Senior Psychcare

SAN FRANCISCO - The bathing of nursing home residents who have dementia does not have to mean pain and distress for either the residents or the workforce, according to two consultants from Kendal Outreach who have produced a "person-centered" technique. "I have been a health professional for a long time, and it has always bothered me to hear those yells from the bathroom and to see the [certified nursing assistants] come out with sweat," Ruth Bish, a nurse instructor, said at the annual conference of the American Society on Aging. "And you understood it wasn’t very good for either one."

The consultants’ bathing technique is part of a larger campaign against the use of restraints that Kendal Outreach, a nonprofit arm of the Kendal string of retirement communities, is conducting along with government agencies in Pennsylvania.

Rather than a fight, bathing should be a pleasant experience for both the residents and their caregivers, stated Janet Davis, a local coordinator for Kendal. Yet many nursing homes still use restraints. "The bottom line is that to bathe a person against their will is mistreatment," said Ms. Davis.

She said that Kendal has been able to help nursing homes stop using psychotropic drugs to subdue residents with dementia for their baths. The key is to figure out why residents become irritated at bath time, said Ms. Davis. For example, the loved ones of one resident pointed out that the resident had worked as a teacher throughout her professional life and had the habit of taking a bath to relax when she came home in the evening. When the nursing home changed her bath time from early morning to evening, she no longer resisted.

Kendal consultants provided tips including:

--Privacy. A good number of residents feel uncomfortable removing their clothes in front of other residents or staff members, particularly those of the opposite sex. A measure as basic as hanging a towel over a resident’s lap can help.

--Temperature. Many bathrooms are cold. The caregivers, who are completely clothed, may not be aware of how cold the bare-skinned residents feel. Some Kendal homes have produced or bought ponchos that residents can wear to remain warm while in their baths.

--Attention. When two or more staff members work together to bathe a resident, they may end up chatting with each other, making the resident feel dismissed.

--Fearfulness of water. Some residents are scared of water. For them, a sponge bath may be the most effective solution.

--Diversion. Sometimes offers of ice cream or soft drinks can take a resident’s mind off whatever is disturbing about bathing.

--Language. If the terms "bath" or "shower" trigger detrimental responses, try euphemisms such as "let’s get ready for the day," "let’s get cleaned up," or "let’s get set to see your spouse."

--Respect. On the other hand, avoid talking to residents as if they were children, which can result in agitation. "There is research out there that the use of elderspeak, that singsong condescending tone, is really a cause for agitation," said Ms. Davis

--Dressing. For some residents, the activity involved in getting undressed, having a bath, then getting dressed again is strenuous. They might benefit from the opportunity to rest by putting on a robe after the bath, then getting dressed later.

--Coordination. Personnel will need to meet to anticipate problems and prepare tactics. Assigning a staff member - an individual with an enthusiastic personality, a flexible schedule, and excellent conversation ability - to organize bathing can prevent traffic jams and scheduling issues.

--Afflictions. Pay attention to residents’ disabilities. One lady with osteoarthritis screamed each time the caregiver raised her arms over her head because of the pain. "That was a really straightforward fix," said Ms. Bish. "Her loved ones got her some clothes that opened in the front."

--Appearance. Making the bathroom a pleasant place can go a long way when it comes to improving the experience.

The video clip "Bathing Without a Battle: Developing a Better Bathing Experience for Individuals With Alzheimer’s Disease and Similar Disorders, " a joint production of the University of North Carolina at Chapel Hill, Oregon Health and Science University, and EO Studios, shows the "person-centered approach" in action is available at www. bathingwithoutabattle. unc.edu