Each day hundreds of thousands of people with dementia are bathed against their will. Their overt or nonverbal refusals are often ignored, and they are removed without permission from their beds and wheelchairs and taken to an often cold, impersonal, frightening shower or tub room to be scrubbed down. As a result, the refusals escalate to verbal and physical resistance, and finally to combativeness. The experience is frustrating and dangerous to caregivers, who become the targets of hitting, spitting, biting, and verbal attacks by the person who they are only trying to help. In the fields of nursing and medical research, such behaviors are called "agitated" or "disruptive", and the impact of such behaviors on caregivers is immense. Nursing assistants report being routinely distressed on the job by patient hitting, verbal aggression, and screaming.
This battle that often occurs between people with dementia and their caregivers is in most cases preventable. The source of the distress is often the caregiver imposing his or her duty to get someone clean; even when that someone is reluctant or distressed. The caregiver may feel bound by cultural, personal, or supervisory influences to "get the person clean" in some predefined time frame using a set method. Unfortunately, this lack of flexibility can have unpleasant results for both the caregiver and the person they are bathing. However, we believe that bathing can be made into a more humane, gentle experience for persons with dementia.
Starting in the early 1990's, two research teams were funded by the National Institutes of Health (NIH) to develop interventions to improve bathing. In 1997 these two research teams teamed up to undertake A Clinical Trial of Two Interventions in Bathing in Dementia. That project achieved impressive results and yielded new possibilities in terms of person-centered methods for bathing individuals with dementia. In studies using these person-centered methods, pre- and post-intervention ratings of over 500 videotaped baths found a 56% reduction in aggressive behaviors against caregivers, a 62% reduction in care recipient agitation, a 67% reduction in care recipient distress, and a 38% decrease in the proportion of bath time spent crying or screaming.
The Bathing Without a Battle: Creating a Better Bathing Experience for Persons with Alzheimer's Disease and Related Disorders DVD offers person-centered methods for making the bathing experience more enjoyable for both caregivers and the people they are bathing. The Bathing Without a Battle program has been endorsed by countless individuals and organizations committed to quality care and culture change in nursing homes, including the Pioneer Network and the Centers for Medicare and Medicaid Services.