When you transition from family member to caregiver, you’re not only coordinating medical care, you often assist with personal hygiene and Activities of Daily Living (ADLs). You want your loved one on hospice to be free from pain, but also to feel dignity and respect.

Your family member on hospice may gradually move from independence to needing assistance with daily care, such as bathing, shaving, and dressing. It can be frustrating and embarrassing for hospice patients to ask for help, but if you see them struggle, remember to: 1) Ask their permission to step in and help them and 2) Reassure them that you love them and that your assistance helps them reserve energy for other more meaningful activities.

If you’re not sure how to properly care for your loved one, especially if they have limited mobility, cognitive decline or are nonverbal, ask your hospice team to train you. Nurse’s aides can help with tasks such as bathing. Your hospice company can also help coordinate safety equipment for bathing, toileting, mobility (like walkers) and sleeping.

Below, read some basic guidelines as you care for your loved one’s physical needs. For detailed hygiene caregiver tips, download Heart to Heart Hospice’s free Patient and Family Handbook. 

Bathing

A patient’s fresh hair and clean body are good morale boosters. If possible, bathing outside of the bed is a good opportunity for your hospice patient to move around, circulate blood flow, and check their skin. Make sure this time is not rushed and is part of a regular schedule. For a safe bath or shower, remember:

  • Have a shower seat, non-skid mat, or grab bar for stability. 
  • Gather all items in a caddy or easy-to-access spot.
  • Stay in the bathroom for safety or to help with washing.
  • If they tire easily, save washing their hair for another day.
  • Daily wash their face, hands, and private areas morning and evening.
  • Wash their hair as often as requested, or at least twice a week. Towel dry or blow dry, comb, and style.

Bed Baths

Even if a patient is immobile and doesn’t work up a sweat, bed baths help remove dead skin and excess oils and improve circulation. Allow the patient to do as many steps as independently as they can.

  • Gather all supplies so you’re not prolonging the process – three towels, three to four washcloths, two basins filled with warm water, mild soap or wipes, no-tears shampoo, body lotion, a waterproof pad to keep the bed dry, gloves, diaper (if needed), and clean clothes.
  • Make sure the room temperature is comfortable. Shut the door for privacy.
  • Begin with the face and work your way down.
  • Only uncover the part of the body being washed. Wash with one soapy cloth, rinse with a different cloth, and pat dry with a towel. Use a fresh cloth for private areas.
  • Roll them over to clean their back, using rails as stability or another person to assist. Pat dry thoroughly.
  • Check for bed sores or other signs of infection or injury.
  • Remember skin is often fragile, especially for the elderly. Massage lotion or oil into skin to moisturize, preferably unscented. Touch can also be therapeutic and comforting for someone who’s bedbound.
  • Change the bedsheets if they get wet. Dress them in fresh clothes and incontinence products (if needed).
  • For hair washing in bed, read our detailed instructions in the handbook.

Oral Care

  • Let your loved one brush their teeth independently as long as possible. Keep items easily accessible in the bathroom or bedside.
  • Brush teeth at least every morning and evening and preferably after meals.
  • If you need to assist bed-bound patients, wear gloves and use a foam roller and floss stick. Make sure they are upright in bed. Use only a pea-sized amount of a mild toothpaste and swipe teeth, gums, and tongue as gently as possible. Rinse thoroughly.
  • Look for evidence of cavities, disease, or damage to dentures or partials. Clean dentures well when removed.
  • Use lip balm to prevent chapped lips.

Other Tips (Consult with your hospice Case Manager first.)

  • Schedule hair cuts, even if a stylist comes to your home, and occasional special treatments like manicures or pedicures.
  • Shave with an electric razor.
  • Make sure fingernails and toenails are clean and trimmed. 
  • Getting dressed daily helps mark a new day and separates morning from evening. Ensure clothing is comfortable, not a trip hazard, and expresses their personal style. Allow independence in this area as long as possible. Hand one item of clothing at a time if they are self-dressing.
  • Talk to your hospice nurse about any changes to their appearance (skin, nails, teeth, hair, circulation) so they can be aware of any potential issues.
  • For a patient who is unresponsive, ask your nurse to show you how to provide proper hygiene care. It’s important to maintain dignity, and there’s evidence that patients can still hear even if they can’t respond.
  • Patients who spend most of their time in bed are prone to painful bed sores, which can cause torn skin and lead to infections. Some tips to avoid bed sores: 
    • Make sure you help them change positions at least every two hours.
    • Massage pressure points like shoulders, hips, knees, and tailbone.
    • Check for broken skin or scabs. Keep the area clean and covered if necessary. Show those spots to your hospice nurse.
  • Loss of bladder and bowel control can be embarrassing. Never let your loved one feel ashamed and help maintain dignity as you assist them. Read more detailed instructions in the handbook.
    • Help them go to and from the bathroom as long as possible. When mobility is an issue, you can use bedpans, a bedside commode, and/or adult incontinence products.
    • Schedule bathroom trips often and make sure the pathway is free of trip hazards. 
    • Don’t delay when they express the need to go.
    • Make sure their private areas are clean and dry. 
    • Maintain proper hygiene for yourself as you assist, like using gloves and thorough handwashing.

Finally, as a caregiver, it’s important and necessary to rely on your hospice team for help. If it’s easier for an aide to bathe your loved one and it’s ok with them, use that time to relax, stretch, or take a long shower yourself. Ask for training if a new area of hygiene comes under your responsibility. 

The difference at Heart to Heart Hospice is our patient-centered approach that provides comfort, support, and dignity for patients and caregivers. If you live in Indiana, Michigan, or Texas, discover if a Heart to Heart team serves your area.