No bigger safety and liability concern in senior living exists than the bathing process. The potential for an accident is greatest at the points of entry and exit from the tub or shower — a situation that is stressful for both residents and staff members. Besides being a safety hazard, the bath time experience can also present anxiety and dignity concerns for everyone involved, experts say.
The rate of falls in senior living remains at a high level, and a substantial portion occur on the slippery surfaces of the bathroom, according to research from the Journal of the American Medical Association and the National Center for Injury Prevention. Among the numbers:
- 50% to 75% of residents fall annually.
- 30% of residents experience falls within the first 48 hours of moving in.
- Fall-related injuries account for up to 15% of rehospitalizations in the first month after discharge from the hospital.
- 34% of male and 25% of female residents who fall with a fracture injury have a one-year mortality rate.
It all adds up to a call for vigilance and security on the facility operator, with part of the responsibility also shared by manufacturers of bathing equipment. Hillary Marshall, Joerns Healthcare's global product manager, patient lifting and repositioning, concedes that bathing issues are ongoing and that operators can address them with a healthy dose of empathy.
“It is important to know not only residents' physical capabilities, but also their comfort levels,” she says. “Dignity and comfort are also important. While it is easier to undress residents in their rooms before wheeling them to the bathing suite, a robe or covering does not always provide a level of discretion for them. The comfort issue concerns how cold residents can get if they have to stay in the tub while the water drains.”
Operators also need to consider the effect on staff and how to best use them on a case-by-case basis, says Tiffany Rayback, vice president of operations at MasterCare Patient Equipment.
“Staff may have difficulty getting individuals into and out of the bath if it doesn't meet the level of care needed for that particular individual,” she says. “Most tubs can be used by most individuals, but some are better suited for different levels of care. To make the process safer, there should be a care plan for each individual, and if necessary, assistance from other staff to get the individual into and out of the bath safely.”
Dementia an issue
Although physical limitations should be a prime focus, cognitive impairments also are significant — especially because they are not as obvious, says Carolyn M. Gatty, regional clinical director for Genesis Rehab Services.
“Because people are living longer, the population of cognitively challenged residents is growing, and their conditions need to be addressed,” she says. “Even if they are physically intact, as the brain deteriorates, it impacts vision, movement and perception so that information can be misinterpreted. So it is essential that caregivers do everything possible to convey every step of the process to the residents so that they don't get confused and act out.”
To help caregivers understand the challenges of dementia residents and develop bathing techniques that correspond with a more comfortable experience, free online training is available through Bathing Without a Battle.
The training program is based on a 1997 research project conducted in North Carolina and Oregon that explored ways to make bathing a more pleasant experience for both residents and staff who live and work in seniors housing and other settings where people need assistance with bathing. It provides practical, relevant information about how to easily and safely adapt the bathing process to meet the needs and desires of residents, particularly those with dementia.
The techniques explained in the program instruct bath attendants on how to respond to resistive behaviors such as hitting, biting and yelling. Following these methods can help reduce stress and anxiety in the bathing process, program trainers said.
Easing the transition
The critical entry and exit phases of the bathing process are where most problems occur, and having the proper equipment can dramatically reduce the number of injuries during these junctures, bathing specialists said. Among them are lifting devices, which range in size, shape and function.
The ceiling lift is a stalwart in transition assistance. Installed in bathing areas, the lifts are ideal for tight spaces and are designed to transfer a resident from a wheelchair or chair into the tub with ease. They also can work for tubs with side doors because bathers can be lifted from the water and wrapped in dry towels before they have a chance to get cold.
Because ceiling lifts eliminate the need for residents to stand on their own, they minimize the risk of sliding on a slick surface and the anxiety that accompanies the fear of slipping. A variety of track and accessory design solutions can be customized to fit any setting, and the sturdy appearance of a ceiling lift affixed to the building's structure can bring residents comfort and ease.
Mesh slings also are compatible for use with ceiling lifts in bathing suites, providing rapid draining and drying, and Joerns offers them in several sling styles, Marshall says.
A sit-to-stand lift can be another solution. For residents who have some trunk and leg control, sit-to- stand lifts are designed to improve their dignity and comfort, and they encourage or prolong mobility and independence in performing activities of daily living.
“Instead of wheeling residents to the shower or bathing suite with a covering, residents can arrive at the bathing suite fully clothed and use a sit-to-stand lift while the caregiver undresses the resident,” Marshall says. “The lift can be placed near a shower chair so the [resident] can be easily positioned for bathing. And since the bather's feet are placed on the lift's foot pad, they do not come in contact with a wet floor.”
Penner Patient Care has approached the transfer system in a different manner. Instead of elevating the bather during the transition, the Penner system enables the transfer from a wheelchair to the tub chair at the same level — 19 inches off the floor.
“Senior living communities are looking for a transfer system that promotes safe [resident] handling,” says President Lee Penner. “This swivel system reduces transfer risk while also relieving back strain for bath attendants.”
Reducing falls related to slippery surfaces requires removing water and keeping the environment as dry as possible. Some tub models have casual water drains to reduce the amount of residual water that ends up on the floor, Rayback says.
Accessibility is paramount as well, she adds, recommending tubs with wider door openings, integrated seating and readily available grab bars, to minimize risks.
Slick surfaces also can be remedied with non-stick strips, resins, placemats, “and if all else fails, slip-resistant footwear for bathers and attendants,” Gatty says.
Even with all the attention being placed on making the transition process safer and the tub or shower experience more enjoyable for residents, a certain percentage of the senior living population always will be resistant, physically unstable or constantly cold. Gatty recommends that alternative options be given to residents who simply cannot be bathed in a conventional manner.
“I think bath time should be eliminated for some residents,” she says. “For them, there should be a waterless bathing option, where they could be washed in bed, with no rinsing necessary.”