Although a relaxing hot bath is considered one of life’s simple pleasures, it can be a complex, difficult and even hazardous process in a nursing home. The risk of injury to both the resident and caregivers is so high in bathing it’s among the reasons the American Public Health Association places nursing homes on a list of “Most Dangerous” work environments.

The APHA ranks long-term care side-by-side with construction, trucking and meatpacking as a “dangerous” occupation because of its “high non-fatal injury rate.” Association researchers attribute the danger to the direct care of elderly and disabled residents, which often is strenuous and can cause musculoskeletal problems, worker absenteeism, worker’s compensation claims and illness.

While bathing specialists acknowledge the risk, they say the chances of injury can be dramatically reduced through the proper approach, the right transfer methods and correctly using bath safety equipment.

“Bathing easily and safely really comes down to looking at each resident’s needs individually,” says Kari Harbaugh, product consultant for Direct Supply Equipment & Furnishings. “Like anything else, what is safe and easy for one resident may not be for another. Having different bathing options available in your building is what will truly create the best bathing experience for your residents and keep them and the staff safe during the bathing process.”

For instance, while some residents would greatly benefit from a relaxing bath, others would be safer in a shower chair and a walk-in shower, Harbaugh says.

If injuries to residents or staff are prevalent during bathing, it is a systemic problem within the facility, observes Bob Vucenovic, president of Mobility Innovations.

“If a facility is not focused on bath safety, they are not aware that it can cost them more in the long run through increased workers’ compensation costs, lost time, lawsuits, turnover and higher overall insurance costs,” he says. “Reducing risk means focusing on the root cause of injuries and taking corrective action.”

As an industry, long-term care has definitely made strides in creating a safer, more dignified bathing experience for residents, says David F. Anderson, national sales manager for Apollo.

“I think facilities are taking greater steps to help workers avoid injuries associated with resident transfers in general and during the bath process in particular,” he says. “Lift companies have worked with facilities to standardize resident transfer protocol, resulting in substantially fewer back injuries related to positioning residents. In regards to bathing systems, transfer systems specifically designed to work with a bathing system are superior to other types of lift mechanisms because it makes the entire process safer for residents and staff.”

‘Lowering’ strain

Lifting, moving and transferring residents from their beds to the bath and back can cause great stress and strain on a caregiver’s  back, hips, shoulders and knees. Bathing and lift equipment manufacturers have been developing products that protect caregivers from injuries associated with moving residents. It has been a challenge, says Hans Siegvardsson, president of Handy Care.

“Any movement that requires caregivers to bend over or use their own muscles is at risk of  [causing] injury,” he says. “The workload toll on the human body is cumulative. Lifting people over the course of the day adds up to tons.”

Adherence to ergonomics — the proper push and pull maneuver — is essential, along with equipment designed to give users leverage for moving a resident without jeopardizing the body, Siegvardsson says.

The biggest issue isn’t just using the equipment, he says, “but using it properly.”

The key for resident transfer is correctly positioning the slide sheet underneath and letting the lift mechanism do the work, he says. For showering, slings and lifts can keep residents steady and secure.

Mobility’s lift and transfer chair, with its stainless steel frame and waterproof cushions, can be wheeled right into a shower.

The side-entry tub has become a common choice for resident bathing because it eliminates the lowering process, Harbaugh says.

“The lowering process is very scary for the residents, but was considered to be the best way to get the resident into a warm bath the quickest,” she says. “However, now with side-entry tubs, residents can either be transferred into the tub through the side door or walk in under their own power, which is much more dignified where applicable.”

It’s important to take away the challenges in bathing, says Lee Penner, president of Penner Patient Care.

He says his company focuses on resident safety for its spa tubs and includes various swivel transfers and door configurations for resident access. 

“We have made our units to be as easy to use as possible and built-in transfers have been designed to help residents access the bath, and they can be raised without the attendants having to bend, stoop, or lift,” he says. 

Though the need to “lower” a resident hasn’t been completely eliminated, Vucenovic says today’s transfer equipment makes lowering significantly easier.

“The resident needs to not only maintain dignity, but to feel safe,” he says. “The caregiver needs to be confident in the equipment — not so much ‘will it lift or lower,’ but confident in the relatively simple operation of it and greater relaxation for the resident.”

Randy Rosen, vice president of training for Drive Medical Design and Manufacturing, advocates for more training  — especially on new lifting and transfer models.

“Most facilities have moved from manual hydraulic patient lifts to the new electric powered lifts,” he says. “These lifts are designed to go lower and lift more weight without any manual exertion. There has been a lot of innovation in the manufacture of the sling that allows patients to be lifted more safely and comfortably.”

Redesigning safety

Now in its 60th year, Pressalit is working with architects in the design of personal bathrooms in large-scale facilities. Private baths are becoming the norm for new and renovated properties, such as a new 228-unit in Boston and a 250-unit rehab facility in Chicago, both Pressalit clients. In creating these new bathrooms, safety is paramount, says Gary Nowitz, president of Pressalit North America.

“Our priority is to individualize a bathroom according to each resident’s needs and acuity level,” he says. “Every bathroom has affixed fixtures, but every patient is different. We are able to create an environment for the resident and for the space allowed.”

Though bathrooms are part of a resident’s living unit, some are quite small and it is common to see bathrooms fashioned as “wet rooms” or “water closets” in which a resident can be bathed anywhere within the room. Wet room floors typically have a gradient slant with a trench drain for easier water removal.

“This design enables safer patient bathing, with less possibility of falling,” Nowitz says. “Our fixtures are adjustable and can be fixed to each resident’s size, weight and stature.”

Resident balance and weight distribution are critical to moving residents within the bathing domain, and something as simple as having weight-bearing grab bars in the right position can make transfers and positioning much easier, Nowitz says.

“Instead of being placed on the wall behind the toilet, there should be parallel support arms that the resident can use for balance and proper positioning,” he says.

Tub talk

Tub bathing is where the biggest equipment innovations have been made, Harbaugh says. For instance, a pipe-less whirlpool tub from InVacare eliminates the risk of cross contamination from improper cleaning. The pipe-less tub can be sanitized in less than half the usual time. It also prevents drain clogging from bath salts and oils, she says.

Rosen points to some new
tub features designed for safety and comfort. A tilting function and reclining contoured seat allow residents to be quickly immersed in warm water. A low threshold and wide side entry doors allow residents to sit comfortably and safely in a slightly reclined position.

There have been great whirlpool improvements in recent years, Rosen says, creating safer and more calming bathing. For example, hydro massage provides millions of preheated air bubbles to increase blood circulation, reduce inflammation and induce relaxation. Hygienic hydro valves and air jets are spring-loaded for back flow prevention to reduce cross-contamination, he says. 

A safer bath

Efforts to make resident bathing a safer process for caregivers and a more dignified and enjoyable experience for residents have been a priority for manufacturers, architects and facility operators in recent years. Among the improvements cited:

The addition of more personal bathrooms, creating more privacy and safety.

Adjustable fixtures that can be modified to each bather’s specific height, weight and stature. 

“Wet rooms” that enable showering and washing from various locations.

Electric lifts that reduce the need for manual lifting.

Side-entry tubs that foster easier and safer resident transfer and positioning.

“Pipe-less” tubs that reduce cleaning time and cross-contamination.

Stronger and more hygienic whirlpool systems that allow more comfortable and sanitary bathing.

Germicidal UV water purification that kills harmful pathogens during the bath, greatly reducing the risk of self-infection.

Source: McKnight’s Long-Term Care News interviews, 2014