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Bathing in the last days of life

by Valerie Hartman

I have been a nurse’s aide and a hospice nurse since the grass roots movement of hospice philosophy took hold in America.  Those years taught me a lot about providing personal care and bathing with sensitivity. A bath can, and should, be more than a daily head-to-toe routine. It can provide a presence that brings dignity and respect during a time of vulnerability. Adapting the bath creates a gentle nurturing experience for both you and your loved one, especially during the last days of life.

I once assisted a patient who came from the hospital ICU into the hospice unit during the last few hours of life. There was not much about that first moment of arrival on the unit that felt personal, or comfortable. Coming from the hospital, she wore a medical gown with band aids covering the bruises from needle sticks, intravenous lines, and tubes. Her skin was dry and the oxygen mask she wore covered her face. But during those few hours the family gathered…and together made the decision to bathe her. Her three daughters, with a little direction, lovingly connected to their mother through their touch and familiar voices. It wasn’t long before they could see their mother’s posture relax, her face soften, and her breathing ease. Together, we combed her hair, moistened her lips, switched the oxygen to a small nasal cannula, and ensured that her dry skin was hydrated. This was not a bath for the sake of a bath. It was a goodbye ritual, and a natural way of caregiving that brought peace for this family.  And when she took her last breath, her daughters surrounded her while they massaged her hands.  This meaningful goodbye helped erase the days of medical struggle that came before it.

I had a similar experience when caring for a young woman in her home. She was bathed by several of her closest friends, some of whom were nurses. The kind, gentle moments of that bath will be held forever in the memories of those who participated in or witnessed it.

Hospice aide assistance is a regular part of hospice services. Hospice aides are specially trained in hospice care and are supervised by the hospice nurse. Not everyone will want to utilize hospice aide services but most patients and families do, whether one or two times a week or every day. As a caregiver, you may want to assist with bathing, or learn gentle approaches to turning and repositioning from the aide when these natural changes in the dying process begin. The hospice care team can teach you and support you if you feel uncertain about how to perform these personal care tasks.

Here are a few ways to increase gentle supportive personal care for your loved one during the last days of life:

  • Set the tone for a quiet, calming presence. Use special care by slowing down and moving gently.
  • Often the bath is done in silence, or you may want to use this time to reminisce–or grieve.
  • The bath water should be warm. Lavender bath wash might be added to calm the environment and wash dampness from the coolness of the palms.
  • You do not always need to give a full head-to-toe bath. Special attention to mouth care, incontinence care, and skin care will shorten traditional bathing time and open up more time to position for comfort.
  • Hydrate stressed skin using lotions and creams such as Shea Butter or creams used by massage therapists. Light application to arms, legs, back, face, hands and feet moisturize dry skin.
  • Add pillows and towel rolls to support the joints of the legs and arms and elevate the sensitive skin of the heels off the bed sheets.
  • Reposition your loved one from side to side with slow and careful turning. Elevate the head of the bed unless there is a medical reason not to.
  • This bath is paced and given in an atmosphere of respect for the transition that is happening.

Even in the tasks of personal care, the founding principles of hospice philosophy teach us to consider the whole person in every intervention. Touch, hydrating skin care products, mouth moisturizers, aromatherapy, and skillful positioning and handling can make a significant contribution to peacefulness.

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