Bathing and hygiene

The problem

The bathroom is the place with the most falls in the home: wet floor, hard surfaces, and little space. Most accidents are avoided before the water runs, by preparing the place.

What is happening underneath

Water on tile is almost like ice, and older skin senses temperature less, so very hot water burns without the person noticing in time. That is why you prepare the supports, the floor, and the temperature before starting.

Step by step

1. Firm grab bars, screwed into the wall, beside the toilet and inside the shower. Never use the towel rack or suction-cup bars: they do not hold weight.
2. Non-slip mats inside and outside the shower, and on the floor. Remove loose rugs.
3. A shower chair or a bench to bathe seated (card E2). A handheld showerhead helps with rinsing without the person having to turn.
4. Temperature: lower the water heater to a maximum of 49 °C (120 °F). Before starting, test the water on the inner side of your wrist: warm, never hot.
5. Have everything within reach before the water runs: soap, two towels, clean clothes. Remove the door lock so you can get in if needed.

The problem

Bathing while standing, on a wet floor and for several minutes, tires and unbalances. Sitting removes almost all the fall risk.

What is happening underneath

The shower chair lets the person bathe seated inside the shower. The tub bench straddles the edge of the tub: the person sits on the outside part and slides in, without having to lift a leg over the edge, which is where most falls happen.

Step by step

1. Choose the seat to fit the bathroom: a chair with a backrest and non-slip legs for the shower; a bench that straddles the edge for the tub.
2. If it has wheels or locks, make sure they are locked before sitting.
3. For the tub: have the person sit on the part of the bench that is outside, then slide in little by little until inside, bringing one leg in at a time.
4. Have them end up with their feet flat on the floor and well back on the seat.
5. Use the handheld showerhead to wet and rinse without asking them to turn or stand.

The problem

For an adult, being bathed by another can be the hardest thing to accept. Done in a rush or carelessly, it feels like a humiliation; done with respect, it remains a moment of dignity.

What is happening underneath

Older skin is thin and dries out, so warm water, mild soap, and drying well protect as much as the cleaning itself. And modesty matters as much as the body: covering what is not being washed completely changes how the person experiences that moment.

Step by step

1. Warm the bathroom beforehand and close the door. Explain what you are going to do, step by step.
2. Cover with a towel what you are not washing at that moment, and let them wash on their own whatever they can.
3. Wash from cleanest to dirtiest: first the face, then the body, and last the private areas. For a woman, always front to back.
4. Use a mild, fragrance-free soap. Rinse well so no soap is left on the skin.
5. Dry with gentle pats, especially in the folds (under the breasts, the groin, between the toes). If the skin is dry, a moisturizing cream helps.

The problem

Sitting down and standing up from the toilet is another transfer, with the added pressure of haste, clothing, and modesty. It is one of the moments where falls happen most.

What is happening underneath

A low toilet forces a lot of lowering and rising, which is hard for older knees and hips. A raised toilet seat and grab bars at the side shorten that distance and give something to hold onto.

Step by step

1. If the toilet is low, fit a raised seat. Put firm grab bars at the side, screwed in, never the towel rack.
2. To sit, have the person come close until the backs of their legs touch the toilet.
3. Have them hold the grab bar (not you, not the towel rack) and lower slowly, as in any transfer (see the Transfers chapter).
4. Seated, their feet must touch the floor. If they dangle, the seat is too high and unstable.
5. Give them privacy if they can stay alone safely, and leave the grab bar and, if there is one, the call button within reach.

The problem

Intimate hygiene and changing a brief are what create the most embarrassment, for both. The key is speed, respect, and protecting the skin, which is easily injured there.

What is happening underneath

The skin of the intimate area, in contact with moisture, gets irritated and breaks down quickly. Cleaning well, drying, and changing in time prevent painful wounds. And respect (warning, covering, not exposing more than needed) keeps the person from experiencing it as a humiliation.

Step by step

1. Have everything ready beforehand: cloths or wipes, warm water, barrier cream, the clean change. Put on gloves.
2. Say what you are going to do and cover with a towel what you are not cleaning.
3. Always clean front to back, especially in a woman, so as not to carry germs.
4. Dry well with gentle pats and apply a barrier cream if the skin is irritated.
5. Change the brief or the clothing as soon as they are damp, without waiting. Check the skin at each change.

The problem

When the person cannot get to the bathroom, the skin still has to be kept clean. The bed bath makes this possible, without them getting cold or hurt.

What is happening underneath

Spending a long time in bed and with moisture dries out and injures the skin. A bed bath, done in sections and keeping the warmth, cleans without chilling the person or tiring them too much.

Step by step

1. Warm the room. Have two basins (or use no-rinse wipes), mild soap, towels, and the clean change.
2. Cover the person with a towel or a thin sheet and uncover only the part you are washing at each moment.
3. Wash from cleanest to dirtiest: face, neck, arms, chest, abdomen, legs, back, and last the private areas (in a woman, front to back).
4. Dry each area well before moving to the next, especially the folds. Check the skin while you wash.
5. Change the sheet if needed (see the Bed chapter) and leave the person comfortable and warm.