Combatting COVID-19 When FTD Causes Hand-Washing Resistance



Partners in FTD Care, Spring 2020
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As the country continues to grapple with the COVID-19 pandemic, hand-washing and hygiene are more important than ever. But when persons with FTD exhibit resistant behaviors, ensuring appropriate hygiene measures can become a challenge for care partners. To ensure safety in the home for both persons diagnosed and their care partners, it is important to employ effective behavioral and communication strategies to help combat the difficulties created by this stressful and uncertain situation.

Resistance to good hygiene is not a willful act of defiance or negligence by persons diagnosed with FTD. It is a result of the cognitive and behavioral changes caused by the disease. Activities that may seem like second nature—washing one’s hands, for instance—can pose great difficulty to someone with FTD, who may not be able to sequence actions without effort and concentration, and may even feel the sensation of soap and water differently because of changes in their brain.

In such cases, developing a simple, sustainable hygiene routine is key to handling the disruptions caused by the current environment. If hygiene and hand-washing is met with resistance from the person diagnosed, care partners can prompt them to engage in hand-washing and other hygiene behaviors by making a card with two or three easy-to-follow steps. For example, a simple guide to handwashing could say: Run warm water, apply soap, wash for 20 seconds. These behaviors can be further enforced by creating a daily schedule, which will add structure to what may feel like an unusual and disruptive environment.

In addition, it is important to ensure communication surrounding hygiene behaviors is direct, but not confrontational, as anger and hostility can further escalate resistant behaviors in the person diagnosed. It is best to use simple instructions and to be straightforward when relaying directions. It is important to remain calm and exercise patience. Speak in a clear, calm, reassuring and positive voice, and avoid saying “no.”

Ensuring proper hygiene may require creativity and flexibility, as goalposts shift frequently in FTD. If one approach does not seem to work, it may be beneficial to try a different tactic and/or set new goals for care. For example, if the recommended 20 seconds of hand-washing with soap and water proves too difficult, try using antibacterial hand wipes or a hand sanitizer containing at least 60% alcohol. Similar methods can be employed to accommodate other hygiene routines.

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