Success Story: Improving bathing experiences for a client with dementia

Today we are fortunate enough to be able to share a success story from a recent client that we worked with. As we are bound by strict confidentiality guidelines, we only ever share details when the client and/or their loved one have given us express permission to do so.

Zoe recently received a referral to support Glenys (not her real name), a lady with Alzheimer’s disease in her early 80s who is living with her adult daughter and her family in North Wales. Glenys has a wonderfully supportive family who were very keen to provide the best care that they could for her, in particular her daughter is really passionate about doing everything she can to make sure her mum has the best life possible. As a behaviour analyst, we know that a support system like this can make the world of difference! 

Glenys was referred due to difficulties accepting help during the bathing routine. Glenys would protest, refuse and become increasingly hostile towards her daughter when she suggested having a bath. If her daughter tried to support her with bathing, her mum would call her insulting names and accuse her of being a bully or treating her like a child. These are really common behaviours that we often see displayed by people with dementia, and they can be very difficult to support. One of the toughest aspects of this case was that Zoe could not directly observe the behaviour happening because of the sensitive nature of the situation (i.e., naked in the bathroom) which would have affected Glenys’s behaviour further and make things worse. 

To overcome this, Glenys’s daughter collected ABC data for a number of days for Zoe to analyse. ABC data is a useful tool that we can use to begin to look for patterns in behaviour-environment interactions that can give us an idea of what factors may be influencing or controlling the behaviour. From there, we can start to determine what need the person has and what their behaviour is trying to communicate to us. Once we know that, we can design a function-based intervention plan. We know from the research that function-based interventions are much more likely to be successful than interventions not based on function. 

Over the following few weeks, Glenys’s daughter and Zoe communicated regularly and they tried out a number of changes to better support Glenys during the bathing routine. One of the first things that Zoe suggested was simply increasing the heating using a small heater in the bathroom. This was very successful and Glenys was much more willing to start the bathing routine. This is such an easy change to make but made a big impact for Glenys- sometimes the simplest things can be the most effective!

The next recommendations were all about empowering Glenys with choice and control. Glenys was a passionate and proudly independent woman with a wonderful sense of humour. It was really vital that this was taken into account when designing a behaviour support plan for her. One of the aspects that Zoe noted in the ABC data and from discussions with Glenys and her daughter was that Glenys needed to feel in control. She needed to know that she had choices in her care, and that she was still seen as herself. Being helped when you are at your most vulnerable (for example, naked in the bath) can conflict with those feelings, and it was hypothesised that the cause of her behaviour was to try and get away from feeling vulnerable.  

Amongst other methods that she was already successfully using, Glenys’s daughter began implementing techniques to offer Glenys more choice and control during the bathing routine. She stopped offering help (which could cause Glenys to react angrily) and instead waited for Glenys to ask for help. She avoided telling her what to do and instead worked to integrate care into what they were doing by making hints or asking for Glenys’s opinion. She also made sure to ask Glenys to decide what to do rather than asking yes or no questions. All of these techniques avoided Glenys being put in the position of feeling like she was being “cared for” and instead placed her as the authority who was in control over herself. 

Although there wasn’t an overnight change, the bathing routine began to improve for Glenys and her daughter and recently Zoe spoke to them and discovered that the last four bath times had been problem free! 

The aspects that made this behaviour plan successful were:

• Glenys’s family were well and truly on board and willing to change what they do to try and improve Glenys’s experience. 
• Glenys’s daughter was happy to collect data for Zoe to analyse and did so comprehensively.
• The family were realistic about their expectations. They knew we were unlikely to get to the point where Glenys would just take a bath when directly asked, but they appreciated that changes in the way they presented the bathing routine could lead to a more peaceful bathing experience for all. 
• The behaviour plan kept Glenys’s unique identity in mind when developing the intervention, honouring what mattered to her and her values. It made sure to preserve her dignity and was completely unique to her individual needs and context. 

We feel incredibly fortunate to have been able to work with Glenys and her family and thank them for their openness to changing what they do and also their consent to share this story with you. 

If you feel that you, or someone you know, could benefit from this type of individual support please don't hesitate to get in touch with us!