The Hardest Things — Hygiene, Incontinence

Keeping a loved one clean and comfortable is one of the hardest but most important tasks an Alzheimer’s caregiver performs. The disease not only takes from our loved ones the ability to control bodily functions, but also renders them incapable of bathing, brushing their teeth, even washing their hands.

one lilyHYGIENE

With the decline of mental and physical capabilities, just getting dressed and undressed comes to be a challenge. The movements which for most of us are instinctive—not just buttoning and zipping, but moving an arm in the proper direction to get it out of a sleeve or lifting a leg to put on underwear, slacks, socks, shoes—those movements become a greater and greater ordeal for the Alzheimer’s patient, both physically and mentally. Taking a bath or shower adds the necessity of getting wet, and being surrounded by the plethora of  items needed for washing—soap, shampoo, washcloth, bath chair, towel, brush, toothbrush, toothpaste. It’s easy to see how the ones we care for can be overwhelmed and resist all forms of hygiene.

To reduce their fear and help them cooperate with hygiene tasks, we can rely on some of the same tools that help us with mood swings and hostility. We can agree instead of argue, keep talking, and use distractions.

It cannot be said too often: arguing with an Alzheimer’s patient is not good. It almost never helps the situation, and often makes things even more difficult. So if a loved one complains about changing clothes or washing hands or some other aspect of hygiene, we do well to agree. “Yes, Mom. It’s a hassle. It will take a few minutes. We have to move around a little.” Once we’ve listened to and acknowledged their feelings, we can just keep talking, hoping our own words will make tasks easier.

Now we can speak about whatever we want. Teamwork, for example. We’ll be doing this task together. We’ll be a team. And together we can be very fast. We keep up the chatter, on any subject at all, as we move to the bathroom. All our attention—words and looks and even touch—should be focused on the one we’re caring for. Our non-stop talk can continue as we wash hands, change clothes, whatever. Even if our loved ones don’t understand the words or the subject, if they are listening to us, the urge to resist may be diminished.

yellow lilies

Use Distractions
The idea is to use a distraction that appears completely unrelated to the task at hand. For example, if Mom didn’t want to get up and wash her hands, I’d wait a few minutes and then bring a pail of water to the table and set it down in front of her. What was this? This was never here before! I’d leave the water there while I went after soap and a towel, which I carried to the table like a surprise behind my back and set down on a chair behind me. What did she put down? What’s happening? I’d put my hands in the water, then hers, as if it was just what we’d planned. By this time, Mom was either sufficiently confused or sufficiently delighted to let me to wash and dry her hands. Another example: If she needed a bath, I’d walk with her down the hall, carrying a plastic cup of lemonade. Once we turned into the bathroom, I’d ask Mom to hold the cup while I took off her clothes, then I’d take it back and set it on the counter. When she was sitting safely on the bath chair, I’d start bathing her, telling her we had to do this quickly so she could get her lemonade.

Please note: Bathing an adult is not easy. If you consider getting professional help, even on a very limited basis, bathing, or hygiene in general, is the first need I would address. In some cases, an aide is accepted more easily than a family member. Mom and I didn’t have issues of shyness; she didn’t mind me seeing her undressed. But by far the greater issue is safety. Helping Mom move around and keeping her stable when she was wet required strength and expertise. A professional caretaker would have made bath time much safer for Mom and easier for both of us.

orange liliesINCONTINENCE

Incontinence is a particularly difficult aspect of Alzheimer’s. Let’s be honest: Changing an infant’s diaper is much easier than changing an adult’s wet or soiled underwear. But many products originally designed to be used with infants are now available to make things easier for adult caregivers.

Disposable Underwear
These products are miracles in themselves. They are super-absorbent, and made in varieties that open on the sides (easier for bedridden patients), or pull up and down, or both. Not having worn them, I can’t vouch for the comfort, but Mom never complained about them. Believe me, that says a lot. What Mom did complain about was our making her wear them in the first place. Though she insisted she didn’t need them, strong evidence indicated otherwise. Only after we removed all her regular underwear and put disposables in their place did she agree to wear them.

Wipes designed for adult use are larger than baby wipes, and stronger. They make cleanups much easier for caregivers and are convenient to carry when you’re going out. When neither talking nor distractions could coax Mom into the bathroom, she sometimes sat in wet or soiled underwear for hours. When she finally allowed me to tend to it, I cleaned everything as best I could without getting her into a tub or shower. Wipes were a tremendous help. I did what was possible and, by the daily miracles that always saved us, it was enough.

Waterproof Pads
Dad and I were fortunate in that Mom usually slept soundly all night. But as absorbent as disposable underwear are, they were often no match for eight or ten hours of sound sleep. We used disposable waterproof pads on top of the sheet to eliminate the need to wash bedclothes every day. The pads come in at least two sizes and can also be used to protect car seats and furniture. In addition, we used washable waterproof mattress pads. They go under the bed sheet and cover the entire mattress.


Once again, we must remind ourselves that we don’t have to handle everything ourselves. If the time comes when, in spite of our best efforts, lack of hygiene causes or threatens to cause health problems for those we care for, the time has come when outside help is not just advisable, but necessary.

lilies of the fieldAs we face the particularly difficult tasks associated with hygiene, it really will help if we can act out of love in addition to simple necessity. Working in that attitude, we elevate the task and we honor our loved ones. And the miracle is that in the midst of our work, our love grows.

Consider the lilies of the field, how they grow: they neither toil nor spin; and yet I say to you that even Solomon in all his glory was not arrayed like one of these.

(Matthew 6: 28-29 NKJV)

Father, we ask for patience, that both our actions and the thoughts of our heart may be pleasing to You. We ask for humility, that we may serve as You served. We ask for love, that we may honor You and our loved ones with our service.


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About atimeformiracles

I'm a writer. And a speaker. And an advocate for victims of Alzheimer's. I write about a lot of things, but right now Alzheimer's has taken center stage. You'll see some of my work on my blog If you're a caregiver, this blog is for you, from someone who has been in your shoes. I offer help in the form of tips and strategies gained through my personal experience. I offer encouragement in the form of witness: You are never alone. The God of all hope is always with you, and where He is, miracles abound. I speak to groups on the same subject, sharing helps and challenging caregivers to expect joy on the path through Alzheimer's. It's a rough road, but it leads through terrain of intense beauty. I can point out some of the miraculous sights along the way. In the U.S., a new diagnosis of Alzheimer's is made every 69 seconds. Please join me in praying for those suffering from the disease and for those who care for them.

2 thoughts on “The Hardest Things — Hygiene, Incontinence

  1. Oh what a difficult problem this was with my husband’s mom. She never learned to swim and water was an enemy, not a friend, even when she was younger and without this confusing disease. And my impatience was not helpful.

    Kathleen, your counsel to caregivers is excellent. I know your Mom smiles, looks down, and tells the angels “That’s my girl!”


    • Thank you, DiAne. I’m very conscious of the fact that it’s easy to make suggestions to caregivers, especially if you yourself have watched them accomplish the desired objective. But as you know, trying to implement those hints is so hard, especially “in the moment.” We all need to pray for all caregivers, everywhere. And if we KNOW a caregiver, we can help: Carry part of the burden, encourage, keep in touch, keep them company sometimes, even give them a break sometimes. But pray always. It’s the strongest help we can give.

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