Bathing and lifts feature: Good clean fun

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New bathing and lifting products and practices make bathing more enjoyable for residents and less stressful for staff.

Ask frontline caregivers to name their most challenging activities and chances are, resident bathing will rank at, or at least near, the top of their list.
And for good reason. Roughly 96% of residents receive some assistance with bathing, and some can become easily agitated or emotionally distressed during the process. Caregivers also face a host of ergonomic challenges related to lifting and transporting residents, and maneuvering about in cramped, cold and often outdated bathing areas.
Couple that with fall risks, high resident-to-staff ratios and the various other activities aides must perform over the course of their shifts, and it's understandable why resident bathing is among the most dreaded work duties.
Fortunately, making the leap from a cringe-worthy bathing experience to a largely pleasant one usually requires neither a complete procedural overhaul nor a budget-breaking investment for the majority of long-term care operators.
"You'd be surprised by what a few well-implemented changes can do," say Fleta Grant, staff development coordinator at Lutheran Home at Trinity Oaks in Salisbury, NC. "All it takes is a widespread commitment and the [facility's] willingness to really see the bathing process through the eyes of the resident."
Dipping into more options
Sources say that adopting a resident-centric, individualized approach is the surest way of creating a safe, successful bathing experience. Because each resident is unique, it is important to offer multiple bathing options – from showering and tub bathing to gentle towel and bedside methods, says Philip D. Sloane, M.D., MPH, co-director of the Program on Aging, Disability and Long-Term Care at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, Chapel Hill.
"Not wanting to bathe is a learned behavior," he says, adding that between 30% and 40% of Alzheimer's residents are averse to bathing. "It's important to understand that these individuals have somehow learned along the way that bathing leads to a negative experience. Only positive experiences will help change that perception."
Providers should consider that some seniors never grew accustomed to showering and prefer tub bathing instead. On the flip side, even those who preferred traditional bathing in the past may be reluctant to do so in a nursing home because of independence and dignity issues. That may especially be the case for some of the 10% to 15% who require mechanical lifts to enter the tub and are frightened by the process, Sloane explains.
Certainly, modern bathing and lift systems play their own part in raising the satisfaction quotient for residents and staff. More than ever, bathing system manufacturers are designing tubs that can fit in even the closest quarters and feature either side- or end-opening access doors. They reduce the likelihood of slips and falls for more independent residents and more easily accommodate chair lifts for those who require extra assistance. Even better, facilities don't have to spend a bundle to realize big benefits, as one bathing system manufacturer points out.
"For the past decade or so we've been seeing bathing system companies put all types of technology, such as computerized systems, into their [units], which caused the cost of ownership to skyrocket," says Kirk Penner, vice president of Penner Patient Care Inc., Aurora, NE.
Although technology isn't a bad thing, Penner says there's nothing wrong with going back to the basics — that is, relying on open-access systems designed without printed circuit boards and computer systems.
"When you really look at tub design, you'll find it's less about the tub itself and all the bells and whistles, and more about how that design allows residents to get into that tub," he notes.
Penner Patient Care offers a series of side-entry bathing systems equipped with a transfer, reservoir and scale. The transfer seat has swing-away arms to aid bed-to-bath transfers and can be height-adjusted to allow caregivers to easily perform foot care.
For small bathrooms, ceiling and wall-mounted lifts can maximize square footage. Like bathing systems, lifts are being more thoughtfully designed to allow caregivers to quickly, easily and safely transport residents from bedroom to bathroom in one smooth move. Mesh slings allow residents to stay in position during the entire bathing process, while motors designed for high-humidity areas help ensure durability.
"The less handling and manipulating that goes on, the better that is for the resident and caregiver. You'll have less risk of falls, skin shearing and lifting-related injuries, and residents will generally feel more secure and dignified if they can stay right on the sling," says Linda Bowman, vice president of marketing for Guldmann Inc., Tampa, FL. She adds that another dignity-enhancing benefit is that ceiling lifts can operate around privacy curtains.
Letting feedback soak in
While user-friendly bathing and lifting systems certainly serve a vital purpose, experts are quick to point out that when it comes to driving bath-time success, well-implemented care processes will always trump technology.
"The cornerstone of good bathing is listening to each resident – picking up verbal and nonverbal clues about what they like and don't like so bath time can be tailored around their own needs, as opposed to what works best for the assistants," says Sloane. "If they're being lifted, communicate with them and get their feedback throughout the bathing process to determine what might be modified to make the experience a more positive one." He recommends facilities develop a "tool kit" of different problem-solving strategies that staff can draw from. If residents aren't good candidates for showering or tub bathing, for example, he says staff should be prepared to offer bed baths or towel baths, as well as different products – soaps and lotions with different scents, for example – that can help create a more pleasant spa-like experience.
A 'movable spa'
Aesthetics also may play an important role. Despite its old, block wall construction, Lutheran Home at Trinity Oaks created home- and spa-like bathing areas complete with two front- and one side-entrance spa tubs, aromatherapy diffusers, soft lighting, towel and blanket warmers, ceiling-mounted heaters, electric soap and lotion dispensers, and relaxing music. Residential-style furniture, such as an armoire to hold towels and other essentials, and soothing murals rounded out the design. The facility sought and received a $25,000 state grant that helped pay for the enhanced bathing program – which also utilizes monthly staff training.
The facility also purchased simple utility carts to transport CD players and aromatherapy diffusers, as well as covered pouches designed to keep lotions, soaps, blankets and gowns warm for at least two hours.
"Essentially, what we've created is a movable spa so every resident can benefit, even if it's at the bedside," Grant said.
At the heart of some Genesis HealthCare facilities' resident-focused bathing program are designated "spa attendants" who are well-trained and equipped to provide a pleasant bathing experience.
"Because bathing is a unique and challenging activity, we carefully interview for this position to ensure that we have the right people in place to manage it effectively," says Mary Tess Crotty, vice president of quality management for Genesis HealthCare, Andover, MA.
Aromatherapy, electric candles, subtle lighting and redesigned, non-institutional tub and shower rooms with front-entrance, air-jet tubs are all part of the plan. Rooms also are designed to allow residents to be undressed and changed directly in the shower areas. To complete the spa experience, some Genesis facilities even provide massage tables, manicures and pedicures.

Resident bathing considerations

Examine how the adoption of a bathing product or solution affects resident health, safety, privacy, dignity and independence. For instance, consider:
- How the use of a bathing product may have an effect on the functional independence of the resident. Does the product's design enable the resident to shower or bathe as independently as possible?
- How a resident's cognitive and physical status plays a role in the appropriateness of bathing devices and programs geared toward increasing functional independence. Although some bathing products provide the potential for greater independence, they might also require the resident to have the cognitive and motor abilities to manage and use these devices effectively, safely and hygienically.
- The possibility that some residents may not view bathing independence as an improvement in their quality of life and may prefer to be bathed by a caregiver, enabling them to conserve energy and time for activities that hold more meaning for them.
- Whether the resident requires a large amount of caregiver assistance with bathing. Does the design of the product facilitate this with as much privacy and dignity as possible?
- How the aesthetics and the perceived appearance of a bathing product can affect a resident's dignity and desire to use it. Consider how emotional and physical comfort will affect the resident's desire to use the product.
- Does the resident prefer to be showered or bathed? Is the resident frightened by the use of particular bathing lifts and more comfortable with other bathing methods, for example?

Source: Technology for Long Term Care, 2007