3.3 Dressing and Grooming
Key Takeaways
- Dressing rule: the weak/affected side goes IN first when putting clothes on, and the strong/unaffected side comes OUT first when undressing — 'Weak in, strong out.'
- Adaptive devices such as button hooks, sock aids, long-handled shoehorns, and elastic shoelaces promote resident independence and dignity.
- Residents have the right to choose their own clothing, including color, style, and weather-appropriate layering.
- Cut fingernails and toenails straight across — never round the corners — and never trim a diabetic resident's toenails; report any concerns to the nurse.
- Use an electric razor for residents on anticoagulants (blood thinners); when shaving with a blade razor, hold it at a 45° angle and shave in the direction of hair growth.
Why Dressing and Grooming Matter
Research on nursing home quality consistently shows that residents who are well-groomed report higher satisfaction, get more visitors, and experience less depression. Dressing and grooming are also part of the federal Resident Rights standards and the NC Department of Health and Human Services quality measures. Survey interviewers ask residents directly, "Do you get to choose what you wear?" A 'no' becomes a citation.
The Dressing Rule: "Weak In, Strong Out"
Residents recovering from a CVA (stroke), hip fracture, amputation, or arthritis often have one side that is weaker, painful, or paralyzed. The garment must be manipulated around the harder side first, so:
- Putting clothes ON: weak/affected side goes IN first, then the strong side.
- Taking clothes OFF: strong/unaffected side comes OUT first, then the weak side.
Think of it as: "The weak arm gets to keep the sleeve as long as possible." The same rule applies to pants, socks, and shoes. Practice this on yourself before the skills test — examiners look for the order, not the speed.
Example Scenario
A resident has left-sided weakness from a stroke. To put on a button-front shirt:
- Slide the left (weak) arm into the left sleeve first.
- Pull the shirt across the back.
- Slide the right (strong) arm into the right sleeve.
- Button the shirt, working with the resident's strong hand if possible.
To remove the shirt that evening: unbutton, slip the right (strong) arm out first, then guide the left sleeve off the weak arm.
Adaptive Devices for Independence
| Device | Used For | Resident Benefit |
|---|---|---|
| Button hook | Buttoning shirts/pants with one hand | One-handed independence after stroke |
| Sock aid | Pulling socks over the foot | Avoids bending for hip-surgery residents |
| Long-handled shoehorn | Slipping shoes on | Eliminates need to bend forward |
| Elastic shoelaces | Slip-on tying | Slip-on convenience, fewer falls from untied laces |
| Reacher / grabber | Picking up clothing or shoes | Reduces fall risk and joint strain |
| Velcro closures | Replacing buttons/zippers | Faster dressing for arthritis or weakness |
Offer the adaptive device, but never insist — resident choice always wins.
Resident Choice in Clothing
- Offer two clear choices ("the blue shirt or the green sweater?") rather than asking an open-ended question that overwhelms residents with dementia.
- Dress for the season and the activity — pajamas at night and clothes during the day support orientation and dignity.
- Respect personal, religious, or cultural preferences (head coverings, modesty garments, jewelry).
- Never substitute facility-owned clothing for the resident's own if the resident's own clothing is clean and available.
Hair Care
- Shampoo per the care plan (often twice weekly in long-term care, more often if the resident chooses).
- Comb or brush hair daily. Start at the ends and work up to the scalp to avoid pulling tangles.
- For tightly coiled or textured hair, ask the resident or family which products and combs to use.
- Inspect the scalp during care — look for lice or nits (small white specks attached to hair shafts), dandruff, sores, or bald patches. Report findings to the nurse.
Nail Care
- Fingernails are cleaned and shaped during the bath. Cut straight across, then smooth with an emery board. Do not round corners (rounded corners cause ingrown nails).
- Trim nails to about the fingertip length — too short exposes the nail bed and causes pain.
- NEVER cut a diabetic resident's toenails. Even tiny cuts in a diabetic foot can become serious infections because of poor circulation and reduced sensation. Report the need for toenail care; only a nurse, podiatrist, or trained professional trims diabetic toenails.
- Do not apply lotion between the toes — trapped moisture promotes fungal infection.
Shaving
- Use an electric razor for residents on anticoagulants (blood thinners such as warfarin, apixaban/Eliquis, rivaroxaban/Xarelto, heparin) — a small nick from a blade razor can bleed for a long time.
- Use an electric razor for residents with bleeding disorders, on chemotherapy, or with thin/fragile skin.
- When shaving with a blade razor (when permitted), hold the razor at a 45° angle to the skin, pull the skin taut, and shave in the direction of hair growth to reduce nicks and ingrown hairs.
- Apply shaving cream or soap and warm water first; rinse and dry afterward.
- Beards and mustaches should be trimmed neatly per resident preference — never trim or shave them off without consent.
- Female residents may want help with facial hair, eyebrow grooming, or makeup — ask, do not assume.
Reporting
Report to the nurse: cuts or nicks, signs of infection, lice or scalp sores, broken or discolored nails, refusal of grooming over multiple days, and changes in self-care ability.
A CNA is helping a resident with right-sided weakness put on a cardigan sweater. The correct sequence is:
A 72-year-old resident with type 2 diabetes asks the CNA to trim her toenails. The CNA should: