Raise Your Hand If You Want To Go To A Nursing Home To Get A Bath

Judy Seidmeyer, R.Ph., and Patricia Johnson, R.N.

No one, huh? Well the facts are simple: If you cannot address the basic living needs of an individual, including seniors, what is the choice?

As baby boomers are in their 60’s, many of them are facing not only the prospect of life in a nursing home themselves in not too many years, but many are currently facing the issue straight on with their parents. They want to make it possible for Mom and/or Dad to stay either in their own home, or move in with their baby boomer children. And in many cases, the bulk of their day-to-day needs can be met well by one or the other of the children or spouses being able to be there with the senior. And, care from agencies both public and private can be excellent. Food, medical attention, even housekeeping can be obtained, and even paid for, by Medicare and other programs.

The rub is bathing.

It is not that some bathing alternatives may be available, especially if you have money. You can do an accessibility re-model to a bathroom, or install one of the “walk-in” tubs. You have to own the house, though, and you have to recognize that the value of the house will not be increased, but will most likely be decreased with this type of re-model. If your parents are in their 80’s, they may not have the financial wherewithal to do a $25,000 re-model. And, baby boomer children may not want to make a permanent change to their house to meet their parents’ needs, especially when they see that the years remaining may not be long.

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AANLCP Bathing Article November 2010

So you want to have a normal life even though you have a disability? As they say, “What a concept!!” Unfortunately, for many individuals with disabilities, some activities that are just part of a normal routine for the able-bodied, such as showering, are not an obvious option.

If normalcy is the objective for life, just what defines “normalcy” when considering hygiene alternatives? Really, there are several criteria: Safety, Accessibility, Independence, Thoroughness, Consistency, Dignity, Comfort, and Health, to name a few. Let’s look at each of these briefly.

Safety is an obvious critical requirement. When we take a shower, we usually are able to first reach in, set the water temperature to make sure that we are neither scalded nor chilled, then walk in, stand while the water runs over all parts of the body, step out as soon as the shower is completed to get dried off and dressed.

But, if you are in a wheelchair, doing each of these can present safety concerns. Reaching into a shower stall to set the temperature can be a challenge. If you can’t reach the controls ahead of time, you may have to transfer into the shower stall or bathtub, then try to reach the controls. When you turn on the water, it may be too hot, or too cold initially, but what can you do to avoid being hit by the water? Not much.

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Bathing Changes from Pediatric to Adolescent to Adult

By: Judy Seidmeyer and Patricia Johnson
Care Giver Support Products

Kathryn was a 16 year old high quad, and weighed 130 pounds. Her dad had pulled his back out while attempting to lift her out of her wheelchair to put her onto a bench in the bathtub. He had dropped her more often in recent months, and she really hated even having him involved in her bathing. But, what choice?

Kathyrn’s story is not unusual. She was born with her severe disability. From the time she was tiny her parents bathed her and cared for her. But, as we all hope to do, she was getting older. And with that came new challenges, especially for families who cannot remodel a home.

Life care planning is difficult enough in defining all the different types of support devices that will be necessary, but when you add to that the complications driven by increasing age, emotional maturation, increased weight, as well as housing situation, you have challenges in getting their assistive environment defined for a whole lifetime.

Bathing is not the only issue that has implications and changed requirements with age, but it is clearly one of the riskiest for both the individual with the disability and their care giver. Safety needs to be paramount in determining the best short and long term solutions. The ideal situation is obviously one where no lifting or transferring is required. And, there should be no risk of slipping, or scalding.

There are safe bathing solutions, if re-modeling for accessibility is an option. Floors can be changed to allow for unobstructed wheelchair access, doorways can be opened to allow for even large sized wheelchairs to roll in, shower heads can be lowered to be within easy reach from a seated position, and tubs can be modified or simply accessed differently with special chairs.

But first, you have to be able to do the modifications, and for many people with disabilities, home ownership is not an option, so remodeling is clearly not possible. And even for those who do own their own homes, remodeling is expensive, and it tends to lower re-sale values when accessibility remodeling has been done. And, if you are doing the remodel to care for an adolescent or young adult who may want to move away from home in a matter of only a few years, this becomes a less than ideal alternative.

In addition to safety, bathing effectiveness needs to be a real concern. Spongebathing is probably the least effective for maintaining skin health and basic hygiene. But far too many individuals see this as their only real option. For some, a sliding chair into a bathtub can work, but if there is no caregiver assisting, slips, falls, or even scalding can be real issues when reaching for the controls of the tub.

And not to be overlooked is also the emotional challenges of sub-optimal bathing alternatives. Whether it is as simple as sheer embarrassment, as with Kathryn, of having someone else lift your naked body into a tub, or the social ostracizing from poor hygiene or catheter accidents that cannot be cleaned up in a timely and thorough manner, the net result is an emotional toll that able bodied individuals who can shower do not have to face.

All of these issues apply to individuals with disabilities of all ages, and their caregivers. But let’s talk primarily about the added complications of children, who have a habit of growing up! And with that aging process, their bathing needs and alternatives change too.

A tiny child with even a serious disability can be bathed in manners not that different from that used with able bodied babies. An adult can usually hold the baby, or put them into a small sink based bathing pan, and do everything necessary. Neither safety nor effectiveness need to be issues.

As the child becomes a little older, bathtubs can still work fine, as long as the caregiver is strong enough to lift the child into the tub, hold them carefully, and still wash them thoroughly to keep their skin adequately rinsed with water to maintain health.

But when the child becomes larger, lifting becomes more of a risk factor for both the child and the caregiver. Bathing positions may become problematic, especially for children who may require some degree of tilt to enable proper breathing, such as a child with cerebral palsy. Now how does the caregiver manage the transfer, maintain the proper positioning, adequately perform the bathing, and ensure that no problems occur. With a 100 pound plus child who may also be growing in height to five feet or more, simply handling and maneuvering can be a major challenge.

And, then, as with Kathryn, there become issues of simple dignity and lack of embarrassment in having to be handled so much just to be kept clean.

Not to be forgotten also is the potential for change in the health condition of the child with a disability. Whereas the physical condition may improve with age, as we all know, too often the years are not kind and physical disabilities tend to worsen rather than improve. So even if a bathing solution may work early on, decrease in strength in combination with increase in size may force a whole new bathing alternative.

So what choices really exist? Until a few years ago, there were few alternatives for the individuals with disabilities, or for their families. Small children were simply lifted into sinks or tubs for bathing, young adolescents were lifted by the stronger family members into tubs, or given spongebaths, and then as adults the options really became only spongebaths. In recent years we have seen the development of slides for bathtub access, which can work provided a transfer is possible without difficulty, and provided that the individual can either reach all bathtub controls from the bench, or have a caregiver who can assist.If controls are not reachable, though, either falls from attempting to reach the controls, or scalding from lack of access to the tub controls can occur.

“Walk in” tubs are being heavily advertised right now as an alternative. But these do present a few challenges as well, such as the need to be able to walk in! And once in, the person to be bathed needs to sit waiting for the tub to fill, then bathe as they would in any other bathtub, but have to wait, wet and cold, while the tub drains sufficiently to allow for egress from the tub.

Again, not a bad option, but when you consider that people with disabilities, especially severe disabilities, tend to be at greater risk for contracting diseases, this is not always ideal. And, as stated above, they are for people who can walk in, which is clearly not the case for many who have disabilities.

Approximately five years ago, a portable shower alternative was introduced. While this solution is not perfect either, it presents some important advantages. It is safe for both caregiver and patient, since no lifting or transferring is required. Bathing is done right in the wheelchair. It is effective, because adequate water can reach all body parts and help ensure that “spongebath disease”, or aeruginosa folliculitis, does not occur due to soap residue buildup, or simply bacteria that cannot be washed away. Water temperature can be set at the faucet before beginning the shower so scalding is not a concern. And, because the portable showers for accessibility are built to enable a caregiver to reach in to assist without having to actually get into the shower, the experience is much more pleasant for both the caregiver and the person receiving the shower.

And, because the shower is portable, no modifications need to be made to the house. This alternative works well for renters, for individuals who live in mobile homes, or for families who are serving as caregivers but do not want to alter their homes for accessibility.

For children, there are alternatives, but it is important to recognize that as they age, their mix of alternatives may change. So from a life care planning perspective, finding solutions that can work for the entire life span are clearly ideal. While a remodeled home is great, even that may not be as desirable, as solutions that can work at all ages, can be transported to different locations, or even to different homes over time may be preferable.

When the child becomes an adult, and with luck is able to move out and have a home of his or her own, and can make the decisions for their own situation, it is incumbent upon the caregivers and the life care planners to provide a good solution during the growing years. The best news is that this is now possible for a fraction of the cost of remodeling, and can make spongebathing a horror of the past!

To finish this story, let me tell you about Kathryn now. She has moved from her parents’ rented home into her own apartment. She took her portable shower stall with her and she is able to handle bathing all by herself. She graduated from high school and is now in college with plans to become an attorney representing the needs of individuals with disabilities. And she will tell you that the way she feels now is very different! She no longer feels like “a piece of meat being handled by her parents.” She is now just a lovely, healthy, sweet-smelling, happy young woman.

Tammy's Team