Helping your loved one feel as clean, fresh and presentable as they would want
Why is it important to help your loved one feel clean, fresh and presentable?
We’re talking about keeping your loved one feeling as fresh, clean and presentable as they’d like to be. You know far more about them than the Hospice Team and you bring key skills of love and compassion. There are no rules or procedures here. There will always be an experienced volunteer to help and to give advice.
If your loved one has always been active up until this point, then you may not have been involved with their hygiene routines before. Now you’ll be doing things that your loved one would ordinarily do for themselves. Undertaking these things from the perspective of doing them ‘with’ and ‘for’ your loved one, not ‘to’ them, and doing them in a loving way, will help minimise embarrassment for both.
Pressure sores, sometimes called ‘bed sores’, are a worry when someone is in bed for a long time. They are caused by sustained contact between the body and the bed. You will need to check for these sores and speak to the Hospice Team if you find anything you’re not sure about. Your loved one has reached the final weeks or days of their life, caring for them becomes mainly about comforting them. We also want to help them keep their dignity and a sense of who they are.
How to help your loved one feel clean, fresh and presentable
There are eight things to prepare:
1. Get the support you need; volunteers are always around.
2. Check the room is warm enough; you can open or close the window and adjust the central heating.
3. Make sure the bathroom tap is running hot; you’re likely to need a supply of warm water.
Top tip – roll up your sleeve and dip your elbow in the water – it gives a better idea of whether the water is hot enough but not scalding – better than your hand!
4. If you use the shower, test the shower water to make sure it's hot enough but not scalding.
5. Locate the bins for general and dirty waste.
6. Protect your loved one’s privacy by changing the door sign to ‘Engaged’.
7. Remind yourself that, at this stage, washing is really about your loved one feeling comfortable and dignified, not about ensuring they emerge spotless.
8. Gather what you need to help your loved one feel as clean, fresh and presentable as they’d want.
There’s no special equipment. Cottage Hospice can provide everything or the Family Caregiver can bring it in. We suggest using:
- Bowl of warm water
- A packet of Wet Wipes
- A face cloth or sponge (we find a face cloth easier for the whole body)
- Your loved one’s favourite soap and shampoo (or an easy-to-buy dry shampoo such as Batiste)
- Moisturising cream (perfumed or not)
- Nail clippers or a nail file
- An electric razor or shaving kit
- A favourite comb or brush
- If they use deodorants, bring in their favourite
- Soft towels
- Bags for general and dirty waste.
Also, in case of a leak through your loved one’s pad:
- Clean incontinence pads
- Gloves and an apron for you.
So, you start at the top and work down. First ask yourself if your loved one’s hair is as they’d like it to look? Often a comb or a brush is enough to freshen the hair. If you feel more is needed, then you can wash gently with a bowl of warm water and shampoo. It can be tricky to wash the hair of somebody whilst they are in bed and some people find it easier to use dry shampoo, such as Batiste, which can be found in most chemists.
To the chest. We won’t do the whole body in one go. It could be cold, uncomfortable and undignified. Some Family Caregivers prefer to slide their hand and the cloth under the sheet to preserve modesty. Others are comfortable pulling back the bedsheets, a section at a time. Keep in mind what feels right for you, and for your loved one.
At this stage of their illness, people’s skin colour changes - as does its feel; it’s often cold to the touch and sometimes clammy too. The skin can also become very fragile, so wiping must be gentle. There is no need to wipe the whole chest, just where there are folds in their skin, particularly the underarms and, for women, under the breasts.
Important: Your loved one’s skin may be very fragile: make sure to wipe gently.
You could use soap and water. If you do:
- check that the water’s reasonably warm (elbow test again) – nothing’s worse than a cold wash
- wet and lather the soap
- gently put the soapy lather onto the areas that you’re washing with your hand
- still gently, wipe the soap off with the moist face cloth
- rinse the cloth in the bowl, having a second bowl of clean warm water to hand.
You may prefer wet wipes instead of soap and water if you’re only washing one or two areas like the underarms. Put the wet wipes into a general waste bag, and pat dry their skin very gently with a towel, as you would after using soap and water. No vigorous scrubbing is necessary.
If you can see any dry skin which might be uncomfortable or anything which might become a sore, for example, deep cracks or red patches, it may help to gently apply some moisturising cream
What about finger nails?
They’ll be growing very slowly now, but if they are longer than your loved one would like or rough meaning that they catch on the bedsheets, then you can gently trim nails or file them to smooth out any rough bits.
There are more notes of guidance and a video about moving your loved one which includes explanation of how to turn your loved one over to check for pressure sores, for example.
As you move down the body, use the bedsheets to cover the areas that you have already washed and dried. Then pull back the bedsheets to uncover the lower body. Again, some family caregivers prefer to slide a hand and cloth under the sheet for modesty.
Glance over the lower body, looking for any particularly dry, cracked or red areas. As with the upper body you don’t need to wash everything, just any folds – behind the knees say - and the feet. You might decide to use wet wipes instead of soap and water and just moisturising cream on the feet. Check toenails and trim if necessary.
If the incontinence pad has become soiled, it will need to be changed and possibly the bedding too. Gently wash and dry the genital area and turn your loved one to wash their bottom. Have a look at the information on ‘Moving your oved one in safety and comfort’ and ‘Helping your loved one meet their toilet needs’ and talk to a volunteer for any guidance.
Your loved one may be using incontinence pads instead of being catheterised. If there is a catheter, you just need wash with soap and water where the tube goes into the body. For a man, the catheter is fitted via their penis, so you need to pull back their foreskin, if not circumcised and gently wash there.
Teeth and the mouth are kept clean by regularly performing ‘mouthcare’: click here for guidance and a video to help you if you do need to do this. Meanwhile, you can keep your loved one’s mouth fresh by giving them sips to drink or crushed ice to suck.
A quick checklist…
- Hair combed or brushed and arranged as they like it
- If they normally use deodorant, you could apply that for them
- If there any lingering odours in the room, you could use an air freshener your loved one likes, that isn’t overpowering
- If it isn’t too cold, you could open the window for a bit of fresh air.
When and how often to help your loved one feel clean, fresh and presentable
Most people will keep themselves clean and fresh once a day and there’s no need for that to change at this stage. Try and stick to a routine that would feel familiar to your loved one.
If your loved one is using incontinence pads, then you will want to discreetly check every couple of hours to ensure that they are clean and fresh.
It helps to relax your loved one if you are relaxed yourself. Talking while you work may help and be a reassurance for both of you.