But creating this ideal bathing scenario isn't without its challenges. Nursing homes are driven by regimented schedules, which makes slotting each resident's favored time a little bit harder. Moreover, staff members are typically stretched thin and workers can't always spend the time necessary for extended bathing sessions.
So how can facilities optimize their operations to accommodate this new, dignified bathing procedure? Bathing specialists recommend focusing on creating a comfortable, soothing atmosphere for residents.
“To provide dignified bathing, a facility should focus on making the resident as comfortable and safe as possible,” said Lewis Duff, director of business development for Norcom of Tennessee, maker of Rane Tubs. “Giving residents a proper bathing room environment with limited sight and sound distractions, proper cleanliness, and safe and comfortable bathing equipment goes a long way for a dignified bathing experience.”
Jennifer Mikula, administrator at Palm Garden of Ocala, FL, says the first step in her facility's transformation was to canvass residents for input on what they wanted.
“It is important to ask your residents about their choice — when they want to bathe and whether they prefer a shower or a bath,” she said. “You should also ask them what it is about their current bathing experience and what they would like to see changed. We did this, and the residents were more than willing to talk about the institutional shower room.
“They spoke of the temperature in the room being too cold, the massive, ugly piece of equipment that we called a whirlpool, and they referred to the sterile feeling of the room with the spartan and bare tile walls. They also mentioned that the room is used for storage of bedside commodes and shower wheelchairs.”
Based on the residents' input, Palm Garden created an environment designed to let residents relax and enjoy their time in the tub.
A time to relax
“Bath time should be a time of calm, warmth and relaxation,” Mikula said. “The surroundings should be inviting, with soft music, aromatherapy, heated towel racks with plenty of warm, fluffy cotton towels. The room should be decorated with soft, inviting colors and the bathtub should be one that is easy to get into, comfortable, and with a non-skid floor so that your resident has a sense of security and safety.”
Mikula acknowledged that the transformation took some time and effort, but that persistence and persuasion have aided the new bathing program's success. A key part was getting employees involved.
“The biggest challenge for us was changing the mindset of the staff. Their first response was, ‘We don't have anywhere else to store all of this equipment, and no one really wants to take a bath in that whirlpool … the residents are afraid of it,'” she recalled. “We then asked the staff to put themselves in the place of the residents and what changes they'd make. As a result, their minds exploded with thoughtful suggestions.”
Palm Garden worked with Piscataway, NJ-based American Standard to install walk-in bathing equipment that the residents would find safe and comfortable. The low entry threshold of the tub makes it very easy for the residents to maneuver, the textured floor provides a safe transfer, and the seating area has a curved back and headrest so the resident can relax comfortably amid the jet massages, Mikula said.
Kalpesh Nanji, director of business development for American Standard, said Palm Garden's new bathing environment has become an oasis in the facility.
“The residents of the center are thrilled with the spa-like services with the heated towel racks, spa robes and slippers, soft music, light-touch hand and feet massage, and of course, the bathing experience,” Nanji said. “What's more, family members are amazed that their loved one has signed up for the spa three to four times per week and brags to their adult children how they love the pampering. When Jennifer gives tours of her center, there is usually a comment from the guest that they would like to sign up for the spas.”
Diane Buchanan, national sales manager for South Daytona, FL-based Gainsborough Specialist Bathing, says that while it is up to the staff to determine how the bathing schedule can be made more dignified, the manufacturer can help by providing bathing equipment that makes the experience more soothing for the resident and less stressful for staff members.
“A bath that adds a ‘spa-like' visual dimension can provide a calming aesthetic for the patient who is uncomfortable or fearful of the procedure,” she said. “Hi-lo baths that allow the staff to raise and lower the bath to a comfortable working height while bathing the patient cause less physical stress to the caregiver.
Baths that incorporate power seats to transfer the patient into and out of the bath provide a level of dignity to the patient who can bathe themselves once they are in the bath.
Somerset, WI-based Apollo Bath is working to prevent cross-contamination in whirlpools and tubs, said product manager David Anderson. The company has patented an ultraviolet light water purification system that purifies water during the bath to help minimize the chances of urinary and respiratory infections, keeping residents safer.
Using tubs right
Anderson says facilities need to be on guard for practices that could have detrimental consequences to bathing systems. One such practice is washing bedpans in the bathing system, he said.
“This puts an undue amount of harmful pathogens in the system, and can cause cross-contamination issues,” Anderson said. “Additionally, I have seen many brands of bathing systems become ‘storage areas' for a variety of items, including shower chairs, slings, boxes, wheelchair parts and a host of other items. All of these items can damage the gel coat or fixtures on a bathing system.”
Kevin Farrell, director of marketing for Norcom of Tennessee, says one of his company's top priorities has been to eliminate the “chill factor” for residents.
“Selecting a bathing system that provides the right blend of safety and comfort is critical,” Farrell said. “Many facilities utilize side-entry bathtubs to help provide a safer transfer for the resident. But the design of some tubs requires the resident to wait until the tub drains before exiting, which greatly increases their chances of chill. A tub that employs an upward swing door and the ability to pre-fill and recline can allow the resident to exit while the water is still draining, reducing the chill factor. Also, side-entry bathing systems can eliminate the need for lift equipment for residents who still have limited mobility, thus helping preserve dignity.”
Bath time bonding
Executives at Summit Square in Waynesboro, VA, concede that finding enough staff time to provide each resident with a leisurely bath can be difficult. But the primary consideration for dignified bathing, they say, is for staff to forge and maintain strong bonds with residents.
“We believe the best bathing experience involves a staff member with whom there is already a level of comfort, trust and relationship — not just someone who drops in for a bath,” organization representatives said in a prepared statement. “We believe the relationship is formed and nurtured all throughout the day and evening.”
Mikula agrees that bath time is the perfect time for staff and residents to get to know each other.
“So many times, staff bond with their residents over bathing,” she said. “The regular caregiver actually enjoys spending this quality time with the resident — it can be a time of quiet relaxation and small talk.”
Education is critical for dignified bathing, Mikula said. She added that giving staff an in-service on how to provide a positive bathing experience is essential.
“Caregivers must feel confident in the services that they are providing and when they do, the bathing experience will go smoothly.”
Preparing a ‘dignified' bath
“Dignified bathing” is a fashionable term within the long-term care industry, but what does it really entail? How can facilities ensure that they are providing residents with a comfortable, enjoyable bathing experience?
Executives from Summit Square in Waynesboro, VA, put together the following checklist to ensure a positive bathing experience for each resident:
—Maintain a warm environment (turn up heat in tub room).
—Use a decorative theme to make the area seem as home-like as
possible (plants, non-commercial furniture).
—Notify the resident about what to expect ahead of time.
—A strong relationship between the caregiver and resident is essential.
—Know resident preferences, such as shower-versus-tub and toiletry products.
—Use a large towel (such as a beach towel) to cover residents during the shower; this is especially beneficial for residents with dementia, as it lessens any stinging sensation.
—Honor the resident's routine for bathing: Wash face before or after; follow an order for washing body parts.
—Allow the resident to wash as much as she/he can.
—For residents with dementia, use a hand-on-hand approach so the resident is washing with the caregiver.
—Towel warmers provide extra comfort.
—Gel mats on the bottom of the tub offer added safety.
—Staff education and re-education are absolutely essential. Administration must support this culture, and management staff must follow up.
Sources: Sue Green, Karen McLean and Annie Fellers, Summit Square, 2011