Caregiving comes with many challenges, but when you’re caring for a loved one confined to a bed due to disability, chronic illness, injury or old age, everyday tasks become even more complex.

Maintaining personal hygiene for bedbound individuals can be difficult for everyone involved.  But keeping your loved one comfortable, healthy and safe in bed is so important to their well-being, self-esteem and identity. Read on for some tips to help you with the more challenging personal hygiene tasks:

Bed Baths

If the person in your care is unable to get up to use the bathtub or shower, you will need to bathe them in bed. Their hands, face and the genital area should be washed daily and full-body bathing should be done once or twice a week. This will prevent odours, discomfort and infection, protect fragile skin and improve circulation. Always let your loved one know what you are doing, even if they are unable to communicate, and close their blinds and doors for privacy.

• If possible, increase the room temperature in advance for comfort, and if your loved one’s bed has a bedrail, raise it on one side of the bed.
• Prepare two water basins—one for soapy water and one for rinsing.
• Keep your loved one covered with a sheet or towel, only uncovering the area you are cleaning. Place a towel or waterproof mat under the body part you are washing.
• Start with their eyes, face and ears and work your way down their body. Use one cloth for the soapy water and one for rinsing.
• Skip the genitals and buttocks and move down to their legs and feet.
• Once complete, roll your loved one to the side. Use a fresh cloth to wash their back and genitals, finishing with their buttocks.
• Pay close attention to the areas that have folds in the skin and use this time to check for signs of skin irritation or pressure injuries (bedsores).
• Carefully pat each area dry and use a moisturizing lotion before putting on clean clothes. Avoid applying lotion between the toes which can lead to fungal infections.
• During bath time, keep an eye on the length of fingernails and toenails, trimming as needed. Long nails can scratch fragile skin, leading to infection or become painful and ingrown.

Hair Washing

Although it may seem convenient to include hair washing in the bed bath process, it is usually recommended to do this on a separate day. Combining these tasks can be strenuous for both caregivers and their bedbound loved ones. Aim to wash hair once a week and experiment with dry shampoo between washes.

• Gently comb your loved one’s hair to remove any knots before the washing process.
• Place a towel or waterproof mat under their head and neck, drape their shoulders with a towel and if they are willing, cover their eyes with a warm washcloth.
• Use a spray bottle with warm water to wet their hair. Apply about a dime-sized amount of tear-free shampoo and massage the hairline and scalp moving down the length of their hair. Slowly add more shampoo, if needed, as it can be difficult to rinse clean.
• Gently lift your loved one’s head to make sure you also clean the back of their head.
• Using a washcloth, rinse with clean water until all the shampoo is removed.
• Use a leave-in spray conditioner and gently brush again. Wrap hair in a dry bath towel, patting their neck, face and shoulders dry.
• Consider using a hair dryer on low heat if your loved one has long hair.
• There are some products available that may make this process easier. Try no-rinse shampoo caps, no-rinse shampoo, and a foldable or inflatable shampoo basin.

Bed Linens

When a person spends all of their time in bed, their bedding must be changed whenever soiled and ideally, every other day. It can feel overwhelming to change bedding with someone in it, but it does typically gets easier with time. If your loved one is in pain, plan to change the bed within 30 minutes following when they take their prescribed pain medication.

• Gather everything that you need—blanket, pillowcases, flat and fitted sheets and a plastic bag or laundry basket (for soiled linens).
• If your loved one’s bed has a bedrail, raise the bedrail on the opposite side of the bed or have another person available to stand along the open side.
• Wearing medical gloves, take pillows off the bed and roll your loved one to the other side of the bed.
• Pull the dirty sheet out from under the mattress and tightly roll it away until it rests against your loved one’s back. Throw out any disposable pads.
• Attach the clean sheet to the corners of the mattress—making sure there are no wrinkles.
• Tuck the other open edge of the clean fitted sheet under the rolled dirty linens.
• If you are using a disposable pad, put it on the bed also tucking it under the dirty sheets.
• Now roll your loved one to the clean side of the bed. Remove the dirty linens, pull the clean sheet tightly over the rest of the mattress and smooth out the disposable pad.
• Roll your loved one back to the centre of the bed, double checking that the fitted sheet is free of wrinkles.
• Add a clean sheet and blanket or comforter on top of your loved one. Change the pillowcases and gently place their head back on the clean pillows.
• Check in and make sure your loved one is comfortable, adjusting pillows and blankets as needed.

Incontinence Briefs

If your loved one is incontinent, changing their absorbent products often and appropriately is critical to prevent rashes, bedsores or infections. Incontinence products should be changed as soon as they are soiled, somewhere around 4-6 times a day. Many incontinence products come with a built-in wetness indicator so it can be helpful to check these regularly.

• Store all incontinence supplies close to your loved one’s bed so you can access them immediately if there’s an accident. Tab briefs are generally easier to use for bedbound individuals than pull on options.
• Wash your hands with soap and water and put on a pair of medical gloves.
• Place your loved one on their back and if their bed can be raised and lowered, raise the bed to just below hip height.
• Unfasten the tabs on the incontinence briefs, tuck one side under their hip and roll your loved one toward the tucked tab.
• Pull the brief out from under them rolling it up to contain any mess. Dispose of it in a nearby garbage. Sealed garbage cans that can be opened with a foot pedal are ideal.
• Using wet wipes, thoroughly clean the diaper area. Roll your loved one onto their back or sides to clean the areas you can’t reach and apply a moisture barrier cream every other change.
• Avoid pressing or rubbing the skin too hard and check for sores or irritation.
• Put on a fresh pair of gloves before putting on a new brief. Tuck the clean brief under your loved one’s hip.
• Flatten the rest of the brief away from them and make sure you also smooth out the sheets underneath.
• Carefully roll your loved one back onto the brief, pulling it up between their legs and fastening the tabs across their waist. Throw away your gloves and wash your hands thoroughly.
• If you notice any pinching, discomfort or leaking, you may need to switch the size of the brief.

Along with more straightforward personal care activities like brushing teeth or gums, shaving and regular clothing changes, these tasks are very important for your loved one’s comfort, safety and physical and mental well-being.

Although they often do get easier with practice, these activities can be very time-consuming and physically demanding. If you’re not comfortable or are struggling to manage your loved one’s personal hygiene care at home, a paid caregiver can assist you. Contact VHA’s Enterprise Health Solutions team at 416-489-2500 ext. 4649 or by email at ehs@vha.ca for more information on how we can help.

Reviewed By: Kristine Coronel, Registered Nurse & Clinical Educator  

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If you enjoyed this article, you may also like to read:

• The Caregivers Guide to Oral Care
• Resources for Unpaid Caregivers