Adaptive equipment can be used and installed to assist in the process, such as:

• Grab bars – either permanent or temporary ones with suction cups, which can be taken anywhere and used when you travel
• Shower chair – if the person to be showered has trouble stepping in, there are models that straddle the tub so they can sit, then put one leg in at a time; there are also roll-in chairs if it is a shower without a lip
• Hand shower – works when someone is using a shower chair
• Bath mat – always use a bath mat if the person may stand in the shower

Process:

• Collect all necessary equipment before beginning the bath.
• Wear plastic medical gloves to protect both of you.
• Transfer the person to be bathed into the shower or tub using the principles of good body mechanics
• If they use a shower chair, place a towel on it before they sit.
• Test the water. Have the person test it as well if they are able.
• Make a mitten out of a washcloth to prevent dragging a wet washcloth roughly across the care recipient’s body. Wash only one part of the body at a time.
• Wash, rinse and pat dry each part of the body and cover immediately with the bath blanket.
• Wash the cleanest areas first (eyes, face, etc.), then the dirtiest.
• If the person can stand safely for a few minutes, have them stand to clean the perineal area.
• This is a good time to observe the care recipient’s skin for any unusual changes or wounds, and to observe if they change over time. Report anything unusual or concerning to the physician.
• Encourage the care recipient to be independent and to help as much as possible
• Before using skin lotion, put the bottle in some warm water while the care recipient is being bathed.
• Apply deodorant, if requested, after bathing.
• Stop the bath if they become distressed or agitated.

• Assemble equipment – soap, wash cloth, bath towels, wash basin, powder, deodorant, clean clothing, bath blanket or large towel, lotion for back rub, comb and hair brush.
• Wash your hands.
• Explain procedure to care recipient.
• Offer care recipient bedpan or urinal.
• Lower bed if possible.
• If the client is not able to roll from side to side independently, place them on a bed pad from about shoulders to knees by moving them from side to side.
• Cover care recipient with bath blanket.
• Remove care recipient’s clothing, keeping top covered when taking off pants, bottom covered when taking off top, etc.
• Fill basin 2/3 full of warm water. Let the care recipient test the water.
• Make a mitten with washcloth.
• Start with the face. Do NOT use soap on the face. Wash eyes from care recipient’s nose to outside of face (inner corner to outer corner). Use separate corner of mitten with each eye. Wash rest of face, including ears.
• Dry each area after washing it.
• Fold bath blanket down to abdomen. Cover the chest area with a towel. Wash, rinse and pat dry chest area. Use one towel for covering the parts of the body and another towel for drying. Keep them separate.
• Place towel under care recipient’s arm farthest from you. Wash with soapy washcloth from wrist to shoulder. Rinse and pat dry.
• Let care recipient soak hand in basin. Wash hand and gently clean fingernails. Rinse and pat dry. Be sure to clean and dry carefully between fingers.
• Repeat steps with arm closest to you.
• Place towel across chest and fold blanket down to pubic area. Wash, rinse and pat dry the abdomen. Pull blanket back up across the chest and remove towel.
• If water is dirty, soapy or cool, empty basin and refill with clean water.
• Place towel under leg farthest from you. Wash, rinse and pat dry.
• Repeat for leg nearest you.
• Empty basin and refill with clean water.
• Turn care recipient onto side. Have them assist if possible, and if not use the bed pad to pull them toward you, using a pillow to hold them in place and offer comfort. Ensure safety by putting the bed rails up, lowering the bed and keeping them as far from the side of the bed as possible.
• Uncover, then wash, rinse and pat dry neck, back and buttocks.
• Give care recipient a back rub, gently with lotion. Assist them to roll back on their back.
• Offer care recipient a washcloth and towel to clean and dry the genital area. You may have to do this if they cannot.
• Help care recipient into clean clothing.

• Hair care is good for dignity, self esteem and cleanliness.
• The simplest hairstyle is the best when caregiving has become a challenge.
• Consider having a hairdresser come to the house for cuts.
• Consider discontinuing perms and hair color treatment. They may be lengthy, stressful procedures that confuse some people with memory impairment. Also, leaning back into the hairdresser sink can be difficult for some people physically.
• Avoid hairdryers unless on the warm or cool setting and use with caution.
• Avoid curling irons.

Shampoo Process – bed

• Remember to protect the pillow if in bed, and shoulders with towels, remove any eyewear and brush or comb the hair from the scalp to the hair ends.
• If the hair is tangled, start at the ends of the hair and work up to the scalp to remove the tangles.
• Consider using a spray shampoo. They can be found in the drugstore and are sprayed in and combed out. They can be used in between shampoos with water.
• Assemble equipment – shampoo, conditioner, towels, wash cloth, pail, plastic cover such as a garbage bag, cotton balls, pitcher or large cup, brush/comb.
• Tell the care recipient what you are going to do.
• Raise the bed to a comfortable working position.
• Wash your hands.
• Protect the top of the mattress with plastic and a towel.
• Brush or comb the hair.
• Cover a chair with plastic and a towel. Place the chair at the head of bed.
• Place a pail or bucket on the chair.
• Help the care recipient move to the side of the bed nearest you.
• Remove pillow, cover with plastic and place under care recipient’s upper back so that head tilts back.
• Use plastic drainable trough or make your own. Roll bath towel and place on short end of a large plastic sheet. Roll three sides of sheet to form a chute. Place the hose of drainable trough or the open end of chute in pail.
• Fan-fold top bed covers to bottom of bed and cover care recipient with towel or bath blanket.
• Cover care recipient’s eyes with washcloth and put cotton in the ears.
• Using pitcher or cup, pour water over hair until wet. Select a water temperature just warm to the wrist. Apply shampoo and massage scalp and hair using both hands. Do NOT use your fingernails, as they could scratch the scalp.
• Rinse thoroughly, having care recipient move head from side to side.
• Repeat procedure with conditioner, if desired.
• Towel dry hair and face.
• Air dry or use blow dryer to finish.
• Remove cotton from ears.
• Wash hands and return equipment.

• Assemble equipment – towels, wash cloth, shaving cream, basin of warm water, shaving lotion or aftershave.
• Wash your hands.
• Place basin of warm water by bedside.
• Have the care recipient in a semi-sitting position or on the back.
• Cover the care recipient with a bath towel.
• Wash the face and apply a warm, damp washcloth for 3-5 minutes to soften skin.
• Spread shaving cream over the area to be shaved.
• Hold the skin taut and shave skin in the direction of hair growth. Begin at sideburns, work downwards over cheeks, and down over chin. Work upward on neck under chin. Use short, firm strokes.
• Rinse razor often.
• Rinse off any leftover shaving cream.
• Apply shaving lotion, if desired.
• Wash your hands.

A clean mouth helps prevent disease, promotes an appetite and helps rid the mouth of tastes that may be the result of taking some medications.

Procedure: Assisting with Oral Hygiene

• Assemble equipment – water, toothbrush, toothpaste, small basin such as an curved “emesis basin” often used in health care facilities, towel, mouthwash, gloves.
• Wash your hands and put on gloves.
• Explain to the care recipient what you are going to do.
• Have the care recipient sit up or help him/her to the sink. If they use the sink, omit the next step.
• Spread a towel across the care recipient’s chest.
• Offer the care recipient water to rinse his/her mouth.
• Hold the basin under the care recipient’s chin to spit the water into or have him/her spit into the sink.
• Put toothpaste on the brush and wet it with water.
• Allow the care recipient to brush own teeth if able. If they cannot, brush using a gentle motion above the gum line and going down the teeth. Repeat until you have brushed all the teeth. Include the insides of the teeth and the tongue.
• Offer water to rinse the mouth.
• Offer mouthwash, if desired.
• Wipe the care recipient’s mouth and make comfortable.
• Remove gloves and wash your hands. Return equipment.

Oral Hygiene for Dentures

• Assemble equipment – denture cup, small basin or sink, tissues, denture toothpaste, towel, mouthwash, denture tablets.
• Wash your hands and put on gloves.
• Explain to the care recipient what you are going to do.
• Spread towel across care recipient’s chest.
• Ask care recipient to remove his/her dentures. Have tissues in the basin.
• Take dentures to sink, holding them securely.
• Place washcloth in the sink and add some water. This will cushion the dentures if they fall.
• Clean dentures with toothpaste or denture cleanser.
• Rinse dentures in cool water.
• Fill denture cup with denture solution, cool water or mouthwash and water. Some people may use cleaning tablets. Place dentures in the cup and cover.
• Help the care recipient to rinse mouth. If care recipient wishes, replace the dentures. Ask if a denture adhesive is used.
• Remove gloves and wash your hands.

• Assemble clean clothes the care recipient has chosen.
• Explain to the care recipient the procedure.
• Assist the care recipient to the edge of the bed.
• Put on underwear and pants. Pull up to the waist by having care recipient stand or, if possible, by having them lift up buttocks as they are lying on their back.
• To put on an over-the-head type of shirt (pullover), place the weak arm (or far arm) in the armhole first. Then, slip the shirt over the head. Lastly, put the strong arm (or near arm) into the shirt.
• Help the care recipient put on socks or stockings. Make sure they are not too tight to interfere with circulation.
• Put on shoes or slippers.

• When assisting to clean the perineal area after toileting, wipe front to back.
• Offer the opportunity for toileting regularly, as the care recipient may not ask.

Procedure: Assisting with the Bedpan

• Explain to the care recipient what you are going to do.
• Wash your hands. Put on gloves.
• Pre-warm the bedpan, if necessary. Position the care recipient properly. If the care recipient can assist, bend knees with feet flat on bed and raise hips. Help as needed. If care recipient can’t help, turn onto side, put bedpan in place, and then turn onto back again. The open end of bedpan points toward feet.
• Help the care recipient to a sitting position, if possible, and cover with sheet.
• Place the toilet tissue within reach. If able, leave the care recipient for five minutes to provide privacy.
• If care recipient is unable to wipe self, put on gloves and wipe the periarea, wiping from front to back.
• Remove the bedpan and cover it.
• Assist care recipient with cleaning the periarea, wiping from front to back.
• Empty bedpan and clean it with disinfectant. Recover and replace it where it is stored.
• Remove gloves and wash your hands.
• Assist care recipient with washing hands, if needed.

Incontinence Care

• Assemble necessary supplies – pad or absorbent undergarment, wash cloth or pre-moistened towelettes designed to be safe for use in the perineal area, barrier cream if used, gloves.
• Don gloves.
• Rip absorbent undergarment on each side at the narrowest part.
• Roll the person away from you and roll the undergarment up toward the person, collecting as much fecal matter as you can as you roll.
• Roll them toward you and pull the garment out, again rolling it up as you go to contain urine and feces.
• Before removing the undergarment clean the perineal area as much as possible.
• Wipe front to back in women to help prevent urinary tract infection from feces entering the body.
• Apply barrier cream if recommended. Do not get it in the vagina.
• If the person can lift their hips use this method to place another garment.
• Otherwise roll them from side to side, for a tabbed undergarment, or pull on a pull-up style undergarment.

Before feeding or assisting:

• Offer toileting so they are comfortable throughout the meal.
• Offer mouth hygiene to promote an appetite.
• Allow the person to do as much as possible to promote independence.
• Make sure dentures are in properly.
• Assist them to wash hands or facilitate washing.
• If you use a clothing protector, do not call it a ‘bib’ as this infantilizes the person.
• Sit at their level.
• Don’t rush the person eating.
• Do not encourage them to converse with you if choking is an issue.
• If proper nutrition is an issue, make dining a pleasant experience; smile, play music in the background that they enjoy, serve colorful foods placed on attractive dishes.
• If they are memory impaired, model eating by eating with them to remind them of what the process looks like.
• If they have difficulty using utensils promote success by offering finger foods so they can continue to eat independently.

Procedure: Feeding or assisting with eating

• Gather meal and supplies.
• Explain to the care recipient what you are going to do.
• Wash your hands.
• Have the care recipient wash hands.
• Position the care recipient properly and place a napkin or towel across chest and/or under chin, if needed.
• Tell the care recipient what kinds of food you are serving.
• Alternate solid food with liquids.
• Use a spoon to feed, for safety.
• Use a short straw if the care recipient cannot drink from a cup or glass.
• Wipe the care recipient’s mouth with a napkin. Do this as often as needed during the meal also.
• Wash your hands.
• Assist the care recipient to wash hands and face, if needed.
• Offer the care recipient oral hygiene afterwards.