By Betty Weiss

As Alzheimer's progresses, the most fastidious fashion plate can become a slob extraordinaire.  Removing dirty clothes is a wrestling match; bathing, a battle royal.  Your loved one is perfectly happy and content 'as is,' threatens you if you get too close and refuses to bathe.

Alzheimer's patients can be very sensitive to loud noise, especially several noises at once.  Bathing becomes frightening because of echoes off tiles in the stall shower, background noise of a radio or TV, screeching children and clanging kitchen sounds are too much.   When helping with bathing, speak normally, try not to yell.  Bathrooms have a lot going on: running water, flushing toilets, temperature changes, heaters, drafty windows, steam, fans, vents and sometimes, strange people.  Water is coming down on their head, something is being rubbed into their hair, it's all slippery, they're afraid of falling.  Glasses and hearing aids have been removed, they can't hear and see clearly, something is dripping into their eyes.  Mirrors add the belief that people are watching, there's no privacy - they won't let you wash them 'down there.'

There are problems with Alzheimer's vision.  A bathroom with white tile floor, tub and shower confuses the patient.  A change in depth perception makes them unable to distinguish where the white tile floor ends and the door to the white tile shower begins.  If floor, tub and shower tiles are the same color, put a different colored towel at the tub or shower entrance. Shallow water in a tub looks like there's no bottom - it's terrifying.  And then, for whatever reason, they are frequently afraid of water.

Before beginning a shower or bath, get the house quiet, although soothing background music may help.  Have everything set up beforehand so there's no standing around half dressed, waiting.  The bathroom should be the right temperature, tumbling a robe and towel in the clothes dryer for a few minutes is comforting.  A shower chair, if wanted, is available at medical stores.  Use a handheld showerhead so you can control the off-on water flow and move around the body.  Test water temperature first.  Have all fresh clothes laid out and dirty ones out of sight.  Putting a book, toy or anything in their hands to distract them will help you get clothes off easier.   

Stick-on decorations and mats on the shower and tub floors are helpful.  Install handrails early on so there is time to learn to use them.  Sometimes you can let your loved one wear underwear or a wrap-around towel for modesty.  Leave glasses and hearing aids on if possible.  Pleasant smelling gels with a net sponge are nice.  If you can't wash their hair in the shower, use a dry shampoo later, otherwise, try baby shampoo. 

You can step into the shower first and coax a loved one in, stay there if necessary.  Give them something to keep their hands busy, a rubber ducky, a plastic anything, a washcloth so they can 'help' wash themselves - but not a bar of slippery soap.  Let them know where you are going to wash next.  Although you will want to work quickly, don't rush your loved one.  Responses and understanding are getting slower.

For tub baths, again, sprayer and shower chair if wanted, plastic floor mat and not too much water, four to six inches is enough.   Sometimes it helps to let them see the water going into the tub rather than having it already there.  Remember, handrails to help getting in and out.  No one needs to bath every day, once a week is more than enough with a sponge bath between, maybe in bed - but don't let them see the basin of water.  A treat is always good.  Promise, 'As soon as we finish, we'll drive over and get chocolate ice cream'.

Sometimes only a sponge bath is possible, but do try to keep face, hands, feet and genitals clean.  It is often difficult for one person to do these things alone.  Ask around at Alzheimer's organizations, support groups, care facilities and senior centers for people who come to the house just to do the bathing, it still may take two of you.  Never leave your loved one alone in the tub or shower!  Whatever or whoever is interrupting you can wait until you are finished. 

Betty Weiss is the author of the best selling Alzheimer's Surgery: An Intimate Portrait, and When The Doctor Says, "Alzheimer's:" Your Caregiver's Guide to Alzheimer's & Dementia. She does not give medical advice.                           
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