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Sponge Bath

by Rundy on July 30, 2009

Where we last left off in Grandpa’s bathing saga I was picking him up and putting him in the shower on the shower chair and lifting him off, cleaning and dressing him entirely myself. Deanna commented on that post that, “I am 13 years younger than my husband but not physically strong enough to do the things you are doing” That is very true. And sometimes just because you can do something doesn’t mean it is the best way. If somebody needs as much help as I was giving Grandpa, it is time to start seriously considering switching to sponge bathing.

I continued to pick Grandpa up and put him in the shower for a number of weeks. But the change in procedure had made me sensitive to Grandpa’s reactions, and–while that method was far better than how things had been going before–I was sensing we still needed to alter things more. Once I understood it was greatly distressing for Grandpa if he had to do anything or even deal with any great or sudden sensory input, I began to see more ways in which the situation could be improved.

Several problems stood out to me in particular:

–There was the constant problem of my hands not being the right temperature. After I got him undressed and moved to pick him up there was the almost constant reaction of “AAARRRGH! Your hands are cold!”

–Getting picked up unsettled Grandpa. He trusted me–but just barely. There was always the muted, “Hey, watch it. What are we doing . . .” whenever I picked him up to put him in the shower.

–Then the seat of the shower chair was always cold. Even more, he was never able to anticipate what was about to happen, so from his perspective he was being whisked through the air to suddenly and unexpectedly have his bare bottom come in contact with a cold and wet seat. This would garner another “Aaaaah!”

–And the water temperature of the shower was never exactly perfect for Grandpa. It was almost always just a little too hot, or too cold. So immediately after placing him on the cold chair I would adjust the shower head so that the water was coming down on him and then–from his perspective–he would be unexpectedly deluged with too warm water. Thus another “AAARGH! What are you doing?”

For me this was much easier than how things had been before–because now instead of laboriously trying to explain and coach Grandpa through the process (and failing) I could now simply do it. But in spite of this I realized the improvement was not enough. Grandpa–with what rationality he had left–recognized that I was trying to help him. However, emotionally it felt like I was torturing him. The workability of our situation was, therefore, still dependent on Grandpa’s mental capabilities, and with an Alzheimer’s patient working against emotions is a method doomed to eventual failure. It would only be a matter of time before Grandpa would throw a fit over being alternately (in his mind) frozen and boiled.

I realized I needed to cut down on the stimuli even more. The transfer to the bathroom from Grandpa’s normal domain got him confused, and set the ground for further agitation. The roar of the shower running further befuddled him. And being picked up naked and whisked into the shower put him right on edge.

If I had been smart, I would have then realized it was really time to start doing a sponge bath. The problem is that I am cheap, and to do a sponge bath properly you have to buy no-rinse soaps. You can’t buy them at your local grocery store–you have to order them special, and they are more expensive than regular soap. So instead of being smart and going directly to sponge bathing I tried to go to an intermediate step where I still used regular soap and rinsed more liberally. You can say I went to bucket bathing.

I found myself a huge shallow container which I could set the shower chair in. This way I could have Grandpa seated on the shower chair and pour water over Grandpa without getting it all over the floor. It was a very ingenious setup. On bath day, after Grandpa finished his breakfast, I would slide the plastic container (it was actually a deep plastic lid) under his wheelchair and then have him stand up. At that point I would remove the wheelchair and place the shower chair under him instead. To avoid the problem with the cold shower chair, I laid towels over the chair (they could easily be washed). I would then pull down Grandpa’s pants and have him sit down on the shower chair. Then I finished getting him undressed. Since I never had to pick him up, that source of agitation was removed. Since his bare skin only touched fabric (clothes, or the towels over the shower chair) he never had the discomforting cold stimuli. And since I had a bowl of nice warm water which I scooped from to bathe him, there was no roar of the shower to confuse him.

It was an improvement. Nonetheless, I soon discovered it could be better. Having water poured over him was better for Grandpa than being tossed in the shower, but even that was discomforting. Imagine if you were sitting there and minding your own business and somebody suddenly dumped water over you. It wouldn’t matter if the water was just the right temperature. It would still be at least slightly disagreeable. Further, I was still getting Grandpa completely naked, and subconsciously he really didn’t like that and it got him wound up. It would be even better, I realized, if I could clean him without pouring water over him (to rinse off the soap) and if I didn’t have to have him completely naked.

In other words, give him a sponge bath.

Don’t be dumb like me. If someone is to the point where they need somebody else to bathe them–get them into the shower/tub and clean them–then it is time to switch to sponge bathing. If you’re to the point of giving that much assistance everyone involved will find it much easier. Tons easier. And the small expense of no-rinse soap is well worth it. Don’t be that cheap.

I got ConvaTec’s Aloe Vesta Body Wash & Shampoo. I am sure there are many more which are equally good. Whatever brand you get, I would make sure it has Aloe in it, because I think it is an excellent moisturizer. The Aloe Vesta I use leaves Grandpa’s skin feeling smooth and smelling really nice.

I actually give him a “washcloth bath” rather than a sponge bath. I mix a small amount of the shampoo in with 6 cups of water (the exact amount of shampoo may vary with brand) and then soak the washcloth to the point where it is very wet without dripping water all over the place. I still give him his bath right after breakfast on bath day, but I no longer make him get out of his wheel chair. Leaving him fully clothed, I first wash his head and face. Then I dry his head and face off. Then I wash his upper body, dry it, apply lotion, and put on his clean undershirt, shirt, etc. Then I pull up his pant legs and wash as much of his legs as I can, dry, and apply lotion. Since Grandpa is still currently able to stand, for the last step I have him stand up and grab the table to steady himself while I take off his pants and diaper, wash his bottom and manly parts, dry him, and put on a fresh diaper and pants.

I wish Alzheimer’s’s caregivers could be taught these things in advance. I wish they could have seen the “before” of how I used to do it in the shower and the “after” when I simply gave him a “sponge” bath. Before it was agitation for Grandpa, and stress for me. Before it was hard work, and near disasters for both of us. Now Grandpa is calm, and it may even be relaxing for him. My stress level over bathing has gone way down, and it is a lot less work.

The key is removing all of the upsetting stimuli.

Comments on this entry are closed.

Pat Goodwin August 5, 2009 at 9:33 am

Thank you for the update – been checking and waiting. This essay is thought provoking for any care giver of any person; not just those with your grandfather’s problems.

“Upsetting stimuli” removal is the key to care for us all. After encephalitis left my then-5-year-old son with almost no control of his emotions and actions, any stimulus including having his older sister tease him, would set him off and his reactions would be dangerous to his sister. Even though it angered his siblings in those situations, I removed him, took him to his room, read him Winnie the Pooh stories and sat with him until he fell asleep. He would tell me he didn’t know why he was crying or screaming or trying to choke his sister.

I didn’t know it then but removing upsetting stimuli was what I was trying to do. He needed more space around him or felt threatened and he needed quiet consistent routines. With your grandfather, he needs to not be bombarded with new and upsetting things every day when it is bath time. If only more caregivers and parents read your essays. I wish I’d had you around to explain my actions to son’s siblings and to his father. Thank you.

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