By Micha Shalev Q: I take care of my mother who has dementia. With the bath, it’s always a battle! I try to convince her that she needs a bath but she resists. She can’t bathe herself anymore and we can’t afford to bring someone in to do it. I need some tips. A: For people with the advanced stages of Alzheimer’ s disease and related dementia (ADRD) — many of whom live in long term care facilities — being bathed by caregivers who they may not recognize can be upsetting or confusing. People who feel vulnerable or attacked during bathing routines may scream, cry or lash out at their caregivers. There is evidence that caregivers can alleviate agitation by tailoring bathing techniques to the person’ s particular needs and attending to their comfort. Although bathing individuals with dementia has been addressed in caregiver literature, there are few instances of empirically tested interventions to guide those looking for the best practice. Here are some guidelines for bathing, based on various sources of information: •Caregivers should be aware of the likes and dislikes of the individual and modify the bathing experience to best meet his or her needs. •Communication is key. Allow the individual to participate as much as possible using simple commands. A sense of control should reduce anxiety and unwanted behaviors. Break down tasks into smaller subtasks for ease of understanding. •Be flexible and creative. Keep bathing options open, including bathing techniques and time of day. Consider towel bathing instead of showering or tub bathing. •Allow enough time for bathing so that the individual or caregiver doesn’t feel rushed. This should reduce anxiety levels for both parties. •Ensure the individual’s modesty — not only will the individual stay warm and be more comfortable, but conscious or unconscious feelings of embarrassment will be reduced. •Set up a safe, secure, private and calming environment. Use soothing music. Limit aural and visual distracters. Use a calming voice. Keep lighting soft. And add home-like touches to the room. •Keep the individual gravitationally secure. Use equipment such as grab bars, shower chairs or benches and non skid mats to ensure safe transfers into and out of the tub or shower. If you meet with difficulty or resistance while you are bathing an individual, you might simply be able to change the subject or refocus his or her attention on the task at hand. If there is still resistance, you can try scheduling the bath for later on when he or she is in a better mood. It is not necessary that they have a bath every day. However, it is important that his or her hands, face and private areas are washed every day for health and well-being. Even if he or she refuses to take a bath, encourage him or her to do so, or ask if you can assist in washing these areas.