Rough waters: rethinking bathing in long-term care

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Rough waters: rethinking bathing in long-term care
Rough waters: rethinking bathing in long-term care
To fully understand how the simple process of bathing affects long-term care facility residents it's important to walk—or more likely slip—in their shoes.

Just think about how this activity, one that able-bodied people require privacy to perform, becomes an exercise in embarrassment once a caregiver enters the picture.

That is why facility operators need to pay even closer attention to how this routine is carried out, and whether it is being done in a manner that minimizes the emotional dread that residents may experience, according to experts. 

Thankfully caregivers are becoming increasingly sensitive to the dignity issue, according to bathing and lift equipment vendors.

“Progressive long-term care facilities are carefully examining ways to make life better for their residents and are making changes that ensure a more individualized and more home-like, less threatening atmosphere,” said Pat Krushen, director of online sales and marketing for Ituna, Saskatchewan-based Safety Bath. “Facilities find that residents who experience [dignified] bathing are happier and feel like they have some independence and control over what happens to them.”

The challenge for ambulatory people—who typically take their mobility for granted—is understanding how a seemingly simple activity like bathing can be a tremendous challenge for someone with a physical or mental limitation. Taking a bath or shower in an area that is not handicapped-accessible is a virtual minefield of hazards: slippery floor, high thresholds, a lack of weight support and a risk of scalding or chilling, among others. 

Like caregivers, bathing and lift companies are becoming attuned to the frustration, shame and despair elderly people may feel, and that has been reflected in contemporary product design.

“There have been instances where obese patients weighing 600 lbs. or more have been placed on the floor and squirted with a hose,” said Rick Rickman, director of sales for Nashville, TN-based AquaBath. “That is what inspired us to create a bariatric-grade bathing system.”

Krushen said it's no wonder why residents feel fearful, embarrassed and exposed when caregivers don't show the utmost concern for their safety and privacy.

“There have been incidents where clients have been scalded in the bathtub or have been left alone,” she said. “Some residents get the chills while waiting for water to fill or drain. And the experience of being lifted high in the air to enter a bathtub is frightening to the point where some residents experience panic attacks.”

Walk right in

Manufacturers offer suggestions on equipment and practices caregivers can use to help improve the bathing experience. They include: using higher tub sides  and wrap-around curtains to ensure greater bathing privacy, and explaining carefully the lifting process to residents who need lift support. This will help residents feel more at ease. 

Safety Bath focuses on walk-in bathing systems, where residents can enter the tub without having to climb a threshold or being hoisted with a lifting device. The walk-in bath has a low- or no-threshold entry point where users can enter independently or with minimal assistance.

“These tubs are particularly suited to patients with dementia or osteoporosis,” Krushen said. “The bather can have a towel or short bathrobe draped over the shoulder until seated—this way, there is no embarrassing exposure. The height of the bathtub also obscures the caregiver's line of sight. While the bather must never be left alone, dignity and self-esteem have been preserved.

Making it accessible

Compliance with the Americans with Disabilities Act requires that 10% of showers and baths be accessible to wheelchairs, though building engineers recommend that skilled nursing and acute-care facilities offer a even higher percentage. 

“It's pretty obvious that more than 10% of patients in a nursing home or hospital will have some sort of temporal impairment,” Rickman said. “A four-inch threshold is low enough for just about anyone to navigate, and strategically placed grab bars and an appropriate seat also allow for an easy and dignified access. An ADA-compliant unit also should have enough space to maneuver a wheelchair easily within the enclosure.”

The walk-in (or “wheel-in”) concept is especially helpful for the bariatric resident— someone who is morbidly obese (more than 100 pounds over ideal body weight), Rickman said. AquaBath developed its bariatric-grade enclosure specifically for residents with large body mass, with extra width and depth to facilitate entry and a special heavy-duty seat tested to 2,500 lbs. in static-load tests and 1,000 lbs. in impact tests. Besides constructing an enclosure that withstands seat pressure, the bariatric model also includes a concrete, non-shrink type of grouting underneath the structure for extra support.

Expanding dimensions

Though still very much a “niche” specialty, bariatric versions of medical products are considered by industry observers to be a hot growth area in manufacturing. Because of America's obesity epidemic, there is a growing number of individuals within the elderly population who are larger and heavier than in the past. Consequently, they are requiring more durable, reinforced equipment. In the past few years, various manufacturers have developed entire lines of bariatric products for bath safety fixtures, mobility equipment like scooters, wheelchairs and walkers, support surfaces and even therapeutic apparel like compression hosiery.

“We feel this gives the marketplace an option that has not been available before,” Rickman said. “It is a dignified bathing atmosphere for the bariatric resident. We have not offered this enclosure before and it is perfect for facilities that are creating special bariatric care wings.”

Rickman says his company is merely responding to feedback from facilities about needing equipment to handle larger-sized residents.

“Our field reps talk with architects, along with plumbing and mechanical engineers, and they all verify the need for bariatric bathing products,” he said. “While this isn't a huge part of our business yet, we believe it will grow in the future.”

Lifting's safety role

While a resident may prefer to use a walk-in enclosure for bathing, the lifting process is still necessary for many in the bathing process, especially from a safety standpoint, notes Joyce Moraczewski, marketing coordinator for Pine Island, NY-based SureHands Lift & Care Systems. 

“As clients age, the use of equipment such as patient lifts becomes more prevalent in facilities, not only to ensure the resident's safety, but also for the safety of the staff caring for these residents,” she said. “For staff specifically, it is essential that they not injure themselves when transferring a resident into a shower, tub or commode.”

As a result, the responsibility of making the resident feel comfortable falls squarely on the caregiver.
“Residents may be reluctant to use equipment such as a lift if they are unfamiliar with it, but if the staff are competent and able to convey the increased safety involved, residents generally feel much better about being transferred,” she said. “One common mistake that can cause an accident is not involving the resident in the lifting process, either when using equipment or not. Lifting a resident incorrectly can cause serious injury—either a back strain, a slip or a fall.”

Skilled-nursing facilities not only face the challenge of not having enough safety equipment, but also not having the right equipment to transfer their residents, Moraczewski said. Therefore, she said, safe lifting methods should be a comprehensive part of a facility's overall safety policy.

“Most injuries to staff are going to occur during the bathing and lifting process,” Moraczewski said. “But there are a number of ways that having the right equipment will bring a pretty immediate return on investment.” 

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