Personal Hygiene for a Bedridden Parent

The principles

• Dignity and consent first. Explain, ask, cover and give privacy; see dignity in intimate care: words, privacy and consent.
• Wash in sections, exposing only one part at a time, and keep the rest covered and warm.
• Gentle, not scrubbing. Skin is fragile; pat dry; see barrier creams and skin care under pads.
• Work from clean to dirty: face first, perineum and anus last, with fresh cloths.
• Use warm, not hot, water, and check the temperature on your wrist; see hot water and scald safety for older skin.
• Encourage the person to help, which keeps muscles and independence.
• Check the skin at every wash.
• Protect yourself: gloves, hand washing, a raised bed and good posture; see how to lift and transfer safely.

Equipment and supplies

• Basins (two: one for the body and one for the perineal area, clearly separated), warm water, mild pH-balanced soap or no-rinse cleanser.
• Soft washcloths or disposable wash mitts, several, and soft towels.
• Alcohol-free wipes for quick cleaning; see wipes and perineal hygiene done gently.
• Disposable gloves, aprons and bags.
• Underpads and clean sheets, a draw sheet or slide sheet; see underpads: disposable and washable options.
• Barrier cream and a skin moisturiser, fragrance-free.
• Mouth care items: a soft toothbrush, small-headed brush or foam swabs, a kidney dish, toothpaste, a cup; see oral care for frail older adults and denture hygiene.
• Comb, brush, a no-rinse shampoo cap or a bed shampoo basin.
• Nail clippers and emery boards; see nail, hair and foot care for a dependent parent.
• Clean nightwear or a gown, and spare linen.
• A hospital bed with adjustable height and head makes care easier; see hospital room at home: complete setup. A pressure-relieving mattress may be advised; see air mattress for pressure sores.

A daily routine

### Morning

1. Greet and explain. Offer the toilet, urinal or bed pan, and change the product if needed; see how to change an adult diaper in bed. 2. Wash hands and face: wipe the eyes from the inner corner outward with a clean, damp cloth, one cloth per eye; clean the ears (outer part only), neck and hands, and dry. 3. Mouth care: brush teeth or clean dentures and gums; see oral care for frail older adults and denture hygiene. 4. Wash armpits, the groin folds and under the breasts (skin folds that sweat), then dry thoroughly. 5. Perineal care with front-to-back cleaning, and a barrier cream if advised. 6. Check the skin of the back, tailbone, hips, heels, elbows and any areas under splints or tubes. 7. Change clothes and make the bed, with smooth sheets without wrinkles. 8. Reposition and offer a drink; see turning a bedridden patient and positioning a bedridden parent. 9. Hair: comb or brush; tie loose hair so it does not tangle. 10. Apply lip balm and moisturiser to dry areas, avoiding between the toes; if oxygen is in use, use only a water-based lip product and keep oils away from the face; see using an oxygen concentrator safely at home.

### Through the day

• Check and change at regular intervals (often every three to four hours) and promptly after soiling.
• Reposition at least every two hours if advised, or as the nurse sets; see preventing bedsores at home.
• Offer drinks regularly; see hydration for older adults.
• Mouth moisture: sips, sugar-free ice chips if safe, or a damp swab for dry mouths.
• Keep the room ventilated and a comfortable temperature.
• Wash hands before and after each task.

### Evening

• Freshen up: wipe face and hands, perineal care and a change of product.
• Mouth care and denture removal at night.
• Skin check and moisturiser.
• Clean nightwear, smooth sheets, pillows, a drink and a comfortable position.
• Dim lights and a calm routine, for sleep.

The bed bath

A full bed bath need not be daily; many bedridden people have a full wash two or three times a week, with daily partial washing of the face, hands, armpits, groin and bottom. In hot, humid weather, more frequent sponging helps. For step-by-step instructions, see bed bath step by step. In brief:

1. Prepare the room, supplies and a warm environment, close doors and windows to avoid draughts and ensure privacy. 2. Wash hands, put on gloves and raise the bed to working height. 3. Cover the person with a sheet or towel, and uncover one part at a time. 4. Wash eyes, face and neck, then arms and hands, chest and abdomen, legs and feet, then roll to the side and wash the back and buttocks, and lastly the genital area. Use a new part of the cloth or a new cloth, and change the water when cool or dirty. 5. Rinse (if using soap) and pat dry, especially in folds and between fingers and toes. 6. Check the skin and apply moisturiser or barrier cream as advised. 7. Dress and reposition.

Skin checks

Check at least once a day, and at every wash:

• Pressure points: tailbone (sacrum), hips, heels, ankles, elbows, shoulder blades, back of the head and ears.
• Skin folds: under the breasts and abdomen, groin, armpits and between the buttocks.
• Areas under devices: oxygen tubing, catheters, splints, stockings.
• Look for: redness that does not fade when pressed, blisters, open areas, dark or purple patches, swelling, heat, dryness, cracks or rashes.
• Report promptly to the nurse or doctor; see pressure ulcers: stages, wound care and prevention and incontinence-associated skin damage: prevention and care.

Continence and toileting care

• Respond quickly to wet or soiled products.
• Offer toileting aids regularly; see bed pans: types and how to use them, urinals for men and women: bedside use and bedside commode and urinal routines.
• Use appropriate products and bed protection; see choosing incontinence products by situation and mattress protectors for incontinence.
• Catheter care as the nurse has taught; see catheter care basics for families.
• Monitor bowels: a record helps; see bowel incontinence and constipation in later life.

Hair, nails, eyes and ears

• Hair washing about weekly, or as needed: use a bed shampoo basin or a no-rinse shampoo cap, supporting the head and neck, with the head slightly back over a waterproof sheet and a basin, using warm water and a small amount of mild shampoo; dry and comb. A hair oil massage is a comfort for many, but wipe the scalp afterwards, and avoid heavy oils in humid weather where they can attract dust and cause itch.
• Nails weekly: see nail, hair and foot care for a dependent parent.
• Shaving with an electric razor or a safety razor with care, for men; soften beards with a warm cloth.
• Eyes: wipe discharge gently from inner to outer corner with a clean, damp cloth; report redness, pain or sticky discharge; for people who cannot blink fully, ask the doctor about eye care.
• Ears: clean the outer ear only; do not use cotton buds; see ear wax and hearing: safe care.
• Glasses and hearing aids: clean and keep within reach.

Bed linen

• Change linen when soiled and at least every two or three days, or daily in hot, humid weather or with incontinence.
• Keep sheets smooth, with no creases or crumbs; tuck corners firmly.
• Choose breathable cotton; see bed linen for sensitive older skin.
• Change linen with the person in the bed by rolling them from side to side.
• Wash hot and dry in sunlight; see disposal, laundry and odour control.

Comfort in hot weather

• Keep the room cool and ventilated; use fans safely, not blowing directly on the person; see summer heat and bedridden care.
• Offer cool sponging and light cotton clothes.
• Change products and linen more often and keep folds dry.
• Offer fluids regularly, unless restricted.

Infection prevention

• Wash hands with soap and water, or use hand rub, before and after each task; use gloves for body fluids.
• Keep separate cloths and basins for different body parts, and wash them after use.
• Clean equipment, such as bed rails and commodes, daily; see commode chair cleaning and hygiene and infection control for home caregivers.
• Watch for infection signs: fever, cough, burning urine, foul smell, skin redness, pus, confusion; see fever in older adults: why it can be subtle and when to call.
• Keep vaccinations up to date, and follow the doctor's advice.

Sharing the work

Bedside care is demanding. Share it among family members, train a paid attendant and take breaks. See hiring a home attendant checklist, training a new attendant: first week, night-time caregiving routines and caregiver burnout: signs and prevention.

When to ask a professional

Ask a nurse to teach and review the routine, particularly bed baths, mouth care, repositioning and skin checks. Ask the doctor about skin changes, pain, fever, swallowing problems or changes in alertness. Ask a physiotherapist for safe moving and positioning. Seek urgent help for fever with confusion, new or worsening red, dark or open skin, difficulty breathing, blood in urine or stool, or no urine for many hours; call 112 for emergencies.