Bath Time: The Challenges of Personal Care

Posted by Allan Tear on July 15, 2008

There's a lot of bathroom talk in the nursing home. Though today's generation of elders is a fairly discreet bunch, you don't have to go too far into a conversation about daily life without some mention of the toilet or the rigors of personal care. Maintaining dignity as an elder who needs assistance is tough, and never tougher than during a visit to the bathroom to use the toilet or to bathe.

In Tockwotton, one of my favorite room visits was the first floor nursing home bathroom, which the residents took the initiative to re-decorate. In the middle of this fairly institutional environment, behind a fire-code rated metal door, is a room out of place in its hominess. Burgundy wallpaper is complemented by a country-themed border. Wall hangings and paintings soften the hard angles. Though the standard institutional ADA compliant sink and toilet occupy the center, the rest of the room has been transformed into a reminder of a life when the residents were in control of the space around them. 

Although the room is very pleasant, fundamental problems remain. The toilet paper dispenser is behind and to the side of the toilet, out of the bending-and-reaching capabilities of any elderly resident. The toilet itself is uncomfortable and difficult for elders to clean themselves on their own. The care giving staff has created makeshift solutions for these problems, like looping the toilet paper over the handrail so that it is within easier reach of the resident. 

At Tockwotten home, the shower room is in a separate room and has serious issues flaws in its design. In a long room with a constrained entry way, the shower area must share space with dirty laundry and miscellaneous equipment. The experience leaves much to be desired. It is sparse and utilitarian and all residents uniformly dislike taking showers. It is important to note that the quality of the shower room is just one of many reasons why bathing is a stressful experience of the residents. The very experience of the “assisted shower” leaves most residents wary of the shower and our team learned that most residents work hard to avoid the shower. Although this is difficult terrain to cover with the residents, the team has found that conversations about personal care are possible if handled appropriately. Care givers and family members are also rich sources of information about the special challenges of personal care for the elderly.

For elders in care, a bathroom visit is rarely a solo affair. For most of us, showers and toilet visits are taken for granted, and we can't imagine the loss of independence and dignity that comes with having to rely on another person, perhaps a stranger, to complete the most fundamental of bodily functions. Nursing home residents dread showers, and the "shower schedule" is one of the most discussed topics of personal care among the caregivers. Trips to the bathroom are a point of significant stress and transition. Accidents in the bathroom must be carefully avoided and it is a fragile balance between allowing residents some level of autonomy in the bath and shower area while keeping them safe from falls or other bathroom-related accidents. Improvements in design to this area could significantly improve resident experience while giving caregivers a deeper sense of security that resident autonomy in the bath will not lead to and increase in accidents.

In 2004, Americans spent nearly $24 Billion in building or renovating home bathrooms, and the room has gone from being the forgotten corner in the house to being a prime stop on the tour (along with the kitchen). Its striking to go from the world of garden tubs and mosaic tiles to a nursing home bathroom, especially since the experience of the users of that space are so much more significant than my own. Besides being a place where individual dignity and independence are preserved or destroyed, they are also environments where dangerous falls occur, and infectious bacteria are washed away (or flourish). We shouldn't leave the task of rethinking the nursing home bathroom to a group of elderly residents and a couple of rolls of wallpaper.