Personal Care for People with Dementia: A Guide for Families

Personal Care for People with Dementia:

A Guide for Families

By: Victoria Rosenwald

Doctoral Candidate

Doctor of Occupational Therapy Program

The University of St. Augustine for Health Sciences

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© 2020 Victoria Rosenwald

Permission to redistribute granted by author for personal use.

This guide was written for families that are caring for a loved one that has

dementia. There are ideas offered in this guide to help people with dementia to take

part in their own personal care. These ideas will focus on safety and getting

someone with dementia ready to take part while making changes to the

surroundings and the activity.

The information in this guide has been gathered from a variety of sources including

recent studies that have been completed in occupational therapy and nursing. A list

of these sources is included in the reference section. All image sources are listed on

pages 126 – 131 except for those either in the public domain or created by the

author.

This guide was developed in partial fulfillment of the requirements for the Doctor

of Occupational Therapy (OTD) degree at the University of St. Augustine for

Health Sciences.

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Table of Contents

How the Caregivers’ Guide Could Help You .............................................. 4

Getting Your Loved One Involved: General Ideas .................................... 22

Getting Your Loved One Involved in Eating ............................................. 46

Getting Your Loved One Involved in Bathing ........................................... 54

Getting Your Loved One Involved in Dressing ......................................... 68

Getting Your Loved One Involved in Grooming ....................................... 83

Getting Your Loved One Involved in Toileting ......................................... 98

Community Resources ........................................................................... 115

Image Sources ........................................................................................ 126

References ............................................................................................. 132

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How the Caregivers’ Guide Could Help You

What is this guide for? How can it help my loved one and me?

• It can be hard to get your loved one to partake in personal

care. You are not alone! This is common for people with

dementia. This guide is to help you set up tasks to help your

loved one do their best. This guide covers personal care

activities including:

o Eating

o Bathing

o Dressing

o Grooming

o Toileting

• Your loved one may be able to do more. If you set up and

make changes to the activity that make it easier, your loved one

may be able to do more than you think they can.

• If your loved one stays involved in their personal care,

research shows it can improve their:

▪ Mood

▪ Behavior

▪ Health

▪ Sense of self and fulfillment

▪ Quality of life

This guide will give you ideas to help

your loved one with all types of

personal care.

Your loved one will probably feel

better and be happier if they

take part in as much as they can.

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• You might feel less stress. Some of your stress might

be coming from how much help you think you need to

give your loved one. You might also be stressed

because you don’t know how to tackle the problems

you are having.

o Having a resource to help with your

loved one also might decrease any of

the following for you:

▪ Feelings of sadness or

depression

▪ Feelings of burden

▪ Doctor visits and health problems

o Having a resource might increase your:

▪ Knowledge and confidence

▪ Sense of control

▪ Fulfillment and sense of self

▪ Ability to take care of your own needs

▪ Quality of life

• It might delay the need to move your loved one into a

nursing home.

o Some of the main reasons that caregivers decide it is time to

move their loved one are:

▪ Feelings of burden.

▪ Their loved one resisting personal care tasks.

▪ Their loved one becoming dependent for personal care tasks.

o Since this guide is focusing on personal care tasks, the

information might make you more confident taking care of your

loved one.

This guide can’t fix all the

stresses related to caring for

a loved one with dementia

but might lessen some of

the common sources of

stress.58

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Ways I think using this guide could help my loved one and me:

____ Make my loved one’s personal care easier.

____ Changing the way we do personal care might help my loved

one be able to do more of these tasks.

____ My loved one might be happier and have a better quality of life

if they can be more involved in their personal care.

____ I might be less stressed.

____ I might feel better about taking care of my loved one for longer.

What changes should I expect from using this guide?

• Your loved one may be easier to work with, but it won’t fix

every challenge. Many unwanted behaviors are a part of

dementia and it is not realistic to expect them all to go away.

The goal is to reduce them.

• You will probably still need to look after and

help your loved one. Since dementia gets

worse over time, the ideas in this guide will not

make your loved one totally independent. The

goal is to let your loved one do as much as they

can for each task, making it easier for them

and for you.

You will most likely still have

to help your loved one, but

this guide may have ideas to

make personal care easier.23

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• It is hard to make changes, and even harder to make many

changes at one time. Pick no more than 4 ideas at a time and

try to make those work.

o Start trying more ideas:

▪ When you feel like you have learned how to use an approach.

▪ If you have decided that an idea is not going to work for your

loved one after trying it 3 times.

• Since you are now helping make decisions for your loved

one, it’s important to first think about what is safe and best

for both you and your loved one. Sometimes stress can come

from trying to make all your choices based on what your loved

one was like many years ago. Often this might not be practical

and can cause a conflict between what makes sense now and

what they used to do.

• This guide is only a source of information – it doesn’t

replace medical care, therapy, or respite care.

o Medical care includes visits to your doctor and might also

include specialists and nurses:

▪ A neurologist is a doctor that focuses on problems with the

brain and the nervous system.

▪ A geriatrician is a doctor that focuses on problems related to

aging.

▪ A mental health professional can help if your loved one is

depressed.

▪ A geriatric nurse, a social worker, or a care coordinator can talk

to all team members to make the best treatment plan for your

loved one.

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o 3 types of therapy could help people with dementia. Even

though therapy may not be able to improve your loved one’s

abilities, it might be able to keep them at their current level for

a longer time. Talk to your doctor to get an order for therapy

that would be best for your loved one.

▪ Occupational therapists can work with your loved one on

keeping them as independent as possible with any tasks that

your loved one needs or wants to do.

• Often occupational therapists will do this by changing the

environment or how the activity is done.

• Occupational therapists can suggest the right equipment

to help your loved one as well as changes to your home

to improve safety.

• Occupational therapists can also work with you to learn

how to manage your stress and how you can best help

your loved one.

Personal care activities are a focus for occupational

therapists when working with someone with dementia.19

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▪ Physical therapists might work with your loved one on

moving safely, lessening their fall risk, and keeping their

balance.

• Exercise can help your loved one’s brain as well as

their body, and a physical therapist can help make an

exercise plan for your loved one.

• Physical therapists can also work with you to make

sure you are moving safely if you have to physically

help your loved one.

▪ Speech therapists can work

with your loved one on

understanding and using

language, as well as memory

and brain activities. They also

can help if your loved one is

having trouble swallowing.

• Speech therapists can work with you on ways to talk to

your loved one that they can understand.

Physical therapists can help your

loved one keep moving safely.

Speech therapists can teach you

ways to keep your loved one

from choking if they are having

trouble.7

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o Respite care is any type of service or person that comes in to

give you a break from caregiving. It is often short-term and

might include:

▪ Professional

caregivers

▪ Adult

daycare

centers

▪ Other family

members

• If you are feeling burned out, you are not alone. Many

caregivers don’t have information that will help them. Stress

can cause health problems later if you don’t find ways to reduce

it and manage it.

o Look for caregiver support groups – these

often share many ideas for lessening stress.

o Look in your area for caregiver classes that

focus on lessening your stress.

Caregiver support groups can

help you feel more connected

and offer ideas to help you.5

It is good for you to take breaks. Adult day care centers often

have activities and are a safe place for your loved one.44

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• Know your limits. It’s important to take care of yourself and to

ask for help when you need it.

o Questions to think about:

▪ If your loved one needs physical help, is it in any way unsafe

for you to offer that help?

____ Yes ____ No

▪ Is caring for your loved one taking a toll on your health?

____ Yes ____ No

▪ Are you feeling sad or low all the time?

____ Yes ____ No

▪ Do you feel a sense of burden from caring for your loved one?

____ Yes ____ No

o If you said yes to any of these questions, you may want to start

thinking about asking for help. If you need help, there are many

choices and your loved one’s insurance may help pay for some

of them. Ways to get help include:

▪ Asking family or friends to take on some of the caregiving so

you can have breaks.

People I can ask: _____________________________________

▪ Looking at adult daycare centers, which offer a safe place for

your loved one to spend time during the day.

Places I can look at: __________________________________

___________________________________________________

▪ Asking your doctor about physical, speech, or occupational

therapy, which usually includes some caregiver education.

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▪ Asking your local Area Agency on Aging about resources for:

• Caregiver education

classes to give you ideas

for how to help your

loved one and yourself.

• Mental health counseling to help you cope with this role.

• Home health caregivers, who can come into your home

to help with your loved one. They can range from a

couple of hours

every week to

giving care day

and night.

• My local Area Agency on Aging’s phone number:

o _________________________________________

• Services they provide that I might want to use:

o _________________________________________

o _________________________________________

o _________________________________________

o _________________________________________

You can hire a caregiver from

a home health company to

help with certain tasks, or

just to stay with your loved

one so you can take a break.1

To find your local Area Agency

on Aging:

• Go to eldercare.acl.gov

• Call 1-800-677-1116

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▪ Looking into moving your loved one to a nursing home. There

are many different types of nursing homes including some

called memory care that are planned for people with dementia.

• Many caregivers feel guilty when thinking about this

choice. Remember that keeping you and your loved one

safe is the first concern. Many families get to the point

where they can’t safely care for their loved one. It is okay

to move your loved one into a place that is ready to meet

their needs.

Things I will keep in mind when using the ideas in this guide:

____ My loved one’s behavior might get better but won’t be perfect.

____ My loved one will still need help; this guide is just sharing

ways to make the tasks easier so they can do as much as they

can.

____ I will only try a couple of ideas at a time, so I don’t get

overwhelmed or stressed.

____ I can use practical ways of taking care of my loved one that are

safer and easier while still following many of my loved one’s

wishes.

____ This guide does not replace medical care or therapy for my

loved one, or respite care (a break) for me.

____ Caregivers often feel burdened and get burned out. I need to

take care of myself.

____ I need to know my limits and know that it is important to ask

for help when I need it.

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How can I better understand dementia?

• Remember that your loved one is not trying to be hard to

deal with. Dementia is a lot more than just memory problems.

If you know what changes the disease causes, it will help you

work with your loved one. Common problems for people with

dementia include:

o Memory:

▪ Short-term (recent things – this is the first area to have

trouble)

▪ Long-term (things from long ago – this often works until

later stages of dementia)

▪ Automatic (things you can do without thinking about –

this often works until later stages of dementia too)

o Personality changes:

▪ Agitation (being uneasy or nervous)

▪ Paranoia (not trusting or being afraid)

▪ Impulsivity (acting without thinking)

▪ Poor judgment (making decisions that are not safe)

o Focusing – their attention span is much shorter.

o Doing tasks:

▪ Planning a task

▪ Starting a task

▪ Doing steps in the right order

1. ?

2. ?

3. ?

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o Language:

▪ Finding the right words

▪ Understanding what you are saying to

them

o Sight:

▪ Not seeing as well or understanding what they

are seeing.

o Confusion:

▪ Wandering

▪ No sense of time, date, season, or place; made worse by

forgetfulness

▪ Sundowning is a term for a change in behavior and mood that

happens to some people with dementia later in the day.

o It can happen because their internal clock is not

telling them the right times to be asleep or awake.

o It can also happen because they are tired or

overwhelmed. Getting rid of extra noise and letting

them relax sometimes can help.

o Examples of sundowning may include:

▪ Extra confusion

▪ Pacing

▪ Aggression (upset and forceful)

▪ Seeing or hearing things that aren’t real

???

If your loved one has no

idea what time or day it is,

that can add to their

confusion and distress.

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• Your loved one’s abilities may change during the day. Meet them at their

level at that moment by being ready to change the amount or type of help

you offer them. For example, the way you help your loved one brush their

teeth in the morning and at night may be very different.

• Defining terms used in this guide:

o Environment: The physical area and the people around your

loved one. It includes anything or anyone that your loved one

can:

o Automatic memory: A memory of how to do

something without thinking about it. You

probably don’t think about how to swallow

water or how to put a shirt on.

▪ Finding ways to use your loved one’s

automatic memory is one of the best

ways to keep them involved.

Automatic memory is the

type of memory people

talk about when they say,

“it’s like riding a bike.”

Hear Taste

See Smell Touch

Anything or anyone that involves your loved one’s senses is part of the environment.

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• Ways to think about the changes in your loved one’s brain:

o Imagine a box that is shrinking. Items on the top of the box fall

out as it gets smaller.

▪ Your loved one’s brain

can’t hold all the

memories anymore. The

items that fall out are like

their memories – more

recent ones are less likely

to stay in their brain.

o Think about a company that is short-staffed; people are doing

jobs they don’t normally do and that may cause more mistakes.

▪ Areas of your loved one’s brain are trying to make up for other

areas and are doing jobs they don’t normally do. This is why

they might start making more mistakes.

o A boat drifting without an anchor will have trouble because

they don’t know where they are or where they are trying to go.

▪ When your loved one doesn’t know the day or time, where they

are, or who is with them, it makes it hard for them to focus on

anything else.

These light bulbs are like your loved one’s memories.

If you try to put more on top, they will fall out.31

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o Highways have made travel time faster, but you can still get to

most places using the backroads.

▪ The “highways” in

your loved one’s

brain are not

working anymore.

They have to use

the “backroads” to

move information

through their

brain. This is why

it might take them

longer to do

things.

• If your loved one is being hard to deal with, keep in mind

they are not doing it on purpose.

o Think about why they are acting this way:

▪ Are they:

• In pain?

• Cold?

• Scared?

• Distracted or overwhelmed by something?

• Bored?

▪ Do they have new changes in their medicine?

• Some medicines have side effects that may not let your

loved one feel their best.

Dementia puts up roadblocks on the

“highways” in your loved one’s

brain. Using backroads is slower

than a highway, which is why your

loved one takes longer to think.

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▪ Are your expectations fair?

• Can they do more or less than

you think they can? Remember

this can change during the day!

▪ Are you:

• Showing them you are relaxed

and friendly?

• Trying to change their routine?

▪ Is this a pattern? Does something

trigger them to react?

o If you find a likely reason your loved one is acting this way,

how can you change it?

▪ Can you:

• Keep them to their routine?

______________________________________________

• Take away a trigger?

______________________________________________

• Do something to get your loved one ready for this task?

______________________________________________

▪ Can you change:

• The environment to be more pleasant for them?

______________________________________________

• How you approach your loved one?

______________________________________________

• The task to make it easier?

______________________________________________

Is there something bothering your

loved one that is making them

unpleasant? Can you fix it or keep it

from happening?

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Things I will try to remember about dementia:

____ Dementia affects a lot more than just my loved one’s memory:

____ Personality changes – their behavior is not their choice, it is

part of the disease.

____ Trouble paying attention to anything for more than a few minutes.

____ Trouble starting and planning a task and doing steps in the right

order.

____ Trouble talking to and understanding other people.

____ Wandering without knowing where they are going or trouble

knowing the time, date, and where they are.

____ Not being able to see or understand what they are seeing.

____ The amount of help my loved one needs may change during the day.

____ Ways to relate to what is happening in my loved one’s brain:

____ Their memory is like a box that is shrinking so the newest items

fall out first.

____ Their brain is like a short-staffed company, so parts of the brain

are doing jobs they don’t usually do.

____ Our brains are filled with highways and backroads to connect

information. My loved one’s brain has roadblocks on the

highways so they can only use their backroads. That is why it

takes them longer to think.

____ They are not oriented to time or place like a boat drifting with

no anchor.

____ If my loved one is being hard to deal with, I will try to figure

out if something is wrong.

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How is this guide set up?

• The guide has ideas that you can use in many areas and a

set of ideas for each personal care task.

• Each task has 4 sections with ideas that you can try to help

get your loved one involved:

o Ways to get your loved one ready for an activity (in orange).

▪ Making sure your loved one is comfortable before you start will

help them take part.

o Ways to get the environment ready for an activity (in green).

▪ Changing the environment can reduce the amount of help your

loved one needs from you.

o Ways to change the activity to help your loved one (in blue).

▪ Prompting your loved one can replace physical help.

o When to see your loved one’s doctor (in red).

• At the end of each section, there is a checklist for you to use.

Every idea won’t work for every person every time. This will

let you mark which ideas you want to try right now.

o Remember that just because an idea works once doesn’t mean it

will work every time. The opposite is also true – if an idea

doesn’t work the first time, it doesn’t mean it will always fail.

o The ideas in this guide have a wide range of the amount of help

you offer. Check in with your loved one to see how they are

feeling and how much help they need at that moment.

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Getting Your Loved One Involved: General Ideas

How can I get a person with dementia ready to

take part in an activity?

• Always focus on your loved one and their comfort more

than the task to decrease unwanted behaviors.

o Try to understand your loved one’s point of view.

Think about how you would feel or act if you

don’t know the people around you, where you are,

or what you are being asked to do. Show your

loved one that their feelings are valid.

o Don’t argue or try to reason with your loved one –

it often doesn’t help. Their feelings are real, try to

connect to them instead of correcting facts.

o If your loved one shows pain, say you are sorry

and change the way you are working with them if

you can.

o Give your loved one choices when you can.

o Give your loved one praise.

• Make routines for your loved one. A routine can help people

with dementia to use their automatic memory, which lets them

do more themselves. Try to make a routine whenever you can

(see the end of this section for an example).

o It will help if you can do some daily events at the same time

every day, such as meals.

If you did not understand

anything going on around

you, it might make you

feel scared and uneasy.

Try to remember this

when you are talking to

your loved one.28

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• People with dementia still value their dignity.

o If you must touch your loved one to help, tell your loved one

what you are going to do before you do it.

o Only give your loved one as much help as they need. It’s

important that they do as much as they can to take care of

themselves to keep their self-image and sense of identity.

▪ Try helping them figure out their plan for a task before you give

them physical help. They might just need help to know what to

do. Keep it simple.

▪ If you start doing things for your loved one that they can do,

they will lose the memory of how to do it.

• Make sure that your loved one wears their

eyeglasses and hearing aids during the day.

They can take part in more activities and

understand what to do better if they can see and

hear.

If your loved one can’t see

or hear well, they might

become more confused.

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• Keep your loved one active. Exercise can help people with

dementia do more for themselves for a longer time. It can also

help keep them calm and lessen unwanted behavior.

o Stay with your loved one to make sure they are safe. Safety is

the most important thing.

o It’s more important that they exercise often than for a long time.

▪ For example, have them walk for 10-20 minutes every day.

▪ Break it up into shorter amounts over the day if your loved one

won’t exercise for 10 minutes. Even 2 minutes is better than

nothing.

o Include different types of exercise that works on their:

▪ Endurance:

• Walking

• Biking (on a stationary

bike)

• Water aerobics

• Gardening

• Household chores

(vacuuming, folding

clothes)

Tip: Folding clothes and other

chores are good exercise for

your loved one.16

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▪ Strength:

• Sit down and stand up 10 times (or more if this is easy

for your loved one). This will help with lots of tasks like

getting in and out of bed and using the bathroom.

o If this is difficult, start with standing up 2 or 3

times and slowly add more over time as it gets

easier.

• Squeeze a rubber ball.

• Use resistance bands, small dumbbells, or canned goods

(at a low weight).

• Use weight-lifting machines (at a low weight).

▪ Balance:

• Tai chi

• Seated yoga

• Stay standing for 2 minutes (give them something to hold

onto if they are unsteady).

▪ Coordination:

• Dance (can be seated)

• Basic stretching

Tip: Resistance

bands are a good

way to keep your

loved one strong.

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o If your loved one does not like exercise:

▪ Do it with them and have them copy you.

▪ Do other activities to get the movement you are looking for. For

example:

• Sing the national anthem to get them to stand up and stay

standing.

• Pretend to bowl to get them to move their arms.

• Play volleyball (seated or

standing) with a balloon to get

them to reach. This could work

for their legs too by kicking the

balloon while seated.

Tip: Your loved one might

enjoy playing volleyball

with a balloon, stretching

and moving their arms and

legs at the same time.52

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Tips to get my loved one ready for an activity that I will try first:

____ Focus on my loved one’s comfort more than getting the task

done by:

____ Trying to understand how my loved one feels and saying I am

sorry if they are in pain.

____ Not arguing with or correcting my loved one.

____ Giving my loved one choices when I can.

____ Giving my loved one praise.

____ Make and follow routines with my loved one whenever I can.

____ Try to protect my loved one’s dignity by:

____ Telling my loved one what I am doing or want them to do, one

short step at a time.

____ Not doing too much for them – I will offer to help them plan a

task before I offer to do something for them and I will try to

keep it simple.

____ Check that my loved one is wearing their eyeglasses and

hearing aids.

____ Make and follow an exercise routine that keeps my loved one

active.

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How can I set up the environment for an activity?

• Improve safety in the house:

o To keep your loved one from hurting themselves by accident:

▪ Make sure they can’t find or use sharp

objects.

▪ Lower the temperature on the hot water

heater.

▪ Remove stove knobs.

▪ Add locks on outside doors so they don’t

leave the house and get lost.

▪ Remove locks on inside doors so your loved

one can’t lock themselves into a room, such

as a bathroom.

Tip: A simple door lock that is

unfamiliar to your loved one

may keep them from using a

door since people with

dementia have trouble learning

new things.50

Tip: Wanderguard is a type of alarm and

tracking system made for people with

dementia that can help you keep your

loved one safe if they like to wander.49

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o To keep your loved one from falling:

▪ Add lighting.

▪ Take away or tape

down throw rugs.

▪ Keep walkways clear.

▪ Install safety equipment in the bathroom

(see pages 57 and 103 for details).

• Set up the activity before you ask your loved one to take

part. It’s often hard to get people with dementia to partake in

activities, especially their personal care. You don’t want to get

them to agree to do something and have them change their mind

when you go to get the items you need.

o Place items from left to right (like reading a book) to

help them know the correct order to use the objects.

Their automatic memory might take over when they

pick up the object.

o If your loved one is in an early stage of

dementia, you might be able to sort the

items for different tasks or parts of a

task into groups.

Tip: Your loved one might just need help

with the order they should do things in.

Laying the supplies out in order could help.

Tip: If you group items for your

loved one, they might know how

to do the rest of the task.

1. Be sure all areas your

loved one goes to are

well-lit without glare.

2. Use night lights or

motion-sensor lights to

help after dark.

3. Make sure your loved

one can reach light

switches.

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• People with dementia get distracted easily, keeping them

from doing a task to the best of their ability. They can get

overwhelmed because it’s often hard for them to take in

information. Take away anything that could distract your loved

one, including:

o Keeping the area where they are working clear of any extra

items that they don’t need for what they are doing.

o Keeping the room warm – your loved one will probably not like

to be cold.

o Getting rid of extra noise.

▪ Don’t talk too much when your loved one is moving or

thinking. People with dementia have trouble doing more than

one thing at a time.

• Making small talk with your loved one is good, just make

sure they are sitting down and not doing something else.

• People with dementia often have trouble telling the difference between

colors that don’t contrast. Use color to help guide your

loved one:

• Doors:

• If you want to help your loved one find a door,

paint it a color that stands out in the hallway.

• If you want to keep your loved one from

entering a room, paint the door a color that

blends into the hallway.

Tip: The color of a door can

help your loved one see it

or can help to hide it.9

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o Certain colors and patterns on a floor can keep your loved one

from walking on it:

▪ Busy patterns can confuse

your loved one and they

might not know where to

step.

▪ Dark areas might look like

holes to your loved one and

can be scary for them.

Tips to set up the environment that I will try first:

____ Improve safety in the house by:

____ Getting rid of sharp objects.

____ Taking off stove knobs and lowering the hot water temperature

to keep them from getting burned.

____ Removing indoor locks so my loved one can’t lock themselves

inside or adding outdoor locks to keep them from wandering.

____ Adding lighting in any room my loved one uses.

____ Keeping the pathways clear and get rid of throw rugs.

____ Set up the tools before my loved one starts, either in order or in

groups.

____ Keep my loved one warm and get rid of anything distracting.

____ Use color in hallways and doors to guide my loved one. Make

sure I cover dark areas on the floor so they aren’t scared.

Tip: Each dark spot may look

like a hole to your loved one

due to changes in their sight

and might make them scared to

walk.

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How can I change an activity?

• Use an approach that isn’t threatening to your loved one.

o Reduce any noise to help them focus:

▪ Close windows.

▪ Keep other people out of the room if possible.

▪ Turn off the TV and the radio.

o Make sure they can see and hear you before you get into their

personal space.

▪ Say hello and wave with your hand next to your

face while you are still 6 feet away from them.

▪ When you walk toward them, move slowly and

stay directly in front of them so they can see you.

Tip: Wave next to your face to get your loved one’s

attention. Show you are friendly to help them relax.37

33



o Once you are in their personal

space:

▪ Turn sideways so you seem

like less of a threat.

▪ Lower your face to their

eye level.

▪ Offer your hand. A handshake is often calming and supportive

for people with dementia.

• After shaking hands, keep holding their

hand and change your grip so that your hand is

under theirs. This grip will help you during

many tasks by:

• Keeping your loved one from hitting

you or squeezing your hand too hard.

• Keeping your loved one calm, let

them feel like they have some control,

and let them move naturally.

1. Start with a normal

handshake.

2. Then shift into a Hand-

under-Hand™ with your

loved one’s hand on top.

1. 2.

Tip: Putting yourself at their eye

level and turning sideways can

seem less scary for your loved

one.20

34



• Think about how you act and talk to your loved one.

o Give your loved one extra time to answer you or to do what you

ask them to do. Their thinking is much slower than it was, and

it might take them 1 – 2 minutes to respond.

o People with dementia can often understand feelings better than

words. Think about your body language:

▪ Smile and make sure you look friendly.

▪ Relax – they will feel it if you are tense or in a hurry.

Your loved one needs more

time to take information in

and then to decide what to do.

Sight

Sound

Smell

Taste

Touch

Talking

Moving

35



o People with dementia will often be better at using body

language than talking. Pay attention to your loved one’s body

language to know what they need or want.

o Think about how you talk to your loved one:

▪ Be positive, ask your loved one to take part in the task, and give

them praise.

▪ Use humor, but don’t make fun of your loved one. They

probably won’t understand sarcasm.

▪ Try to talk to them in an upbeat but normal way. People with

dementia don’t want to be talked to like a child. Avoid baby

talk and using a sing-song voice.

▪ Your wording matters. Try the following tips:

• Open-ended questions might be hard. Ask your loved one

questions with only two possible answers, like yes or no,

or this or that.

o Give your loved one two choices you are okay

with.

▪ For example, say “do you want to wear the

red shirt or the blue shirt?” instead of asking

if they want to get dressed.

o Give instructions as a statement.

▪ For example, say “it’s time to get dressed”

instead of asking if they want to get dressed.

Tip: Giving your loved one

choices helps them to take

part. Showing them the

choices when you ask will

help your loved one

understand.

36



• Indirectly ask your loved one to do the task.

o For example, say “after you brush your teeth, do

you want to listen to music or go for a walk?”

• Offer a reward for doing the task.

o For example, say “do you want a cupcake or a

cookie after you take a shower?”

• Limit the need for physical help by giving your loved one

prompts. It’s important that your loved one does as much as

they can to use their abilities. This helps keep their dignity.

Give them more help if they show signs that they are getting

frustrated.

o Try to make the task as simple as you can.

o There are many ways to prompt your loved one. The following

are examples, starting with the smallest amount of help and

adding more:

▪ Written:

• Keep steps short and simple.

▪ Verbal (said out loud):

• Make sure these steps are short and simple too.

• Give them one step at a time.

o For example, say “stand up” and then wait for

them to stand up before telling them what to do

next.

37



▪ Visual (things they can see, like pictures or objects):

• Have the items needed for the task set

out; it might help your loved one to

know what you want them to do.

• Label places or items with pictures or symbols to help

them when they don’t understand words anymore.

o For example, using a Do Not Enter or a Closed

sign might keep them from going into a room.

o If your loved one does not know what to do with a

picture of the task, try using a picture of your

loved one doing the task.

• Give them a short and simple list to check their work. It

might help them catch mistakes.

▪ Gestures (using motions to show them what to do):

• For example, say “stand up” while you stand up so they

can copy you.

• Do one step at a time.

▪ Guide your loved one with your hands on their hands. Be gentle

and move slowly.

Tip: If your loved one can see the

objects for a task, they may know

what to do.

Think about what

symbols mean – a Stop

sign means you can go

after you stop. A Do

Not Enter sign means

you can never go that

way.

38



• People with dementia often resist personal care.

o There are a few reasons that a person with dementia might

panic:

▪ Personal care tasks are often very intrusive.

▪ Your loved one might feel attacked, embarrassed, or like they

aren’t in control.

▪ Your loved one may not know who you are at that moment.

▪ Your loved one might be afraid of pain or being cold.

o The following are ways to keep your loved one from getting upset:

▪ Use their senses:

• Sight:

o Show your loved one pictures of

things they like.

▪ For example, showing them pictures of

puppies and babies before you start a task

might make them more likely to agree.

o Show your loved one a video of another family

member asking them to do the task.

• Sound:

o Play background music. You may want to change

the type of music for the activity.

▪ For example, you might want to play upbeat

music for a more active time in the day and

softer music when you want your loved one

to relax.

Tip: Show your loved

one pictures of cute or

pleasant things to put

them in a good mood.

39



• Touch:

o Massage your loved one’s hands to help calm them

and get them used to being touched for other tasks.

o Wash your loved one’s hands in warm water to

help calm them and help them get used to the

water before bathing.

▪ Use an activity your loved one likes to put them in a good

mood. If they are happy when you start a personal care task,

they are more likely to agree. Do something they like to do:

• Cook a meal.

• Do one of their hobbies.

• Look at old pictures.

• Listen to old music.

• Talk about events from a long time

ago.

Tip: Looking at old pictures will remind

your loved one of their memories and

will often make them feel good.27

40



▪ Find and help with any pain:

• People with dementia often act out because they are in

pain and don’t have a way to tell you. Signs of pain

include:

o Frowning or looking scared.

o Holding or guarding an area of their body.

o Making sounds like groaning or crying.

o Changing their habits or not eating.

o Showing more confusion.

▪ Stay calm. Remember that your loved one isn’t causing trouble

on purpose – it’s part of dementia.

If your loved one is protecting an

area of their body, it might be

because they are in pain.

41



o When your loved one gets upset:

▪ Remain calm and don’t show fear.

▪ Discuss their feelings, not their reality.

▪ Start singing with your loved one.

▪ Use a pet, a baby doll, or a lifelike stuffed animal to calm them

down. These will often prompt them to sit down and hold the

doll or pet the animal (real or fake) and start to relax.

• Having your loved one hold a doll when you start the

task can keep them calm and help them to take part in the

task.

▪ Do not physically force your loved one to do something.

• If they won’t cooperate, leave them for a few minutes, let

them calm down, and then try again.

Tip: If your loved one is upset, calm

them down with a stuffed animal51 or

doll21 that looks real to your loved one.

They will probably want to sit and hold

it. These items can also help put your

loved one in a good mood before a task.

42



Tips to change the activity that I will try first with my loved one:

____ Use an approach that is friendly and relaxed to put my loved

one at ease.

____ Think about how I act and talk to my loved one by:

____ Giving extra time for my loved one to answer me.

____ Paying attention to both my loved one’s and my own body

language.

____ Being positive and using humor with my loved one.

____ Giving my loved one answer choices or offering a reward for

taking part.

____ Make the task as simple as I can.

____ Try to trigger my loved one’s memory by:

____ Giving one step at a time.

____ Using related objects, labels, pictures, or a checklist.

____ Showing my loved one what to do with motions or

guiding them with my hands on theirs.

____ Help my loved one to take part in activities by:

____ Showing my loved one pictures or videos of something they

like.

____ Playing background music.

____ Giving my loved one a hand massage or washing their hands in

warm water.

____ Doing something my loved one likes before I ask them to take

part in personal care.

43



____ Checking on my loved one to make sure they aren’t in pain.

____ Using a doll, pet, or stuffed animal to put my loved one in a

good mood.

When should I see my loved one’s doctor?

When the person with dementia:

• Shows repeated signs of pain and you are sure they are not

hungry or bored:

o Crying, groaning, or frowning.

o Rocking more than normal.

o Holding or protecting a body part.

o Changing habits suddenly.

• Suddenly seems more confused than is normal for your loved

one – this can be a sign of an infection.

o A physical therapist or an occupational therapist can help create

an exercise program that is safe for your loved one.

44



Sample Schedule

Morning

Use the bathroom and get dressed.

Make breakfast, eat, and clean up together.

Brush teeth, wash face, brush hair.

Go for a walk together.

Quiet time.

Do some household chores together.

Afternoon

Make lunch, eat, and clean up together.

Stretching.

Do a project together: garden, paint, or bake.

Use the bathroom and get clean (shower).

Quiet time.

Evening

Make dinner, eat, and clean up together.

Read out loud or play cards together.

Listen to music and sing.

Brush teeth, use the bathroom, and put on pajamas.

45



___________________’s Schedule

Morning

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

Afternoon

___________________________________________

___________________________________________

___________________________________________

___________________________________________

Evening

___________________________________________

___________________________________________

___________________________________________

___________________________________________

46



Getting Your Loved One Involved in Eating

How can I get a person with dementia ready to eat?

• Pain may cause unwanted behavior or keep a person with

dementia from eating. To help to prevent pain:

o Give your loved one pain medicine at least 30 minutes before

meals.

o Brush teeth and clean dentures every day (see page 83 for ideas to

make brushing teeth easier).

• Good posture will help your loved one to swallow and digest

safely.

o Have them sit up in a dining room chair if possible.

Good view of the food on the table.

Sitting upright in a firm chair.

Pillows for support at

the lower back.

Hands on the table if possible.

Hips and knees bent at 90 degrees.

Feet placed on floor (use footstool

for correct height if needed).33

47



o If your loved one must remain in a wheelchair

to eat, make sure to:

▪ Sit them upright.

▪ Wheel their legs under the eating

surface.

▪ Lock the brakes.

▪ Place their plate right in front of them

for easy reach.

o If your loved one is

bed-bound, adjust the bed

to have them sit as upright

as possible.3

• Involve all senses during meals to increase your loved one’s

independence:

o Massage hands right before eating to improve mood.

o Make sure your loved one uses eyeglasses and hearing aids

during meals if they need them to help see their food and hear

any conversation.

Make sure your loved one is

sitting up straight in their chair

before they start eating.57

48



• Wash hands or say a blessing or both if those were

meaningful habits for your loved one. Habits may trigger

their automatic memory to start eating.

Tips to get my loved one ready to eat that I will try first:

____ Give medicine and brush teeth to prevent pain.

____ Have my loved one sit up as much as possible to eat.

____ Have my loved one wear their eyeglasses and hearing aids

during meals.

____ Wash hands and say a blessing before meals like my loved one

used to.

How can I prepare the environment for eating?

• Eat in a quiet and relaxing place where meals are usually

served. Eating in a familiar place might help your loved one to

know what to do.

• Use items that make eating easier. Consider

using built-up silverware handles or mugs instead

of glasses.

Tip: Built-up handles may be easier

for your loved one to hold.55

49



• Prevent distractions:

o Put only 1 cup, 1 plate, and 1 utensil at your loved one’s place.

o Keep serving dishes off the table and only serve 1 food at a time.

• Set up the environment to involve all your loved one’s

senses. This will help them to take part in mealtime:

o Serve their preferred foods.

o Use familiar cooking aromas.

o Make sure there is good

lighting so they can clearly see

their food.

o Use contrasting colors to help

them see the plate and the food.

o Play soft background music.


____ Eat in a quiet place where meals are usually served.

____ Use built-up silverware or mugs to hold things more easily.

____ Use only 1 plate, 1 utensil, and 1 glass on the table.

____ Serve preferred foods and use familiar cooking aromas.

____ Provide good lighting and contrasting colors.

____ Play soft background music.

Tip: White plates without designs on a

dark surface are easier to see and less

distracting.29

50



How can I change the activity?

• Safety issues related to eating:

o Make sure your loved one is swallowing their food and not

leaving it in their mouth.

o Check your loved one’s mouth for sores, broken teeth, or loose

teeth.

• Limit the need for physical help by

serving foods that are easy to pick up.

Many items can be finger food, even if

we usually would not eat it that way.

o Put food into sandwiches and

soft food into ice cream cones

to help your loved one feed

themselves.

• People with dementia copy actions and emotions. During

mealtime:

o Try to be calm, relaxed, and patient. Give plenty of time for the

meal.

o Eat with your loved one to show them what to do and give them

praise when they do well.

▪ Make sure you have food in front of you so your loved one

doesn’t think they need to share their food.

o Stay seated – if you get up and down, they probably will too.

▪ Set the table before you ask the person with dementia to sit for

a meal.

Tip: Put a puree like mashed potatoes in a

cone to make it easier for your loved one

to eat.24

51



• If the person with dementia isn’t eating enough:

o Start the meal over several times until you feel like they have

eaten enough or serve several small meals.

o Have snacks on hand and put them where your loved one can

see them.

o People with dementia can taste sweetness

longer than other tastes. In later stages of

dementia, sweeten food with honey or put sugar

in the saltshaker if they resist eating.

o Have them help cook the meal. For example, they

can help to:

▪ Rinse fruit or vegetables.

▪ Tear or snap vegetables.

▪ Stir mixtures.

• If your loved one gets distracted, redirect them:

o Use verbal prompts in a calm, clear voice. Give them 1 – 2

minutes to respond to each command.

o Gently touch your loved one.

o Consider limiting conversation during meals.

o If you are taking the person with dementia to an event, let

them eat before you go. Hunger may cause distraction or

unwanted behavior at the event.

If your loved one takes part

in cooking the meal, they

might be more likely to eat it.

52




____ Pay attention to safety issues related to eating.

____ Serve foods that can be picked up with my loved one’s fingers.

____ Be calm and relaxed.

____ Give plenty of time for the meal.

____ Eat with my loved one so they know what to do at the table.

____ Get the table ready before seating my loved one.

____ Help my loved one to eat enough by:

____ Starting the meal over again.

____ Giving them snacks.

____ Sweetening food.

____ Having my loved one help get the meal ready.

____ Redirect my loved one using verbal prompts or a gentle touch.

____ Let my loved one eat before we go to an event.

53





• Has a sudden change in weight, appetite, or eating habits

o That causes them to lose or gain more than 5 pounds or

o That does not improve after you have tried at least 3

ideas from this section.

• Has broken teeth, loose teeth, or sores in their mouth.

• Needs your help to eat, coughs when eating, or looks like they

have trouble swallowing.

o A speech therapist can work on diet changes and methods for

safe swallowing.

o An occupational therapist can work on positioning and show

you the safest ways to feed your loved one.

54



Getting Your Loved One Involved in Bathing

How can I get a person with dementia ready to bathe?

• Pain may cause unwanted behavior or keep a person with

dementia from bathing. To help to prevent pain give your

loved one pain medicine at least 30 minutes before starting.

• People with dementia still value privacy during personal

care, but you need to stay with them during the whole

bathing activity to make sure they stay safe. Ways to support

their dignity during bathing:

o Tell your loved one what you are going to do before you do it.

o Don’t have them remove undergarments unless they want to

when helping your loved one undress.

▪ They can bathe in their undergarments – once they are wet,

your loved one will probably want to take them off on their

own.

o Put a warm towel around their shoulders and another across

their lap for privacy.

▪ Your loved one can bathe with the towels in place, removing

them only while washing the areas they cover. Replace towels

if they get wet to keep your loved one warm.

• To lessen unwanted behavior, focus on your loved one and

their comfort more than bathing (see page 22 for more

information), and approach them in a way that isn’t

threatening (see pages 32 – 33 for more information).

55



• Give your loved one choices to help make a routine. Sticking

to a routine helps people with dementia complete personal care,

so ask them if they prefer:

o Taking a shower or bath – try to keep old habits.

o Bathing at a certain time of day.

o Help from someone that is the same gender as your loved one

(if you have this choice).

• Use more welcoming terms for bathing. People with

dementia may not be interested in bathing. Invite them to a “spa

treatment” or to “get clean” instead. It may be more successful

than using the words “bath” or “shower.”

o Your wording is important, say “let’s get clean,” “let’s wash

up,” or “let’s do your spa treatment” instead of asking if they

would like to bathe.

o Think about what makes a shower pleasant for you and try to

include those things for your loved one.

• Use distraction to help your loved one relax:

o Play soft background music or sing a favorite song to calm your

loved one.

o Give them something they like to hold, to look at, or to talk

about.

• Give your loved one a reason that they care about to bathe:

o Get them ready for another activity or a visitor.

o Show your loved one off to others and give them compliments.

56



o Reward your loved one for taking part in bathing.

o Use other activities to help with bathing:

▪ If you garden, paint, or bake with your loved

one, they may notice they are dirty and want

to get clean.

▪ If they do an activity with soap and water,

they can get clean in the process. For

example, if they wash dishes, they will also

wash their hands.

Tips to get my loved one ready to bathe that I will try first:

____ Give medicine 30 minutes before starting to prevent pain.

____ Tell my loved one what I am doing or want them to do, one step at a

time.

____ Use towels or undergarments to protect their privacy.

____ Focus on my loved one more than getting the shower or bath done and

approach my loved one in a friendly way.

____ Make and follow a routine for bathing.

____ Use welcoming terms for bathing.

____ Use music or favorite items to distract my loved one.

____ Use other activities with my loved one that encourage bathing.

Tip: Doing fun activities that

get your loved one dirty may

cause them to want to bathe.

57



How can I set up the environment for bathing?

• Improve safety in the bathroom:

o Have grab bars professionally installed so they are

secure and your loved one doesn’t fall getting in

and out of the shower or bathtub.

o Place a shower chair in the shower or bathtub so

your loved one doesn’t have to stand and risk

getting tired or losing their balance.

▪ Put a towel on the chair as padding to

increase their comfort.

▪ Make sure their feet are resting on the floor

or a stool.

o Place nonslip mats in the bathroom.

• Color contrast in the bathroom can help ease

fear caused by vision changes in people with

dementia. If your bathroom fixtures and floor

are mainly one color, try:

o Placing 2 – 3 drops of blue food coloring

in the bathwater so they can clearly see it.

o Taping an outline of the bath, sink, and

toilet with colored tape that is a

contrasting color with the rest of the

room.

Tip: Painters’ tape can make a

bathroom fixture more visible

to your loved one.

53

58



• Heat everything before you start – the room, the water, and put their

clothes and towels in the dryer. People with dementia don’t like to be cold.

This can cause them to refuse to bathe. If you aren’t hot, it’s probably not

warm enough!

• Use items that make bathing easier:

o Collect shampoo, soap, and other items before asking

your loved one to bathe.

o Cut steps by using:

▪ Shampoo/conditioner combinations

▪ No-rinse soaps and shampoos

o Consider the form of soap:

▪ Liquid soap is easier to use than bar soap.

▪ Bar soap may trigger an automatic memory for

bathing in people with dementia that used it

regularly in the past.

• If this is true for your loved one, have both

types within reach and see which works

better.

o A wash mitt can be helpful if it is

hard for your loved one to hold a

washcloth.

Tip: Soaps and

shampoos that don’t

require rinsing can

make bathing easier

and faster.54

Tip: A wash mitt can

keep your loved one

involved without

holding a washcloth.22

59



• People with dementia often have sensory overload from

sight, sound, smell, or touch. Bathing is very intense for the

senses; try to lessen this for your loved one:

o Temperature:

▪ Lower the hot water temperature setting to prevent burns.

▪ Check the water temperature during the shower or bath to make

sure it’s pleasant.

o Pressure:

• Install a hand-held showerhead so that

your loved one can only have water

directed to specific body parts.

• Only wash 1 area of the body at a

time during the shower or bath.

• Lower the water pressure – medium

to high pressure may feel unpleasant

or like it’s stinging to people with

dementia.

o Put your hand under the nozzle

and let the water drip through

your hand onto your loved one.

• Use a wet washcloth to rinse soap.

Tip: Hand-held showerheads

increase your loved one’s control

over the activity.13

60



o Sound:

▪ Add extra towels or bathmats or both to the bathroom to lessen

any echo.

o Lighting:

▪ Make sure there is enough light to see easily but not so bright

that it startles your loved one.

▪ If your loved one doesn’t recognize themselves, remove

or cover the mirror because it will be confusing. They

might not take a shower if they think someone else is in

the room.

o Smell:

▪ Remove any clothing or other items from the room that have a

bad smell.

61




____ Install safety equipment in the bathroom.

____ Use food coloring or colored tape to make bathroom fixtures

easier to see.

____ Warm up the room, the water, their clothes, and their towels.

____ Use items that make bathing easier and gather supplies before I

start.

____ Make changes to make bathing more pleasant for my loved one:

____ Lower the hot water temperature setting.

____ Check the water temperature during the shower or bath.

____ Install a hand-held showerhead.

____ Wash 1 area of the body at a time.

____ Lower water pressure.

____ Use a washcloth to rinse soap.

____ Reduce the echo.

____ Check that there is enough lighting but that it’s not too

bright and cover the mirror.

____ Take any items that have a bad smell out of the room.

62




• Safety issues related to getting clean:

o Make sure to wash, rinse, and dry all hard to reach areas,

including areas between folds of skin.

o While your loved one is drying off:

▪ Have them stay seated to decrease the risk of falling.

▪ Have them pat with a towel instead of rubbing and use lotion to

protect thin skin.

▪ Look for any sores or rashes.

• Break down the shower or bath into steps:

o Give your loved one clear directions for one step at a time.

o Consider only washing 1 or 2 areas of the body per day to

shorten the activity.

o Wash the least painful areas of the body first:

▪ Be careful around toes and feet, these are often very painful.

▪ If you know your loved one has a painful area:

• Go slow.

• Tell them what you will do or move before you do it.

• Have your loved one start any movements if they can.

• Try to get them to wash the area themselves.

▪ Washing the hair and face may be unpleasant or make them

cold – consider washing these areas last or at a different time.

63



• Try not to give physical help for your loved one if they don’t

need it. Often people with dementia can do a lot for themselves

with some prompting. Doing as much as they can to take care

of themselves helps protect their self-identity. If they are getting

frustrated, give them a little more help.

o Choose a time for bathing when you won’t need to rush your loved

one.

▪ Rushing may make them feel scared or embarrassed.

▪ It may take them 1-2 minutes to answer a question or to do

what you ask.

o A symbol like a rubber duck or a washcloth with soap could

trigger your loved one’s automatic memory to start washing

themselves.

o If your loved one needs more help:

▪ Give simple commands with motions to show them what to do.

• For example, say “take off your shirt” while you pretend

to take off your shirt, or say “wash your armpits” while

you pretend to wash under your own arms.

▪ Hand your loved one objects for washing in the order they need

them.

64



• If your loved one needs physical help, try the following to

keep them as active during bathing as possible:

o If your loved one has trouble

knowing how to move during

bathing, placing your hand under

their hand can help guide them using

a normal motion.

▪ Stand on their dominant side to

help them use the skills they

still have. For example, if they

are right-handed, stand on their

right side.

o If you start a step together with your loved one, it may trigger

them to take over and finish it. People with dementia often have

trouble starting a task.

▪ For example, if you start washing an area of your loved one’s

body with your hand over or under their hand, they may

naturally take over and finish washing.

o If your loved one is in an advanced stage of dementia and needs you

to bathe them, even holding an extra washcloth with soap or a

shampoo bottle helps them to focus and to feel involved.

Tip: Using a Hand-under-Hand™ method

keeps your loved one’s fingers free to

increase their ability to wash

themselves.

65



• People with dementia often resist bathing because it’s scary

and unpleasant. If your loved one is resisting:

o Leave your loved one alone and try again a few minutes later,

or if possible, have a different person try. Your loved one

should not be crying or screaming – the goal is to get them to

say yes.

o Try a towel bath or even a sponge bath of just 1 area of their

body:

▪ Towel baths:

• Get people just as clean as a shower.

• Feel like a gentle massage.

• Won’t dry out their skin.

• Use warm, damp washcloths soaked in no-rinse soap –

you don’t need much water.

• Go to https://tinyurl.com/exampletowelbath

for a short video showing a towel bath.

• Go to http://bathingwithoutabattle.unc.edu/

and sign up for the free online study for

videos with complete instructions for in-

room bathing and giving towel baths.

o If you have not already, change your expectations of how often

your loved one should bathe.

▪ Twice a week with sponge baths in between is reasonable

unless they are incontinent (can’t control when they go to the

bathroom).

https://tinyurl.com/exampletowelbath

http://bathingwithoutabattle.unc.edu/

66



• Take advantage of other times that your loved one may be

dressing or undressing. When they are getting ready for the

day or using the toilet, some undressing is already taking place.

It might be easier to bathe at one of these times if you aren’t in

a hurry.


____ Pay attention to safety issues related to bathing hygiene.

____ Break down bathing into step-by-step directions.

____ Only wash 1 or 2 areas of the body per day.

____ Wash the least painful areas of the body first and wash the head

and hair last.

____ Choose a time when I don’t have to rush my loved one.


____ Using a symbol.

____ Giving simple commands with motions.

____ Handing them the items they need in order.

____ Help my loved one physically if they need it by:

____ Starting a step and letting my loved one finish it.

____ Putting my hand under their hand to help.

____ Having them hold a related object while I help them wash.

____ Try a sponge bath or a towel bath.

____ Try to get my loved one to bathe at times when they are already

undressing.

67





• Shows aggression (is upset and forceful) during

the bathing process.

• Shows poor balance or needs physical help

to get into the shower or bathtub.

• Has any rashes or sores.

• Has an area of discolored skin that either doesn’t

turn white or stays white when you press on it.

o A physical therapist or an occupational

therapist can help with balance and moving

your loved one safely in and out of the

bathtub or shower while protecting yourself.

o An occupational therapist can help with setting up the

environment and showing you the safest ways to help your

loved one bathe.

If you see an area of skin

with a different color, let

your doctor know.40

68



Getting Your Loved One Involved in Dressing

How can I get a person with dementia ready to dress?

• Set up a routine for dressing. If your loved one dresses at the

same time in the same order every day, they are more likely to

use their automatic memory. Using a routine or a pattern will

help your loved one to do more on their own.

o People with dementia often

want to wear the same clothes

every day. Make it easy and

buy 3 or 4 of the same shirts

and pants so they can wear

what they like and be clean.

o When your loved one takes off

their dirty clothes at night, put

the clothes in the laundry so

they won’t see them in the

morning and want to put them back on.

• People with dementia still value privacy during personal

care. To protect your loved one’s dignity during dressing, keep

them covered as much as possible and tell them what you are

going to do before you do it.

Tip: Having more than one of your

loved one’s favorite outfit will make

dressing easier.30

69



• If your loved one gets dressed at strange times, be flexible if

possible. For example, if they wake up in the middle of the

night and get dressed for the day, don’t make them put their

pajamas back on.


their comfort more than dressing (see page 22 for more



• Remind your loved one to put on their eyeglasses and

hearing aids. It’s important that people with dementia be

able to use their senses to the best of their ability.

o Make sure they can see the clothes because it will

also help them to dress.

Tips to get my loved one ready to dress that I will try first:

____ Make and follow a routine for dressing.

____ Buy several of the same shirts and pants for my loved one.

____ Tell my loved one what I am doing or want them to do, step-by-step.

____ Be flexible if they get dressed at odd times.

____ Focus on my loved one’s comfort more than getting them dressed

quickly and approach my loved one in a positive way.

____ Remind my loved one to wear their eyeglasses and hearing aids.

Tip: Many people with

dementia have tunnel vision,

so put clothes right in front of

them.

70



How can I set up the environment for dressing?

• To keep your loved one from falling, have them dress while

seated in a chair with armrests. Many people put their pants

on while they stand up, but your loved one may not have good

balance.

o Make sure you stay with your loved one in case they forget to

stay seated.

o Gather supplies before you start so you don’t have to leave your loved

one.

• Use clothing that makes dressing easier:

o Make clothes easier to fasten:

▪ Adding an extender to zipper pulls will make it

easier to hold.

▪ Replacing buttons with

Velcro. Velcro is much

easier for your loved

one to fasten.

▪ Using Velcro shoes will be easier

for your loved one to put on. Elastic

shoelaces can replace regular

shoelaces and are also easier to use.

Tip: This zipper pull

will be easier to

grab if the person

has arthritis.56

Tip: Elastic shoelaces

make it easier to slip

shoes on or off.15

71



o Choose clothing that is easier to handle:

▪ Clothing that is 1 size too big may be easier to put on and take

off.

▪ Clothes or shirts that close in the front are easier to put on than

shirts that pull on overhead.

▪ Elastic pants are easier than pants that button.

▪ Dresses and skirts may be easier for your loved one, especially

when they go to the bathroom.

o You may see or hear about tools that are supposed to help

someone with dressing if they have physical limits. Since

people with dementia have trouble learning new things, these

items are usually more confusing and don’t help.

• Heat the room and the clothes. Your loved one may not want

to change their clothes because they don’t want to be cold.

• Use clothing and shoes that are easy to wash. People with

dementia may have spills and accidents. Clothing made of

100% cotton doesn’t hold the smell of urine when washed.

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• Grouping clothing makes it easy to find. Ways to sort clothing include:

o Putting all like items in 1 spot so

your loved one can see what is on

hand.

o Storing all items for 1 outfit in 1

place; for example, put a shirt and

pants on 1 hanger together.

• Limit clothing choices. If your loved one can pick out their

own clothes, too many choices can be overwhelming. Only put

out 1 or 2 outfits to choose from.

o Take away clothing for different seasons.

▪ For example, move all shorts and short-

sleeve shirts out of your loved one’s closet

in the winter so they will pick clothes

that are warm enough.

o Take away clothing that doesn’t fit your loved

one.

Tip: Make sure your

loved one can only find

clothing that is right for

the weather.11

Tip: Labeling drawers with pictures

may help your loved one find items.47

73




____ Have my loved one sit down while dressing and undressing.

____ Use clothing that is easy to fasten or make it easier to fasten.

____ Use clothing that is 1 size too big or easy to handle.

____ Heat the room and the clothes before we start.

____ Use washable clothing and shoes.

____ Sort and store clothes to make it easy to find items.

____ Limit clothing to choices that are okay with me.

74




• Safety issues related to dressing:

o Be sure to look for any sores or rashes when

your loved one is dressing. People with

dementia may not notice sores or be able to

tell you if something is wrong.

o Make sure your loved one wears non-slip

shoes that fit well. This can help keep them

active and prevent falls.

o Prevent pain by:

▪ Having your loved one start any movements if they can.

▪ Moving them slowly if you have to help.

▪ Putting a weak arm into a sleeve or a weak leg

into a pant leg first before the stronger side when

dressing. When undressing, take clothing off the

stronger side before the weaker side.

If you see an area of skin with a

different color, let your doctor

know.18

Tip: If your loved one

has a weak arm or leg,

put the weak side into

clothing first.35

75



• Break down dressing into steps and set up visual reminders:


▪ Give your loved one as many steps as they need. For example,

you could use “put your shirt on” if they only need general

steps or “put your arm through this sleeve” if they need more

specific directions.

o Make a poster that gives directions for dressing with pictures

and hang it on their bedroom wall (see the end of this section

for example posters).

o Lay out clothes left to right (like reading a book) in the order

that your loved one should put them on.

▪ If this is too distracting, stack the

clothes in order from top to bottom.

Tip: Laying out or

stacking clothes in the

correct order might be

all the help that your

loved one needs to dress

on their own.

76



• People with dementia can often do more than you might

think they can. Often a little help figuring out the steps for a

task might be all they need. Letting them take part as much as

possible keeps their mind active. If they are getting frustrated,

give them a little more help.

o Make sure to allow for extra time so you won’t need to rush

your loved one.

▪ Be patient; it may take them 1-2 minutes to move or to answer a

question.

▪ If you move or talk too fast, your loved one may get frustrated

or act out.

o Ask your loved one to show you how to put on an item of

clothing.



• For example, say “put on your pants” while you pretend

to put on your own pants.

▪ Hand your loved one their clothes in the order they need them.

77



• Your loved one may need physical help at some point.

Staying focused on dressing and doing at least some of the

movements will help them keep their muscle memory and make

it easier for both of you.

o Putting your hand under their hand can help guide your loved

one’s movements if they can’t understand how to do the task. It

also will let you move their arms through sleeves without

catching fingers.

▪ Go to https://tinyurl.com/Teepagetsdressed to watch a video of

this method.




▪ For example, if you help your loved one to pass their arms

through the sleeves, they may naturally take over and finish

putting the shirt on.

To help someone put their shirt on:

1. Pass your arm through the

sleeve backwards.

2. Hold their hand with a Hand-

under-Hand™ grip.

3. Keep holding their hand while

you pull it through the sleeve.

*If it is an overhead fit, do both

arms first, then the head.

Step 1

Step 2

Step 3

https://tinyurl.com/Teepagetsdressed

78



• It may be hard for people with dementia to make the same

choices about dressing that they used to make.

o If you have not already, change your expectations of how your

loved one should dress.

▪ It may not always be important that your loved one’s clothes

are matching or they dress how they used to. Ignore

mismatched clothing if they are dressed right for the weather

and are wearing the clothing correctly.

▪ If your loved one makes a mistake when dressing that must be

fixed, give them kind and exact directions and offer help.

o People with dementia often undress when it isn’t proper. This

can be because they find the sensation calming. If your loved

one is undressing when they should not, try to reduce this by

having them do repetitive tasks:

▪ Folding towels

▪ Rocking in a rocking

chair

▪ Sorting items:

• Buttons

• Nuts and bolts

• Coins

• Socks

• Beads

• Colored dominos

Tip: Sorting lets your loved one involve

their sense of touch, which might help

keep them from undressing at the wrong

time. It might keep them from picking

their skin too.41

79




____ Pay attention to safety issues related to dressing.

____ Break down dressing into step-by-step directions.

____ Hang up a poster with directions and pictures.

____ Lay out or stack the clothes in the order in which my

loved one should put them on.

____ Choose a time when I won’t need to rush my loved one.


____ Asking them how to put on an item.




____ Trying to start a step and let my loved one finish it.

____ Putting my hand under their hand to help.

____ Use other activities with my loved one to help prevent

undressing at the wrong time.

80





• Shows poor balance or needs physical help to stand up.


• Has an area of discolored skin that either doesn’t turn white or

stays white when you press on it.

o A physical therapist or an occupational therapist can help with

balance and safely helping your loved one stand up and sit

down.

o An occupational therapist can show you the safest ways to help

your loved one dress.

81



Let’s Get Dressed

1. Sit down.

2. Put your shirt on.

3. Put your legs through your

underwear.

4. Put your legs through your pants.

5. Put your socks on.

6. Put your shoes on.

7. Stand up.

8. Pull your pants and underwear up.

26

10

82



Let’s Get Dressed

1. Sit down.

2. Put your bra on.

3. Put your shirt on.

4. Put your legs through your underwear.

5. Put your legs through your pants.

6. Put your socks on.

7. Put your shoes on.

8. Stand up.


26

10

83



Getting Your Loved One Involved in Grooming

How can I get a person with dementia ready for grooming?

• Set up a routine for grooming and dental

care. Doing grooming tasks as part of a

routine will help your loved one to do more

on their own.

o Use other events that happen daily to

trigger an automatic memory.

▪ For example, always brush

teeth after breakfast. This way

your loved one may

automatically start the task after breakfast.

o People with dementia often get confused if they

don’t use the same items every day. Buy 3 or 4 of the

same items so it’s not confusing when you must replace

them.

o Use older brands of products that

your loved one knows and

connects with to try to trigger an

automatic memory.

Grooming includes:

• Shaving

• Washing and styling hair

• Washing the face

• Brushing teeth

• Cleaning dentures

• Putting on makeup

• Putting on deodorant

• Nail care

Tip: Replacing a toothbrush

with an identical one is less

confusing for your loved one.38

Tip: Using a brand that your

loved one remembers may

help them to know how to

use it.

25 45

84



• People with dementia still value their dignity during

personal care. If you must touch or get close to your loved one

to help them do a task, tell them what you are going to do

before you do it.


their comfort more than the task (see page 22 for more



• Make sure that your loved one’s eyeglasses are clean, and

their hearing aids are working well. People with dementia

take part more often when they can use their senses to the best

of their ability.

• Give your loved one a reason to care about grooming:

o Get them ready for another activity.

o Show your loved one off to others and give them compliments.

o Reward your loved one for taking part in grooming.

o Pamper them – visits to the hairdresser or barber keep you from

having to wash their hair as often at home.

85



• Distracting your loved one with singing, soft

background music, or holding a favorite object may be

calming.

Tips to get my loved one ready to groom that I will try first:

____ Make and follow a routine for grooming.

____ Use other daily events or older products to trigger grooming

tasks.

____ Buy a few items for grooming that are the same so they are easy

to replace.

____ Tell my loved one what I am doing or want them to do, one step

at a time.


done and approach my loved one in a friendly way.

____ Check my loved one’s eyeglasses and hearing aids to make sure

they are clean and working.

____ Give my loved one a reason to groom.

____ Distract my loved one by singing or handing them a calming

object.

Tip: People with dementia

often find comfort in holding

dolls and stuffed animals.2

86



How can I set up the environment for grooming?

• Have your loved one do their grooming tasks in the

bathroom or at least in front of a sink. Doing tasks in a

familiar place that your loved one often does them might help

trigger their automatic memory to do the task.

o To keep your loved one from falling, have them groom while

seated. Many people complete grooming tasks while they stand

up, but your loved one may not have good balance.

o If the bathroom is all one color, it may be hard for them to see

the sink. Tape an outline of the sink in a contrasting color (see

page 57).

• Grouping items by task makes them easy to find. Label groups with a

picture of the task.

o For example, put all the items for shaving in 1

container with a picture of a razor on the outside.

o All items inside the container can also have the

same picture of the task on them to help your loved

one organize.

o Using a picture of your loved one performing the

task may help them understand.

Tip: Labeling the items

with pictures may help

your loved one know

how to use them.

87



• Have your supplies out and ready and keep the grooming

area clear of extra items that aren’t needed for the task. If

your loved one sees the items they are going to use, it might

prompt them to do the task.

• Use items that make brushing teeth easier:

o Use fluoride toothpaste to protect teeth. You can buy it at any

store that sells toothpaste, or your dentist can order some that is

stronger.

o Use a child-sized toothbrush; it will be softer and may be easier for

your loved one to handle.

o Use an electric toothbrush if your loved one can hold the

toothbrush but can’t move it well. You may want to change

back to a normal toothbrush in later stages of dementia because

the sound and vibration may bother your loved one.

Look for fluoride on the label at the store.43

Tip: An electric toothbrush can

make it easier for your loved

one to keep brushing their own

teeth.

88



o Use a built-up handle for your loved one’s toothbrush

to make it easier to hold.

o Use interdental picks instead of flossing – it’s

easier and safer.

• Set the bathroom up for your loved one’s comfort and to

support them:

o Make the room pleasant:

▪ Keep the bathroom warm.

▪ Use warm water for all tasks, even for brushing teeth

because older people’s teeth are more sensitive to cold.

o Lessen distractions:

▪ Use a mirror unless your loved one doesn’t recognize

themselves. If they don’t recognize themselves, turn your

loved one away from the mirror or cover it because it will

be confusing.

Tip: Interdental picks are easier for

your loved one to use, even if they

will not open their mouth.42

Tip: You can make built-up handles

out of foam or you can buy a

toothbrush with a bigger handle.39

89



• Set up a pretend “dentist’s chair” and tell your

loved one the dentist asked you to help with

cleaning their teeth.


____ Do grooming tasks in the bathroom or in front of a sink with

my loved one seated.

____ Sort and group items by task and label them with a picture.

____ Have supplies ready and keep the area clear of unneeded items

for the current task.

____ Use items that make brushing teeth easier.


____ Set up a pretend dentist’s chair and tell my loved one the dentist

has asked for my help to clean their teeth.

Tip: Use a recliner as a dentist’s chair to

help your loved one clean their teeth.

90




• Safety issues related to grooming:

o Give physical help with anything electrical.

o Use an electric razor to prevent cuts.

o Dental care:

▪ Look for any sores, loose teeth, or

broken teeth in the mouth or dentures

during dental care. Apply chapstick

after dental care.

▪ Check that your loved one is cleaning their mouth and teeth

well enough.

• Brush teeth, tongue, and gums for 2 minutes at a time.

Do this 1 time in the morning and 1 time at night.

▪ Clean dentures and make sure they are out of your loved one’s

mouth overnight.

• Brush dentures 1 time per day with a denture cleaner.

• Check that dentures are in place after every meal. People

with dementia often throw them away by accident.

o Support wearing makeup if your loved one wants to but try not

to have them use eye makeup to protect from an injury or an

infection.

o People with dementia should not clip their own fingernails or

toenails. Use a nail file to prevent cuts and to keep their nails

short.

Tip: Electric razors are safer

for people with dementia and

let them take part in shaving

for longer.

91



• Break down grooming into steps:


▪ Break it down in as many steps as your loved one needs. The

steps could be general, such as “put your make up on,” or

specific like “brush some powder on your cheeks.”

o Make a poster for a task that shows the steps to follow with

pictures and hang it on their bathroom wall (see the end of this

section for an example poster).

o Lay out items left to right (like reading a book) in the order that

your loved one should use them.

• Prompt your loved one by giving instructions and setting

out items related to grooming to lessen the need for physical

help. People with dementia feel less threatened when they are

taking part in the task and their self-esteem is higher when they

do things for themselves as much as they can. Give them more

help if they show signs that they are getting frustrated.

People with dementia

often have trouble

choosing the right order

to do things. If you set

up the items in the right

order, your loved one

might be able to do the

rest themselves.

92



o Make sure you have plenty of time so you won’t need to rush

your loved one.

▪ They can’t process information or move as fast as they used to,

and rushing might make them upset.

▪ Since your loved one may not think as quickly, it may take

them 1-2 minutes to answer a question or to react to a request.

o Ask your loved one to choose the order they will do the grooming

tasks to keep them involved. For example, it does not matter if they

wash their face or brush their teeth first – let them choose.



• For example, say “brush your hair” while

you pretend to brush your own hair.

• Brushing your own teeth or hair with your

loved one may also be helpful because

people with dementia often copy other

people’s actions.

• Have your loved one say “eeee” and “ah”

when brushing teeth to get them to open

their mouth.

▪ Hand your loved one the items they need in the order they need

them.

Tip: Brushing your teeth together

will let your loved one copy your

actions to complete the task.36

93



• Keep people with dementia involved when they do need

physical help. Even if you help your

loved one, there are ways to make them

feel like they are doing the task:

o Putting your hand under their hand

gives them support if they aren’t

sure what to do, but still lets your

loved one do the task with normal

movements (see page 33 for Hand-

under-Hand™ grip).

▪ Since most items used for

grooming are small, you may

need to put them in your

hand instead of your loved

one’s hand during the task.

▪ Stand on their dominant side to involve the hand your loved one

would normally use for the task; this will improve their ability

to take part. For example, if they are right-handed, stand on

their right side and make sure the object is in their right hand.

▪ Go to https://tinyurl.com/Teepatoothbrushing to watch a video

of this method.

Tip: If you hold the toothbrush in a

Hand-under-Hand™ grip, you can

help to move the toothbrush around

but your loved one will feel like they

are brushing their own teeth.

https://tinyurl.com/Teepatoothbrushing

94






▪ For example, if you start brushing your loved one’s teeth with

your hand over or under their hand, they may naturally take

over and finish brushing.

o If your loved one is in an advanced stage of dementia and needs

you to complete grooming tasks for them, have them hold an

object related to the task to help them to focus on what you are

doing.

▪ For example, have your loved one turn on and hold an

extra electric razor to feel, hear, and see the sensation

while you use another to shave them.

• People with dementia often don’t like some grooming tasks.

o If your loved one resists and there is more than one person

available, try “rescuing”:

▪ For example, have caregivers come in and take over for each

other for different tasks, or even partway through the task if

needed.

o Do not change how your loved one does a task if the result is

good.

95




____ Pay attention to safety issues with my loved one, including:

____ Giving help with anything my loved one uses that is electrical.

____ Using an electric razor.

____ Looking for sores in their mouth and check that dental care is

complete.

____ Keeping them from wearing eye makeup.

____ Keeping their nails short using a nail file.

____ Break down grooming into step-by-step directions.


____ Lay out items in the order in which my loved one should use

them.

____ Choose a time when I won’t need to rush my loved one.



____ Doing the grooming task for myself at the same time.




____ Putting my hand under or over their hand to help.

____ Having them hold a related object while I help them groom.

____ Tag in and out with others during grooming tasks and don’t try

to fix my loved one’s approach if they get a good result.

96





• Has any broken teeth, loose teeth, or sores in their mouths.

• Has bad breath that is unusual for your loved one – this can be

from bleeding or an infection in the mouth.

• Needs their toenails cut and they have diabetes, a nerve

condition, or shows pain or distress when you help them.

o A dentist can help plan for your loved one’s dental care.

▪ Your loved one should see a dentist every six months.


your loved one do grooming tasks.

o A foot doctor (podiatrist) can safely care for your loved one’s

feet.

97



Let’s Brush Your Teeth

1. Open the toothpaste.

2. Hold your toothbrush in one hand.

3. Squeeze toothpaste onto

the toothbrush.

4. Put the toothbrush into your mouth.

5. Brush the left side of your mouth. Make

sure to brush your top and bottom teeth.

6. Brush the right side of your mouth. Make

sure to brush your top and bottom teeth.

7. Brush your front teeth.

8. Brush your tongue.

9. Spit out toothpaste into the sink. 8

98



Getting Your Loved One Involved in Toileting

How can I get a person with dementia ready to use the

bathroom?

• Set up a schedule for using the bathroom. Your loved one

may not realize when they have to go. Following a schedule to

use the bathroom may help keep your loved one from having an

accident.

o If you know there is a certain time your loved one usually needs

to go to the bathroom, remind them a few minutes before so

they get there in time.

o Set an alarm or reminder to help you keep to the schedule. Have

your loved one go to the bathroom:

▪ Every 2 – 3 hours.

▪ Before meals.

▪ Before bed.

o Pay attention to signs that your loved one may have to use the

bathroom such as:

▪ Agitation (being uneasy or nervous)

▪ Restlessness or fidgeting

▪ Touching private areas

▪ Tugging at clothes

▪ Hiding in corners

99



o If your loved one has accidents at night, limit how

much caffeine, alcohol, and water they drink in the

evening.

o Check to make sure they really

went to the bathroom; people with

dementia can often get distracted

and forget to go.

• People with dementia still value their privacy when they use

the bathroom.

o If you must touch your loved one to help, tell your

loved one what you are going to do before you do

it.

o Your loved one will probably not want you to be in

the bathroom with them. If it isn’t safe to let them

use the bathroom alone, give your loved one a

reason that you are staying that isn’t related to

them. For example:

▪ Wash your hands.

▪ Clean the sink or mirror.

▪ Look for a lost earring or contact.

Tip: Sometimes people with

dementia forget to drink or do not

understand that they are thirsty.

Make sure your loved one drinks

enough water to stay healthy. If

they don’t drink enough, they can

get headaches or an infection.34

Tip: When you stay with

your loved one in the

bathroom to keep them

safe, doing a task might

help protect their

dignity.

100




their comfort more than the task (see page 22 for more



• Distract your loved one to keep them seated. People with

dementia may not sit on the toilet long enough to use the

bathroom. You can also use this idea if you have to help clean

them when they are finished. Ways to distract them include:

o Listening to music.

o Singing.

o Giving them a magazine.

• Make sure that your loved one is wearing their eyeglasses

and their hearing aids. If they can see and hear better, they

can follow directions and do more for themselves.

101



• Keep your loved one from being constipated. People with

dementia often have trouble emptying their bowels

(constipation). The following are ways to prevent constipation:

o Exercising.

o Eating a diet high in fiber.

o Drinking plenty of water.

o Keeping good posture.

o Massaging the stomach area.

• Use adult terms for incontinence briefs and

pads. People with dementia often can’t control

when they go to the bathroom (incontinence) and

don’t want to wear “diapers.” Using the words

“panties” or “shorts” may be more agreeable to

your loved one.

Tip: Calling briefs or pads

by the word that your

loved one normally uses for

their undergarments may

be less embarrassing for

them.6

102



Tips to get my loved one ready to use the bathroom that I

will try first:

____ Make and follow a bathroom schedule; use an alarm to help me

stick to it.

____ Remind my loved one to go to the bathroom a few minutes

before they usually need to go and check that they actually go.

____ Pay attention to nonverbal signs that my loved one has to use

the bathroom.

____ Make sure my loved one drinks enough water, but limit caffeine

and alcohol at night.

____ Tell my loved one what I am doing or want them to do, one step

at a time.


done and approach my loved one in a way that makes them feel

safe.

____ Distract my loved one while they are using the bathroom or

when I have to help them clean up.

____ Check that my loved one is wearing their eyeglasses and

hearing aids.

____ Call incontinence briefs and pads by terms that are okay with

my loved one.

103



How can I set up the environment for using the bathroom?

• Improve safety in the bathroom:

o Have grab bars professionally installed so they are

secure and your loved one doesn’t fall getting on

and off the toilet.

o Place a commode over the toilet or use a raised

toilet seat so your loved one doesn’t have to lower

as far to sit down. Armrests can help them to stand

up and sit down and help them to balance while

seated on the toilet.

o Put a commode or urinal by the bed at night

so your loved one does not risk falling on the

way to the bathroom. This may be harder in

the later stages of dementia because they may

not know to use a commode or urinal

as a toilet.

o Keep the path to the toilet clear. If your loved one walks to the

bathroom at night, use motion sensor lights to make sure they can see

the path.

o Make sure your loved one can’t lock themselves in the

bathroom.

Grab bar53

Tip: Using a bedside commode12

or a urinal32 at night may be

safer for your loved one than

walking to the bathroom.

104



• Label the bathroom with arrows, a picture of a toilet, and

the word “toilet.” Keep the door to the bathroom open when

it’s not in use so your loved one can see the toilet.

o Painting the door a color that stands out in

the hallway may also help your loved one to

find the bathroom.

• Take away distractions:

o Keep the bathroom and the area around the

toilet clear of clutter to keep your loved one

focused.

o Cover or take away all containers and plants.

Sometimes people with dementia think a

wastebasket or a plant is a toilet.

Covering or removing them helps your

loved one know where to toilet.

TOILET

Tip: Painting the bathroom

door a bright color will help

your loved one see it.46

Tip: Using a covered trash can

may prevent your loved one

from using it as a toilet.48

Tip: A label on the bathroom

door with a word and a picture

may help your loved one know

where the bathroom is.

105



• Color contrast in the bathroom can lessen

problems from vision changes in people with

dementia and improve their ability to see objects.

If your toilet and floor are the same color, try:

o Painting the toilet seat.

o Installing a padded seat that is a

different color.

o Taping an outline of the toilet with tape that is a

contrasting color with the rest of the room.

• Use items that make toileting easier:

o Wear clothing on the lower body that is loose and

easy to take off and put on to prevent accidents.

Elastic waists are easier than zippers and buttons.

o Use adult pads or briefs to prevent accidents.

o Wet wipes may help to clean your loved one.

Check to make sure you can flush them.

o Make sure any supplies you need are ready and in reach.

Tip: Using a seat that is a

different color will help your

loved one see the toilet.14

Tip: A contrasting color strip on

the toilet seat can help men to

aim more accurately.17

If your loved one has

accidents, there are

many choices of items

that can help.6

106



• Set the bathroom up for your loved one’s comfort and to

support them:

o Make the room pleasant:

▪ Keep the bathroom warm.

▪ Use warm water to wash up after they are done.

▪ Make sure there is enough light.

o Lessen distractions:

▪ Don’t talk too much when your loved one is moving or using

the bathroom. People with dementia have trouble doing more

than one thing at a time.

▪ If they don’t recognize themselves, remove or cover the

mirror because it will be confusing. They might not go to

the bathroom if they think someone else is in the room.

107




____ Install safety equipment in the bathroom.

____ Use a commode or urinal next to the bed.

____ Keep the path to the toilet clear and well lit.

____ Remove any locks on the bathroom door so my loved one can’t

lock themselves inside.

____ Label the bathroom with a picture or paint the bathroom door a

bright color.

____ Keep unrelated items off the toilet and take away or cover any

containers.

____ Change the color of the toilet seat or use contrasting tape.

____ Use items that make using the bathroom easier and gather

supplies ahead of time.


108




• Safety issues related to toileting:

o Make sure your loved one gets clean after toileting. If they

aren’t clean, they can get infections and sores.

▪ If you are helping a woman clean up, make sure to wipe front to

back.

▪ If they are really dirty, consider using soap and water or even

bathing them to clean up.

o Be sure to look for any sores or rashes when helping your loved

one clean.

o Prevent pain by:

▪ Having your loved one start any movements if they can.

▪ Moving them slowly if you have to help.

o To reduce the risk of falling:

▪ Think about having men sit down to urinate (pee).

▪ Make sure your loved one pulls their pants up when they finish.

People with dementia may forget and it might make them fall.

109



• Limit the need for physical help by giving your loved one

prompts. It’s important that your loved one does as much as

they can to use their abilities. This helps keep their dignity.

Give them more help if they show signs that they are getting

frustrated.

o Don’t rush your loved one. Give them enough time to empty

their bladder and bowels.


o Make a poster for using the bathroom that has simple steps to

follow with pictures and hang it on their bathroom wall (see the

end of this section for an example poster). Put the poster in

place of the mirror if they don’t recognize themselves.



• For example, say “wipe your bottom” while you pretend

to wipe yourself.

▪ Turning on the water or giving

them a drink of water may help

them to start urinating

(peeing). Turn on the water

again to prompt them to wash

their hands.

Tip: Turn on the water in the

sink to trigger your loved one to

urinate (pee) or to wash their

hands when they finish.

110



• People with dementia may get to the point that they need

physical help. It’s still important to keep your loved one as

involved as possible. The following are ways to help them take

part when taking off and putting on their clothing and washing

their hands:

o When taking off or putting on

clothes, placing your loved one’s

hands on top of your hands gives

them support if they aren’t sure

what to do, but still lets your

loved one feel like they are

doing the task.




▪ For example, if you start helping them wash their hands, your

loved one may naturally take over and finish washing.

o If they need help to clean your loved one’s bottom, it’s better to

distract them than to try to do it together.

Tip: Placing your loved one’s hands

on top of yours while you are

helping them with their clothes will

help them focus and keep them

involved in the task.

111



• Sometimes people with dementia don’t want to go to the

bathroom or think that they just went.

o Give your loved one a reason to try to go again:

▪ Getting ready to go to a meal.

▪ Getting ready to leave the house.

▪ Getting ready for a visitor.

o Distract your loved one or leave for a few minutes and try asking

them again.

• Be kind if your loved one has an accident. People with dementia

will still feel embarrassed if something goes wrong and they need

your understanding.

o Remember that it isn’t their fault.

o Try not to look angry or embarrassed.

o Be matter of fact and help them keep their dignity.

o Clean them up right away to protect their skin and keep them

comfortable.

• Be ready when you are out in public.

o Know where the bathrooms are so you can get your loved one

there quickly.

o Bring an extra set of clothes for your loved one in case of an

accident.

112




____ Pay attention to safety issues with my loved one, including:

____ Making sure they get clean after using the bathroom.

____ Looking for sores or rashes.

____ Give my loved one plenty of time to finish using the bathroom.

____ Give my loved one step-by-step directions to use the bathroom.




____ Turning on the water.


____ Putting my hand under or over their hand to help.


____ Be ready for helping my loved one use the bathroom when we

go out in public.

113






• Can’t wait long to go to the bathroom, goes more often than is

normal for your loved one, or shows pain or distress when

using the bathroom – this can be signs of an infection.

• Needs a laxative for more than 1 week to be able to defecate

(poop).

• Shows poor balance or needs physical help to get on and off the

toilet.

o A physical therapist or an occupational therapist can help with

balance and moving your loved one safely on and off the toilet

while protecting yourself.


your loved one with toileting.

114



Let’s Go to the Bathroom

1. Pull your pants and underwear down.

2. Sit down on the toilet.

3. Go to the bathroom.

4. Wipe your bottom.

5. Stand up.


7. Flush the toilet.

8. Wash your hands.

10

10

10

10

10

10

115



Community Resources: Where can you get more help?

Which national caregiving resources focus on

dementia?

• Alzheimer’s Association

o Phone: 1-800-272-3900

o Website: www.alz.org/care

o Help offered:

▪ Web pages and seminars online covering many topics such as:

• Stages and behaviors of dementia for caregivers

• Caregiver health

• Caregiver training

• Online courses

Key for Symbols:

Information and training

Services to help you

Support groups or counseling

116



• Alzheimer’s Foundation of America

o Phone: 1-866-232-8484

o Website: http://www.alzfdn.org/caregiving-resources

o Help offered:

▪ Licensed social workers ready to help by phone, live

chat, or email

▪ Links to information and online seminars

▪ Support and counseling

• Caring.com

o Phone: 1-800-973-1540

o Website: www.caring.com/caregivers/dementia-caregiving

o Help offered:

▪ Web pages covering many topics such as:

• Sundowning

• Unwanted behaviors

• Getting your loved one to take part in activities

• Finding respite (a service or person that gives you

a break from caregiving) or residential (live-in)

care

• Today’s Caregiver

o Website: https://caregiver.com/articles/alzheimers

o Help offered:

▪ Articles about topics related to Alzheimer’s disease

▪ Weekly newsletter about general caregiving

http://www.alzfdn.org/caregiving-resources

https://caregiver.com/articles/alzheimers

117



National resources focused on dementia I want to look at:

____ Alzheimer’s Association

____ Alzheimer’s Foundation of America

____ Caring.com

____ Today’s Caregiver

Notes:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

118



What national resources focus on caregiving in

general?

• American Association of Retired Persons (AARP)

o Phone: 1-888-687-2277 or 1-877-342-2277 (Spanish)

o Website: http://www.aarp.org/caregiving

o Help offered:

▪ Web pages covering many topics such as:

• Special issues for dementia

• Finance and legal issues

• Types of care:

o Home

o Adult daycare

o Residential (live-in)

• Caregiver tools

▪ Support groups and online communities

• Area Agency on Aging

o Phone: 1-800-677-1116

o Website: eldercare.acl.gov

o Call the phone number or go on the website to find your

local Area Agency on Aging to see what services they have

available.

o My local Area Agency on Aging’s phone number:

_________________________________________

http://www.aarp.org/caregiving

119



• Caregiver Action Network

o Phone: 1-855-227-3640

o Website: www.caregiveraction.org

o Help offered:

▪ Tips, tools, and articles for caregivers

▪ Online forums and communities

▪ Videos on special issues for dementia

• Family Caregiver Alliance

o Phone: 1-800-445-8106

o Website: www.caregiver.org/caregiver-learning-center

o Help offered:

▪ Articles, online seminars, and videos on topics such as:

• Health problems

• Caregiver tips and strategies

• Mmlearn.org

o Phone: 1-888-414-3822

o Website: http://www.mmlearn.org

o Help offered:

▪ Many videos covering several topics such as:

• Dementia

• Alzheimer’s disease

• Brushing teeth

• General caregiving issues

• National Caregivers’ Library

o Website: www.caregiverslibrary.org

o Tools and research for caregivers to use.

http://www.mmlearn.org/

120



• Next Step in Care

o Website: www.nextstepincare.org/Caregiver_Home

o Tools and guides to manage different parts of medical

care:

▪ Doctor visits

▪ Hospital stays

▪ Rehabilitation

▪ Home care

• VA Caregiver Support

o Phone: 1-855-260-3274

o Website: caregiver.va.gov

o If you are caring for a veteran, you might be able to use

this resource.

o Many programs are offered such as:

▪ Caregiver training

▪ Caregiver support

▪ Mentors

▪ Respite care (a service or person that gives you a break

from caregiving)

• 211.org

o Phone: 211

o Website: 211.org

o Links people to national, state, and local health and

human services programs.

121



General national caregiver resources I want to look at:

____ AARP

____ Area Agency on Aging

____ Caregiver Action Network

____ Family Caregiver Alliance

____ Mmlearn.org

____ National Caregivers Library

____ Next Step in Care

____ VA Caregiver Support

____ 211.org

Notes:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

122



What local resources might help?

(San Antonio, Texas area)

• Area Agencies on Aging

o Caregivers’ Services Program: Alamo Caregiver Empowerment

▪ Phone: 210-477-3275 or 1-866-231-4922

▪ Website: acewings.org

▪ Links to:

• Alamo Service Connection

• National resources

• Caregiver classes

• Caregivers’ Coalition (community partners that offer

services for caregivers)

o Email: [email protected]

o Alamo Service Connection

▪ Phone: 210-477-3275 or 1-866-231-4922

▪ Website: bexar.tx.networkofcare.org

▪ Connects to services offered by government agencies and

nonprofit organizations.

• Alzheimer’s Association San Antonio & South Texas

o Phone: 1-800-272-3900

o Website: alz.org/sanantonio

o Help offered:

▪ Help to find things you need

▪ Online communities

▪ Support groups

123



• Caregiver SOS

o Phone: 1-866-390-6491

o Website:

https://www.wellmedcharitablefoundation.org/caregiver-

support/caregiver-stress-busters/

o Email: [email protected]

o Help offered:

▪ Caregiver coaching

▪ Stress-busting class for caregivers:

• Training and information

• Problem-solving

• Support

• Managing stress

• The Glenn Biggs Institute for Alzheimer’s &

Neurodegenerative Diseases (University of Texas San

Antonio Health)

o Phone: 210-450-9960

o Website: biggsinstitute.org/resources

o Help offered:

▪ Medical care for your loved one

▪ Support groups

▪ Presentations of the latest research on dementia

• Take Time Texas

o Website: taketimetexas.org

o A part of Health and Human Services that helps you find

respite care. Respite care is a service or person that comes in to

give you a break from caregiving.

https://www.wellmedcharitablefoundation.org/caregiver-support/caregiver-stress-busters/

https://www.wellmedcharitablefoundation.org/caregiver-support/caregiver-stress-busters/

124



• The University of Texas at San Antonio (UTSA) Health

Caring for the Caregiver

o Phone: 210-567-7000

o Website: utcaregivers.org/resources

o Help offered:

▪ Essentials of Caregiving classes (focused on people

with dementia)

▪ Caregiver skills training workshops (general caregiving)

▪ Memory cafes (let people with dementia get together and talk)

▪ Grace notes community choir (for people with dementia and

their families)

• 211 Texas

o Phone: 2-1-1 or 877-541-7905

o Website: 211Texas.org

o Connect to state and local health and human services

and programs.

Local caregiver resources I want to look at:

____ Area Agencies on Aging

____ Alzheimer’s Association San Antonio & South Texas

____ Caregiver SOS

____ The Glenn Biggs Institute for Alzheimer’s &

Neurodegenerative Diseases

____ Take Time Texas

____ UTSA Health Caring for the Caregiver

____ 211 Texas

125



Notes:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

126



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