March 6

Care Home Safe Holding: Non-Escalation in Personal Hygiene Tasks for Dementia Caregivers


Caregivers in nursing facilities rate assisting persons with dementia during bathing or showering one of the hardest, if not the hardest, caregiving task that they perform (Miller, 1997; Namazi & Johnson, 1996).

SENSES:  Bathing typically happens in a room, which provides a visual, auditory, olfactory, thermal, and textural context. There are also spatial qualities of the room that can either cause problems, support independence, or support caregivers providing assistance.

RELATIONSHIPS:  An important insight we gained was that the relationship between the caregiver and care recipient was essential. Nursing assistants who were able to shift from a task-focused to a person-focused approach were more successful in trying new approaches. Another insight was that nursing assistants valued the support they experienced from the consultant for trying new ideas.

IN-BED BATHS:   Another important “discovery” was that an in-bed bath, where the person is fully covered with a towel moistened with no-rinse soap and washed and massaged through the towel, often was comforting and soothing for persons who found even an person-directed approach to the shower or tub bath distressing. It was also effective in reducing aggressive behaviors and distress. The nursing assistants who participated also found bathing persons with dementia to be a more positive experience.

COMMUNICATION:  Engaged communication included: conversation with the person about general topics attention to the person’s need for comfort and personal preferences during bathing reassuring, explaining, and comforting phrases diversion requests for the person’s participation humor and compliments.

Nonengaged communication included: talking to another caregiver rather than the person firm directives and coaxing degrading comments and jokes at the person’s expense saying nothing when the person indicates a desire for communication or shows anxiety.

A person-directed approach—paced to meet the needs of the person being bathed—rather than a task-oriented approach that is often rushed to meet the needs of the caregiver, is key to preventing the battle.

RIGID POLICIES:  Some facilities allow only one towel and one washcloth per bath. This makes it difficult to keep the person covered and warm. Other facilities require showers and do not allow bed baths. In homes, there may be rigid beliefs about how to help someone stay clean or beliefs about when baths can or can’t be done. Such policies and beliefs can set the stage for a battle.

Perhaps ideas about past and present bath practices will help transform bathing into pleasurable and comforting spa-like rituals for elders rather than into a cleansing task that just needs to get done


Bathing Without a Battle –

Bathing without a Battle (UNC.EDU)


assault, challenging behaviour, dementia, distressed behaviour, hygiene, older people, personal care, personal hygiene tasks, safe holding, violence

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