Providing Care & Support
Over time there may be some activities of daily living (ADLs) your loved one is no longer able to perform independently. Below is information for caregivers about how to provide mouth care, bathing, changing an occupied bed, toileting and incontinence care, skin care and feeding.
Mouth Care
It is important to keep the mouth clean and moistened. Cleaning the mouth is refreshing and helps the patient feel more comfortable. Regular mouth care helps prevent sores and may improve the appetite.
If the person you are caring for can cough and spit, it is generally safe to brush their teeth, but ask your Hospice nurse if you are unsure. To help prevent choking, make sure his/her head and torso are upright (in a sitting or standing position) even if they are unable to get out of bed. It can be difficult to be as thorough with another person as you would with yourself, but try to brush their teeth twice a day and as needed in between. Know that there are other methods for cleaning the mouth if brushing seems too difficult (e.g., the mouth is clenched shut or the patient is coughing while brushing is taking place). Toothettes are small sponges on a stick that can be moistened with mouth wash and/or water and used to clean a person’s mouth when brushing is difficult.
Things You’ll Need
- Soft toothbrush or Toothette
- Toothpaste, Mouthwash
- For Dentures: denture brush and cleanser
- Cool water
- Small basin or bowl
- Dry towel
- Lip balm or Vaseline
Steps for Providing Mouth Care
- Put a dry towel under the chin.
- Moisten the toothbrush and apply toothpaste, or dip a Toothette in mouthwash.
- Gently move the brush or Toothette over the teeth, gums and tongue.
- Rinse the mouth with either cool water or diluted mouthwash.
- Apply a small amount of lip balm or Vaseline to the lips to prevent drying.
- Individuals with dentures should continue their usual denture cleaning routine. After eating, remove and clean the dentures and clean the person’s mouth.
- As an individual loses weight, dentures may not fit properly and can cause mouth sores. Some people may choose not to wear their dentures and eat softer food.
Oral Care After Meals
It is common for people to need their mouth cleaned after meals, especially if they are having a hard time swallowing and tend to hold food in their mouth (aka, “pocketing”). Pocketed food can create a choking hazard so it is important to check all areas of the mouth after meals and remove any uneaten food. Do not use your finger to remove the food! Instead, Toothettes or a toothbrush can work well to get the food out.
As a person’s illness progresses, losing one’s appetite is common; some may stop eating or drinking entirely. The ability to swallow will diminish as well, so giving a drink of water is not always an option, yet keeping the mouth moist is an important comfort measure. In this situation, dip a Toothette in water (or preferred beverage) and run it along the inside of the patient’s mouth or cheek. When a patient is unable to swallow, too much water introduced into the mouth at once may create an aspiration risk. For this reason, squeeze the Toothette against the inside of the cup and get some of the excess water out before attempting this task.
Bathing and Washing Face/Hands
Bathing is important to maintain cleanliness and provide a sense of well-being. How often someone needs to be bathed varies from person to person. Many people only need to be bathed a couple of times per week. If the individual you are caring for can no longer bathe themselves, giving them a bed bath is a safe and effective way to keep them clean.
Things You’ll Need
- Large bowl or basin for warm water
- Soap
- Washcloths, Towels
- Light blanket to prevent chills
- Lotion
- Clean clothes
- Gloves
How to Give a Bed Bath
- If required for comfort, give pain or anti-anxiety medication at least 30 minutes prior to the bath.
- Bathe only a small area at a time, and dry as you go to avoid chills.
- Only uncover the area actively being cleaned to maintain modesty and warmth.
- Begin by washing the face and work down to the feet. Gently soap the skin, rinse and pat dry.
- The face should be cleaned daily (especially around the eyes, nose, and mouth) even if the person is getting a bath that day. Start by cleaning the eyes. Use a warm, moist washcloth. Don’t use soap around the eyes. Start by cleaning the inner corner of the eye, then move toward the outer corner.
- Roll the person to their side and wash/dry their backside.
- Wash the legs and feet before washing the buttocks area.
- After washing the feet, change the water.
- Gently wash and dry the genitalia. Daily attention to this area is especially important since bacteria tend to collect there. Wash from front to back to prevent the spread of bacteria.
- Apply a skin-protecting lotion or ointment if the person you are caring for is incontinent.
- Keep hands and nails clean along with the rest of the body. Trim and file nails as needed.
Important Considerations
Change the water frequently, especially if dirty or cool. If the person is too tired or unable to have a full bath, wash the face, hands and genitalia (groin area). Avoid powders (unless recommended by your Hospice team or physician) because they can promote the growth of bacteria and yeast.
How to Change an Occupied Bed
Crumbs, creases, or moisture in the bed are uncomfortable, and may contribute to bed sores. If or when the person you care for is too weak to get out of bed, it is possible to change the linen while he/she remains in bed.
Changing an occupied bed may require two people. Good body mechanics are essential to avoid injury while providing this care. It may be helpful to think of the bed as two halves. Change one half of the bed while the person you care for lies on the other half. Then roll him/her onto the clean half and make the other half. Be sure he/she cannot roll off the bed. Consider using bedrails to provide something he/she can hang onto to self-assist with positioning. Consult your Hospice nurse with questions.