Jun 28, 2013

You Have to be Actively Involved in Everything You Do

Never underestimate the power of positive reinforcement in your caregiving efforts for a person living with dementia.

Never underestimate the power of positive reinforcement

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By Bob DeMarco
Alzheimer's Reading Room

Almost every single day my mother will resist when it comes time to take a shower. When she occasionally says something other than NO, I look to the heavens as if it is a reward.

My answer to the question about how do I get my mother to bathe is rather difficult to describe. I'll do my best. If you have questions, put them in the comments box and you will likely bring more information out of my head. It will likely improve this article.

Step one, constant positive reinforcement about the positive effects of being clean.

I usually take my shower in the morning. But, I wait until my mother is up and around so she can see me.

Immediately after my shower, I come out with my hair wet and I start saying I am all clean, this feels great. I get Dotty to touch my nice smooth shaven face. While she is touching it, I say nice, nice and smooth. Sometimes she says, smooth as a baby's ass. I laugh, she laughs.

I reinforce how great it feels to be nice and clean. It feels good when you are nice and clean -- doesn't it?

This is how I start to set the stage for what is coming later in the day -- Dotty's shower.

I make a big deal about the shower. I am tying to establish a pattern. Establishing patterns is one of the only ways I know that works well to establish consistent behavior with someone living with Alzheimer's disease. 

I am convinced that trying to do the same thing, at the same time, every day is very helpful in Alzheimer's caregiving.

I try and make sure my mom is in some bright light before and during the period directly before her shower. It helps if it is sunny outside. Then we have bright light inside. Bright like effects my mother's overall behavior. Of this I am certain. Bright light, bright mom.

My mother usually gets her shower around 3 - 4 in the afternoon. I gave up trying to do it in the morning. Why? Because it was easier for me to establish the "morning pattern" and then slot the shower into the late afternoon.

Right before shower time, I start talking to my mother. About the weather, or what is going on in the world, or whatever could be on our mind at the time. Communication and dialog. I don't sneak up on her and tell her she needs a shower, or has to take a shower.

No matter what, when I say time to take a shower mom almost always says the same thing. NO. Of course there are variations on this theme. I don't need a shower. I already took a shower.

I already took a shower. This one is pretty funny since mom is still in her pajamas. I learned a long time ago, trying to explain to mom that she could not have taken a shower because she is still in her pajamas is a  mistake. All it does is lead to confusion, consternation, and those famous words, kiss my butt Bobby.

Instead of saying you are still in your pajamas, I usually envision something like me solving the world hunger crisis. I have a better chance of solving the world hunger crisis than I do of convincing my mother she did not shower and she is still in her pajamas.

Here is one simple way to get someone living with Alzheimer's to take a shower (in my opinion). I learned this as a freshman in college in Psychology 101. Let's call this Pavlov's dog and the shower.

I start out like this. Mom its time to take a shower. Sometimes I sit down and pat her hand after she says no, and discuss the merits of being clean. How wonderful it is going to feel, how great she is going to look.

Then I fire in the zinger. Okay mom lets do this. After you take your shower you will get a nice snack. I usually say potato chips because they are her favorites.

Positive reinforcement before the shower, BIG positive enforcement after the shower. For many of you, ice cream or chocolate should do the trick.

When I get mom up for the shower, I hold her hand and walk her toward the bathroom. We get her watch off. The only time mom takes that watch off is when she goes in the shower. She wears her watch to bed and won't allow me to take it off. She has other watches. One looks like a bracelet, so sometimes she has a watch on each wrist.

When I was dumb, I use to try and get her to take one watch off. Then I got smart and learned how to laugh. If mom wants to wear 4 watches fine by me, and if it will help with the shower she can wear 6.

I think you might be surprised to learn this. I take off mom's robe. She still has her pajamas on. I turn on the shower. I put her bra and panties on the sink. I put her towel on the sink. I hand her her wash cloth. I tell her to make sure she gets all the stinky parts. Then I close the bathroom door, but I leave a crack so I can peak in.

We have a glass shower. It might take 10 minutes before mom gets in. She gets in. I check to see how she is doing. It varies. Most of the time, good enough. She does gets the stinky parts. She is not good at getting her legs and feet. I take care of that. (As you might expect, as my mother's Alzheimer's progressed I had to become more actively involved in the shower and washing her).

Twp points here.

One, mom gets the positive reinforcement after every shower. Two, I am involved with mom all the way. I don't say you need a shower and then wait for her to go take the shower. I assist her right up to the door of the shower.

You have to be actively involved with a person suffering from Alzheimer's in everything they do.

All of the above was extracted from the article

Alzheimer's World and the Power of Positive Reinforcement

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