How to get someone with dementia to wash their hands?

Navigating the challenges of dementia care can be difficult, with a reported 83% of dementia caregivers finding it emotionally stressful.

Learning how to get someone with dementia to wash their hands is a common hurdle, but with the right approach, you can maintain hygiene and reduce distress for both you and your loved one.

Quick Summary

Approaching handwashing for a person with dementia requires patience and gentle redirection.

By simplifying the task, using positive reinforcement, and maintaining a consistent routine, you can turn a challenging task into a smoother, less stressful part of their day.

Personalizing the experience with preferred scents or towels can also help greatly.

Key Points

• Simplify the Task: Break handwashing into small, single steps and provide one clear instruction at a time.

• Use Visual and Verbal Cues: Accompany verbal guidance with physical modeling, showing your loved one exactly what to do.

• Establish a Routine: Consistent timing for handwashing, such as before meals, helps it become a predictable and expected habit.

• Maintain a Calm Environment: Reduce potential stressors like loud noises or strong water pressure, and ensure the temperature is comfortable.

• Offer Alternatives: Keep hand sanitizer or pre-moistened wipes available for situations where soap and water cause distress.

• Leverage Positive Reinforcement: Use praise and a gentle tone to reward successful handwashing, creating a positive association.

• Consult Professionals: Seek advice from healthcare experts like occupational therapists for personalized strategies and environmental modifications.

Understanding the Resistance to Handwashing

For many individuals with dementia, resistance to hygiene tasks like handwashing isn't a deliberate act of defiance but rather a symptom of their cognitive decline.

Memory loss can cause them to forget the purpose or process of washing their hands. Other factors might include a fear of water, sensitivity to temperature, or the overwhelming number of steps involved in a seemingly simple task. The inability to communicate these feelings can lead to frustration, anger, or anxiety, which a caregiver may misinterpret as obstinacy.

Why a Person with Dementia Might Resist Hygiene Tasks

• Cognitive Impairment: They may not remember the importance of hand hygiene or how to perform the multi-step task.
• Sensory Changes: Their perception of water temperature, soap texture, or the sound of running water can change, causing discomfort or fear.
• Loss of Control: A sense of losing independence and control can lead to resistance against caregiving efforts.
• Environmental Factors: A bathroom with poor lighting, loud fan noise, or slippery floors can be frightening or disorienting.

Compassionate Strategies for Encouraging Handwashing

When helping a person with dementia with personal hygiene, the focus should always be on preserving their dignity and minimizing stress. A compassionate approach involves creating a positive environment and simplifying the process.

Create a Positive and Calm Environment

1. Warmth and Comfort: Ensure the bathroom is a comfortable temperature. Test the water to make sure it is not too hot or too cold. Some people may prefer warm, pre-soaked wipes instead of running water.
2. Soothing Scents: Use a mild, pleasant-smelling soap. Lavender, for instance, is known for its calming properties. A scent they associate with positive memories might also be effective.
3. Reduce Noise: A loud faucet or exhaust fan can be startling. Run water gently and consider turning off any noise-making appliances.
4. Clear the Clutter: A cluttered sink area can be visually overwhelming. Keep only the necessary items—soap, towel—within sight.

Simplify the Steps and Offer Choices

Break the task down into small, manageable steps and offer one instruction at a time. For example, instead of saying, "Wash your hands now," try, "Let's wet our hands," followed by, "Now, let's use the soap."

• Step-by-Step Guidance: Use verbal cues and gentle physical guidance to lead them through the process. "Let's rinse now." "Okay, let's dry them."
• Model the Action: Wash your hands with them, showing them what to do. This can make the task feel more like a shared activity than a command.
• Offer Simple Choices: A small sense of control can reduce anxiety. Ask, "Do you want to use the blue towel or the white one?" or "Should we use the pump soap or the bar soap?"

The Power of Routine and Positive Reinforcement

Establishing a consistent daily routine can provide a comforting sense of predictability for someone with dementia. Linking handwashing to other routine events can be a strong reminder.

• Link to Activities: Always wash hands before eating meals, before preparing food, and after using the restroom. This consistency helps build a habit.
• Create Visual Cues: A simple, clear sign with an image of someone washing hands can serve as a non-verbal reminder.
• Positive Praise: When they successfully wash their hands, offer genuine praise. "Great job washing your hands!" or a simple smile and a happy tone can reinforce the positive behavior.

Alternatives to Traditional Handwashing

If resistance is high, forcing the issue can cause more distress. Having alternatives ready can be a useful fallback.

• Hand Sanitizer: Keep an alcohol-based hand sanitizer with at least 60% alcohol readily available. Apply some to your own hands and then gently massage it onto theirs.
• Pre-moistened Wipes: Soapy, pre-moistened disposable wipes are a discreet and effective option, especially when away from a sink.
• Engage in a "Hand Massage": Frame the task as a soothing hand massage. Use lotion or a nice-smelling moisturizer after they have dried their hands to make it a pleasant, bonding experience.

Comparison of Hand Hygiene Methods

Method	Pros	Cons	Best for...
Soap & Water	Most effective for removing germs and visible dirt. Traditional and familiar.	Can be distressing due to noise, temperature, or cognitive overload.	Individuals who still respond well to routine and gentle guidance.
Hand Sanitizer	Quick, portable, less steps, and less mess.	Ineffective on visibly dirty hands; can dry out skin.	When on-the-go or when an individual is highly resistant to the sink.
Pre-moistened Wipes	Less intimidating than running water. Good for quick clean-ups.	May not feel as thoroughly clean; can still cause resistance for some.	Quick, easy cleaning after light soiling or after meals.

Working with Professionals

In some cases, the best course of action is to consult with a medical professional or geriatric specialist. They can offer tailored advice and help determine if the resistance is caused by an underlying issue, such as a fear or a coexisting condition.

An occupational therapist can also provide strategies for adapting the environment to better support independent hygiene. They may suggest modifications like installing easy-to-turn faucets or providing colored soap to help with visual recognition. For more detailed information on managing daily care, the Alzheimer's Association offers a wealth of resources and support for caregivers www.alz.org.

Frequently Asked Questions

Why does someone with dementia refuse to wash their hands?

Refusal to wash hands is often not intentional but a result of cognitive decline. The person may have forgotten the routine, be confused by the steps, or feel overwhelmed. Sensory issues, such as a fear of the water's temperature or sound, can also be a factor.

How can I make the handwashing process less intimidating?

Make the experience more comforting by using mild, pleasantly scented soap and ensuring the water temperature is warm and soothing. Eliminate loud noises and keep the area clutter-free to reduce sensory overload. You can also try using a hand-held shower instead of the tap.

What if my loved one is afraid of the running water?

If running water is an issue, avoid it entirely. Instead, use a basin of water or pre-moistened, soapy washcloths. You can also try a no-rinse soap product. Introduce these alternatives calmly and without pressure.

Is hand sanitizer a good substitute for handwashing for someone with dementia?

Hand sanitizer with at least 60% alcohol is a good alternative when soap and water are not possible or are causing significant distress. It is important to note that it doesn't remove visible dirt, so use it as a backup rather than a primary method if possible.

How do I deal with resistance without causing an argument?

Instead of confronting their resistance, try redirection. Gently guide them by starting the task yourself and inviting them to join you. Distraction can also be effective; talk about something they enjoy, sing a familiar song, or tell a story while you perform the task.

Should I be worried if they don't wash their hands for 20 seconds?

While the CDC recommends 20 seconds, any amount of handwashing is better than none. Focus on achieving a calm, consistent hand-washing routine, even if it's shorter. If a person with dementia has trouble with scrubbing, the caregiver can provide assistance.

How can I use routines to help with handwashing?

Integrate handwashing into their daily routine, linking it to regular activities like before and after meals. This consistency helps cement the habit and provides predictability. For example, always wash hands right before sitting down to eat.