Shared Experience: Mary's Bathing Day

“Mary's Bathing Day” is a custom canvas visual communication tool that met the challenge of "Mary’s bath day’. We partnered with Mary, her family and caregivers to find a creative solution for Mary’s overall behavioral challenges. Finding a strategic solution for Mary was guided by experiences with my loved ones’ similar challenges over the years – and having access to resources such as Alzheimer’s Association http://alz.org/ the UW-Milwaukee Center on Aging and Community http://cac.obiki.org/index.htmlMAREP Murray Alzheimer Research Program http://marep.uwaterloo.ca/ and specifically the writings of Gwendolyn deGeest RN,BSN,MA author of “Living with Dementia”, and “Bathing Sparky.” Gwendolyn deGeest provides useful coping strategies for persons dealing with behavioral challenges. She has been working in dementia care for over two decades and, like me, has witnessed the joys and sorrows of families struggling to maintain a quality of life for themselves and their loved ones. Gwendolyn deGeest’s experience and guidance as written in her book “Bathing Sparky” is strikingly similar to Mary’s story (and my grandmother’s challenge with ‘bath day’).

Embracing Mary, the Person. Mary is 81. Diagnosed with Alzheimer’s dementia at age 77. Mary’s husband passed away in 1986. She has a son and a granddaughter. Mary is a resident of a “memory care unit” of an assisted living home. Mary had 3 poodles over her lifetime. Her poodle Daisy lived with Mary in her home from 1984 to1997. Mary has fond memories of her granddaughter, Patty, and Daisy. They spent many summer afternoons in Mary’s backyard. This is “one of Mary’s stories”. – and was evident from the time we spent viewing the family photo albums and meeting Mary.Mary’s granddaughter Patty visits regularly. Patty has carried on the tradition of having a poodle and regularly visits Mary with her poodle.

Behavioral Challenge:Mary’s most challenging behavior is extreme agitation and fear that surfaces on bathing day.Mary, now 79, paces up, down and across the hallways of St. Anne’s where she resides. She always paces on this day, because today is Mary’s bath day. Things are done on a regular schedule at St. Ann’s. The health caregivers are always on time for Mary’s bath day. Even though Mary has dementia, she never forgets the day and time of her bath day. When the health caregivers approach her to offer to assist Mary with her bath, she becomes agitated with verbal outbursts, walks away and wants to ‘go home’.

Solution: Modify Mary’s Home Environment…. . . . a meaningful memorable photo of Mary’s dog provided a creative solution for the challenge of bathing a loved one with dementia…We chose to utilize a photo of Mary, Patty and Daisy to serve as a visual cue. We added text (names) and enlarged the photo. Printed it to canvas, stretched it around wood frame for ease of display. It is on the wall in a ‘common area’ hallway adjacent to the bathing room. It serves to redirect Mary as needed. It evokes a positive emotional response and positively engages Mary and her health caregivers. It is displayed as art. The canvas adds dimension and texture for Mary;s sensory. It is a small change to the environment, yet provides such positive results. Further, strategic display of a custom canvas in the common area is a step towards providing for a home-like environment. It eased the subject of bathing into the conversation. “Who is this Mary?” I ask. “That’s my little granddaughter Patty and Daisy, my dog,” recites Mary, with a grin and smile. “What are you all doing in this picture Mary?” “Well we are giving Daisy her bath,” says Mary. “On those warm days Daisy loved her little pool and running around all fresh and clean.” “It sure looks like fun and Daisy likes to be fresh and clean. Let us help you to be warm fresh and clean too. And when Patty and the pup come for a visit, you will be fresh. How does that sound?” Well, I suppose, -- is Patty coming to visit today? “She visits all the time with her pup, and you have such nice fun visits. Let us first get started and help you with your bath. Ready , let’s go.” “Ok we better get ready says, Mary” as she accepts the hand of her caregiver.

Sitting down with Mary and her care partners we get an introduction to personal history. Create a timeline of life events leading up to present day. Ascertain what the moment to moment, day to day life is like. An exercise of placing selves in the shoes of Mary. Strategize what changes to Mary’s environment might help to address the behavioral challenges and improve her quality of life. Address the current primary challenge - bathing.What is the main obstacle in giving Mary her bath? She insists she doesn’t need it, insists she just took a bath. Wants ‘to go home’ and take a bath. It’s “too cold” for a bath. She says she is chilled and doesn’t want a bath.What have you tried so far? We layout her thick plush soft terry cloth full body robe and slippers to reassure that she will be warm. Reassure her that it will be a quick bath and that her hair will be shampooed and dried and styled at the beauty parlor. Layout her warmest set of comfy clothes.How is this working? Takes staff an hour + to persuade, insist. Results in an agitated stressful event for Mary.What are some of Mary’s memories that bring her joy, evoke a positive emotion? She responds to family photos and will participate in reminiscing about the house and yard she lived in for 50 years, her dogs and grandchildren. Might talking about these memories help during the moments of her agitation?Yes. If she had a visual cue to spark the positive memory, that would make her feel at ease… Bottomline best overall suggestion for family / caregivers in approaching Mary: To never argue with her or try to get her to do something she doesn’t want to do. Allow her time, and try again 30 minutes later. Does the family visit make any difference to Mary’s behavior? Of course. She especially loves the dog visits and going outside for walks.

Summary Bathing time can be one of the most challenging times for the caregiver, and one of the most frightening times for the person with dementia. Think of all the steps we ourselves need to take when preparing for a bath. First, we need to gather all of our supplies and draw the water. Then we must undress, and for Mary, that means taking off her robe in front of another person. All of us strongly dislike feeling a chill. Persons with dementia especially do not do well with being cold. The next step is to actually get into the water, which can be very frightening for persons with dementia. Their perception may be that they are drowning. And when the bathing is done, we must get out of the nice, warm water, towel dry, and then all of the fuss of finding our clean clothes and putting them on. She is not interested in bathing. She doesn’t see any reason for taking a bath. In fact, any discussion over three minutes is too long to even discuss the bath. The caregiver needs to change the subject / redirect and discuss what makes Mary happy. Mary is down to the very basics. She lives in the moment. Talking about her dog, granddaughter and yard makes her happy. Reminiscing about meaningful memorable moments in her past brings her joy. Family caregivers have brought their loved one to the nursing home, and trust that the professional caregivers will provide care and understanding. Professional caregivers trust that the family will share information with them about their loved one. And the person with dementia trusts that they will receive care and understanding.

Great resource: Gwendolyn deGeest RN,BSN,MA is the author of “Bathing Sparky.” She has been working in dementia care for over two decades and has witnessed the joys and sorrows of families struggling to maintain a quality of life for themselves and their loved ones. Gwendolyn’s thesis, “The Relation Between the Perceived Role of Family and the Behavior of the Person with Dementia” is published in the American Journal of Alzheimer’s Disease, May/June, 2003.