In my job as an occupational therapy assistant, one of the most daunting tasks I complete with my patients is bathing. This is because a high number of falls occurs in the bathroom while transferring in and out of the shower or tub.
In most cases, this will be one of the last tasks I will train patients and their caregivers on before discharging them. Before a patient is ready for this step, however, I teach family members how to bathe their loved one safely in their bed.
This may sound like a strange concept, but with some guidance, it is a realistic goal for you as a caregiver and a very important self-care task to master.
Pro Tip: In addition to bed baths, I’ve compiled some helpful caregiving guides. Learn more about these techniques by reading my senior caregiving guide.
What Is a Bed Bath?
A bed bath is just that: a bath you give to a person while they are in bed. Typically, bed baths are sponge baths, using a basin and washcloth. There are several reasons a person may require a bed bath instead of a traditional bath or shower.
One reason is if the person is non-weight bearing, meaning they are unable to put weight on one or both legs, often due to surgery or injury. Another reason to give a bed bath is for safety. If the person cannot safely transfer into a shower or even onto a tub bench, it would be wise to give bed baths until they are more suited for a regular shower to avoid falling.
Oftentimes, a person is simply too weak to get out of bed, possibly due to general age-related debility, or neurological or autoimmune conditions like multiple sclerosis, Graves’ disease, or Guillain-Barré syndrome.
The Importance of Bathing
Proper hygiene should be important to all of us; however, when it comes to seniors, it is even more vital. As we age, we become more susceptible to illness due to weakened immune system responses. Because of this, poor personal hygiene can have a more serious effect on older adults.
It can lead to skin infections, rashes, flare-ups of eczema or psoriasis, bacterial and fungal growth in skin folds or between toes, and even parasites on skin and in hair. Some of this can be transferred to others, and it has the potential to lead to more serious health conditions, such as sepsis (blood poisoning) or abscesses.
When preparing to give a bed bath, you’ll want to be sure you have the following:
Towels will be used to dry, cover the body for privacy, and act as a barrier for bedding during the bed bath, so I normally grab at least three.
Try to have one washcloth for the face/neck, one for the body, and one for the perineal area.
Always use sensitive skin-friendly soap due to the fragility of more mature skin.
Basin for water
One basin is fine, but when the water becomes visibly dirty or too soapy, you must replace it with fresh water.
If your loved one has a latex allergy, vinyl gloves are widely available.
How to Give a Bed Bath: Step by Step
To ensure a bed bath that is both safe and effective, you should adhere to the following steps:
Wash your hands, don gloves, and explain the procedure to your loved one, speaking slowly and clearly so they know what to expect.
Make sure doors are closed and shades are drawn to provide privacy for your loved one. If they are in a hospital bed, adjust it to waist level for your comfort.
Place a towel (or small blanket, if desired) over your loved one’s body for privacy and assist them as needed in undressing beneath it. Fill the basin with warm water and have them test the temperature with their wrist.
Uncover one body part at a time, and place a towel under the body part being washed. Wash, rinse, and dry one body part at a time. We do this to ensure privacy/dignity, as well as to prevent your loved one from getting cold.
Wash your loved one in this order:
Eyes/face/ears/neck: Wash face with warm water only, using a clean part of the washcloth for each eye, and wash from the middle outward.
Arms/hands/chest/abdomen: Remove one arm at a time from under the towel and place a dry towel underneath. Wash with a warm soapy washcloth using long strokes from top to bottom; rinse and dry. Wash the chest then the abdomen in a similar fashion.
Legs/feet: Remove each leg one at a time from under the towel and place the towel underneath. Wash with a warm soapy washcloth using long strokes from top to bottom; rinse and dry. Be sure to rinse and especially dry thoroughly between toes.
Back: Gently assist your loved one in rolling onto their side, place a towel lengthwise next to the back. Wash the back of the neck, back, and buttocks with long downward strokes. Rinse and dry.
Perineal and genital area: Assist your loved one in rolling onto their back once more. Place a towel under the buttocks and thighs. Always change basin water before washing this area. For females, use very little soap to prevent a UTI. Using a clean part of the new washcloth each time, work front to back using single strokes. Rinse and then pat dry.
After the bath is complete, consider applying a fragrance and dye-free lotion to prevent skin dryness, which can lead to minute skin tears and infection. Take this time to also clean under and clip fingernails, if needed, and inspect toenails. Thickening toenails are a byproduct of aging and are not always safe to manage alone. Consider calling a mobile podiatrist or making a regular podiatry appointment to clip and clean as needed.
When Possible, Encourage Participation
Encourage your loved one to participate in washing, if they are able. This will not only help with maintaining range of motion, flexibility, and functional stamina, but it will also give an element of control to the task. The above is a thorough, step-by-step guide for an entire bed bath provided by you, the caregiver, in cases where your loved one is unable to participate.
Always follow the above instructions, but you can urge your loved one to do as much of the washing as possible, with you as their guide. They may sit at the edge of the bed (if safe to do so) for steps 1 and 2 if desired.
Common Issues With Bed Baths
In my practice, giving bed baths as an OT was not always a therapeutic use of time, so CNAs often completed this task. Because of this, it took me a few years to get the procedure down pat. As you can imagine, I had my share of slip-ups.
Here are a few common issues I’ve encountered and how to address them:
Getting the bed wet: This was a big problem for me before I understood the right way to administer bed baths. I often would end up making much more work for myself because I’d always have to change the bedding afterward and transfer the patient in and out of bed to do so. Using towels placed under each body part as instructed above, as well as wringing out the washcloth, will usually prevent this issue.
Loved one getting cold: To prevent this, you should wash, rinse, and dry one body part at a time, placing it back under the privacy towel. Additionally, change the water as often as needed to make sure the water doesn’t get too cold. If you know your loved one gets cold easily, consider using a warmer blanket as opposed to a towel for privacy.
Avoidance of bathing: It’s very common for older adults to refuse bathing altogether. There are a few explanations for this, including a loss of vision, dulled sense of smell, and memory loss. Gentle reminders or creating a bath schedule can help. Alternatively, loss of function and control over their lives can lead to depression, which in turn can lead to loss of interest in personal hygiene. If you suspect your loved one is depressed, you should contact their primary care physician.
Helping your loved one maintain proper personal hygiene is a vital part of your role as a caregiver, and a bed bath is a safe way to do so. Don’t expect to be an expert immediately; there is always going to be a learning curve, even for us professionals!
It took me a while to learn how to keep everything running smoothly, and I am sure that with a little time and practice, you will become confident and competent in this important aspect of caregiving.
Also, be sure to check out my additional caregiving resources to learn about all things related to caring for your loved one at home:
Explain the process so your loved one knows what to expect, have them test the water for safety, and cover them with a towel or blanket for privacy. Additionally, you should wash, rinse, and dry one body part at a time.
Expect to bathe your loved one at minimum two to three times per week. This will be sufficient to prevent skin breakdown and infections, while avoiding risks that come with over-bathing, such as dry, cracked skin. Bed baths will be the optimal method for those who are bedridden due to the risks involved with transferring them.
While bathing an elderly person in a traditional shower or shower-tub combo may be possible for those who are physically able, a bed bath is a good alternative.
A former member of the Navy, Jenny Atwell has spent six years as an occupational therapy assistant, working in rehab hospitals, skilled nursing facilities, and, most recently, as a home health care specialist. Her primary focus is on geriatric care in a variety of settings.