Workforce shortages continue to challenge skilled providers in many areas, and patient bathing isn’t exempt. In spite of all the disruption, however, COVID-19 has revealed the resilience of staff and patients. It also has opened many eyes and minds about approaching daily long-term care routines, such as bathing, with great creativity and flexibility.
1. Be mindful of acceptable practices as a guiding light.
Continuity is essential for resident comfort and privacy, said Mary Madison, RN, RAC-CT, CDP, clinical consultant for LTC and senior living at Briggs Healthcare.
“The importance of consistent staffing applies to bathing as well,” she said, adding that many facilities try to maintain a dedicated group of bath aides. “Residents need to feel comfortable during this very vulnerable activity.”
When that’s not possible, consider transitioning from a department-based to a team-based approach. Direct care staff have a more central role in directing that care, according to Patricia Howell, RN, BSN, WCC, CFCS, clinical support manager for McKesson Medical-Surgical. Another approach is to hire home care agencies to fill gaps.
“Some can be enlisted to schedule resident showers on a specific day each week,” Howell said. “I’ve also heard of nursing homes hiring non-traditional staff such as medical assistants to perform vital signs and lighten the CNA load for things such as bathing.”
2. Consider accepted workarounds and “shortcuts.” This could include retrofitting for walk-in tub/shower systems to improve safety and require less staff time for highly mobile residents.
“Nursing staff should be aware that patients/residents have varying preferences, and it is important to incorporate the patients’ preferences in the development of bed-bath practices,” Howell said. “Sometimes the staff may have to negotiate with the patient when the requests are too time consuming or not practical.”
Howell noted a recent study showed a “disposable bed-bath method” was performed in less time by fewer nurses, and was more cost-effective than traditional methods.
3. Make prudent use of accessories and tools.
The industry continues to innovate when it comes to streamlining bath care in long-term care environments.
According to Howell, safer alternatives to basin baths include disposable, no-rinse bath wipes; bathing gloves; and a waterless, leave-on, skin compatible bathing system.
Even when bath and shower times are more stressful due to staff shortages, providers can ease stress by making the area less institutional. Incorporate features including walk-in tubs, soft lighting, warmer temperatures, music, comfortable floor mats, and towel warmers, Madison recommended.
4. Remain vigilant.
Diminished staffing can be a recipe for bathing hazards that could cause patient, and ultimately, institutional harm.
For example, regular use of bath basins with water and soap can potentially become contaminated with nosocomial pathogens. The infamous “bathtub ring” also can occur around the rims of plastic basins. McKesson’s Howell strongly urged infection preventionists to monitor this equipment.
“Unvaccinated residents must be protected so masks — or better, face shields — will need to be used by both the resident and the bather,” said Madison. She also called for more frequent cleaning and disinfecting.
“New staff should also not be involved in bathing until they’re received their first dose of the (COVID-19) vaccine and follow all specific mitigation and PPE policies.”
Madison discouraged assigning bathing responsibilities to staff with vaccine exemptions.
5. In light of workforce challenges, family members can play a role in assisting at bath time.
“I have seen family members assisting with feeding, shampooing and styling hair and providing personal care, including toileting and assisting with brief changes for those who are incontinent,” said Howell. “That said, it is important that the family provide safe care and receive training for any equipment that is needed to provide the care.”
Madison, however, strongly warns against allowing any non-employee to operate bath lifts.
“There’s liability to leaving a resident with a family member in the bathing area without staff supervision,” she said, stressing the importance of providing a call button to alert staff in the event of trouble.
