Skills for the Job of Living: Focus on Bathing in the Home Health Setting

 A blog posted on October 11, 2013 focused on the many aspects of caring for the elderly in the home with the assistance of an Occupational Therapist (OT). OT's focus on common, every-day occurrences known as activities of daily living (ADL’s), such as bathing, dressing, toileting, grooming, and feeding. Bathing and toileting are the most personal and complex of the ADL’s. Both require cognitive and physical abilities such as dexterity, flexibility, balance, strength, and coordination. This post will focus on the specific task of bathing.

Families and caregivers often find the older adult to be more resistant to bathing. To the person who requires assistance in this area, it represents a decline in well-being and independence. Bathing becomes emotionally and physically uncomfortable because of factors such as pain, fatigue, weakness, confusion, anxiety, and embarrassment. These factors arise from being naked in front of strangers or family members, fatigued, fear of falling, discomfort from getting cold, and a dislike of harsh shower spray. Many of these older adults grew up in the era of bathtubs and therefore dislike showers. During the aging process, they may have learned that they can no longer get in and out of the bathtub safely and have resorted to sponge bathing at the sink, or not bathing at all. The issue of bathing is particularly difficult in the Alzheimer's population as confusion increases.  

Families and caregivers often feel that sponge bathing is not enough, and they may be correct. As the elderly client loses physical and mental abilities, they may not be able to reach as easily, they may be losing bowel and bladder control which leads to a need of more frequent bathing, their memory is fading so they can’t remember if they have bathed, they may be too fatigued, or they don’t want to get cold.  

All of these reasons are valid for bringing an Occupational Therapist on board through home health services. An OT is trained to assess the environment for safety, make equipment recommendations, address physical abilities such as the strength, pain, and endurance of the client, and finally, to address the psychological aspects, such as confusion, problem solving, safety awareness, and how these may interfere with bathing.  

Improving the ability of a client to bathe can be as easy as using a shower chair to address weakness, installing grab bars to address safety and fear of falling, heating the bathroom to keep the client comfortable and warm, making sure medications are on board to address pain, appropriate draping to honor client modesty, and lastly, modification of a shower head to a gentle spray with a hand held shower head, which allows the client to direct and control the spray. 

An OT will assess how much the client can help themselves, and then consequently, how much a family or caregiver will need to help.  Studies have shown that 31% of adults 73 years and older have difficulty with bathing. The therapist can train a family member or the family may decide that they would like to hire an agency bath aide to take care of this important activity.

This post touches briefly on the complexities of bathing and provides some answers. An OT is trained to help families sort out the issues and come up with a plan that will help your family member experience bathing as a safe and pleasant activity.   

For answers to your specific questions, contact Cascade Home Health at 541-228-3050.