Adult Daycare for Alzheimer's Patients

Adult daycare is a rapidly growing service that provides valuable respite to caregivers as well as important mental and social stimulation to people with early and mid-stage Alzheimer's. Programs vary widely in terms of their offerings and fees.

What is adult daycare?

The primary purpose of the adult daycare centers are to: prevent premature or inappropriate institutional placement of persons with moderate to severe levels of impairment due to dementia; provide support and respite for caregivers; serve as models of the optimum type and level of day care services that are needed by persons with dementia; make training opportunities available to professionals and other persons providing care and treatment for this population; and increase public awareness and knowledge about Alzheimer's disease and related disorders.

The centers provide services that support the physical and psychosocial needs of persons with Alzheimer's disease or related dementia. Individual care plans are developed for each program participant with activities scheduled in accordance with these plans. The overall objective is to keep the participants as healthy and active as possible by helping them maintain their highest level of functioning and to improve the quality of their lives while providing respite to caregivers.

Thus, adult daycare centers provide structured activities and therapy in a safe, supportive environment to adults who need mental and social stimulation. Typical daycare clients have lost a degree of independence due to normal aging, a medical crisis, or a chronic condition such as Alzheimer's disease or other dementias, but they live alone or with a caregiver. Half of all users have cognitive impairment. As the name suggests, it's a day service, not a housing option.

This increasingly available type of eldercare may be affiliated with (or run by) medical centers, nursing homes, assistive-living facilities, or other organizations either on site or at another facility (such as a community center or church). Some are established as "stand-alone" private businesses. There are more than 3,500 adult day centers in the United States.

Why should I consider adult daycare for my parent?

Adult daycare is a form of respite care that's provided outside the home by professionals (as opposed to in-home respite care). It's designed to benefit both the person using the services and, especially in the case of Alzheimer's disease, that person's caregiver.

For the elder with Alzheimer's, adult daycare offers:

• A chance to get out of the house
• A break from being with the caregiver
• Interactions with other people
• Stimulating activities
• Other therapies as needed (such as physical therapy or speech therapy)
• Possibly a delay in cognitive decline, in the early stages
• Prolonged independent living

For the Alzheimer's caregiver, adult daycare provides:

• Stress relief, lessened depression
• Predictable hours of relief in order to attend to personal needs, run errands, and release stress
• The ability to continue caring for a parent at home
• Cost savings over more expensive in-home care
• Reduced guilt because the parent's independence is supported
• An improved mood in the patient, making care giving easier
• Possible family counseling or training through the center, to help cope

Programs run from several hours to a full day. Participants may attend daily, a few times a week, weekly, or just for special activities. Weekend and evening care are less common, although this is changing as demand for adult daycare rises. (All options vary by center.)

How is it different from a senior center?

Senior centers tend to cater to a healthier, more mobile, and more independent clientele. Adult daycare programs generally offer services that are more intensive. Some specialize in Alzheimer's disease, and staff members have special education and/or training in working with geriatric clients and in managing behaviors characteristic of a disease like Alzheimer's.

What happens at adult daycare?

Programs typically include organized and supervised hands-on activities that may involve:

• Stimulating recreation (such as crafts, group conversation)
• Music therapy
• Art therapy
• Sensory stimulation
• Physical therapy
• Occupational therapy
• Speech therapy
• Access to a library
• Entertainment (such as music, movies)
• Outings to museums, parks, or other local attractions
• Support groups and counseling
• Socialization activities
• Personal and nursing care (including help in keeping up with medications)
• Meals (usually lunch) and snacks

Activities are usually customized to individual needs and abilities, but at the same time, there's an emphasis on group participation. The setting is often homelike and comforting.

Additionally, some programs offer medically oriented care for patients who need it (administering medication; caring for basic medical or personal needs, such as podiatry services). Some offer counseling and educational services to caregivers and families.

Some adult day programs are connected with children's daycare centers. An advantage to this arrangement is that intergenerational connections that are made. A potential disadvantage that some researchers have found is that the adults can feel that they're being treated like children themselves, if the activities are largely child-centered.

Does a parent with Alzheimer's need a special kind of program?

Any daycare provides caregiver respite. But the ideal type features services tailored to people with Alzheimer's. Some adult daycare programs specialize in people with dementias of all kinds and stages, while others specialize more narrowly in early-stage Alzheimer's. In these dementia-specific programs, you're most likely to find tailored activities and staff who are specially trained in the disease. A 1991 study found that Alzheimer's-specific daycare tended to provide more support for families and a greater emphasis on therapeutic recreation (rather than on clinical or rehab services) than general adult daycare. Be aware, however, that there's no special licensing required for a facility to call itself an "Alzheimer's/dementia daycare."

Adult daycare is especially useful in the early stage of Alzheimer's, when the afflicted person retains some good cognitive and social skills and might find it easier to become acclimated to the center and people there. There's also evidence that early stimulation of the type provided by adult day centers can slow cognitive decline.

Daycare is also useful in the middle stages of Alzheimer's disease, when the burden of care becomes greater and caregiver burnout is a strong risk. People in the final stage of the disease tend to be unable to manage daily care tasks without help and are often nonverbal; when the burden of 24/7 care completely overwhelms, it may be a nursing home rather than respite care that the caregiver really needs.

Can both of my parents attend?

Many day programs accommodate both the adult with dementia and a partner without, or a couple whose members each have some kind of disability. If it's a dementia-specific program, though, your healthy parent may feel out of place. In such cases, look into whether she might be able to volunteer there. What's possible depends on the individual program.

Bear in mind that a key purpose of adult day programs is to provide relief for the caregiver. (And many nonprofit programs described as "respite" obtain funding because of this.) If your well parent is the main caregiver, she's supposed to be taking a break while her partner attends. Even if your parents prefer being together, limited separation through a day program can benefit both of them.

What does adult daycare for a parent with Alzheimer's cost? Who pays?

Daily fees range from $60 to $150 dollars per day but can vary widely depending on the services provided, where you live and the needs of the individual, according to the National Adult Day Services Association (NADSA). Most programs are nonprofits, which may cost less than for-profit programs. Ask if a center offers a sliding scale of fees based on income.

Some places charge a fee per session; others charge monthly "tuition." Many centers charge an added fee for transportation, while some offer it free.

Social model day care services are usually paid for privately. Some private insurance plans may cover some of the cost; check with your plan's administrator or the facility to find out.

Medical day care services, which are usually affiliated with a nursing home or health care provider, may be covered by private insurance or by Medicaid, provided your state's Medicaid plan includes it, the person needing care is eligible, and the facility participates. Contact your local Medicaid office to find out. A few programs also accept Medicare if the person requires rehabilitative surgery, such as from hospitalization, but Medicare does not generally cover adult day care services. Otherwise, medical day care must be paid for privately.

Are there any reasons not to like adult daycare?

Some people hear the phrase "daycare" and, associating it with children's daycare, imagine being talked down to and babied. Getting past suspicions and resentment can be a challenge. Run through the many benefits. Suggest a no-strings trial run: "Let's just go once and see what it's like, Mom." You could also avoid describing it as "adult daycare" and find terms more palatable to your parent, such as "a senior club" or "therapy for people with early Alzheimer's disease."

Most participants quickly come to enjoy the new faces and varied activity. Some, however, refuse to participate and may even become belligerent or disruptive; in such cases, they're usually not allowed to return.

Sources and Additional Information:

http://health.msn.com/health-topics/alzheimers-disease/adult-daycare-for-a-parent-with-alzheimers-a-beginners-guide

http://www.aging.ca.gov/programs/adcrc.asp

http://www.alzinfo.org/08/treatment-care/adult-day-care

http://www.webmd.com/alzheimers/guide/caregiving-adult-day-care

Hiring Caregiver for Alzheimer’s Patient for In-home Services

It may seem to you as though taking care of a person with Alzheimer's disease requires a never-ending series of decisions. One of the most sensitive decisions is whether you should hire someone to provide all or some of the care. This becomes complicated by the fact that the person with Alzheimer's may say he does not see the need for more care, or may not want to be taken care of by a stranger. The family caregiver may also feel uncomfortable about hiring an outsider to provide care that he or she was previously giving. A variety of feelings, ranging from guilt to mistrust, together with practical issues such as finding the right person and figuring out how to pay for the service, further complicate taking this step.

Your family may have differing perspectives about what care is needed and who should provide it. However, as the disease progresses it is almost always necessary for more than one person to take care of the person with Alzheimer's, and if family resources are not available, ultimately a professional caregiver will be needed at least some of the time.

Before you hire someone, try to get a clear idea of what you would want him or her to do and the number of hours of work involved. It will cause problems if you do not express your expectations and agree on a plan. Also be sure to provide a good picture of the person who needs care--not only the physical care needs but also some history and the kinds of things the person likes to do. Try to match the potential home care worker to the interests and abilities and temperament of the person with AD. Remember: Care is about relationships and you want to make the best match you can.

NOTE: It is essential that the person you hire understands the effects of Alzheimer's disease and how to communicate with and provide care for a person with this illness.

Once you have hired someone, familiarize the aide with the home, the schedule, the person's taste in food and any other details that will help her to be appropriately responsive to the person she is caring for. Be sure that she has emergency contact information and understands the protocol.

It may help the person in your care to accept the new caregiver if you tell him that the aide is there to help you. Do not suggest in any way that it is because he or she is too much trouble for you. You too will have to learn to trust the person you have hired and to accept that she may not do things exactly as you would. She may do them differently but well enough. Encourage the aide to ask questions. In time, the person you have hired will understand the needs of the person she is caring for, and everyone will feel more comfortable. However, if you get the feeling that the person is not right, don't be afraid to make a change. Sometimes it takes some trial and error to find the right person.

NOTE: At first, you may feel uneasy about leaving the aide alone with the person you have cared for. This is natural. And don't be surprised if you are not sure what to do with the free time you have worked so hard to create for yourself. This too is natural.

Caregivers who have been reluctant to hire a stranger to care for a family member often find that a warm and caring relationship develops that goes beyond everybody's expectations.

A primary caregiver – particularly the caregiver responsible for a senior diagnosed with memory loss or Alzheimer's disease – must account for the needs of the patient. A primary caregiver has every right to insist that a caregiver for an elderly person:

• Have some knowledge of the aged person's condition, whether it's Alzheimer's disease or some other ailment.
• Be able to show compassion.
• Be comfortable around older people in order to be attentive to the senior's needs.
• Maintain the client's dignity.
• Be tuned in to the elder's habits and lifestyle, especially when the client has trouble communicating.

Parents may need a caregiver to help with a child (or an adult child) who has a cognitive impairment, physical disability, or other special needs. By asking similar questions as those above, parents can decide if a friend is suitable, responsible, and good with children.

Hiring a Friend for a Caregiver

Caregivers are hired for all sorts of reasons, but a disabled adult who hires his own caregiver(s) has to consider more than compatibility when considering a friend for the job. Companionship or in-home support – helping with domestic chores, grocery shopping, helping the client organize bills, etc. – may be something a good friend is willing to do as employment.

Using a friend as a personal care attendant (PCA) takes deep consideration. The PCA position is considered critical and the applicant must be dependable, trustworthy, and must be able to show a willingness to learn the client's daily personal care routine.

PCA duties are very specific. Friends or not, applicants need to know that the job may include bathing, skin checks, dressing, and toileting, just to name a sample list of PCA caregiver tasks. Employers must emphasize that the PCA has an enormous responsibility in that the client's well-being depends on how well and how efficiently the worker performs. The person must be reliable, and must show up for work even on weekends and holidays.

There are benefits to hiring a friend as a caregiver, especially if the client has known the applicant for a long time. The client knows the friend's personality, level of intelligence, and shortcomings. Friendship may be an incentive to do a better job. The friend probably knows much of what has to be done for the client and may know the routine without much training.

The risks of hiring a friend as a caregiver can start with disturbing results from a background check. Otherwise, the client may have difficulty firing a friend who just isn't performing as expected. A friend may expect frequent raises or days off. And finally, the client may find the friend is not all that dependable or the friend wants to rearrange a schedule for his own benefit.

How to Select an Agency

There are several ways to approach the task. You may ask your friends, family, or co-workers if they know somebody who will be willing to work as caregiver for your AD patient, you may post ads in the local newspapers or in the online message boards. However, many people prefer to deal with professional caregivers’ agencies, who specialize on delivering home-based services to the patients. This way, you may have a higher degree of confidence on the experience a responsibility of the employees and you have better ability to get sustainable support, provide by the organization.

So you have to decide if you want to hire through a caregiving agency (which is more expensive, but the workers are usually supervised and bonded), or if you want to find someone on your own (which will require a lot more on-going supervision).

To select an agency, follow the recommended steps:

• Interview several agencies.
• Get references and CHECK THEM.
• Make a list of services you want and ask the agency what it will cost.
• Ask what the steps are in the care planning and management process and how long each will take.
• Find out how and when you can contact the care manager.
• Find out if the agency has a system for sending a substitute (stand-in) aide if the regular one doesn't show up.
• Ask if the agency will replace the aide if that aide and the person in care do not get along.
• Ask about the skills and ongoing training of personnel.
• Do they have staff especially trained to work with dementia?
• Ask how they keep track of the quality of services.
• Ask for the services needed by the person in care, even if the insurance company is trying to hold down costs.
• Be aware that if a social service agency is providing the care services, they may limit you to only the services that they provide.
• Ask them to tell you about any referral-fee agreements they may have with nursing homes or other care facilities.
• Know what you have to do to lodge complaints against the agency with the state ombudsman or long-term-care office.
• Get in touch with the local/state Division for Aging Services to check for complaints against a particular agency.

Sources and Additional Information:

http://www.caring.com/articles/choosing-caregiver-for-alzheimers

http://www.healthcentral.com/alzheimers/c/43/2934/tips-hiring-elder

http://www.caring.com/articles/hiring-in-home-help-for-alzheimers

http://www.suite101.com/content/hiring-a-friend-as-a-caregiver-a196355

http://www.caring.com/articles/selecting-a-hiring-agency

Effective Communication with Alzheimer’s Patients

Effective communication, both verbal and nonverbal, is essential to quality care. The breakdown in communication between a person with Alzheimer’s Disease and his or her caregiver leads to frustration. For caregivers, living with a person who no longer remembers them and their relationship is painful. Understanding the language and communication problems that occur with Alzheimer’s Disease can help caregivers develop realistic expectations and improve communication as the disease progresses.

People communicate both verbally and nonverbally. Verbal communication is an exchange of words or noises that express thoughts or emotions. Nonverbal communication consists of gestures, facial and body expressions, touch and tone of voice.

Memory disorders such as Alzheimer’s Disease affect the ability to use and understand both nonverbal and verbal communication. People with Alzheimer’s Disease do not understand information coming to them. While their sense of hearing and eyesight may be fine, the brain systems that make sense of incoming information may not be able to process it properly. What they hear, see or read may not make sense. Some information may get lost; other signals become confused. The end result is that people with Alzheimer’s Disease often are unable to understand what is going on around them and may react in confused or inappropriate ways.

Effective communication requires speaking and being heard. It is important to listen carefully to people with Alzheimer’s Disease, because what they say may not be easy to understand. Listen for key words and phrases which, taken alone, may not make sense, but in the context of the situation may have a great deal of meaning.

Nonverbal Communication

Nonverbal communication, often called body language, is an important part of how people communicate. Nonverbal messages are sent through gestures, body movements, facial expressions, touch, tone of voice and speed of words.

When people lose their word skills, nonverbal communication becomes critical. Sometimes people with Alzheimer’s Disease who no longer understand spoken words depend on body language for their information. It is especially important that caregivers be aware of their own body language and the messages it sends. In addition, caregivers should learn to read the body language of people with Alzheimer’s Disease to help figure out what their needs are and how they are feeling. Remember that a smile can help connect, reassure and calm a person with Alzheimer’s Disease even after the ability to use and understand language is gone.

Tips and Techniques

1.      Use all senses, such as vision, hearing, touch, smell and taste;

2.      If a person seems to ignore you and is unreceptive, leave him or her alone for a few minutes. Tell the person that you understand that they want to be alone and that you will return;

3.      Be sensitive to nonverbal messages. Be aware of your own nonverbal communication and use it to help calm, cheer or encourage;

4.      Make nonverbal messages match your words. Smile when you greet someone and wave when you are saying goodbye;

5.      Adopt positive, pleasant nonverbal behaviors to reassure and encourage. Look at facial expression and body posture to determine what is pleasurable or uncomfortable. Remember that you may be conveying emotions, such as sadness or irritation, through your actions more than through your words. If you are in a hurry, frowning or speak quickly and angrily, a person with Alzheimer’s Disease will react to your emotions.

Verbal Communication and Language Changes

People with Alzheimer’s Disease experience changes in their ability to use words. At first they may have a hard time finding the exact word to use in a sentence. Later, they may have a great deal of trouble finding most words and have to use many “filler” words to talk. In the latter stages of the disease, there may be very little language though they are trying hard to speak. They may use nonwords, speak gibberish and be unaware that they are not making sense.

It is important to recognize that communication is a two-way street. Effective communication requires both speaking and being heard. Caregivers must listen carefully to people with Alzheimer’s Disease because what they say may not be easy to understand.

Tips and Techniques

1.      Use simple, short sentences. Organize your thoughts into the shortest sentences possible;

2.      Say the person’s name. Establish eye contact. Speak clearly, calmly and repeat as needed. Be aware of hearing difficulties;

3.      Look for clues, such as eye contact or facial expression, that the person heard you. Does the person respond appropriately? Which of the person’s words or actions are the actual response?;

4.      Act out the message. Point to the object you are talking about;

5.      Address the person by their familiar name or nickname.

Communication and Alzheimer’s Disease

The steady loss of communication skills is one of the hallmarks of Alzheimer’s Disease. The information presented in this section explains some of the behaviors and offers tips and techniques for making communication clearer during each stage of the disease.

Early in the disease, people with Alzheimer’s Disease are often aware of gaps in their communication. If they are aware of language difficulties, they may try hard to cover them. They may make up stories, or act indignant, tough, stubborn, nervous or anxious. Or they may admit their difficulty coping with a particular task of problem. Many people withdraw and avoid troublesome situations that might reveal their problems with communication. They don’t want others to see them fumble at a task they could once do easily.

Keep in mind that people with Alzheimer’s Disease may have trouble with some tasks because they don’t remember the purpose, task or instructions given to them. Sometimes all that is needed is gentle reminders.

Stage One: Early

Closely related words are substituted for forgotten words. When you can’t make out what a person with Alzheimer’s Disease needs, point to the objects in question while asking questions like: “Do you want your purse? Your comb?” The person will have trouble understanding and following directions. Keep your sentences short and your directions clear. “Mother, fold the scarf.” “Put the scarf in the drawer.” “Close the drawer.”

Tips and Techniques

1.      Discuss important business during the morning when everyone is fresh;

2.      Focus on one topic at a time;

3.      Use specific words, names of people and objects;

4.      Do not use pronouns or general language;

5.      Words or events may be forgotten. Don’t take it personally if birthdays or other special events are forgotten.

Stage Two: Middle

At this stage, recall and word recognition decrease and attention span is shortened. A person with Alzheimer’s Disease may change the subject often. You may need to repeat the same question or sentence many times and in different ways before it’s understood.

Tips and Techniques

1.      Give stimulation that can be sensed emotionally, like music and touch;

2.      Present objects with the quality of moderate novelty. Things that are familiar enough so that they do not frighten or confuse, but unusual enough so that they interest;

3.      Give touch in a systematic way. Stimulate the person’s forehead, cheeks, ears, neck, shoulders, back, forearms, hands, feet and lower legs through small circular stroking movements. Use skin lotion to protect the skin;

4.      Stimulate smell with bread, wood, soft soap, fur, camphor, yarn, etc.;

5.      Comb the person’s hair and give him or her the opportunity to look in the mirror;

6.      Stimulate taste buds;

7.      Elicit listening behavior and maintain attention by touching;

8.      If the person speaks only in single words, then you should speak in single words. However, note that the person may be able to understand better than he/she can talk;

Stage Three: Late

Toward the end, a person with Alzheimer’s Disease loses almost all ability to communicate or understand. Both long- and short-term memory are severely impaired, and he or she is totally dependent on the caregiver.

1.      Continue speaking warmly, quietly and with eye contact;

2.      Pat or stroke the person. Touch with love;

3.      Smile. After all else is lost, a smile can calm and bring joy.

11 Steps to Improved Communication

1.       Get the Person’s Attention; Use Eye Contact: Securing eye contact helps to get the individual’s attention and gets them to focus on what you are saying. A gentle touch can also accomplish the same thing. Remember that your facial expressions help communicate your intention. Maintain contact and extend yourself to the person to convince him that you want to talk to and be with him. Look directly at the person to get undivided listening attention before you speak; identify yourself at the beginning of each interaction.

2.      Speak Clearly, In Short, Direct Sentences; Use One-Step Commands: Keep it simple. Complex or abstract subjects will be difficult for them to follow. Talk about things that are seen, heard, touched or smelled. Be matter of fact; ask “yes” or “no” questions as much as possible.

1. Avoid open-ended questions;
2. Ask questions that include limited choices: “Would you like to go for a ride or take a walk?”;
3. Be direct; say exactly what you mean. People with Alzheimer’s Disease find it difficult to understand hints or suggestions. Instead of saying “Do I look like I have nothing to do?”, say “I am busy now. I will come back.”;
4. Be concrete. “We are going to have company today.”
5. Be literal. Nonliteral terms are used frequently in conversation: “That dress is a knockout;” “This dessert is heavenly.” People with Alzheimer’s Disease find it increasingly difficult to understand nonliteral terms;
6. Present a limited number of choices and give positive direction (for example, “Now it is time to take a shower,” not “Would you like to take a shower now?”

3.      Be Willing To Repeat And Rephrase:

1. Repeat yourself and restate critical facts several times. Restate and rephrase what is not understood: use simpler words to express your ideas and be brief. Remember that at some point, logical explanations will be meaningless and persistence in explaining leads only to frustration;
2. Use simple subject-verb sentence combinations;
3. Left-branching sentences (“Because Ben left the house without his coat, his mother was upset”) are more difficult to process and require more memory than right-branching sentences (“His mother was upset because Ben left the house without his coat.”);

4.      Don’t Use Slang: Consistently use the same word for the same thing, and use the word most familiar to the person. (“It is time to go to the bathroom [or toilet], Frank.”) However, vary the introduction of a topic, such as bathing, if it triggers resistance;

5.      Keep Your Tone Warm and Empathetic: Provide affectionate encouragement; use diversion and humor to overcome resistance;

6.      Ask Simple Questions: Closely related words are often used instead of forgotten words. When you can’t make out what a person needs, point while asking simple questions: “Do you want your sweater? Your necklace?”;

7.      Avoid Pronouns – Use Specific Words And Names For Clarity: Use names so it is clear who you are talking about. Don’t say “he,” “she” or “that group.” Also be sure to call a person with Alzheimer’s Disease by the name he or she is most comfortable with.

8.      Write Big, Clear Messages and Post Them: It may be helpful to have signs on room doors (such as bathrooms) or a “911” tag posted on the telephone;

9.      Use Your Nonverbal Skills:

1. Use illustration. Drawings and photographs give additional cues and jog the memory;
2. Enhance what you say with frequent gestures. Additional physical cues and emphasis increase the chance of successful communication;
3. Avoid environmental distractions. Noisy and busy surroundings are distracting. It is easier to get and keep someone’s attention in a quiet environment;
4. If verbalizations do not make sense to you, search for important clues. Smile to connect with the person.

10.  Praise and Encourage the Person; Show Affection: Be patient. If you or the person become frustrated, take a break and try again later. Remember that a person with Alzheimer’s Disease will sense when you are tired, stressed or in a hurry, and may become upset or confused as a result. Although they are not able to comprehend the reasons for them, people with Alzheimer’s Disease still seem to sense emotions such as frustration, anger and happiness. A quiet, soothing voice, gentle touch or a calm presence may reassure and calm someone who is confused or upset.

11.  Be Patient!:

1. Give the person time to respond. If a verbal or nonverbal response does not occur in one to two minutes, repeat the exact set of words and gestures;
2. Do not attempt to force a person to do anything. If he or she will not cooperate, leave for five or 10 minutes and then try again;
3. Do not assume that one set of behaviors, whether positive or negative, will stay the same. Simple changes in the environment, such as a different nurse or a room change in a nursing facility may cause behavior changes.

Source: http://www.ec-online.net/CGE3/cad2.htm

Bathing Guide for Alzheimer’s Patients Caregivers

Introduction

Bathing is often the most difficult personal-care activity that caregivers face. Because it is such an intimate experience, people with dementia may perceive it as unpleasant or threatening. In turn, they may act in disruptive ways, like screaming, resisting or hitting.

Such behavior often occurs because the person doesn’t remember what bathing is for or doesn’t have the patience to endure such unpleasant parts of the task like lack of modesty, being cold or other discomforts.

Personal care, including washing and bathing, is a common source of anxiety for people with Alzheimer's and their caregivers. It’s not hard to understand why – most of us have been carrying out these activities on our own since we were small children.

There are some particularly common reasons for anxiety among people with Alzheimer's, including:

• Deep bath water
  Deep water can make some people feel worried. You can reassure them by making sure the bath water is shallow, or by setting up a bath seat for them to use.
• Overhead showers
  Some people find the rush of water from an overhead shower frightening or disorienting. A hand-held shower may work better.
• Incontinence
  This may be a sensitive issue for both of you. If the person has an accident, they may feel ashamed. They may refuse to admit that it has happened, or to wash afterwards. Try to be reassuring. A matter-of-fact approach, or humor, may work well. Adopt an approach that fits with the nature of your relationship with the person.
• Self-consciousness
  The person with Alzheimer's may find it embarrassing to be undressed in your presence. One way to overcome this is to uncover only the part of their body that you are washing at the time, leaving the rest covered.
• Isolation
  Some people may become anxious if they are left on their own and may want you to stay with them while they are washing

Talk to the person about how you feel about bathing them. Ask how they feel and how they would prefer you to do things. Try to find ways to help them remain independent in as many ways as possible, and offer support as unobtrusively as you can. Here are some practical tips.

Know the person's abilities

Encourage the person to do as much as possible, but be ready to assist when needed. Assess his or her ability to:

• Find the bathroom.
• See clearly.
• Keep balance without fear of falling.
• Reach and stretch arms.
• Remember steps in the bathing process, follow cues or examples.
• Know how to use different products (soap, shampoo, washcloth, etc.).
• Sense water temperature.

Prepare the bathroom in advance

• Gather bathing supplies such as towels, washcloths, shampoo and soap before you tell the person that it’s time to bathe.
• Make sure the room is warm.
• Use large beach towels or bath blankets that completely wrap around the person for privacy and warmth.
• Have a washcloth ready to cover the person’s eyes to prevent stinging from water or shampoo.
• Make sure that soap and shampoo are easy to reach. Try using hotel-sized plastic containers of shampoo.
• Fill the tub and then assess the person’s reaction to getting into the water. It may be better to fill the tub
  after the person is seated.
• Use only two or three inches of water.
• Try using a hand-held shower head and make sure the spray isn’t too intense.
• Monitor the water temperature. The person may not sense when the water is dangerously hot or may resist bathing if the water is too cool.

Focus on the person, not the bathing task

• Help the person feel in control. Involve or coach the person through each step of bathing. Be sure the person has a role. For example, have the person hold a washcloth or shampoo bottle.
• Give the person choices. For example, ask if he or she would like to bathe now or in 15 minutes, or take a bath or a shower. Try saying “Let’s wash up” instead of “Let’s take a bath.”
• Be aware that the person may perceive bathing to be threatening. If the person resists bathing or acts out, distract him or her and try again later.
• Often praise the person for his or her efforts and cooperation.
• Always protect the person’s dignity, privacy and comfort. Try to help the person feel less vulnerable by covering the person with a bath blanket while undressing.
• Cover or remove the mirrors if a reflection in the bathroom mirror leads the person to believe there’s a stranger in the room.
• Have a familiar person of the same sex help, if possible.
• Be flexible. Allow the person to get into the tub or shower with clothes on. He or she may want to undress once clothes are wet.
• Don’t worry about how often the person bathes. Try sponge baths in between showers or baths. Wash one part of the body each day of the week. Or, consider shampooing hair at another time or on a different day.
• Pad the shower seat and other cold or uncomfortable surfaces with towels.
• Have activities ready in case the person becomes agitated. For example, play soothing music or sing together.

Adapt the bathing process

• Set a regular time of day for bathing. If the person usually bathes in the morning, it may confuse him or her to bathe at night.
• Use simple phrases to coach the person through each step of the bathing process, such as: “Put your feet in the tub.” “Sit down.” “Here is the soap.” “Wash your arm.”
• Use other cues to remind the person what to do such as the “watch me” technique. Put your hand over the
  person’s hand, gently guiding the washing actions.
• Use a tub bench or bath chair that can adjust to different heights. The person can sit while showering if it is easier.
• Washing the person’s hair may be the most difficult task. Use a washcloth to soap and rinse hair in the sink to reduce the amount of water on the person’s face.
• Be sure the person’s genital areas are washed, especially if incontinence is a problem.
• Be sure the person is washed between folds of skin and under the breasts.
• Simply the bathing process by sewing pockets into washcloths to hold soap or using soap that washes both hair and body.

After-bath care

• Check for rashes and sores, especially if the person is incontinent or unable to move around.
• Seat the person while drying and putting on fresh clothes.
• Be gentle on the skin. The person’s skin may be very sensitive. Avoid scrubbing, and pat skin dry instead of rubbing.
• Use cotton swabs to dry between the toes.
•  Apply lotion to keep skin soft.
•  Use cornstarch or talcum powder under the breasts and in the creases and folds of skin. If the person won’t use deodorant, use baking soda.

Make the bathroom safe

• Never leave the person alone in the bathroom.
• Lower the thermostat on your hot-water heater to prevent scalding injuries.
• Always check the water temperature, even if the person draws his or her own bath.
• Always put a nonskid mat in the tub or shower.
• Use a anti-slip bath mat outside shower stall/bathtub.
• Install grab bars and use a tub bench or bath chair that can adjust to different heights. 
• Make sure there are no puddles on the bathroom floor; think about installing carpet.

Other Considerations

• If a person is absolutely refusing a bath or a sponge bath and if his/her lack of hygiene is intolerable, consult a doctor. For some people medications may ease the anxiety. Use only with very careful supervision and as A LAST RESORT. (Sometimes these medications have side effects and occasionally they increase the agitation.)
• In the later stages of dementia when total assistance with personal care may be needed, meticulous and careful attention to hygiene is important in preventing skin breakdown. This becomes a major challenge for caregivers coping with urinary and bowel incontinence.
• Bathing is a very personal and private activity. Many people have never completely undressed in front of anyone else and this can be uncomfortable and vulnerable experience. Also, when a caregiver offers to help someone who is confused, it is a strong statement that the person is no longer able to do for him/herself. This loss of independence can be terribly difficult for people with dementia. It is important to recognize that these feelings may be contributing to some of the resistance to bathing.

Sources and Additional Information:

http://www.alz.org/living_with_alzheimers_bathing.asp      

http://alzonline.phhp.ufl.edu/en/reading/tet_bathing.php

http://www.healthyplace.com/alzheimers/grooming/bathing-alzheimers-patient/menu-id-56/

http://caregiverrelief.wordpress.com/2010/01/02/alzheimers-problems-wb-n/