Safety for Dementia Patients while Toileting
Yes. We have to talk about this.
Navigating Dignity and Safety: A Guide to Assisting Dementia Patients with Toileting Needs
Caring for a loved one with dementia presents unique challenges and assisting them with toileting can be one of the most delicate tasks. Maintaining dignity and safety for both the patient and the caregiver is very important in these situations. I’m sure that even the most loving caregiver did not grow up hoping to have a job cleaning another person’s bottom. Nor did the patient grow up hoping to have someone else cleaning his or her bottom. You must always remember that the patient is still a sentient being and is entitled to as much dignity as possible.
Dementia affects cognitive abilities, including memory, judgment, and communication skills, making tasks like toileting increasingly difficult. Patients may forget the purpose of the bathroom, have trouble with clothing fasteners, or struggle to communicate their needs effectively. I have read that they also may not realize they are defecating or urinating. Establishing a schedule for using the toilet can help with this situation.
As a caregiver, it's crucial to approach toileting assistance with patience and empathy.
Safety Features for the Bathroom
Creating a safe environment in the bathroom is essential to prevent accidents and ensure the patient's well-being. If possible, consider adding these safety features to the bathroom used most frequently by the patient.
Grab Bars: Install sturdy grab bars near the toilet and in the shower to provide support and stability for the patient.
Raised Toilet Seat: A raised toilet seat reduces the distance the patient needs to lower themselves, making it easier to sit and stand.
Non-Slip Mats: Place non-slip mats on the floor to prevent falls, especially in areas that could be wet.
Night Lights: Install night lights to illuminate the path to the bathroom, reducing the risk of tripping or falling in the dark.
Accessible Storage: Keep essential toiletries and supplies within easy reach, avoiding the need for the patient to stretch or bend over. This is also helpful for the caregiver if the patient needs to be supported in place.
Minimizing Embarrassment
Both the patient and the caregiver may experience embarrassment or discomfort during toileting assistance. These suggestions may help both of you.
Maintain Privacy: Let the patient know you respect their privacy. Close doors or draw curtains to provide privacy during toileting. Stand back or wait outside the door if the patient prefers.
Empathetic Communication: Speak calmly and respectfully, using simple and clear instructions. Avoid using baby talk or condescending language. Acknowledge the patient's feelings and concerns with empathy. Validate their emotions and reassure them that their feelings are understood and respected.
Respectful Instructions: Provide clear and simple instructions using respectful language. Use terms the patient is familiar with and avoid using slang or medical jargon that may confuse or intimidate them.
Listen Actively: Encourage the patient to express their preferences and concerns. Listen attentively and respond with compassion and understanding.
Offer Choices: Provide options whenever possible, such as which clothing to wear or whether to use the toilet or bedside commode. Dementia patients are very aware of their lack of control in their life. Giving them choices helps restores some sense of control.
Normalize Assistance: Remind the patient that everyone needs help with certain tasks from time to time, emphasizing that your assistance is given out of love and care.
Maintain a Positive Attitude: Approach toileting assistance with a positive attitude and a sense of humor when appropriate. A lighthearted approach can help diffuse tension and reduce embarrassment.
Timing Choices: Establish a routine for toileting assistance to maintain consistency and predictability. When feasible, accommodate the patient's preferred timing for toileting, respecting their body's natural rhythms and routines. This allows the patient to anticipate and prepare for the process, reducing anxiety and discomfort.
Cleaning and Hygiene
Maintaining proper hygiene is essential for the patient's health and well-being. It will never be easy, but here are some ideas that may help you provide cleaning and hygiene management:
Gentle Assistance: Offer gentle assistance with wiping and cleaning, being mindful of the patient's comfort and dignity. Use soft, disposable wipes or dampened toilet tissue for sensitive skin. Disposable wipes usually are not flushable. Dispose of them in a plastic bag in the regular garbage. You don’t want to add a stopped-up toilet to your day.
Hand Hygiene: Practice proper hand hygiene before and after helping the patient with toileting. Use soap and water or alcohol-based hand sanitizer to reduce the risk of infection.
Incontinence Products: Consider using incontinence products such as disposable briefs or pads to manage accidents and minimize cleanup. Ensure these products fit comfortably and are changed regularly to prevent skin irritation.
Odor Control: Use air fresheners or odor-neutralizing sprays to maintain a fresh and pleasant environment in the bathroom. Empty and clean the waste receptacle regularly to prevent unpleasant odors.
Professional Assistance: If toileting assistance becomes overwhelming or challenging to manage, don't hesitate to seek help from professional caregivers or healthcare providers. They can offer guidance, support, and additional resources to ensure the patient's needs are met effectively.
Normalize Assistance
Normalize the need for assistance by emphasizing that it is a natural part of caregiving. Here's how to promote a sense of normalcy:
Universal Experience: Remind the patient that needing help with toileting is a common experience shared by many people, regardless of age or health status.
Compassionate Explanation: Explain to the patient that your assistance is provided out of love and care, aiming to ensure their comfort and well-being.
Reassurance of Support: Offer reassurance that you are there to help whenever needed, emphasizing the strength and resilience shown by the patient in accepting assistance gracefully.
Maintain a Positive Attitude
Approach toileting assistance with a positive demeanor and a sense of humor when appropriate.
Here's how to maintain a positive attitude during caregiving:
Light-hearted Approach: Incorporate humor and light-heartedness into the caregiving process, when appropriate, to ease tension and promote a sense of ease. You are the only one who can determine if the patient’s personality will respond positively to a humorous approach to this part of caregiving.
Don’t force it. And don’t be juvenile.
Focus on Achievements: Celebrate small victories and achievements during toileting assistance, reinforcing positive experiences and boosting the patient's morale. I read this somewhere (I can’t remember where) and I’m still trying to imagine it in action. Personally I think comments like “Good job” might insult the patient, but I won’t be in the bathroom with you, so you are on your own.
Self-Care for Caregivers: Prioritize self-care and emotional well-being as a caregiver to maintain a positive outlook and effectively support the patient's needs. You are the rock your patient will cling to; you have to be able to give your all today, and then get up an give it your all tomorrow. Ask for help. Demand assistance from family and friends if they don’t automatically help you. Please don’t believe you can do it all by yourself; you can’t.
Conclusion
Minimizing embarrassment during toileting assistance involves creating a supportive and respectful environment that prioritizes the patient's dignity and comfort. By maintaining privacy, using gentle and respectful language, offering empowering choices, normalizing assistance, and maintaining a positive attitude, caregivers can ensure a dignified and compassionate toileting experience for dementia patients. It's essential to tailor these strategies to the individual needs and preferences of the patient, fostering a sense of autonomy and empowerment throughout the caregiving journey.