letters from Santa! Now that even our grandparents are internet savvy, it might be cool to do.

Part three of our series is about problems with bathing. Bathing is almost universally a dreaded caregiver chore. I have never seen the slightest bit of research to prove this next statement, but I believe hydrophobia is a real symptom of Alzheimer’s. I say that because I cannot recall a single Alzheimer’s patient that did not fight taking a bath or a shower, tooth and nail. Starting even in the early stages they make excuses like; “I just took a bath”, “I don’t need it”, “I don’t need help”. In the later stages they don’t even bother to make excuses, they just refuse. Even if you are able to get them into the shower, it’s not unusual for them to physically resist by yelling, scratching, punching and even biting.

Nevertheless, it is possible to get your loved one peacefully into the shower. It’s just a matter of taking your time and figuring out what about getting in the bath or shower is affecting them and then developing some unique tricks that will make the process manageable. However, the key to this whole problem is realizing that you need set aside a lot more time than you would expect.

You are about to read one of the most comprehensive reports I have ever seen on the topic. I got this from a booklet in my library called “Understanding Difficult Behaviors: Some Practical Suggestions for Coping with Alzheimer’s disease and Related Illnesses”.

Problems with Bathing
I have a theory that Alzheimer’s sufferers are hydrophobic; afraid of water. I’ve never seen any literature talking about this, or any research to prove it. However, in all my years working with Alzheimer’s I have never seen a person that didn’t kick, scream and bite to avoid taking a shower. They will tell you that they just had one, or that they don’t need it. But never ever have I seen somebody look forward to taking one.

POSSIBLE CAUSES

Physiological or medical causes:

Depression, causing a loss of interest in personal hygiene.
Physical illness, causing a loss of interest in personal hygiene (e.g. flu, infections, etc.).
Changed sense of perception of hot and cold water temperature. This may be caused by damage to the hypothalamus region of brain which regulates “internal thermostat.”
Different sensation of water due to brain damage.

Environmental causes

Poor lighting – unable to see the bathtub or shower.
Can’t find the bathroom.
Lack of privacy (especially in assisted living or board and care facilities)
Room temperature too cold.
Water too deep.
Water too hot or cold.

Other Causes

Fear of falling
Fear of water or of being hurt by it.
Disruption in daily routine or schedule.
Unfamiliar caregivers.
Mechanics of taking a bath too overwhelming.
Purpose of bathing forgotten.
Humiliation of being reminded to take a bath.
Agitated from an upsetting situation, such as an argument with caregiver.
Reeling of being rushed by caregiver.
Feeling embarrassed and vulnerable about being naked or having another person in the bathroom.
Fatigue.
Fear of hair washing, which is no longer understood.
Person kept waiting too long while caregiver prepares bath.
Fear of soap, washcloth, sound of running water, etc.

COPING STRATEGIES

Evaluate the best time of day for bathing. Try to be consistent with the person’s old bathing routine before the onset of the illness. For example, consider time of day when person is most relaxed, type of bathing (tub, shower, sponge bath, etc.).
Make sure the bathroom is warm enough and inviting. Pull down blinds, or close curtains and doors to create a feeling of privacy.
Provide adequate lighting in bathroom, especially during evening hours.
Try bathing instructions written by a doctor on a prescription pad. For example “Bathe 2 or 3 times weekly.”
Prepare bath ahead of time. Check the water level. Some people can only tolerate 1 inch of water in the tub; others 3-4 inches.
Lay out soap, washcloth, towel and clean clothes in sequence so that the person with dementia won’t have to wait.
Use quiet, calm, matter-of-fact approach. For example, “Mother, your bathwater is ready.”
Avoid getting into length discussions about whether a bath is needed. Instead tell the person one step at a time what to do to get ready for the bath.
Simplify task of bathing as much as possible. Do one step at a time, gently talking the person through each step. Combine visual and verbal cures when giving instructions. Use simple, respectful language.
Try offering the person one or two choices. For example: “Would you like to have a bath or shower?” or “Would you like to take your bath now or before going to bed?”
Try not to get nervous or excited or threaten the person who objects to taking a bath. This only causes additional agitation and frustration. It may be helpful to wait and try again later when the person’s mood is more favorable.
Encourage a bath instead of a shower if person can get in and out of tub. Baths are generally safer, less frightening and easier for the caregiver to manage.
Try showering with the person. Sometimes this is the simplest solution, although not all caregivers are in a position to do this.
Let the person feel the water before getting into the tub. Sometimes gently pouring water over hands reassures the person that the water isn’t too hot. Saying something like “The water feels nice,” or “This feels good,” may help calm the person.
Don’t bathe the person every day, if bathing continues to be difficult. A partial sponge bath daily and a full bath every three to four days may suffice.
Try using a bath chart or calendar to indicate when bathes were given. For example, a caregiver might pint to a note or a sticker on a calendar to show the person that it has been three or four days since the last bath.
Offer a “reward,” such as a favorite food or an activity like going for a drive in the car. This may be an effective way of cajoling the person into taking a bath. Having something to look forward to sometimes takes the focus off of the task.
Try separating hair washing from bathing. Some people with dementia associate bathing with having their hair washed and become terribly upset, because water being poured over their head frightens them. Sometimes hair washing can be done separately in a beauty shop. Try a shower cap when bathing or it may be easier to wash hair in kitchen sink if there isn’t a spray attachment in the bathtub.
Also try dry shampoo.

MAKING THE BATHROOM/PERSON SAFE

As a safety precaution, adjust temperature setting on the hot water heater so that the water is not scalding (between 120 – 130 degrees F.). You can get a thermometer at places like “Smart and Final” or any Restaurant Supply store.
Since the person may have an altered sense of hot and cold, adjust the water temperature to his/her comfort.
Avoid leaving an impaired person alone in the tub or shower.
Remove locks from bathroom doors.
Use plastic instead of glass containers in the bathtub.
Make sure hairdryers, electric razors, etc., are out of reach.
Use a non-slip bathmat on the floor outside the tub. Be sure there are no puddles of water on the floor.
If Lubriderm or other oil is used, be careful of slippery residue on the tub.
Put a rubber mat or non-skid decals on the bottom of the tub or shower.
Install grab bars so that the person can get in and out of the tub easily. These bars can be mounted to the wall or they can clamp onto the side of the tub.
A hand-held spray attachment on a flexible hose can convert a tub into a shower. The attachment can be helpful for rinsing the person thoroughly and makes washing hair much easier.
Adjustable safety benches or bath chairs (which have holes in the seat so the water can drain) can be used in both tub or shower. These help make people feel more secure because they are sitting above the water. If safety benches aren’t available, try a kitchen chair. These assistive devices are available through medical supply houses, large drug store and department stores, and home health care catalogs. Medicare, Medicaid, or major medical insurance may pay all or part of the cost of equipment if ordered by a physician.
Be sure that all parts of the body, especially the genital area, are thoroughly washed to avoid rashes and infections.
Try giving the person with dementia a washcloth to hold or something to fiddle with for distraction while bathing.
Play soft music in the background to create a calming and relaxing atmosphere.
Wrap a towel around the shoulders of the person sitting in the tub and fasten with clothespin, if he/she is embarrassed about being undressed. It is important to respect the person’s privacy and dignity.
Try tomato juice added to bathwater, if persistent body odor is a problem.
Be sure the person is thoroughly dry. Use a refreshing after-bath scent and dry skin lotion to keep the skin moisturized. Baby powder can also be used.
Remember, powder on the floor can be slippery. Cornstarch is an inexpensive odorless, non-allergic substitute for talcum powder.
While the person is undressed, check the skin for rash or sores. If any red areas or sores appear, notify the doctor immediately. Pressure sores or decubitus ulcers can develop quickly on people who sit or lie down much or the time.
Check the person’s toenails and trim them as necessary. Proper foot care is essential to prevent problems such as ingrown toenails. If trimming nails is difficult, have the person seen by a podiatrist.

IN LONG TERM CARE SETTINGS:

Be sensitive to the approaches used when talking to residents about bathing.
Try making the bath schedule flexible to accommodate the person’s mood.
Allow plenty of time for individuals to relax and enjoy a quiet, peaceful bath.
Train staff or family members who assist with bathing to allow people to do as much of the bathing themselves, whenever possible.
Consider making the environment in the bathroom warm, familiar and private.
Be aware that some people with dementia become quite upset when required to take a whirlpool bath. Institutional equipment such as whirlpool baths can be impersonal and terrifying.
Avoid using commode chairs when giving showers. This practice encourages people to be incontinent when bathing.
Avoid forcing or arguing with a person to take a bath when he/she is resistant. This only causes further agitation.

OTHER CONSIDERATIONS

If a person is absolutely refusing a bath or a sponge bath and if his/her lack of hygiene is intolerable, consult a doctor. For some people medications may ease the anxiety. Use only with very careful supervision and as A LAST RESORT. (Sometimes these medications have side effects and occasionally they increase the agitation.)
In the later stages of dementia when total assistance with personal care may be needed, meticulous and careful attention to hygiene is important in preventing skin breakdown. This becomes a major challenge for caregivers coping with urinary and bowel incontinence.
Bathing is a very personal and private activity. Many people have never completely undressed in front of anyone else and this can be uncomfortable and vulnerable experience. Also, when a caregiver offers to help someone who is confused, it is a strong statement that the person is no longer able to do for him/herself. This loss of independence can be terribly difficult for people with dementing illnesses. It is important to recognize that these feelings may be contributing to some of the resistance to bathing.

Finally, don’t let your personal habits dictate what is normal. A generation ago, most people did not bathe and change their clothes as often as we do today. Taking a bath once a week may have been the way the person did things in his/her home.

Now, since you didn’t do it the previous two time asked – here’s one final request: if you are a caregiver, if you nothing lose, a lot to gain from signing up at www.DementiaCareSecrets.com it is a free membership site.
see you soon, Donahue

WWW.DementiaCareSecrets.com

P.S. For a short time you can sign up to get personalized care and guidance from a USC graduate (me) No lie!!

Sign up for a free membership at www.DementiaCareSecrets.com

Donahue

 I Am…

 …Nothing special,

Just a person.

Losing something of myself,

But nothing special to anyone

Except to myself.

…Writing for the world,

Yet,

Just to myself.

…A dreamer,

Who is slowly finding the dream

Enfolding me,

Soon,

I will be unable to escape.

…A watcher of the world,

Of people,

Of ideas and ideals,

All that will one day mean nothing to me.

…Leaving behind something,

Yet,

Nothing.

Someone,

Yet no one,

Especially no one special.

…A dream,

As much as a dreamer,

Caught in between

Reality and dreams.

When day fades to night,

For the final time,

Will I even notice the sunset?

…A whisper

That will one day

Fade,

A dying echo

That time will wash

Away.

prolog: Dallas is in her 40′s, her husband works at various jobs to support the family. She has 3 children. The youngest, I think, is about 14 years old.

Can you imagine losing your mom before your very eyes. See her every day, struggling to hold on to what she can. Sense her fear, her sadness, her frustration.  When mom’s are supposed to be giving you hugs and advice about boys, and makeup, your’s cannot. 

See in her eyes the panic, and then even that is forgotten, and there is nothing left but the blank empty eyes, the useless hands at her side, like watching someone drowning just out of reach, where you can’t help them, though you wish it with all your might.

Its not fair, we should never have to feel so powerless. The word “heartbreaking” does not even begin to describe what we feel – The guilt, the heartache, the last words and declaration of love, that won’t be remembered.

If your family is affected by this illness. Please make a comment here, or anywhere, but let others know that they are not alone…that YOU hear their words, and feel their pain. In turn, they will do the same for you – and in this way we are a Tribe.

If you wish to join us, we are forming our  tribe at:

www.DementiaCareSecrets.com

#1 Nobody is telling you the truth about Alzheimer’s

Go to any number of online forums for caregivers, and you will read over and over again how the caregiver is at the end of their rope: financially and emotionally!
A quick look at any one of the many caregiver forum websites and you will see comments like this:

“How do I approach the subject of assisted living with my brother and sister? Mom gets angry at everyone and everything that is not done the way she wants it. I want my life back. I have sacrificed 15 years for her with no appreciation.”

“I hate the way most doctors pass the buck and will not commit to any answers. I just want a straight answer for once! If this is the end I want to know what to expect and what kind of time frame.”

“Dad is horribly depressed and just can’t seem to get moving. I honestly don’t know what to do. I want to be there for him, but I get so frustrated when I go over to his house. He just doesn’t seem to want to “help himself”. It gets so that I almost cringe when I see his number on caller id because it’s depressing me to be around him.”

This is the norm! And let’s face it, there is little or no help out there. Not from the government, not even from your family. They are fast and loose with advice about what you should do, but they don’t get it, because they are not living it 24/7 like you are. So, you have almost no help, not even financial, and most of your friends have seemingly moved on too. Who can blame them, right?
Granted, this sounds terribly negative.

But there IS help out there. There ARE solutions. However they can be hard to find, and your circumstances really are unique! So the solution has to be hand tailored to your situation. Each family is different.
If you found my website www.EasyCargiving.com/DementiaAssessment recently it is probably because of the free Geriatric Assessment that I am offering. I hope you downloaded it, and to get the most out you should watch the videos. More importantly, make an effort to reach me. You would be surprised how many people do not even try. They are desperate for help but if its free it must not be any good, or be “common knowledge that I can figure out on my own”. (I am not posting my email here for obvious reasons, but with a little effort I can be found. Google me or just go to the website I mentioned in the beginning).

If you are new here, or did not get the assessment form: Go Here For Your Free Geriatric Care Assessment Form, and videos explaining it

Please take a look around,  Donahue Vanderhider, MSG

7 Ways the U.S. Population is Changing

For example Boomers will remember all those years of doom and gloom, that the world was reproducing so fast that we were using up all the worlds resources? Well surprisingly the first “change” is

1. (Slowing) Growth

The most obvious and constant change to the U.S. population is growth. But 2010 census numbers show that population growth had dropped to 9.7 percent, its lowest level since the Great Depression. The U.S. growth rate has also lagged behind world population growth over the last decade. The estimated world population of nearly 6.9 billion, meanwhile, is up 12.5 percent from 2000. However, U.S. growth remains ahead of many other developed nations, particularly European countries, whose populations may actually decline between now and 2050.

2. Moving West and South

… According to the Pew Hispanic Center, the state with the largest share of foreign-born residents is California, with 26.9 percent. Another western state, Montana, posted the largest increase of foreign-born people over the last decade, with a 60.9 percent jump.

Number 3 below comes at no surprise, especially for those taking care of parent. The unmentioned impact is that for every retired non-working adult, there will be only 4 working adults paying taxes to support that person:

3. Aging

The estimated population median age in 2009 was 36.8, up from 35.3 in 2000—a natural consequence of 77 million baby boomers pulling that figure upward with every passing year. The birth rate has also been relatively flat since the 1970s, and in 2009 posted the largest two-year drop in over 30 years, according to the Centers for Disease Control. Altogether, the elderly segment of the population is expected to increase dramatically. A Congressional Research Service report released this year projected that people 65 and older—currently constituting 13 percent of the population—would make up 20.2 percent of the U.S. population by 2050.

4. Becoming More Diverse (…and particularly, more Hispanic)

The white, non-Hispanic segment of the population is steadily shrinking … The Census Bureau predicts that, by 2050, white people will only make up 46.3 percent of the population. The burgeoning Hispanic population is one major reason for this projected shift—the Hispanic populace grew a staggering 43.1 percent from 2000 into 2010, and is expected to make up 30 percent of the population in 2050, up from its current share of 16 percent. Other groups expected to post significant growth are Asians, from 4.7 percent in 2010 to 7.8 percent in 2050, and people of two or more races, from 1.9 percent in 2010 to 3.7 percent in 2050.

Aye Caramba!

Moving on the number 5 below, what can you say? The rich are getting richer and the poor…
Bad news for someone trying to take care of a parent or spouse with Alzheimer’s. Last year’s statistics have Americans spending well over $100 billion out of pocket for the care of a family member with dementia.

5. Increasing Income Inequality:  (for details please refer to the original article at US World & News Report.  Essentially, the heading Increasing Income Inequality says it all)

Continuing on, number 6 is good news. Now if we can just get women earning equal money for equal pay, we might make dent on number 5 above.

6. More Women with Diplomas
The U.S. population is getting more educated as a whole, with 87 percent of adults 25 and older having high school diplomas in 2010—up from 84 percent in 2000. But women in particular are helping to drive America’s growing educational attainment. The Census Bureau reported this year that 37 percent of employed women have attained a bachelor’s degree or more (as of 2010), compared to 35 percent of men. Women have also surpassed men in terms of advanced degrees; 10.6 million American women have master’s degrees or higher, compared to 10.5 million men. However, men still have far more professional and doctoral degrees than women.

Finally we have number 7 below. Which is a little anti-climatic, as it seems this has been going on for a long time. Do you remember the Yuppies and DINKS of the 1980′s? Double Income No Kids was the description of married couples that were putting off children way back then…

7. Waiting to Procreate
An increasing number of those educated women are putting off childbearing. According to the Census Bureau, among women aged 25 to 34 in 2000, 83 percent with less than a high-school education had given birth, compared to 42 percent of women with bachelor’s degrees. But 10 years later, the gap within that same cohort had closed considerably—88 percent of women without high school diplomas had children, as well as 76 percent of women with bachelor’s degrees.

–thanks to Ms. Kurtzleben and World & News Report

Taking Care of Parent with  Alzheimer’s?

Come to the first ever One-Stop-Shop membership website exclusively designed for Boomers taking care of a parent with dementia

It’s FREE, and its chock full of articles, videos, and podcasts. It has stress management guided imagery recordings, links to other sites and little known secrets about dementia and Alzheimer’s care.

It also has a forum as well as an “Ask The Experts” section where you can get hand-tailored answers to your specific needs and questions.

(someday it will be a paid membership)

but not TODAY!…come join now and its free for life.

Its a free membership site exclusively for caregivers. You will find articles, videos, interviews, podcasts, quizzes, even games and a social forum to chat on. Did I mention FREE? Please go take a look. The idea for that site came from this blog and a desire to provide more information that you could in a traditional blog.

But there are always exceptions to the thumb rule.

For example: I am working for a small company that owns both assisted living communities as well as nursing homes. It’s a new job and I have been there a mere 3 weeks.
But I have to say, in my 15 years in this business, I have never met a more ethical and honorable man, as the owner of our little company. And with most organizations: the leadership personality trickles down to all levels of the company. So in my brief time with this company, I have seen some thoughtful and considerate decisions made by this organization, that quite frankly had fallen out of my playlist, from disuse. So I must temper my criticism of the industry in general and take a moment to caution you all…there are some good ones out there. Albeit rare.

Tell you what…come on over to www.DementiaCareSecrets.com my new membership website. I will make everything on the site available to Bronze Members (our free level), so that you can get a feel for what we are trying to do. Take some time, read a few articles, listen to a stress management recording, and use the forum to communicate with other caregivers. And we will give you a resource list as long as your arm of websites that you can go to for everything you need or ever will want.