Long-Term Care Survey Alert

Surveyors will be looking for 'person centered' bathing.

If you think suds and a regular tub or shower bath are a must to get residents really clean, you may be setting your facility up for poor outcomes and F tags for residents who combat the bath.

Nursing facilities wash frail elders twice a week with soap and water and then apply all this lotion to lubricate their skin, notes Diana Waugh, RN, BSN, of Waugh Consulting in Waterville, OH. Not only that, but the way nursing homes bathe residents agitates residents with dementia, she notes.

In nursing facilities, we got locked into thinking there are only two ways to bathe a resident--in a shower or the tub, comments Joanne Rader, RN, MN, of Rader Consulting in Silverton, OR.

Yet the findings of a classic study performed by Rader and her research cohorts found that residents with dementia who received a comforting towel bath in bed using no-rinse soap were just as clean or cleaner than residents who received typical, traditional showers.
To reach that conclusion, the researchers examined the skin of residents in the towel bath and traditional shower groups. "We looked at the residents' axillary and groin areas for debris--and cultured their skin looking for odor-causing bacteria," Rader tells Eli. The residents who received the towel bath also had better skin condition than those who'd received traditional showers, Rader adds. "Their skin was less dry and flaky," she says.

Reduce Agitation, Aggression

The towel bath also provided an alternative to bathing residents who became agitated or frightened by a shower or tub bath.

In a follow-up study, researchers found that when nursing assistants learned various bathing options to provide "person-centered" bathing focused on promoting residents' comfort, they reduced resident aggression during bathing by close to 70 percent. Using that approach, CNAs "also reduced residents' agitation by around 50 percent--and significantly reduced residents' discomfort," reports Philip Sloane, MD, MPH, one of the researchers performing the study and professor of family medicine at University of North Carolina at Chapel Hill.

And the person-centered bathing did not increase the time associated with bathing. Sloane notes that in many settings, staff bathe residents in a hurried manner that causes everyone anxiety and agitation. "We're not really convinced that making bathing go even faster is better for anyone," Sloane says. "It's better to have a resident get one relaxing, thorough, pleasant bath a week than two hurried, unpleasant baths a week."

In the study performed in 15 nursing facilities in North Carolina and Oregon, CNAs learned to view resident behaviors as reactions to unpleasant things, such as getting cold. "We'd wrap the resident in warm towels immediately after the bath--and at times we'd wrap parts of the body that we were not directly bathing," says Sloane. The research team also padded the seats of the shower chairs "and, if the person was short, we'd get them a foot stool," he adds. "We taught the caregivers to converse with the resident about things the resident is interested in, as a distraction" during the bath. Researchers also taught staff to avoid spraying water in the resident's face.

Shampooing requires individualized approaches to make it more comfortable for residents, says Sloane. "In some cases, that meant sending the resident to the hairdresser for a shampoo. In other cases, we would put a washcloth over the person's forehead to block the water from running into the person's eyes."

Free abstract: The study, "Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial," is the culmination of a10-year series of studies aimed at reducing agitation during bathing persons with Alzheimer's disease. Read the abstract for free in the Journal of the American Geriatrics Society (November 2004) at http://www.americangeriatrics.org.

Resource: You can order an educational CD-ROM and video to train staff in person-centered bathing at www.bathingwithoutabattle.unc.edu.