Aug 09, 2021

Caring for people living with dementia: How to overcome objections to showering

Man having a shower at home

While it’s important for older people to continue showering regularly, carers often face a struggle in getting the person to comply.

Refusal to shower can lead to arguments and even hostility.

The matter came to HelloCare’s attention through our Aged Care Worker Support Group on Facebook. A member of the group, Amanda*, asked if others could share their tips for how to encourage a “severely depressed client who often refuses to shower”. 

“I would like some ideas on how to approach this situation” and ways to “motivate” the client, she asked.

Members of the support group shared dozens of useful tips they have gleaned in their years of first-hand experience.

The support group provided the following tips and advice:

  • Ask the person if they have a preferred time to shower, for example, do they prefer to shower in the morning or before bed?
  • Ask them what their concerns are about showering, and try to get to the bottom of the problem. Address the problems they raise.
  • Play music they enjoy; music can put the person in a more positive frame of mind.
  • Encourage the person to choose clothes they can put on after the shower.
  • Build rapport with the person, ensure they feel more comfortable in your presence. After all, showering is a very personal matter. Reassure the person you are there to help.
  • Ask the person if they would like a cup or tea or coffee before they shower. Sit and chat with them to make sure they are comfortable.
  • Run the water, that can get them thinking perhaps a shower would be nice, after all.
  • Make sure the shower feels safe. For example, are there grab rails and a shower chair so the person is less likely to fear falling? Place lots of towels on the floor to avoid slipping.
  • Offer them a back rub afterwards with moisturiser.
  • Let the person know in advance you will be there to shower them so they know what to expect and they are prepared.
  • Remind the person how good they will feel after showering and in clean clothes.
  • Let the person know showering is good for their skin.
  • Speak to family or the GP about medication.
  • Let the person know you are going out or will have visitors, so it’s important to be fresh and look tidy.
  • If the resistance continues, offer a bed bath or face wash instead.

Despite all this tried and tested advice, members of the support group admitted sometimes you simply can not get the person to take a shower. 

In these situations, it’s best to let it go and try again another day. 

Each time, you can try a different approach. Conversely, an approach that didn’t work on one day, might work the next.

A person-centered approach

Dr Lee-Fay Low is a registered psychologist with an expertise in dementia and aged care. 

Low said it’s important to take a “person-centred approach” to showering by ensuring you put the needs and preferences of the person first.

Low said it was important to assess any “environmental” reasons the person is reluctant to shower. 

Environmental problems might include:

  • The room is too cold. 
  • The water is too hot or cold.
  • The person doesn’t feel safe showering by themself, but they don’t know how to ask for help.
  • The person doesn’t like the shower chair.
  • They don’t want to get their hair wet. 
  • Perhaps the person isn’t comfortable with the gender of the person helping them.

“You need to fix those environmental issues, for example, with a heater, shower cap or handheld shower head,” Low suggested.

Understanding what might motivate the person to shower can also help. 

Motivations to shower might include: 

  • Having someone come to visit.
  • As a favour to the care worker.
  • So they can put on nice clothes and do their makeup.
  • If they have an outing planned.
  • Simply that it’s good for their health.

“It can take several tries and that is OK,” Low said reassuringly.

“It’s also OK that the person doesn’t shower every day, as long as they do have enough showers for hygiene reasons.”

“Feeling much more confident”

“Thank you everyone!” Amanda wrote to the support group. “You’ve all given me really great ideas and insights. Feeling much more confident now.”

Amanda told HelloCare she learnt so much from the support group. 

“As a support worker in the community who is fairly new to the industry, I have limited direct contact with my coworkers. The support group has been such a great source of learning for me.”

Unfortunately, the client Amanda was originally asking about had to be hospitalised, but she was able to use the advice for another client with severe alcohol dependence.

“He refused to shower, but he is a great lover of music from the 1960s. This week I finally convinced him to hop in the shower with the promise I could play him any song he wanted,” Amanda explained.

“Thank goodness for Spotify Premium, is all I can say!”

*Name has been changed.

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  1. Thank you for the informative article on this very challenging issue.
    Just a couple of points:
    1. Check who wants the shower. Is it the family, nurses or the facility routine. If it’s not the resident, don’t shower them. Standard 1 Aged Care quality..
    2. People do not ‘need’ to shower fir hygiene. There are many ways to assist a person with their personal hygiene, by using the basin, wipes and foot basin. Only hands, teeth and perianal need frequent attention.
    3. Be careful, there is a fine line between encouraging and ‘coersion’ – which could be a reportable offense.

    Make the environment pleasant, 1 client’s bathroom was turned into a spa with fake candles and scented oil, look at your resident, check if it is the right time by their cues. Keep routine for those who find comfort in routines. Build trust by listening and empowering them and giving them the control.
    Ultimately, let it go! We don’t need a shower to enjoy our lives.

  2. My mother would have what she called a daily “strip” wash. Using a soapy flannel and a warm water rinse. She never had a shower and was unable to use the bath later in life. She always smelt lovely using scented talc, and never had any skin issues,she passed at 87 years old. So this could be an alternative for people who are constantly resistant to showering.

    1. I grew up in Germany as a child. Bath times were Saturday nights in a Tin Bathtub. Coming to Australia my parents still only had a Shower every Saturday night but during the week it was “Top and Tail” with a seperate soapy facecloth and warm water. Showering daily as you get older is NOT good for your skin as it dries it out of natural oils. My parents ALWAYS looked and smelled immaculate and my Mum died when she was 94 years old her facial skin looking like a 80 year old

  3. It really depends on how much time you have. When I worked in Aged Care I had 15 minutes max to get the person out of bed, escort them to the toilet usually on a commode with a cover over them, make their bed, shower them, shave them, transfer the person to the bed and adjust the person’s pad and clothing and apply creams to pressure areas, transfer the person to their wheelchair, clean their dentures and finally give them their medications slowly and then bring them breakfast. This is back breaking high speed work. If you want to implement all of the suggestions in this article there is going to have to be at least one other Nursing Attendant / Nurse on the shift. It is extremely unlikely that any private provider is going to do this. At the moment if you refuse a shower you simply don’t get one. This is why some people with major psychiatric illnesses like depression or schizophrenia are simply left in bed for days at a time.

  4. Residents are daily living so important.
    Nurse are need a resident condition properly.
    Empathy attitudes is significant for each resident.
    More understanding cultural value language value & social live individually.
    Proper education related to resident daily living.
    Nurse are need a practical nursing care.

  5. Often people who are in facilities that resemble hospitals and not homes object to “unknown” persons attended to an otherwise very personal and private activity.
    I as a senior would vehemently object to any one forcing me into a shower as I never take showers I always gave a bath in a tub.
    The culture and the model of care such as the medical model ( normally applied to those who are sick and aging has not been classified as a disease) is actually the wrong model of care for social care activities such as bathing, eating, that one forms a routine around and an order for doing these activities.
    The best way to figure out other reasons for a hue ruins to bathing or showering a resident is to actually feel what it is like to be bathed or showered by strangers. It is a very enlightening experience.
    Especially concerning to those with dementia is privacy and not being pushed or forced as the rudimentary responses should be expected. What is it about the facility equipment that is unfriendly or unnatural to most people.
    There are combination tin/showers that allow for relaxation which may be a huge reason why people enjoy their shower or bath but not if strangers are rushing them.
    Feel what residents feel and adjust to meet their needs first. Have a fundraiser fir news bathing equipment.
    Oh and lastly feel the risks and facecloths are they rough and unpleasant to the touch? Most are and that is a big deterrent to bathing in LTC facilities.

  6. My husband benefited from medical cannabis which unfortunately took about a year to organise. Very quickly, his pain was completely relieved; his contractures somewhat relieved, and he was able to enjoy a shower once again.


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