BED BATH

  When you take on the care of another person, you will be faced with many jobs, some easier than others.  It isn’t easy to reverse the role of mother or father and child, but that is what happens when you are caregiving.  You take on the role of the mother and care for your mother as if she were a child again.  One of the jobs you will be faced with is giving your loved one a bath.

     Chances are when a loved one can no longer bathe, you will have to step in and bathe them.  There are a few things you will want to remember to do before you start a bed bath.

     Warm the room.  Someone who is confined to bed needs more warmth than you or I.  Use a space heater or turn up the thermostat.  It’s a good idea to warm a blanket in the dryer to place over the patient before you begin.  Place another blanket in the dryer to have nice and warm for when you are finished.

     Lay out all the needed supplies: a basin filled with hot water, wash cloth, mild soap, talcum powder, and of course, clean clothes for the patient.  Be sure the water is hot, as it will cool quickly during the bath.  You may have to add hot water as it cools.  Be sure to change the water if it becomes too soapy.

     Now for the bath.  Help the patient remove their clothing.  Place a warm cotton blanket under the patient and over the pillow, removing any unneeded pillows.  Place towels or a blanket under the patient to catch any moisture as you bathe them.  Place the warm blanket over the patient to keep them comfortable.  You will be moving this blanket to expose the area that you are bathing.  Using a blanket not only keeps the patient warm, but also preserves their dignity.  You will also need a couple of towels for drying the skin as you proceed.  Make sure the towels are soft so that you don’t damage the skin.

     Start with the face.  Wash, rinse and dry the face, moving from the nose out to the hairline, making an S motion around the mouth.  Wash, rinse, and dry the neck and ears with attention to all the folds of skin.  Be sure the soap is rinsed off thoroughly, because it has a drying effect on the skin.

     Now move gently down to the torso.  Pull the blanket down to the waist and cover the chest with a towel.  Soap, rinse and dry the patients chest and the sides of the chest under the towel, using long, firm but gentle strokes.  Be sure to wash under the breasts.  As you cleanse each portion of the body, observe the condition of the skin for any problem areas.  Cover it quickly with the warm blanket.  Move the towel to expose the shoulder and one arm, bathe that portion of the body, then cover it quickly, going on to the other side.  Take the basin of water and carefully place the patient’s hand in the warm water and wash it.  Dry the hand and be sure to get between the fingers.  When you are finished with the torso, carefully roll the patient on their side to wash the back.  Gently dry the back with a towel before returning the patient to their back.

     Then fold the towel up, exposing the lower part of the body, and begin washing the legs and the feet.  Bend the patient’s leg and place the foot in the basin of water.  Take particular care of the toes and between the toes.  Dry them carefully, rubbing gently to remove any dead skin.  Talk to the patient while you are bathing them, to keep them comfortable.  Finish by washing the private parts (they may want to wash themselves).  It is important to keep the genitals clean to prevent soreness or infection, especially if your patient is a man and he hasn’t been circumcised.  It is important to pull the foreskin back to wash the penis completely, getting into all the folds and pulling the foreskin back into place when you are finished.

     If your patient is bedridden, sprinkle baby powder on their body and smooth it on the back with a gentle massage.  It will help to eliminate friction that could lead to bedsores, and the gentle massage will help them relax.  

     If you see pressure points where the skin is becoming red, give these areas special care.  The circulation in these areas needs stimulation.  Massage gently around the red spots, kneading with the heel of the hand or the tips of the fingers to stimulate circulation.  Rub around rather than on the reddened areas to lessen the danger of causing breaks in the skin.  If left untreated, they could lead to painful bedsores.  One caregiver told me to apply Maalox to bedsores.  She said it worked beautifully.

     

     

LIFTING

     While I was taking care of Wayne in the apartment, I had to transfer him from the bed to the wheelchair often.  This was a real chore, especially when he couldn’t stand or walk at all.  The physical therapists gave me instructions that helped me to save my back.

      When a patient can’t walk or even stand, it is up to the caregiver to assist the patient so that they don’t slip or fall.  It is important to observe certain conditions when lifting a patient, to keep from injuring your back.  The proper manner to transfer a patient is using the legs, not the back.

     A belt is used by physical therapists, a strong woven belt about three inches wide, that fastens with Velcro.  This belt is used to stabilize a patient being transferred from one place to another.

     You place the belt around the patient’s waist and fasten it snugly.  Place your feet around the patient’s feet to keep them from slipping and keep their feet controlled.  Place your hands on each side of the patient, grabbing the belt from the bottom.  If the patient can help, he should place his hands on your hips or around your wait.  This gives the patient a secure feeling and he can help lift.  Now, you are ready to transfer the patient from one place to another.  Place the chair to the side of the patient, so that you can pivot him to the chair.

     To protect your back, bend your legs in a semi-squat position and lift straight up, pivot the patient toward the chair and place him in the chair.

     If the patient can assist you a little, have the patient grab the arm of the chair to assist in the transfer.  There is a transfer board available through the hospital that makes it easier to slide the patient from bed to chair or chair to car.  It works very well.  You must have a wheelchair with a removable arm rest for this to work.  You remove the armrest, place the board on the wheelchair and on the car seat, then slide the patient from the chair to the car seat.  It makes it easy for you and the patient.  I used this method with Wayne for quite awhile.

     When Wayne was with me in the apartment, he used to stiffen up when I tried to transfer him from the bed to the chair, making it very difficult to get the job done.  There were times when he slipped off the chair and slid to the floor.  I used this method of lifting to get him from the floor to the chair.  We are talking about dead weight, when the patient can’t help you.  I would scoot him over to the chair and then grab the belt and lift with my legs, until I got his butt on the edge of the chair.  I then pushed with my knees to help him slide to the back of the chair.  It was difficult, but it worked and I didn’t hurt my back.  It isn’t easy to lift 145 pounds of weight from the floor, but it can be done.

     If the patient is lying on the floor in the fetal position, another option is placing a straight chair on its side under the patient’s butt, as though he were sitting on it.  Then you roll him and the chair over, so that the patient is on the chair.  Then lift the patient and the chair to a sitting position, watching that the patient doesn’t fall off the chair.  Be sure to use your legs with this method too.  It helps if you have assistance for this procedure.  This is the way the emergency medical team got Wayne off the bathroom floor when he collapsed.

     These are ways to help you help yourself when lifting your patient.  Always take care of your back.

     

PREPARING THE PATIENT'S BED

PREPARING THE PATIENT’S BED

     Save yourself a lot of trouble and make accidents easier to clean by preparing the bed with a rubber sheet or a piece of plastic and a draw sheet.

     A draw sheet is a sheet folded in half and placed over the normal sheet to pad the area under the patient’s posterior.  When an accident occurs it can be cleaned up easily by removing only the draw sheet and the plastic.  

     I have learned that when you are dealing with the unknown be sure to prepare yourself for the worst.  At first this wisdom meant be prepared for a mess.

     It is also important to learn how to change a bed while the patient is in it.  There will be times when you will not be able to put the patient in a chair while changing the bed.

     First, turn the patient on her side.  Help her flex her knees for ease of turning.  If the patient can’t turn alone, grasp the draw sheet across the patient and pull it toward you as you pull the sheet.  The patient should have both legs bent for ease of staying on their side.  Now, loosen the soiled linen and roll in toward the patient.  Put the clean sheets on that side of the bed and roll the new sheets under the patient along with the old ones.  Next, roll the patient over the bundled sheets and onto the clean ones and smooth the new ones in place on the other side, as you take away the soiled ones.  Keep the patient with knees flexed for comfort.  Add the plastic pad and draw sheet in the same manner, pulling the draw sheet tight as you tuck it under the mattress.  Now add the top sheet, blanket and spread and you are finished.  If the blanket bothers the patient’s feet when they are on their back, simply make a pleat in the top sheet and the blanket, to give them more room for their feet.

     This method of changing a bed is simple and doesn’t require moving the patient from the bed.  If your patient can get up, have them sit and relax while you change the bed.

     You should change the bedclothes twice a week, if the patient spends most of their time in bed.  It will keep them more comfortable and lessen the chance of bedsores or pressure points.

     

MORE ON PATIENT'S ROOM

     If a commode is used, an extension that raises the seat to a more comfortable height should be used if necessary.  The normal toilet seat is a little low when an elderly person tries to sit down and could give them a feeling of falling before they reach the seat.  Placing a grab bar next to the toilet is also a good idea, it gives the patient a sense of stability.

     If the patient can take a shower alone, a grab bar should be placed on the wall to steady the patient when bathing, and another grab bar can be attached to the edge of the tub to help them enter and leave the tub.  Be sure to place a rubber mat on the floor of the shower to prevent slipping, a bath mat with rubber backing on the bathroom floor for when they step out of the shower.

     There are also stools that have an extra seat that extends outside the tub, so the patient can slide into the tub without a problem, if they are unsteady.  There is a slit for the shower curtain, so the water stays in the tub.

     If the patient has a hobby, now is the time to pursue it, especially if it can be done in bed.  Many hobbies can be done in a sitting position, with a bed table across the lap.  Crossword puzzles are a pleasant way to pass time, as well as knitting, crocheting, and embroidery or needle point, if that is their choice.  Keep a variety of hobby items close to the patient, so they can reach them.

     Also put some thought into choosing the most appropriate bed for your guest.  If you can’t use their own bed, there are hospital beds available for rent, normally through home-care facilities at the hospital.  Some home-care items are paid for by Medicare.  Be sure to check with the hospital social worker to find out exactly what you can acquire through Medicare.  There is no sense buying or renting items that are available through their insurance plan.  The cost of caring for a loved one at home is high enough without the added burden of buying items that are covered by insurance.  Check everything.  You will be surprised by how many home healthcare items are covered by Medicare.  We received a hospital bed, commode, walker and oxygen, with Medicare picking up the majority of the cost.  Mother’s supplemental insurance paid for most of the difference.

     It is also important to have a well lit room.  If there are windows, be sure the curtains are open.  There is no substitute for sunshine to keep a cheery atmosphere in a sickroom.

     Green plants, placed where they can be seen not only are cheerful but help clean the air.  They keep the room fresh and bring a little of the outdoors inside.

     Some people enjoy television, but don’t forget music.  A radio or stereo system can soothe the patient and perk up their spirits.  If you cannot find their favorite music on the radio use CD’s to fill the room with music.  Music sometimes evokes beautiful memories, bringing back the past with warm feelings.

PATIENT’S ROOM CHECKLIST

•   On the main floor
•   Bathroom close by
•   Their own bed used if possible
•   Guard rails if needed
•   TV remote, telephone, books, tissues and wastebasket close to the patient
•   Fresh water, glass, and straw always next to patient
•   Patient surrounded with their personal belongings
•   Had rails, toilet extension, and stool for the shower
•   Their favorite chair

FOR THE CAREGIVER

     Try to get the help of your loved one in arranging their room.  After all, they want everything where they can reach it or at least find it.

THE PATIENTS ROOM

In setting up the patient’s room, be sure the room you use for home health care is located on the ground floor, near a bathroom.  This saves the patient from having to negotiate stairs,  It is safer and it conserves the patient’s energy.  It also saves the caregiver frequent trips up and down the stairs.

     Use their own bed if you can.  Sometimes a small thing like sleeping in their bed can give them comfort.  If there is a possibility the patient could fall out of bed, be sure to attach guard rails to the bed.  They are available through your local medical supply company or the hospital.

     Give the patient all the independence they can handle.  Place the TV remote, telephone, books, tissues and wastebasket close to the patient.  A bedside caddy that can be attached to the side of the bed is handy.

     As your patient begins to regain strength, put the TV and their favorite chair across the room, to encourage them to move around.  Don’t make life too easy for them.

     There are a few necessities for all sickrooms. Most important of all, surround them with their own personal item---objects and keepsakes that hold special meaning.  Favorite pictures should be strategically placed where they can see them, especially if they are confined to bed.  There is nothing like familiar objects to make your loved one feel more secure.

     A favorite picture album can be a useful item, especially if the patient is beginning to forget things.  Label all the pictures with names and dates.  Use a small album so that the patient can hold it easily, then look at the album with them, pointing out familiar faces and asking who they are.  Keep their mind busy.  Good brain exercise.

     If they walk with an aid, they will want their walker or wheelchair nearby in case they need it.  There should be a comfortable chair in their room, with a table next to it, for rest and reflection.  A favorite chair from their home or a rocking chair is nice, especially if you can place it near a window.

     A pitcher of water should always be within reach, along with a plastic glass and straw, unless the patient is not to have liquids.  If the bathroom is very far away and the patient is weak, a portable commode or bedpan should be kept close to the bed for easy use.  There are two types of bedpans, one that is the normal depth and another that is called a fracture pan.  The pan is cut low for those patients who can’t lift themselves. If a commode is used it can be covered with a throw or afghan to disguise it.

     

IT'S RAINING AGAIN AND THE DOGS HAVE TO GO OUT

I’ve never seen such rain as the winter I was in Portland with Wayne.  Nineteen ninety-six was one year that Portland was plagued with flooding and mud slides.  What a mess.  By the time I went home, I had webs between my toes.  When spring came, the rain continued but the beautiful flowers began to bloom and the city became lovely, with flowers everywhere.  Maybe it was worth all the rain to see such beauty.  I missed the tulips that were springing up in my front yard in Hermiston.  I was eager to get home to our house, where we could get things back to normal again.  At least I hoped it would be normal again.

     It’s a good thing I carry two umbrellas around in the car.  We don’t need umbrellas in the Eastern side of the state.  Eastern Oregon doesn’t get much rain, we have mostly sunshine year round.  As I looked out at the rain, I realized how lucky we were to be in a nice apartment and together.  I was alone for so long that even all the problems seemed better than being alone.

     I lost myself in my writing, and for a change of pace, I would bake cookies and give them to all the neighbors and the hospital staff.  I love to make cookies and it helped to calm me when things got really bad.  The smell of the cookies baking seemed to help Wayne too.  He would remark on how good it smelled.

     We did have a problem with the dogs during the rainy times---they didn’t want to go out in the rain to do their business.  You should have see Mother in her slippers and robe, holding an umbrella over the dog, while she got wet, just so he would do his business.  It was a funny sight, but she would do anything for her little poodle.

     You should have seen me trying to hold an umbrella over Wayne while pushing the wheelchair up the hill to the hospital.  I tried to have him hold it but he would drop it every time.  So, we both just got wet.  I will say one good thing about all that moisture, though.  My skin stayed dewy fresh all the while we were in Portland.  It was so smooth and soft, it was almost worth the rain.

     Our dog Maynard died while we were in Portland.  One morning he woke up but he couldn’t stand; his back had given out on him.  He was a miniature dachshund, and that breed seems to have problems with their backs as they get older.  It happened to our other dog last year, as well.  It was a sad day when I had to have him put down.  I cried all the way home from the vet.  I missed him so much!

     Pets are wonderful companions to the elderly.  They give their owners unconditional love, and caring for a pet gives the older person a reason to stay well.  The simple act of petting a cat or dog can actually lower a patient’s blood pressure.  Sounds crazy, but it works.

     If your patient is agitated, give him the dog or cat and let him stroke the animal---you will see a marked difference immediately.  Researchers have given animals to mentally challenged patients and observed the calming affect that the love of an animal brings to the patient.  A patient rocking or banging on the table will suddenly become quiet when handed an animal to love.  Amazing!  Very good therapy.

     There are volunteer groups that bring animals to nursing homes so the residents can spend time with their favorite animal, since they are unable to keep one on the premises.  The residents really look forward to the visits.  You can see the big smiles that appear when they know it is visiting day for the animals.  The anticipation perks them up, their energy level rises and they are far happier.  When you place a kitten or puppy in the lap of the elderly person, they cuddle the animal like a baby and the animal responds with lots of licking and cuddling.  After the animals have gone, the patients glow with love for days and look forward to the next visit.

     Older people take better care of themselves when they have a pet to care for.  They know that their dog or cat depends on them for everything.  Studies have shown that pet owners live longer and are happier people with someone to love.  I know that my mother was much happier with her little dog to care for.

         THOUGHT FOR THE DAY

Happiness is something that comes from within.  It is 

our choice to be sad or happy each day.

Happy is always better