Troubleshooting

1. The administration must support of the gentle bathing program and develop a non-coercive bathing policy which is explained to families and staff if this approach is to succeed.
2. Changes may need to be made to make the bathing area more private, pleasant and functional for staff and necessary equipment provided to accomplish the goal of gentle bathing. Storage space for bathing supplies can be added to prevent leaving the resident during the bath to obtain needed supplies. Other modifications which facilitate comfort and safety can also create a more familiar environment with cues such as pictures, scented soap, a vanity or oval mirror.
3. When a resident adamantly refuses a bath, caregivers consider whether it is really necessary to bathe the resident in this way at this time. The point of reference for care of the resident with dementia in a difficult situation should be the home. The question: "What would I do if I was at home with this resident and the resident was my relative?" should be asked. This helps staff to put aside institutional ways of thinking about relating to residents in a caregiver to patient role, and lends itself to a more human person to person cooperative approach.
4. Caregivers are trained to individualize their approach, structure the environment to provide comfort and pleasure, utilize caring and creative communication skills, and remain flexible, using a variety of methods to maintain personal hygiene in reluctant residents.

   Communication Techniques Found to Be Helpful When Bathing Persons With Dementia
   Technique	Comments/Examples
   Use a Calm, Personal, Gentle Manner	Go slowly, projecting an attitude of warmth and respect for the dignity and worth of the resident as an individual.
   	Give the resident your complete attention and talk to him/her in a soothing but adult manner throughout the bath.
   	Keep the EDGE Caregiver Goals in mind as you attempt to help the resident have the best experience of bathing possible. Try to determine how to help the resident to feel safe, physically comfortable, experience some sense of control, feel valued as a person, and experience pleasure during bathing.
   	If the resident begins to get agitated, slow down, change your technique, move on to another part, or stop and give the resident time to calm down while you try to soothe the resident and find out what part of the process is most upsetting and how to bypass that part.
   	Cover all parts of the body you are not bathing at the time.
   	Keep the room and the water warm according to the resident's preferred temperature.
   	Explain what you are going to do before you do it (unless the resident is made more agitated by the explanation).
   Distraction	Talk with the resident about something familiar/interesting to him/her.
   Persuasion	Use a cheerful manner and phrases that have been found to work to encourage the resident to bathe. Don't use force or ignore the resident's feelings.
   	Make an appointment with resident for a bath.
   Provide a Reason to Go with You	"Your hair will look beautiful for your daughter's visit, after we wash and comb it".
   Address the resident in language (s)he understands and by the name or title preferred by the resident.	"Let's get washed up before lunch, Mary Louise."
   Provide Information	"I'm going to soap your face now. I'll go slowly and be very careful."
   Have One Person (Rather than Several) Approach the Resident	It is less threatening, and the resident will feel less like a group is coming to force him to do something.
   	If two caregivers are needed to bathe the resident, have the caregiver most familiar with the resident, talk to the resident and give directions during the bath. Do not carry on a conversation between caregivers during the bath, as this is confusing and distracting.
   Use past Memories to Convince or Reassure Resident	To a resident who does not want to disrobe: "You have a beautiful green dress to wear to dinner, I see."
   Offer Rewards	"After your bath, we'll ... (a favorite thing)".
   Give Positive Feedback for Cooperating	"You're going to look so good for the party when we finish your bath. It sure goes faster when you help by raising your feet for me like that".
   Give the Resident a Choice	"Would you like to wash your face, or shall I do it?" Give in more often, try to do it the resident's preferred way, if possible.
   Come Back Later When the Resident's Mood Is Better	Talk to co-workers and find out under what circumstances the resident is usually more cooperative with bathing. Return at a time when the circumstances are most favorable.
   Use the Caregiver Who Is Most Likely to Be Successful	Find out which caregiver is most trusted/successful in bathing. Put techniques found to be successful on the care plan. Have alternate caregiver help with bath to learn techniques and become familiar to resident.
   	Use same-sex caregiver (in most cases), if possible
   	Sometimes a family member may be most successful at bathing the resident or helping staff to bathe the resident

5. A frightened resident who strikes out or screams in response to bathing requires soothing, not an angry reprimand or threats from the caregiver. The emphasis is on being gentle, not overpowering the resident.
6. Staff has permission to decide to use a different bathing technique, to stop a bath in the middle, wash the resident standing up, or do whatever works with a particular resident. Staff is encouraged to use persuasion not coercion to preserve resident autonomy and to promote dignity.

Residents are not bathed over their objections unless a compelling health concern exists, and all other methods fail. In that case, one staff member supports the resident emotionally, by making close eye contact and talking soothingly (maybe while holding the resident's hands gently), while other staff members wash only what is absolutely necessary and provide safety measures to prevent potential injury.