“How Do I Get Them to Shower?”
Rethinking Hygiene Support in Care Roles
After running workshops in various care settings with staff who support disabled young people and adults, I noticed a common theme emerging – questions about hygiene. They were often framed around how to get someone to do something. Our conversations revealed that these weren’t just practical concerns. They pointed to something deeper about trust, autonomy and past experiences. This blog grew out of those conversations about what real support can and should look like.
I get asked a lot about hygiene support.
How do I get them to shower?
How do I get them to just wash their face?
How do I get them to brush their teeth?
Image from Canva, by TRAVELARIUM from Getty Images Pro
You may also be interested in my blog ‘Supporting PDAers with Hygiene: A Compassionate Approach‘
And I get it, when you’re in a care role, these questions can feel urgent. You’re worried about health, dignity and how others might perceive the person you’re supporting. But here’s the thing, whenever someone asks me these questions, we usually end up digging a little deeper. What we often find beneath the surface is a long history of compliance-based interventions and repeated loss of bodily autonomy.
We’re talking merits and demerits. Earning rewards or more time with their interests. Sticker charts. Hand-over-hand support. Physical prompts. Forced washing.
All with good intentions. But still, actions that taught this person:
Your body is not fully yours. Your “no” does not matter. We will do things to you, not with you.
And so now, this same person is being asked to take ownership of their hygiene. But the trust, the control the safety that would make that possible might not have been given space to grow.
From the outside, it might look like ‘refusal’ or ‘non-compliance.’ But from their side? It might not feel safe to be vulnerable around you. Self-care tasks and hygiene are incredibly vulnerable activities. You might be saying “it’s your choice” with your words, but their past experiences may be anticipating for the moment when it won’t be. It makes sense that they feel the need to protect themselves and distance themselves from hygiene.
That’s why I can’t in good conscience give you step-by-step advice on how to get them into the shower. If the foundation isn’t there, if the relationship doesn’t feel safe, then we’re not talking about hygiene support anymore. We’re talking about coercion. And that’s not okay.
Relationship. Safety. Bodily autonomy.
That’s where hygiene support has to start.
Can this person trust that they’ll be listened to?
That their “no” will be respected?
That they will have access to their AAC* devices in order to communicate during this?
That they won’t be touched without consent?
That they won’t be rewarded or punished for things that should be their private choices?
*AAC stands for Augmentative and Alternative Communication, which are ways people use to communicate besides talking (verbal speech). To learn about more resources and signposting, you may want to check out my blog ‘AAC Users and Resources’
If the answer is no, if trust hasn’t been built yet, then that is where to start. That’s what needs to come first. Not the washing. Not the shaving. Not the toothpaste. The trust.
When someone feels truly safe with you, they are more likely to accept support. They may ask for help or ask for space. They may be more open to discussing new routines, trying new tools, or developing skills on their terms. But it starts with safety. It starts with real, deep respect for bodily autonomy.
So, the better question is:
How do I become someone this person feels safe saying no to?
Because once they can say no without fear, they may one day trust you enough to say yes.
Thank you for learning about the community,
Laura Hellfeld
RN, MSN, PHN, CNL
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Disclaimer: The information shared in this blog is for informational purposes only and is not intended to replace medical advice, diagnosis, or treatment. Please consult a licensed healthcare provider for personalised support and care tailored to your specific needs.
Signposting and Resources:
AAC Users and Resources: A Growing List, Blog
Thank you, thank you, thank you! I feel like I have been waiting for this exact post for the last 15 years.
This is so accurate, straightforward, and explained with an open heart. And I could easily give you 50 more examples to back it up.
This pattern and these results are far more common than not (by a very large margin), and are not limited to any one realm in neurodivergent young adults (and older)!
I think, as you said, it's the vulnerability of hygiene self care that makes this particular area become the hill to die on for our family members, friends, and clients.
I would add that *sometimes* there can be an added sensory component as well. In which case, *while* working on trust / respect there can also be collaboration on finding an individualized hygiene routine that works best for them.
Again, our very deepest gratitude!
This timing of this is serendipitous! I am struggling with hygiene and my 15yo PDA AuDHDer. I know that the loss of autonomy and trust from earlier years is definitely having an impact now. And I also know that my own experiences from childhood mean that hygiene is important to me. Knowing all of this doesn’t make it any easier and I frequently need my parenting consultant to listen to my frustration and grief. Thank you for writing about this topic and providing even more support!