Personal Care

What is Personal Care?

Personal care relates to personal activities of daily living, which includes personal hygiene and toileting, dressing or undressing and maintaining personal appearances. In health and social care, the term is used in relation to the amount of supervision or support a person requires to complete these tasks safely and satisfactorily. When a person starts to face challenges in maintaining their own personal care, support is crucial to prevent infection and illnesses so that the person can maintain good physical health. However, support is equally important to enable a person to maintain their quality of life, mental well-being and to retain some of their independence. Provision of care by family, friends or professional carers must always be delivered with dignity, compassion and respect. It should be a supportive and enabling and it should be tailored to the needs of the individual reflecting their personal preferences

How might dementia impact a person’s ability to manage personal care?

The specific symptoms experienced by a person with dementia will depend on which disease they are diagnosed with and which area of the brain has been damaged. A diagnosis of any form of dementia is unique to that person and everyone will have a different experience. Other factors such as additional illnesses, and the environment can affect how a person may respond to their symptoms. Regardless of how dementia might affect a person, personal care can often be a source of anxiety for both the person living with dementia and the carers. As the persons dementia progresses it is likely that they will start to need some supervision or support with their personal daily living tasks.

The brain can be described as the bodies control centre, responsible for all vital functions. It manages both unconscious functions such as heartrate, breathing, temperature regulation and digestion as well as conscious motor functions such as balance, movement and speech. The brain is also responsible for cognitive function, for storing memories and assisting in skill or knowledge acquisition through its information-processing ability. This ability to process and store information is due to a complex network of nerve fibres through which different chemical neurotransmitters pass. Cognitive function is the utilisation and processing of thoughts, emotions, behaviour and sensory signals which enable us to complete daily activities and engage in our world. However, dementia causes atrophy in some parts of the brain, which means cognitive function may be impaired. Dependent on the type of dementia and area of atrophy, some of the nerves may be blocked, interrupting signals or there may be either a reduction or an increase in some chemicals affecting how information is processed. Any impairment in cognition can affect our independence, ability to complete functional activities and affect our quality of life.

How can we support a person with dementia to manage personal care?

Personal care can be anxiety inducing for both the person and the carer, the key to supporting with personal care is to enable to the person to maintain independence as much as possible. Care should always be person-centred, reflecting personal routines and be given with dignity and respect.

As mentioned, care is very personal and what works for one person may not work for another or what works today may not work tomorrow. Below are some general tips to support with the practicalities that should be considered if you are supporting a person living with dementia with their personal care.

TOP TIPS

Tip 1: Routines can really help

• Incorporate the usual time and location for washing and dressing - keep it familiar.

• Follow the usual sequence if you can e.g., teeth first then face etc just like the past.

• Keep to the preferred style of washing as much as possible ie. shower vs bath, and/or integrate a strip wash.

• Replicate clothing choices.

Tip 2: Encouragement

• Use phrases like “it’s time to have a wash” or “the bathroom is ready for you” rather than asking as this gives the opportunity to decline.

• Be flexible and if you are greeted with a “No” then try again later. Use the opportunity if they are going to use the toilet to prompt for a wash at the same time. Alternatively, maybe try before going out, before a meal or if visitors are coming over then say “Let’s get washed before…”

• Keep requests really simple and easy to understand.

• Allow time to process and to complete each step of the tasks.

• Take a break if things aren’t going so well and try to complete later if that’s possible.

• If the person requires more support than you are able to give, consider domiciliary home care once a day to complete personal care routines. Sometimes people respond better to someone in a uniform helping with things that they have always kept private.

Tip 3: Washing

• Use familiar items. For example: don’t offer liquid soap if they have always used a bar of soap; or don’t introduce an electric toothbrush if they don’t usually use one.

• Introduce coloured flannels and towels that are different to the bathroom suite for easier identification and make them personal to them.

• Make sure the bathroom is ready before starting. Keep it uncluttered, warm, well-lit and well stocked with towels to maintain privacy and importantly dignity.

• Empower them to be independent with their own flannel to use, even if they need you to wash them.

• Wash hair over the sink with hose or use a jug if a shower or bath is too difficult.

• Make sure the person gets properly dry especially in skin crease folds to avoid rashes, sores.

Tip 4: Showering

A shower can cause anxiety or discomfort as some people are very sensitive to the feeling of water hitting the skin. You could try a shower seat and either let your loved one use a handheld shower or a sponge rather than have the shower water directed at the skin.

Tip 5: Toileting

• Put a sign with both the symbol and written word on the toilet door so it is easy to find.

• Sight can often be an issue with dementia so consider a different colour toilet seat to make it more visible.

• Introduce coloured toilet paper so there’s contrast with your walls or paint a coloured square or a coloured tile behind the toilet roll holder as contrast.

• Wipes can be a great alterative and help with cleanliness. Bright containers to hold them can help sustain independence as they will be easier to find.

• If getting to the toilet in time is a challenge, consider a commode in the living space – they can be very discreet!

• If getting up from the toilet is difficult, consider installing a handrail or a raised toilet seat (a community Occupational Therapist should be able to assess for this)

• Introducing night lights or sensor activated lights can be such a help for a person to locate toilet at night.

• Don’t let worry of incontinence hold you back from doing things – disposable pads/underwear can create a safety net if there’s not much time to react. Easy pull up clothing is also helpful in these situations.

• If incontinence becomes an ongoing issue affecting quality of life, then speak to your GP for a referral to an incontinence nurse who can look at your personal situation and offer support.

Tip 6: Dressing

• Take dirty clothes or night wear away after undressing to encourage fresh clothing the next time.

• Lay out clothes for the day ahead, or better still offer 2 options so the person is still enabled to make their own choice.

• Offer step-by-step dressing prompts or hand items to the person one at a time.

• Minimise items in the persons wardrobe and keep the rest in another room.

• Introducing loose fitting clothes, elastic waistbands, no buttons, or easy to pull zips can really help, as well as slip on shoes with Velcro fastening rather than laces.

• Encourage hair, shaving, nails, make up as part of the routine. It makes us all feel better about ourselves!

Key priorities

• Keep the person safe, maintain dignity & privacy

• Prioritise basic hygiene to prevent infection

• Pay attention to oral dental care

Further support & Take-away Tasks

• With the correct support, future planning and an understanding of dementia it is possible to live well. A diagnosis is the start of a new & different journey but not the end.

• Family and friends can all access support from Sage House to improve their understanding of dementia and enabling you to have a better quality of life.

• Whilst finding out about the different types of dementia is likely the start of your journey, it is important to remember that you’re not alone.

There are lots of strategies and tips to support with different aspects of dementia and they can be found in some of our other information sheets.

Contact Sage House and book an appointment with a Wayfinder to discuss any concerns you might have around dementia.

DISCLAIMER: This information sheet has been produced by Dementia Support as general advice. It should not be relied on as a basis for any decision or action and cannot be used as a substitute for medical advice. Dementia Support and Sage House do not accept any liability arising drom its use and it is the readers sole responsibility to ensure any information is up to date and accurate.

Published October 2023 – Peer reviewed by carers, people living with dementia and expert reviewers