Helping with personal care, dignity and consent

The principles

• Approach with respect; the person is an adult, not a child;
• Explain what you are doing and why;
• Allow time;
• Maintain modesty and privacy;
• Notice non-verbal communication;
• Stop and try again later if the person resists;
• Calm tone, simple language, one step at a time.

Washing

Whole-body washing is often the most resisted task. Practical strategies:

• A warm bathroom with bright but not glaring light;
• Have everything ready before you start;
• Offer choices ("Would you like a bath or a shower?");
• Hand the person the cloth or sponge where they can manage some of the work themselves;
• Wash one section at a time, talking about something pleasant;
• Use a towelling robe rather than full undressing;
• Music in the background often helps;
• Frequency: a full wash every 2 to 3 days is usually adequate; daily strip-washes for face, hands and intimate areas in between.

Dressing

• Lay clothes out in the order to be worn;
• Choose easy-fastening clothes (elastic waistbands, Velcro, slip-on shoes);
• Offer 2 or 3 choices, not a full wardrobe;
• Respect personal style;
• Avoid changing clothes more often than needed;
• Adaptive clothing (with poppers, easy fastenings) is available for those who need extra support.

Toileting

See continence. Practical tips for assistance:

• Prompted toileting every 2 to 4 hours;
• Privacy where possible;
• Adequate lighting;
• Easy-fastening clothes;
• Grab rails and raised toilet seats;
• For night-time, a bedside commode may be safer than walking to the bathroom in the dark.

Resistance and refusal

Refusal of personal care is common and rarely random. Look for the cause:

• Pain (joints when undressing, scalp when washing hair);
• Embarrassment;
• Misunderstanding what is being done;
• A different person's preferred order or routine;
• Cold;
• Earlier negative experience.

Strategies:

• Try again later in the day;
• Try a different person (a daughter rather than a son, a carer rather than a family member, or vice versa);
• Change the order;
• Reduce the demand (a strip wash rather than a full wash);
• Address the underlying cause (analgesia for joint pain).

The role of paid carers

Paid carers (homecare visits) can take over some personal care tasks. Often this is more acceptable to the person than family doing it, because:

• The role is clearly that of "carer", not "spouse" or "child";
• The carer has training and a calm, professional manner;
• The family member's role can shift to companion rather than carer;
• Brief, focused tasks are easier for both sides.

Local authority funded homecare is means-tested; private homecare typically costs £20 to £35 per hour. Care Quality Commission inspects homecare agencies.

Dignity in advanced dementia

As dementia progresses, personal care needs increase. The principles do not change:

• Talk to the person as you work, even if they cannot respond;
• Explain each step;
• Cover and uncover as you go;
• Be gentle;
• Watch for facial expression, body tension, withdrawal;
• Music, touch, calm voice all help.

Equipment

Several practical aids reduce strain on both parties:

• Bath seat or shower stool;
• Grab rails;
• Non-slip bath mat;
• Raised toilet seat with handles;
• Long-handled sponge or comb;
• Slide sheet for repositioning in bed;
• Hoist for transfers in advanced disease.

An occupational therapy home assessment identifies what is needed.