary),

f. Large towel or sheet,

g. Stool for shower, and

h. Body powder, deodorant, and other grooming aids.

Prepare and check area for safety.

a. Tub or shower should be clean with a non-skid surface. (A rubber bath mat or adhesive strips can provide a non-skid surface. A towel may be used on the tub or shower floor.)

b. Prepare a safe pathway to the bathroom.

1) Remove any electrical cords from the floor.

2) Remove any throw rugs from the floor.

c. Use a safety belt if the person is unsteady when walking to the bath or shower area.

1) A "gait belt" or ordinary belt can be used.

2) Secure the belt firmly around the person's waist.

3) Hold the belt firmly at the person's back with one hand.

4) Place your other forearm in front of the person. Ask the person to hold your arm for stability.

5) Pull on the belt if the person stumbles or appears to be falling.

(If assistance is needed, be prepared to use transfer method. Check with the individual regarding comfort level in using a belt. Insist on using a belt if you determine it to be safer.)

d. Place a bath mat or small towel on the bathroom floor.

Encourage the person to use the toilet before taking a bath or shower.

a. Assist, if necessary.

b. Observe as much privacy as possible.

Run and regulate the bath or shower water. a. Run the water into the tub to 1/3 to 1/2 full.

b. Check water temperature on your inner wrist.

c. If taking a shower, regulate the water pressure and temperature before allowing the older person to enter the shower.

Prepare to assist the person into the tub. a. Seat the person on a stool (or closed toilet seat).

b. Assist with removal of clothes. Encourage the person to do as much as possible.

c. Fold a large towel or sheet to use as a safety belt while the person gets into the tub or shower. (A sheet or towel is more comfortable on bare skin than a belt.)

d. Place the folded towel or sheet from front to back around the person's waist. Tie the sheet securely or use large safety pins.

e. Hold the towel or sheet firmly in the back.

f. When ready, have the person sit on the side of the tub with both feet on the bathroom floor.

g. Have the person swing one foot at a time into the tub. (The person may need help to lift the leg over the tub. Do so while still holding onto the safety belt.)

h. Before lowering into the tub, make sure the person is stabilized. Do this by having the person place both hands on the side of the tub, by holding onto handrails, or by gripping your forearm.

i. Remove the safety belt and place it on the stool close to the tub.

(Determine the person's ability to self bathe. Offer help as needed. Try to observe privacy when possible.)

Prepare to assist the person into the shower.

a. Place a stool in the shower.

b. Make sure that the shower spray is not centered on the stool.

c. Be sure to check the water pressure and temperature before beginning the shower.

d. Use a safety belt, like above, to assist the person into the shower stall and onto the stool.

Follow a routine if assisting with bathing such as:

a. Wash the person's face. Avoid using soap on the face, unless requested to do so by the bather.

1) Rinse the washcloth, and squeeze out excess water.

2) Wash the forehead, nose, cheeks, and chin.

3) Rinse the face thoroughly.

b. Wash the person's neck and ears using soap on the washcloth. Rinse thoroughly. (Be sure to return the soap to its container to avoid a too sudsy cloth and soft soap.)

c. Wash arms.

1) Wet and soap washcloth.

2) Wash the arm with long firm strokes. Begin with the arm farthest from you.

3) Wash the underarm.

4) Rinse.

5) Repeat the procedure for the other arm.

d. Wash hands.

1) Put the soap into the person's hands to allow self washing.

2) Wash well between the fingers.

3) Return the soap to its dish.

4) Have the person rinse hands well.

e. Wash the chest.

1) Rinse and resoap the washcloth.

2) Wash the chest using circular motions.

3) For a female, wash the folds of skin under the breasts. 4) Rinse chest area well.

f. Wash the lower part of the body.

1) Soap the washcloth.

2) Using circular motions, wash the lower body.

3) Be sure to clean naval area and skin folds well.

4) Rinse.

g. Wash the person's neck, back of the neck, and buttocks.

(Be sure to check for any breakdown of skin during the bathing, especially in the back and buttocks area.)

1) Wet and soap washcloth.

2) Wash the back and neck area with long, firm strokes.

3) Rinse the cloth, the neck, and back area.

h. Wash legs.

1) Wet and soap cloth.

2) Raise leg farthest from you, and support the leg behind the knee.

3) Wash using firm strokes down the leg to the ankle.

(Do not raise the leg beyond comfort level or entirely out of the water. The person may only be able to slightly bend the knee comfortably.)

i. Wash the feet.

1) Wet and soap the cloth.

2) Wash particularly between the toes.

3) Rinse the cloth and the feet.

j. Wash between the legs from front to back.

(Encourage the person to self-wash this area. Try to observe privacy whenever possible.)

1) Wet and soap the cloth using a small amount of soap.

2) Give the cloth to the person.

3) Turn your back briefly to give the person privacy.

4) Assist the person only if necessary.

Help the individual get out of the tub.

a. Let the water out of the tub before getting the person out.

b. Put the sheet or towel safety belt back on the person. Secure well.

c. Have the person put hands on the side of the tub, on the handrail, or on your forearm.

d. Hold onto the safety belt while helping the person to sit on the side of the tub. Keep both the person's feet inside of the tub on the rubber mat or nonskid surface. (Use good body mechanics when performing this step.)

e. Help or have the person take one foot at a time out of the tub while you continue to hold the safety belt.

f. Have the person stabilized before moving.

g. Have the person move from the side of the tub to the stool.

Dry and dress the person. (You may use a second towel to cover the areas which are not being dried and to provide warmth and privacy.)

a. Dry the person in the same order as washing: face, neck, ears, arms, hands, chest, lower body, back, buttocks, legs, feet, and between the legs.

b. Use any body powder, deodorant, or other personal grooming aids as requested by the individual.

c. Dress the person.

(Allow the person to choose clothes before the bath.)

d. Return the person to the pre-bath situation or to another requested area of the home. Use a safety belt if necessary.

Wash hands and straighten the bath area.

Content for PERSONAL CARE is from the Volunteer Information Provider Program (VIPP), by Dr. Burton Halpert and Dr. Share Bane. For additional information on this program, click on Publications, or write: Center on Aging Studies, 5215 Rockhill Road, Kansas City, MO 64110; call: (816) 235-1747; or Fax: (816) 235-5193.