Caregiver support seminars for family caregivers while cruising

Introduction

"Bathing Sparky" is a true story of the challenges faced in bathing persons with dementia. I worked with Peter and his family for several months. I always admired and respected the flexibility and resourcefulness of the caregivers in dealing with challenging behaviors. In this particular case study, Peter’s dog actually provides the solution.

The caregiver interview following the story, illustrates many useful coping strategies that worked in this situation, and may prove useful for others dealing with similar challenges.

BATHING SPARKY

…a dog provides creative solutions for bathing a person with dementia

Peter was 13 when he had his first dog, 18 when he worked in the lumber camps, and 20 when he married. Peter, now 74, is pacing up and down the hallways of Tick Tock Manor where he is a resident. Peter always paces on this day, because today is Peter’s bath day.

Things are done right on schedule at Tick Tock Manor. The caregivers never forget Peter’s bath day. Even more amazing, is that, although Peter has dementia, he never forgets the bath day either.

This morning is different however. Peter is clutching a small book close to his chest. When the caregiver approaches him to offer to assist Peter with his bath, he becomes agitated and walks off quickly in the other direction. Any further mention of bathing sets Peter off in an angry outburst.

When I approach Peter and ask if he would like to share what is in his book, Peter continues walking off in the opposite direction. He then pauses to think, gives me an indignant look, places his hand on his hip, and replies, “Sure, why not?”

Peter and I sit side by side in the lounge situated next to the bathing area. And Peter proceeds to share the family photos in his small album. It becomes evident that many of Peter’s photos have been taken of a black Labrador dog in a garden.

“Who is this Peter?” I ask. “That’s Sparky, my dog,” replies Peter, with a big smile on his face. Peter is happy to share that he and his dog, Sparky, have spent many happy years together. He also adds that he misses Sparky very much. In one of the photos, Peter is in the backyard with Sparky, where Sparky is receiving a bath.

“What’s going on in this picture Peter?” I ask. “Oh, Sparky is having his summer bath,” says Peter. “I can’t do the bath in the house, because Sparky races around after, shaking off all the water. Sparky loves being clean.” Peter shows pride on his face.

I see this as an opportunity to distract Peter away from his own bathing situation.

“Peter, I see that you and Sparky are having a lot of fun together. And Sparky likes to be nice and fresh and clean. That’s great. Let me help you to be nice and clean as well. And when Sparky comes for a visit, you will be fresh. How does that sound?”

“I don’t know about that. Do you think my wife can bring Sparky for a visit?”

“Sure she can Peter, anytime, and you and Sparky can have a good visit. Let me first help you with your bath. Let’s go.”

“Oh, alright,” says Peter. He takes my hand and we walk together to the bathing area.

The small book is left behind on the table, the book containing memories of who is Peter, the book that holds the photos of Peter’s best friend, Sparky.

Interview with Peter’s caregiver follows:

What seems to be the main obstacles in giving Peter his bath?
Just about everything. Peter doesn’t like taking his clothes off. He doesn’t like having his hair washed, and he doesn’t like getting wet. Then when the bath is finished, Peter wants to put the same clothes right back on. He gets really angry with us if we try to persuade him.

What have you tried so far?
We no longer wash Peter’s hair on bath day. Rather, his hair is shampooed in the salon where the hair cuts are done. Also, the girls on the last shift, lay out fresh clothing for Peter in the morning, so the clothes Peter insists on putting on following the bath are clean.

How is this working?
Good, Peter is far less agitated.

I understand Peter has a dog, Sparky. Does Peter ever talk about his dog?
To be honest, I didn’t know that Peter even had a dog. That is really good information for us. Maybe we can ask the family to bring the dog in for a visit.

That’s a great idea, Peter would love that. Also, does Peter ever speak of the days he worked in the lumber camps?
Yes, now that you mention it, Peter loves to reminisce about those days. He’s told me he feels lucky that he didn’t lose a finger when he was working in the lumber camps. And he says, “Those were the best days of my life.”

Do you think talking about “the best days of Peter’s life” might help on bath day?
That’s a good idea. We can sure try.

Can you offer suggestions for other caregivers having similar difficulties?
The most helpful thing I have discovered is to never argue with the person with dementia, or to try to get them to do something they don’t want to do. Rather, I allow the person time, and perhaps try again twenty minutes later.

Do Peter’s family visit often? Do you think they might have some suggestions about the bathing time?
His wife visits every day. That’s a good idea; I will discuss with her some suggestions for Peter’s bathing time.

Does the family visit make any difference to Peter’s behavior?
During the time she is here, Peter is happy. However, when she leaves, Peter starts pacing again. I think he’s lonely.

Overall, what is your perception of the present situation?
I’ve learned to never rush Peter, and not to argue with him. No means no. When Peter gets agitated, and feels that we are trying to rush him, he will say, “don’t guess; wait till my mind tells me.” This is Peter’s way of letting us know he is still in charge.

ANALYSIS

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.

Firstly, we need to gather all of our supplies and draw the water. Then we must undress, and for Peter, that means taking off his clothes 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.

Peter is down to the very basics. He lives in the moment. Talking about his dog, Sparky makes him happy. Reminiscing about the days of working in the lumber camps makes Peter happy. Peter is not interested in bathing. He 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 and discuss what makes Peter happy.

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.

What Works
• Choosing a topic of interest
• Keeping the person warm
• Utilizing distraction

What Doesn’t Work
• Discussing the bath
• Rushing the person with dementia
• Allowing them to get a chill

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. This work was presented at The International Congress of Gerontology, Vancouver, Canada. Gwendolyn resides in Vancouver, with her family where she is a professor.

Gwendolyn welcomes your questions/comments at gmdegeest@cruiserespite.com