Although it technically is considered custodial care and not directly paid by Medicare, bathing is a critical part of the overall care long-term care residents receive and expect. To some individuals’ surprise, improper or lack of documentation around the bathing process could indirectly affect payments, as well as lead to fewer referrals. Experts weigh in here on the important parts of bathing services.
1 While documentation doesn’t specifically affect payment, lack of it can hurt in other ways.
“While bathing is not directly tied to reimbursement, it’s directly tied to quality outcomes, which can translate into higher census, resulting in higher reimbursement,” stresses Jessie McGill, RN, RAC-MT, curriculum development specialist for the American Association of Nurse Assessment Coordination.
It begins with knowing what to document, says Mary Madison, RN, RAC-CT, CDP, clinical consultant, LTC/Senior Care for Briggs Healthcare.
“Staff members involved in bathing any given resident should be recording when that event happens, albeit it on a paper flowsheet or on an electronic point-of-care kiosk,” she says. “Documentation of bathing shows that it was done and how often.”
Madison cautions that surveyors will look at the documentation to determine compliance with the Requirements of Participation (RoP), as well as honoring the resident’s preferences and choice.
Timing is everything. According to Betty Bogue, president and owner of Prevent Inc., the resident’s bathing preference should be documented on admission, quarterly and with a change in condition.
“The method of bathing must be determined, and it is imperative that care plan interventions be communicated to all caregivers,” she adds.
After bathing is complete, caregivers need to note the proper reimbursement codes for ADLS— such as bathing — that require weight bearing.
“This coding should be audited routinely to ensure it reflects the care plan directives,” Bogue says. As Madison reminds, “the RoP speak to bathing in terms of resident rights, proper care, privacy, confidentiality and dignity — all under the umbrella of resident-centered care and resident preference.”
2 Begin with a good resident assessment.
Madison advises each resident be assessed upon admission and then at specific intervals throughout their stay. Their preferences and right to self-direct their life in the facility include bathing frequency, time of day, and type of bath (shower, tub, sponge or bed). The evaluation also should include preferences around type of soap products and any special needs, such as mobility support, adds Bogue. And always note functional equipment needs, as well as clinical challenges that could impede bathing, such as falls, open wounds, anxiety, skin conditions and weight, she adds.
“Creating procedures to support bathing provides residents with a dignified, comfortable and safe process,” Bogue adds. “A process for residents who require partial or total assistance should be established for undressing, transporting, and the number of staff needed.”
3 Don’t underestimate resident preferences.
“The resident-centered care plan needs to clearly reflect what the resident’s preferences are for bathing,” says McGill. “Many of the benefits that may come from bathing are directly related to them. Do they prefer a warm whirlpool bath? Would they rather take a nice shower? What is the preferred temperature? The resident-centered care plan should answer these questions.
But the team also must make sure that the resident’s preferences are well communicated to the staff who will be performing the bathing activity. The resident’s choices must be honored with each bathing experience.”
McGill reminds staff to include these preferences in the baseline care plan developed within 48 hours of each admission.
“Bathing for some residents, especially those with impaired cognition, is not always a relaxing experience. So, working on consistency and following the resident’s choices in the bathing process will be a very important component, and can lead to a much brighter outcome for the resident,” she notes.
4 Successful bathing requires an adequate workforce.
“Staffing should be carefully monitored to ensure there are enough people to meet the needs of every resident admitted to and living in the facility,” says Madison. “Some long-term care facilities have designated bath aides for full baths while others assign the bath to the CNA with responsibility for the overall care of the resident on that shift.”
Meanwhile, Madison adds, other facilities have adopted the Universal Caregiver model so the staff member does all kinds of services — “bathing, feeding, housekeeping, whatever is needed for resident care,” she adds.
Finally, Madison strongly advises administrators pay close attention to staffing when it comes to the requirement for the facility assessment, or F-838.
“If there are 100 residents in a given facility, for example, there needs to be sufficient and competent staff in place to meet those needs,” she adds. “If all 100 residents want a shower or tub bath each day, staffing needs to be available to meet those preferences.”
Mistakes to avoid
Failing to perform and document resident assessments concerning bathing within the first 48 hours.
Overlooking resident preferences for types of bathing (shower, tub, bed or sponge).
Not providing adequate staff, or failing to train staff on bathing equipment.