This page is part of the PrimeCarers guide to personal care, alongside what personal care covers and bathing and toileting an elderly parent. If your relative has dementia and is refusing food and medication as well, when someone with dementia refuses care covers the wider picture.
The short answer
- A bath or a shower is not the daily requirementThe Alzheimer's Society sets the daily minimum as the face washed every day, and the bottom and genitals washed every day. A wash at the basin does all of that.
- Find out what the no is about before you ask againA painful shoulder, a cold bathroom, the fear of slipping and low mood all come out of a person as the same word, and each of them is something you can change.
- Being washed by your own child asks more of a parentHelp with the most private part of the day costs them something when it comes from a son or a daughter, and less when it comes from outside the family.
- Sore skin changes the questionYour parent is allowed to want a bath less than you would like them to. Broken skin, or weeks with no wash at all, is a reason to ring the GP.
Hourly figures here are what carers on PrimeCarers charge, £18 to £25 an hour with our fee included, on a one-hour minimum visit. Agencies charge £28 to £35 an hour for the same visit.
Behind the refusal
Reasons an older person stops washing
Stopping washing is rarely a decision about wanting to be dirty. Something has made it harder, frightening or not worth the effort, and no is the shortest way a person can say so.
The order of the steps has gone
Something hurts and they cannot explain it
They are frightened of falling
The bathroom is cold
Low mood has taken the energy first
It is you asking
One change needs acting on quickly. If your parent has become confused over hours or a day or two rather than over months, that is a different problem from a refused shower. The NHS advice on sudden confusion is to get medical help straight away, because an infection, dehydration or a new medicine can cause it and all of those can be treated.
How much is needed
How much washing your parent needs
A bath or a shower asks more of a person than anything else below. Knowing what has to happen every day, and what can wait a week, gives you somewhere to go when a shower has been refused, instead of losing the wash altogether.
Asks the most of your parent
Rung 1 of 5
A bath or a shower standing up, with somebody there
- What it needs
- Enough steadiness to get in and out, a warm bathroom, and somebody in the room for the whole of it. A grab rail, a bath board or a hand-held shower head brings this back within reach for a lot of people who have given it up.
- What it gets clean
- Everything, hair included.
- When to reach for it
- Aim for it on the day of the week your parent tends to be at their best, rather than trying for it every morning and arguing about it every morning.
Rung 2 of 5
A shower sitting down
- What it needs
- A shower seat or a chair that can go in a wet room, and a hand-held head so the water is not coming at their face.
- What it gets clean
- Everything, hair included, without anyone standing on a wet floor.
- When to reach for it
- When it is standing and slipping that frightens them rather than the washing itself. This is the change an occupational therapist can assess for.
Rung 3 of 5
A strip wash standing at the basin
- What it needs
- A warm room, a full basin, two flannels and two towels, and a rail or a worktop to hold on to.
- What it gets clean
- Face, underarms, bottom and genitals, feet. Hair needs its own turn at the basin, or a dry shampoo.
- When to reach for it
- The wash to fall back on the moment a shower is refused. It asks far less and it still gets the day covered.
Rung 4 of 5
A wash sitting on the edge of the bed or in a chair
- What it needs
- A bowl of warm water carried to them, towels to keep everything covered that is not being washed, and somebody doing most of the work.
- What it gets clean
- The same areas as a strip wash, done one part at a time with a rest in between.
- When to reach for it
- When the walk to the bathroom is the part being refused, or after a bad night when nothing else is going to happen.
Rung 5 of 5
A wash in bed with warm cloths
- What it needs
- Warm damp cloths or no-rinse wipes, a towel underneath, and a warm room. No water has to be carried and nobody has to stand up.
- What it gets clean
- The daily minimum below, and clean nightclothes afterwards.
- When to reach for it
- Illness, a chest infection, the days your parent cannot get up, and the days everything above this has already been said no to.
Asks the least of your parent
What has to happen every day, whichever rung you are on
The Alzheimer’s Society sets the daily minimum as the bottom and genitals washed every day, and the face washed every day. Hair can wait; their guidance suggests washing it about once a week. A bath or a shower is not the daily requirement, and knowing that takes a good deal of heat out of the argument at nine in the morning.
Dropping to a lower rung is a decision an experienced carer makes without fuss, and it is worth making before the morning turns into a row. A wash at the basin keeps a person clean and takes about fifteen minutes, which is more than a shower that never happens achieves. The steps for each rung are set out in the Alzheimer's Society guidance on washing, bathing and showering, and the daily minimum above comes from its page on a person who does not want to wash or change their clothes. Both apply just as well without a dementia diagnosis.
Two rungs depend on equipment rather than persuasion. If getting over the side of the bath is the obstacle, ask the council: the NHS guide to home adaptations says an occupational therapist visits you at home, and under regulation 3 of the Care and Support (Charging and Assessment of Resources) Regulations 2014 a council must not charge for community equipment or for an adaptation costing £1,000 or less. Grab rails, a bath board and a shower seat sit inside that limit. Larger work such as a level access shower goes through a Disabled Facilities Grant. Writing down what works as a washing and dressing care plan means everyone who helps does it the same way.
What carers do
How an experienced carer gets a wash done
Carers who do this every day are not better at persuading people. They have arranged the wash so that less persuading is needed, and almost all of that work happens before your parent is asked anything.
- 1
Warm the room and the towels first
Five minutes beforeHeater on, door and curtains closed, towels warm and within reach. The advice is to keep the room warm and make sure nobody else will walk in. - 2
Set everything out before they come in
Before you askBasin filled, soap, flannels, towels, clean clothes in the order they go on. Nothing should send you out of the room once your parent is undressed. - 3
Say what you are about to do, one step at a time
ThroughoutThe guidance is to talk through each step and give the person time to understand it, which also gives them the chance to say no to any part of it. It takes the surprise out of every touch. - 4
Uncover only the part you are washing
ThroughoutA towel or a dressing gown stays over everything else and moves down as you go. That is the difference between a wash that feels like care and one that feels like being handled. - 5
Hand them the flannel for what they can still manage
ThroughoutFace, hands, chest. Holding out the soap at the moment they would normally reach for it is a prompt rather than an instruction, and it leaves them the part of the job that was still theirs. - 6
End with something that is not a task
AfterwardsClean clothes, hair brushed, a cup of tea, the radio on. What your parent remembers about today decides how tomorrow goes.
When to worry
When a refused wash becomes a health problem
An adult is allowed to wash less than their family would like, and that preference belongs to them. Some of it turns into something a GP or a district nurse needs to see, and this is how to tell the two apart.
What to do, and how soon
0 of 10 ticked
Ring the GP or 111 today
Ask for a GP appointment this week
Ring the council
Skin is why a run of missed washes matters more than it appears. Washing and drying the areas that stay damp is what keeps skin intact, and once it breaks it is slow to come back. The NHS guide to pressure ulcers sets out the early signs, and pressure sores covers what to do about them. Managing incontinence covers the leaking that can sit underneath a refused wash. Where it is dignity that has been lost rather than hygiene, privacy and dignity of the elderly is worth reading before the next attempt.
Somebody from outside
Bringing in somebody who is not family
Families refused every morning for a month are sometimes surprised when a carer gets a wash done in the first week. The same request costs your parent less when it comes from somebody whose job it is.
What to ask a carer before you book
- What they do when somebody says no. Listen for an answer about timing and patience rather than persuasion.
- Whether they can come when your parent is at their best, rather than when it suits a rota.
- Whether they have worked with somebody at a similar stage, and what a wash looked like in that house.
- Whether your parent would rather have a man or a woman for this, asking them rather than deciding for them.
What not to expect in the first week
- A full shower on day one. Starting with a cup of tea or the shopping, and leaving washing until the second week, asks far less of everybody.
- The approach that failed for you to succeed because somebody else uses it. What changes is the relationship rather than the technique.
- A carer to override a refusal. Nobody may wash an adult who is saying no, whoever is paying for the visit.
- An answer on qualifications from us. PrimeCarers checks identity, right to work and an enhanced DBS on the Update Service, and interviews every carer online, so training and references are for you to ask about.
If your parent will not accept any help at all, how to get someone to accept care is about that first conversation rather than this morning. When you reach the point of looking, you can search for carers near you and compare their rates by postcode and message the ones you like. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, against £28 to £35 at an agency, and the hourly cost of care at home sets the two side by side. PrimeCarers is an introductory service rather than a care agency and holds no CQC registration: carers are self-employed, you agree visits with them directly, and they hold insurance that covers them while they work. How we vet every carer lists what is checked before a profile appears.
Book an hour rather than half an hour for this task in particular. The NICE guideline on home care says visits must be long enough for the work to be done without compromising the person's dignity, and that the same worker should support the person so they become familiar. A carer watching the clock is the surest way to be refused. The minimum visit on PrimeCarers is an hour.
Questions
Questions families ask when a wash is refused
A full bath or shower is not what a body needs daily. The Alzheimer's Society sets the daily minimum as the face washed every day, and the bottom and genitals washed every day, with hair about once a week. All of that can be done at a basin, on the edge of the bed, or with warm cloths in bed. Aim for a bath or shower on the day your parent is at their best.
Not that she has not, because that argument cannot be won and it leaves you both upset. Giving her a reason that belongs to her, such as freshening up before a visitor comes, is more use than the calendar. If she still says no, leave it and come back in twenty minutes.
No. An adult who can make that decision is entitled to make it, even where the family thinks it is the wrong one, and that holds for somebody with a dementia diagnosis too. What you can change is everything around it: the time of day, the warmth of the room, whether it is a bath or a basin, and who is asking. If washing has stopped altogether and the skin is becoming sore, ring the GP.
A strip wash is done standing at the basin or sitting in a chair, one area at a time, with a towel over everything that is not being washed. It covers the face, underarms, bottom, genitals and feet, which is the daily minimum, so on an ordinary day it is enough. Hair needs its own turn at the basin or a dry shampoo.
Ring the GP rather than working out the cause at home. A smell can come from skin that has broken down, from a urine infection, or from leaking nobody has been willing to mention, and the last of those is itself a reason people refuse a wash. A GP can arrange a continence assessment, and a district nurse can visit if there is any sign of pressure damage.
Sometimes, and it is worth trying rather than assuming it will fail. Being undressed by a son or a daughter changes a relationship that has run the other way for decades, and accepting help from a carer does not ask that of a parent. Somebody who comes at the same time each day becomes part of the routine rather than a visitor. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, against £28 to £35 at an agency.
Under the client contract a visit cancelled by the client is payable in full, apart from unplanned hospitalisation, illness, or another reason the carer agrees to. PrimeCarers charges nothing itself for a cancellation and does not set the terms between you and the carer. Notice for hourly care is 48 hours. Agree with the carer at the start what should happen on a morning like that.