Introduction to Dressing and Grooming

Providing assistance with dressing and grooming is an important task of the Home Health Aide/Personal Care Aide. Maintaining a person’s appearance is important especially during times of illness. It helps people to feel more like themselves and helps the patient appear familiar to family, which is important during times of stress and illness. Maintaining hand and foot care helps to maintain good physical health. By providing hand and foot care, the Home Health Aide/Personal Care Aide has an opportunity to assess the patient’s skin and nail health. Patients, especially those with conditions such as diabetes in which there is poor circulation to the feet, should have their feet inspected daily. Any red, open, bleeding, or problematic conditions should be reported to the supervisor. This section provides instruction about how to assist with patient dressing, apply compression stockings, provide hand and foot care, and shave a patient. Complete these tasks as directed by the Care Plan. Keep in mind patient preferences and respect the patient’s wishes.

Procedure – Assisting with Dressing

Some patients may be able to independently dress. For these patients, provide assistance only as needed. Home Health Aides/Personal Care Aides should encourage their patients to do as much as possible on their own. Other patients may need extensive assistance with dressing. In order to promote self-esteem and empower in patients, allow them to select the clothing they prefer.

1. Explain the procedure to the patient.
2. Wash and dry your hands. Don gloves as needed.
3. Allow the patient to select clothing they wish to wear.
4. Assemble clothing in the order it is to be put on. Clothing for the upper body should be put on before pants/skirts, which should be put on before socks and shoes.
5. Ensure the patient’s clothing is clean and in good condition. Clothing should be appropriate to the weather.
6. It may be helpful for the patient to wear clothing that is easier for them to put on independently. For example, pants without buttons or zippers can easily be pulled on; shirts with few buttons are easier to close; sneakers with velcro versus laces and slip on shoes all may be helpful for patients who have difficulty with their fine motor coordination or finger dexterity.
7. Encourage the patient to do as much self-dressing as possible. Assist if they become fatigued, frustrated or are unable to perform the task.

Procedure – Assisting with Dressing for Patients Who are Weak, Frail, or Paralyzed

1. Move the patient to the center of the bed. Use proper body mechanics.
2. Raise the bed to waist level.
3. Remove clothing one piece at a time and replace with clean clothing before moving on to the next clothing item. For example, remove and replace the upper body clothing prior to moving on to uncovering the lower body. This provides privacy and warmth for the patient.
4. Position and cover the patient for comfort. Return bed to a safe height. Ensure side rails are up.
5. Remove your gloves. Wash and dry your hands.
6. Document completion of the task and record any changes in condition or behavior

Procedure – Assisting with the use of Elastic Support Stockings

Some patients may be prescribed by their doctor special elastic stockings to wear on their legs. These stockings are used for patients with poor circulation who are at risk for getting a blood clot. They are also used to help prevent or reduce swelling. Stockings should be placed on the patient’s legs prior to them getting out of bed in the morning. Follow manufacturer instructions in applying stockings. Follow instructions written in the Care Plan for guidelines for when to apply, how long the patient should wear stockings each day, and when to remove stockings.

1. Explain the procedure to the patient. Ensure they understand the importance of wearing the elastic support stockings. Seek guidance from a supervisor as needed and report refusal to wear stockings.
2. Wash and dry your hands.
3. Assemble equipment (e.g. support stockings, lotion, shoes).
4. If the patient has been moving around out of bed, have them lie down with their legs elevated for 15 minutes before applying the stockings.
5. Make sure legs are clean and dry. Observe skin for condition and changes such as sores, swelling, and changes in color. Make note of any observed changes and any patient complaints such as numbness, pain, or tingling in the lower extremities.
6. You may use powder or lotion on the patient’s legs prior to applying the stockings. This provides for comfort, ease of application of stockings, and protection for the patient’s skin.
7. Raise the bed to waist height. Position patient in the supine (lying on back) position.
8. Apply stockings according to the Care Plan and as a supervisor directs.
9. Place your hand and arm inside one stocking and turn it inside out up to the heel of the stocking. Grasp the heel of the stocking with your fingers of the hand holding the stocking.
10. Move the stocking down over your arm so that the length of the stocking is now bunched near your hand.
11. Carefully take the patient’s foot and position the opening of the stocking that is near your hand over the patient’s toes.
12. Place the foot of the stocking over patient’s toes, then over the foot, then over the heel. Pull the stocking up slowly as you move it upwards over the patient’s leg.
13. Gently pull the top of the stocking up over the entire calf.
14. Make sure the heel of the foot is in the heel of the stocking.
15. If there are no toe openings, gently pull on the tip of the stocking by the toes to relieve pressure. For stockings with toe openings, the patient’s toes should be positioned appropriately in the toe area.
16. Repeat with the other leg.
17. Always ensure there are no wrinkles in the stockings.
18. Discard gloves if wearing and wash your hands.
19. If the stockings do not appear to fit well and appear to be digging into the top of the patient’s leg, inform a supervisor right away. The patient may need to be refitted for the appropriate sized stocking.
20. Stockings should be removed and skin should be cleaned, dried, and inspected at least once per day.
21. Observe for changes in skin color, temperature, swelling, sores on legs, and patient complaints.
22. Document and report any changes in condition or behavior.

Nail Care

Providing nail care for a patient allows Home Health Aides/Personal Care Aides an opportunity to assess the health of their patient’s skin, nails, and the strength of their hands and feet. It also provides a sense of comfort and promotes self-esteem for the patient. While many patients may enjoy having their hands and feet cared for, take special care with patients who do not find this a pleasurable experience. Some patients have very sensitive feet and may be ticklish. Home Health Aides/Personal Care Aides should always tell a patient when they are going to touch their feet and inform them of what they are doing so that they expect the touch.

Make sure to follow directions from a supervisor and those written in the Care Plan for nail care performed. Never use a nail clipper to clip finger or toe nails. Use an emery board to smooth nail edges. Home Health Aides/Personal Care Aides should inform their supervisor if advanced nail care needs to be performed. Never perform toenail care on a patient who has diabetes. These patients require special care from a podiatrist. It is acceptable to cleanse and inspect these patient’s feet, but never clip their toenails.

Procedure – Hand Care

1. Explain the procedure to the patient.
2. Wash and dry your hands. Put on gloves as necessary.
3. Gather equipment and supplies as needed.
4. Use proper working height by raising the bed to waist level if the patient is bed bound. If the patient is sitting in a chair or wheelchair, Home Health Aides/Personal Care Aides may sit next to them to avoid bending their back. Keep the back straight, feet planted on the floor and face the direction you are working.
5. Soak patient’s hands in warm (not hot) water. Temperature should be no greater than 105 degrees Fahrenheit. Soak hands for at least five minutes, or according to patient preferences. Clean under nails with a soft nail brush or nail stick, or do as directed in the Care Plan.
6. Remove the patient’s hands from the water and wash with a soapy wash cloth. Rinse and dry well. Be sure to rinse and dry between fingers.
7. Remove basin from the patient area.
8. File nails as necessary and as requested with an emery board or nail file to keep edges smooth and free of rough edges or hangnails.
9. Massage hands with lotion.
10. Apply nail polish as the patient requests.
11. Discard the water and rinse the basin. Put away equipment and supplies.
12. Lower the bed to its lowest level and ensure side rails are up.
13. Remove your gloves. Wash and dry your hands.
14. Document completion of task and record any changes in condition or behavior. Report any skin conditions observed.

Procedure – Foot Care

1. Fill a basin with warm water. Do not exceed 105 degrees Fahrenheit. Have the patient test the water for comfort.
2. If providing foot care in bed, soak and work with one foot at a time. Place the basin of water over a waterproof pad or towel at the foot of the patient’s bed. If the patient is sitting, place the basin on the floor with a towel or waterproof pad underneath. Ensure the patient’s feet and ankles are supported. Feet should be flat against the bottom of the basin.
3. Soak the patient’s feet in warm (not hot) water for at least 10 minutes. Add warm water to the basin as needed. Clean under their toenails with a soft nail brush.
4. Working with one foot at a time, remove a foot from the basin and wash with a soapy wash cloth. Take care to clean between toes. Rinse their foot well. Make sure no soap is left between the toes.
5. Dry the patient’s foot. Take special care to dry well in between toes.
6. Repeat for the other foot.
7. File toenails as needed. Do not cut patient’s toe nails. Discuss any needed advanced toe nail or foot care with a supervisor.
8. If applying lotion on feet, take care to not apply lotion between the toes. Place socks and/or other footwear on patient once done.
9. Apply nail polish as the patient requests.
10. Discard the water and rinse the basin. Put away equipment and supplies.
11. Lower bed to its lowest level and ensure side rails are up.
12. Remove your gloves. Wash and dry your hands.
13. Document completion of task and record any changes in condition or behavior. Report any skin conditions observed. Report and document any discoloration of the feet, blood, drainage, ingrown toenails, thickened toenails, reddened heels, or foot/ankle swelling.

Procedure – Shaving the Patient

Shaving facial hair may help a patient feel good about themselves and helps them to maintain their appearance in the way it was prior to becoming unable to provide their own care. It also helps the patient to appear familiar to their family and friends, which can be comforting during periods of illness. Before shaving a patient, Home Health Aides/Personal Care Aides should obtain their consent. Inquire about their preferences as to products used such as shaving cream and aftershave, and the style they prefer to wear their facial hair. Always wear gloves during shaving due to the risk of bleeding. Use the type of razor a patient prefers. Always check with a supervisor and the Care Plan to ensure that the patient can be shaved with a razor that has a blade. Some patients are on medication or have conditions that put them at a higher risk of bleeding. Their doctor may only want them to use an electric razor. Shaving cream should always be used with razor blades. Shaving cream is not to be used when using an electric razor. Never use someone else’s razor on a patient. Blood borne diseases can be spread this way due to the possibility of blood on the patient’s razor.

Explain the procedure to patient.

Wash and dry your hands. Always wear gloves when shaving.

Assemble equipment (e.g. razor/electric razor, shaving cream, wash cloths, towels, basin with water, lotion, aftershave).

Provide for privacy and comfort. If the patient is in a bed, adjust the bed to safe working height. Lock the brakes. If the patient is sitting in a wheelchair, ensure the brakes are on. Use proper body mechanics while shaving the patient. Never lean or bend over the patient.

Place a towel under patient’s chin, covering his shoulders and front of his chest.

If the patient is able to shave independently, place all equipment and supplies within reach and provide assistance as needed. Ensure razor blades are sharp, as a dull blade can irritate the skin and increase the risk of cuts and bleeding.

Wash the patient’s face with warm water, leaving the area to be shaved wet. You can leave a warm towel on the patient’s face and neck for several minutes to help soften their hair. This helps to avoid cuts and makes for a smoother shave. If using an electric shaver, dry the patient’s face after washing it.

Rub shaving cream into patient’s beard and mustache if using a razor. The shaving cream helps to soften the skin and hair and provides a smoother shave.

Pull skin taut in the area to be shaved. Shave one area at a time.

Shave using gentle, short strokes in the same direction. Shave in the direction of hair growth.

Shave beards in downward strokes, and use upward strokes on the neck.

Rinse the razor often. Apply shaving cream as needed. Ensure the water temperature does not get too cool while shaving.

If using an electric razor, pull skin taut. If using a foil shaver (a single head shaver which is usually rectangular shaped), shave with smooth and even movements in an up and down direction along the line of hair growth. If using a three head shaver (a shaver with three round heads set inside a triangle), shave in a circular motion. Make sure to shave the patient’s chin and neck.

Once shaving is complete, rinse and dry the patient’s face. Offer a mirror so they may inspect the shave. Touch up any areas the patient requests.

If the patient has cuts from shaving, blot the area with a gauze pad until it stops bleeding.

Apply moisturizer and/or aftershave, per patient request and preferences. Avoid applying lotion or aftershave to irritated or cut skin.

Ensure the bed is at its lowest height and side rails are up to ensure safety.

Remove your gloves. Wash and dry your hands.

Document completion of task and record any changes in condition or behavior. Report any skin conditions observed, such as red, irritated skin, broken skin, or pimples, boils, or cuts. Inform a supervisor of any cuts the patient received during shaving.

To assist with shaving underarms and legs, follow the same procedures and guidelines as above. Shave leg hair from ankle to knee, using short, smooth strokes upward. Some women also like to shave their knee to thigh area. Ask the patient what their preference is. Apply shaving cream to legs or underarms prior to shaving. Ensure the razor used is sharp, not dull. Shave underarm hair in short, smooth strokes. Underarm hair can grow in all directions. Always shave in the direction of hair growth.