When getting to the shower or tub isn't possible, a bed bath is the only option.
When to do a bed bath
If the person you're caring for is sedentary or on bed rest, the best approach to bathing may be a bed bath. It sounds simple enough -- you basically wipe her clean with a wet cloth. But in reality, giving a good bed bath is a bit tricky.
Giving a bed bath requires you to wash the person's front, sides, and back, not to mention crevasses and folds -- while she's lying down. Depending on her condition, merely touching or moving her body may cause discomfort. If she weighs a lot, it can be strenuous for you. Not to mention the challenge of keeping the mattress dry.
Don't worry! People have been giving bed baths for centuries: They're a standard of hospital and home healthcare. All this practice has produced practical techniques that make giving a bed bath much easier.
Beginning the bed bath
Before you begin a bed bath, make sure you have a huge pile of clean, dry bath towels and clean, dry washcloths, at least a dozen of each. Also, there should be a table or shelf within easy reach to hold a water container and supplies. A wheeled cart -- such as a basic TV or kitchen cart -- is ideal. Finally, adjust the room temperature so it's toasty warm.
Lay thick bath towels under the person from head to toe. These are to absorb water, protecting the bedding and mattress. You might want to also use a waterproof sheet under the cloth sheet to ensure that the mattress stays dry.
Undress her but keep her under a blanket or large towel. This covering stays on during the whole bath for both warmth and privacy.
Fill two large bowls with warm water, one for washing and one for rinsing. Put the bowls within easy reach.
Stand at her shoulder. You'll be washing down one side of her body, section by section, lifting the cover away only as much as necessary. It helps to tilt her up on the side a little, facing away from you, so you can reach underneath her body. Start with her shoulder, then her arm and hand, including the fingers. Move to the side of her torso and hips, then wash her thigh, lower leg, foot, and toes.
The washing itself is straightforward: Soap then rinse, using a different washcloth for each. Rinse sufficiently to get all the soap off. (Soap residue is drying to the skin, and elderly skin is prone to dryness.) Refill the water bowls as needed. Make sure the temperature of the water stays warm to the touch. When washing, stroke in the direction of the heart , toward the torso, to help blood circulation.
After a section is rinsed, pat it dry with a towel and lay the cover down as quickly as you can for warmth.
After you've finished one side of the body, start at the other shoulder and work down. Afterward, move to the head and neck. This is a great time to shampoo, which is easiest with a soft plastic bed bath shampoo bowl, sold at hospital or medical supply stores. The shampoo bowl can be placed right on the mattress, and all you need to do is lift or edge your family member's head into it. (Don't leave her unattended for even a few seconds when a bowl of water is near her head.) If you don't have a shampoo bowl, lay dry towels under her head and do the best you can with your bowls of water, soaping and rinsing. Consider using baby shampoo, which rinses out easily.
Save the privates for last. Do these quickly, lifting the cover only as much as necessary to soap and rinse. With a man, you'll need to wash under his testicles. With a woman, wash the labia; there's no need for a deep cleaning. To reach the rear, tilt the person's body to the side as much as you need to or can. Or you can bend her knees and reach under from the front.
When you're done, the person's entire body should remain covered with the blanket or towel. If it's damp, exchange it for a dry one. You may need to add another layer. Slowly pull the wet towels from under her body.
Take a deep breath and relax before dressing her. Giving a bed bath is a bona fide workout, and you've earned a break.
Alternative bed bath techniques: through-the-towel, the chair bath, and more
In addition to the standard bed bath described above, there are variations on the theme. You may very well discover your own useful adaptations as you gain experience.
One alternative method of giving a bed bath is to wash and rinse through a towel, never touching the person's skin. Using a washcloth, you soap and rinse through the layer of towel, which acts as a sort of second skin. This is one way around modesty concerns, which can be extremely uncomfortable for you and her.
This technique for giving a bed bath minimizes the need to rub or stroke. Instead, you pat or gently massage the wet towel t hat covers a section of her body. When you're done with that section, take off the wet towel and quickly replace it with a dry one or a blanket to avoid a post-bathing chill.
Another twist on giving a bed bath: Keep several washcloths in large plastic zip-close bags of warm water, one clean and the other soapy, and take them out as needed. This eliminates the need to rinse washcloths in bowls of water. As soon as a washcloth gets dirty, stop using it and get a clean one from the bag. Check the bags regularly to make sure the water remains warm.
Then there's the chair bath. If the person you're caring for feels comfortable sitting up in a chair, this may be the best position for bathing. The routine is pretty much the same as for a bed bath.
Of course, you'll need to protect the chair from water. Vinyl-covered chairs can work, or you can get creative with plastic garbage bags or a tarp.
Tips for giving a bed bath to overweight or sensitive people
If the person you're bathing is resistant to a bath or particularly sensitive to water, try using no-rinse soaps and shampoos. You rub them in and towel them off -- the dirt comes off in the toweling. No-rinse bathing products can be a huge help, but they do leave a residue, so you'll need to rinse with water every now and then.
Giving a good bed bath requires a lot of movement on your part -- lifting, holding, and tilting the person's body. If she's overweight or heavy, a bath may be a two-person job. The same is true if she's easily irritated or feels pain when touched.
"You may need other people to help, like a relative or home health aide," says Jennifer Serafin, a registered nurse and geriatric nurse practitioner at the Jewish Home for the Aged in San Francisco.
You can hire a home heath worker to assist you, enlist relatives or friends, or try a combination of the two. Hiring a professional for a one-time crash course on giving a bed bath could also be extremely helpful.
You won't need to give a full-body bed bath daily. Ask the medical team, but in most cases a full bath once or twice a week should be sufficient.
It's recommended that you clean the private areas and under any skin folds daily. You'll need to wash under the testicles, breasts, armpits, and tummy rolls, which are more of an issue with overweight people.
Once-a-day washing can be done efficiently with a wipe or damp washcloth. If the person in your care uses the toilet, take this opportunity for a quick cleaning.