Editor’s Note: The online version of this article has been tweaked to provide further clarity.
As a small, independent rehabilitation and long-term care facility, Burgess Square Healthcare can’t afford to throw money down the drain in pursuit of trends.
But the 143-bed community in a Chicago suburb sank a $40,000 state grant into two spa-like areas where patients can receive individualized therapy for lymphedema or get a mood-lifting massage in a serene environment.
With just a handful of en-suite baths, officials also updated the new, non-slip shower flooring and invested in specialty shower chairs from Joerns Healthcare to ensure patients with significant weakness or lack of trunk strength can still enjoy bathing.
At any given time, only about five residents might be assigned in-bed bathing out of medical necessity or because a shower or tub soak would cause discomfort. The rest are transferred regularly to shower rooms with as much equipment or staff assistance as needed.
Patient and family expectations around bathing — and the cleanliness and comforts it provides — are rising. Burgess Square co-owner Mike Hensley says providers should be preparing to make near-daily showers and baths standard for all but extreme cases, even as debate over when and how best to offer in-bed washes continues.
“When I first started working, the generation in the nursing center (only) had Saturday night baths growing up,” says Hensley. “Now, they’re used to taking baths and showers every day.”
It’s not surprising that bathing is a major area of focus in long-term care. It’s time-consuming and potentially dangerous for staff and patients, yet critical to patient hygiene and well-being.
Studies show that need for bathing assistance increases a senior’s odds of being admitted to a facility in the first place, says Megan L. Multanen, senior sales officer with Bestbath.
“The development of a bathing disability is often the first thing that occurs as individuals need more help with activities of daily living,” Multanen says. “Every individual is different. There is no one-size-fits-all bathing adaption.”
Decisions abound. In-bed or in-bathroom cleaning? Shower or tub? Lift or no lift? Water-based cleaning or disposable wipes?
Caregivers need to ensure they use a bathing safety assessment that is tailored to the individual and their own specific needs.
Joerns Healthcare Prevent, for example, helps caregivers determine safe patient-handling products based on population and staff needs and provides specific handling techniques to match specific conditions.
“Because the bathing process introduces more risk factors — such as wet, slippery surfaces, an environment that may be less familiar to the resident, and possible discomfort — proper staffing and equipment are even more critical,” says Hillary Marshall, Joerns Healthcare’s global product manager of patient lifting and repositioning.
It’s ultimately up to staff to make the call on who to transfer and who to clean in their room.
For certain patients, such as those with open surgical sites or doctor’s orders against baths, the decision to provide in-bed baths remains a wise one.
At Burgess Square, staff use washcloths, towels and McKesson brand disposable wipes for those residents.
A 2015 advisory from the Agency for Healthcare Research & Quality found no clear-cut winner in the bath basin-versus-disposable wipes debate, partly because of a lack of evidence-based literature.
But the clear finding is that caregivers need to ensure any basins used are disinfected with germicidal wipes, assigned to specific residents and discarded if damaged. Disposable wash-basin liners also are an option.
Bathing is critical for its ability to remove sweat and germs from the skin’s surface, but ATI Nursing Education warns bathing too often can be dangerous for bed-bound patients because of its drying effects.
Plus, moving a patient side-to-side for access to hard-to-reach places can be risky for staff. It also opens facilities up to liability, a fact Accessible Systems points out in marketing materials for its Adjust-a-Sink system.
Matt Jante, Direct Supply’s product manager for bathing, lifts and textiles, says many states are moving toward a “zero-lift” policy, meaning staff members are required to use slide sheets or mechanical lifts to reposition patients even when shifting them in their own bed.
Tubs are a particular point of emphasis for Direct Supply, which has seen many facilities shifting from the use of shower gurneys to rapid-fill reservoirs systems and front-door entry tubs that accommodate patients with mobility issues. The front-entry tubs also allow caregivers to maintain eye contact while offering some patient privacy, a plus for dementia patients or others with cognitive issues.
Penner Manufacturing offers clients a way to make its open-concept and reservoir systems even more accommodating for patients with memory loss by incorporating television and DVD in two unit types. Facilities that opt for the DVD player can ask families to create a memory-packed video that entices patients who might be otherwise be agitated.
“The bath attendant can go up to ‘George’ and say, ‘Let’s go see that Fourth of July picnic,’ ” says President Lee Penner. “He sits there for 15 minutes, and, oh, by the way, he’s had a bath too.”
Penner says he’s seen the technology make bathing a soothing experience rather than a chore to complete.
The bathroom is no exception in the push to make facilities more homelike, but a resident can’t get the comfort of a tub soak if he or she can’t get there and stay there safely.
Designers and manufacturers are becoming more adept at making bathrooms accommodating for more people with more acute conditions.
Shower chairs are no longer restricted to PVC contraptions, tub entries are safer (and more reassuring to leery bathers) and rooms may soon be able to instantly reshape themselves to best suit the residents who enter.
“The innovation is the intelligent bathroom itself,” says Gary Nowitz, president of Pressalit North America. “All of us are different. All of us are taller, shorter or weigh more than someone else. That requires customization of the space.”
Once known for its toilet seats, the company is becoming a presence in the flexible toilet, sink and shower chair market.
The company also is in research and development on a Bluetooth enabled system that would make equipment in shared bathing suites adjust instantly to a patient’s pre-programmed settings.
Nowitz notes, also can help older facilities make more efficient use of tight spaces, in some cases making the difference in meeting the ADA-required 60-inch wheelchair turning radius.
New lifts also are welcome in tight bathroom spaces, with ceiling-mounted options taking up a “much smaller footprint,” according to Direct Supply’s Matt Jante. They offer fall prevention and staff protection, while some models in the marketplace can lift 625 pounds, making them an option for bariatric patients who might have previously been washed in their beds.
Direct Supply increasingly provides lifts to clients that have one or two shared tubs per wing. Used in combination with transfer benches and raised toilet perimeters, the bathroom can remain a fully useful space even if a patient is in decline.
“It is important to understand residents’ insecurities as well as their physical limitations,” says Joerns’ Hillary Marshall. “Ceiling lifts, which lift residents from the water, enable caregivers to immediately wrap dry towels around residents while they are still over the tub, greatly improving their comfort and satisfaction and minimizing the surfaces that become wet.”