Alzheimer's Habilitation Our Approach to Personal Care

 

Module 6:
Our Approach to
Personal Care
Section B

Areas Where We Can Help

What You’ll Learn

Identify 2 ways to make bathing easier

Identify 2 ways to make dental care easier

Identify 2 ways to make dressing easier

Identify 2 ways to make toileting easier

Identify 2 ways to make eating or feeding easier

A Trip to Wal-Mart

This nicely dressed man greets you at the door and then…

 

Why Might They Be
Afraid or Angry?

Person is naked; they feel exposed

Person feels embarrassed or uncomfortable

Person doesn’t like feel or sound of water

Water is too cold or too hot

Bathroom is cold

Person is afraid they will fall

Before Bath or Shower

Know and follow their bathing preferences or habits:

Morning or evening? Bath or shower?

Get what you need before you begin:

Soap, washcloths, towels, bathing sheet, creams

Don’t ask if they want/need a bath:

Connect with them through conversation first, then:

Say matter-of-fact, with smile, “It’s time for a bath! 
Let’s wash up and get ready for the day.”

Always check water temperature

Don’t argue or try to explain

 

During Bath or Shower

If possible, use hand-held shower

Start with legs, hands or arms (less threatening)

Don’t start with water on their face or head

Use bath or shower chair to prevent falls

Encourage them to do as much as they can

Give them a washcloth of their own:

They can assist with their face, arms

At same time, you can wash other areas

During Bath or Shower

If cold or embarrassed, place a towel or bathing sheet on their shoulders or lap

Wash under towel so they feel less exposed

Be patient and gentle – do not rush

Talk with them in a soothing manner

 

After Bath or Shower

Wrap them in a towel

Pat them dry (don’t rub)

Pay attention to areas under folds of skin

Use lotion for dry skin

Use protective
ointment if
incontinent

A Healthy Smile
Is Still Worthwhile

Dental Care Is Important

Prevents dental problems or eating difficulties.

To assist with brushing:

Break down into one step at a time

Provide short, simple instructions

Use “watch me” or “hand-over-hand” technique

If needed, do parts of task

Remove and clean dentures each night

Investigate signs of mouth discomfort

Report dental pain or discomfort to supervisor

Success with
Helping Them Dress

Dressing and Undressing

May need help choosing clothing for weather
or time of year

May forget they already wore something
(take away dirty or soiled clothes)

May take longer – be patient and allow time for person to do what they can

Don’t correct them; encourage them to make
a different choice

Dressing and Undressing

As the disease progresses:

Let them select clothing but limit choices to
2 things (pink or white blouse?)

Lay clothes out in the order they will be put on

Clothing should be comfortable and loose fitting

Pre-select clothing that is easy-on and easy-off

Give simple step-by-step instructions to
undress or dress

Can help them to do the task

Dressing and Undressing

As the disease progresses further:

Go slowly and talk with them as you assist

They may change clothes repeatedly throughout the day – try to keep them active with other things

If the person resists dressing or undressing,
try gentle encouragement

If they continue to resist, stop and try again later

Toileting and Incontinence:
Helping with Respect and Dignity

Incontinence Is Not Always
Because of Alzheimer’s or Dementia

If the person does not have a history of accidents:

Urine incontinence may be caused by a
Urinary Infection

Bowel incontinence may be caused by flu
or bowel obstruction

After assisting patient to wash and dress,
report this change to supervisor

A doctor may need to determine the cause

Alzheimer’s or Dementia
Can Affect Continence

They may have difficulty finding bathroom 
(we should make sure there is a clear well-lit path
to and from the bathroom, even at night)

They may have difficulty removing clothes 
(it may help to provide clothing choices that are
easy to get off and put on)

They may not recognize the urge to use the bathroom and wait too long

They may not notice or realize they had an accident

To Help Prevent Accidents

Notice their verbal and non-verbal cues:

They may pull at or take off their clothes

They may pace, be restless or be agitated

They may ask to find something or be looking
for something

Dress them in easy to remove clothes:

Pants with elastic waists or no belts

Make sure bathroom is clearly visible and marked with a sign or picture

To Help Prevent Accidents

Work with the care team on a toileting schedule:

Track incontinence:  When?  How often?

Schedule when to remind or escort person
to bathroom

In private, encourage person to visit the
bathroom or escort or assist as needed

If you assist, talk as you go so the walk
to the bathroom is enjoyable

If a Person Needs Help
in the Bathroom

Assist only as needed

Start with verbal cues or gestures

Encourage urination by running water in sink

Be patient

Allow person privacy but stay with them

If more help needed:

Assist with clothes

Help to sit on toilet

Wipe and adjust clothing

Help wash hands

Make sure you use proper care precautions

It Isn’t Easy to Assist, But…

People with Alzheimer’s and most dementias eventually become incontinent

This change is part of the disease

Losing control is embarrassing for them

Helping can be difficult but:

Must be done with respect and dignity

Do not blame or shame them

Give assistance with a minimum of fuss

Talk with them about other things, or sing a song

If the Person Needs
to Be Changed

Understand this is part of the disease

They may be confused or fearful

Don’t shame them or say things like:
“I knew you needed to go to the bathroom!”
“Couldn’t you hold it?”

Don’t bring attention to them in front of others.

Help them feel safe and secure, say something like:
“This happens sometimes, but you are okay.
I’ll help you get more comfortable.”

Nutrition and Eating
Keeping Mealtime Enjoyable

Nutrition Is Still Important

A good diet can help to:

Prevent dehydration (they forget to drink water)

Prevent constipation

Avoid weight loss or weight gain

Make sure they get enough fluids,
even if they are incontinent

Don’t argue if they should avoid sugary
or fatty foods

Keep these foods out of their sight and out of reach

What Changes about
Eating Over Time?

May need help to find dining room

Will lose ability to use knives, forks and straws

Late in the disease may have trouble swallowing (report to supervisor)

Ways to Help at Mealtime

Provide meals in a calm, relaxing place

If needed, peel fruit and get food ready before serving them

Serve meals at same time and place

Encourage them to take time and do not rush

At some point, easier to use bowl instead of plate

Change in appetite may mean a medical problem. Report it to a supervisor.

 

What did we
talk about today?
Let’s review…

Ways to Make Bathing Easier

Know and follow their
bathing habits

Get what you need before
you begin

Don’t ask if they want/need a bath

First connect thru conversation

Check water temperature before

Start with legs, hands or arms
not their face or head

Use bath or shower chair to prevent falls

Encourage them to do what
they can

Give them a washcloth of
their own

If cold or embarrassed, place towel or bathing sheet on shoulders or lap

Be patient and gentle –
do not rush

Talk with them in a soothing manner

Ways to Make
Dental Care Easier

Break down into one step at a time

Show the person or do “hand-over-hand”

If needed, do parts of task, like putting toothpaste on brush

Investigate signs of mouth discomfort

Report dental pain or discomfort to supervisor

Ways to Make Dressing Easier

Take away dirty clothes

Be patient – give them time to
do what they can

Limit choices – but give choices

Lay clothes out in order they
are put on

Give simple step-by-step instructions

If the person resists try gentle encouragement

If they continue to resist, stop
and try again later

Clothing should be: comfortable, loose fitting, easy-on and easy-off

Prevent frequent undressing and dressing by keeping them active

Ways to Make Toileting Easier

Notice their verbal or non-verbal cues they need bathroom

Easy to remove and put on clothes

Make sure bathroom is visible, well lit, easy to get to

Track incontinence: Schedule to remind or escort to bathroom

In private, encourage person to visit the bathroom, escort or assist as needed

Talk as you walk to bathroom, focus on something else

When assisting in bathroom:

Start with verbal cues or gestures

Encourage urination by running water in sink

Allow person privacy but stay with them

When they are incontinent:

Don’t shame or blame them

Don’t bring attention to them for incontinence

Show them you understand, help them feel safe & secure

Ways to Make
Eating or Feeding Easier

Re special diet: Don’t argue over sugary or fatty foods.  Keep these out of sight

Encourage independence, even if using a
spoon or fingers

Provide meals in a calm, relaxing place

Get food ready to eat before serving

Serve meals at same time & place

Encourage them to take time, don’t rush

May be easier to use bowl instead of  plate