10. Module 9 · Personal hygiene & nutrition in dementia

10.2. Application: planning care that works with the person

Application

Planning care that works with the person

This page shows how to plan one personal care routine for one person and gives phrases to adapt. Your organisation’s hygiene and care procedures apply in every case. The steps below are about attitude and approach, not about clinical technique.

Worked example: Mr Kowalski and the morning wash

Six steps for dementia-sensitive personal careSix steps for personal care (example: Mr Kowalski)1PrepareWarm room, towels,time, who is there2Greet and askName, eye contact,what you will do3One stepSay it, show it,wait for a sign4Stay with cuesCover, warmth,let them help5Stop or pauseIf distress grows,try later or differently6Note and shareWhat worked,at handoverThe example is fictitious. The steps are a sequence to adapt, not a protocol.
Figure 9.3: Six steps for dementia-sensitive personal care, using a fictitious example. Source: own illustration.

Return to Mr Kowalski from the beginning of this module. His team asks his daughter about his routine. She says that her father was a night-shift mechanic for years, never rose before nine, washed at the sink and always had black coffee first. The team follows the six steps in Figure 9.3.

  1. Prepare. The bathroom is warmed, a towel is laid out and the carer chosen is the one he knows best. The time moves to 9.30 a.m.
  2. Greet and ask. “Good morning, Mr Kowalski. Here is your coffee. After that I would like to help you with a wash at the sink, as you like it.”
  3. One step at a time. The carer hands him the flannel, says “face first”, and waits. He washes his face. Then she says “now your hands”.
  4. Stay with cues. When he pulls his shirt closed, she puts a towel around his shoulders and turns away a little. He relaxes.
  5. Stop or pause. On the second day he becomes tense during the lower body wash. The carer stops, says “That is enough for now”, helps him dress, and returns for that part after lunch.
  6. Note and share. She records: “9.30 a.m., coffee, sink, flannel, towel; calm. Lower body washed later.” At handover the team keeps the plan.

Notice that nothing here is unusual. The change is mainly one of timing, order, speed and tone. The carer also checked that he had no pain and that his skin was intact, as she would for any person. If the problem had remained, the team would have reported it and asked for advice.

Phrases to adapt
SituationYou might say
Announcing“Mr Kowalski, I am going to help you with your shirt now.”
Person pushes your hand away“I will stop. Let us take a breath. I will try again in a little while.”
Offering a choice“Would you like the blue shirt or the grey one?”
Meal refused“Would you like to try something small? Here is your favourite.”
Informing the team“He refuses at 7 a.m. but accepts at 9 a.m. Could we move the wash?”
Exercise (voluntary self-check). Mrs Yilmaz (fictitious), 82, used to cook for a large family. At meals she now sits for a few minutes, pushes the plate away, stands up and walks off. She has lost weight. Her plate holds soup, potatoes, meat and vegetables on white china. She coughs sometimes while drinking. List three possible reasons for her behaviour, three changes to try, and one sign that you must report to the nurse in charge.
Hint 1
Use the five groups of causes in the text: perception, attention, movement, the body and the setting. Look at Figure 9.2 for the plate.
Hint 2
Think about her life: she used to cook, and she walks away. What could she do at the table? Remember that coughing while drinking is a sign for the nurse or doctor.
Suggested answer
Reasons: pale food on a white plate is hard to see, a full plate is confusing, she cannot stay seated, and she may have a swallowing problem or pain in her mouth. Changes: a plate with a contrasting colour and one dish at a time, finger food that she can eat while standing or walking, sitting beside her and inviting her to help set the table or taste the soup, and favourite dishes. Report: the coughing while drinking, together with weight loss, so that a swallowing assessment can be arranged. Until then, keep her upright, offer small amounts and follow your organisation’s rules. Do not force food, and note what she eats.
In German practice you will hear …
  • Grundpflege – basic care such as washing, dressing, toileting and eating
  • Körperpflege – personal hygiene and body care
  • Bezugspflege / Bezugsperson – key-carer system / key person
  • Basale Wahrnehmungsförderung – basic sensory stimulation, an approach working through touch, movement and the senses
  • Biografiearbeit – life-history work (Module 5)
  • Fingerfood – finger food, food eaten by hand
  • Logopädin / Logopäde – speech and language therapist, also assesses swallowing
  • Pflegegrad – care level under section 14 SGB XI