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Better bathing for larger residents

December 4, 2013
by Sandra Hoban, Managing Editor
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Bathing is an invigorating way to start the day and a pleasurable, relaxing way to encourage good sleep. However, people with bariatric issues require special care and planning to ensure their safety and dignity.  The Centers for Disease Control and Prevention (CDC) considers anyone with a body mass index (BMI) of 30.0 and above.

But can a long-term care (LTC) facility that isn’t dedicated to the bariatric population provide the same bathing care and comfort as a facility that is?

Mark Godfrey, vice president of business development at Apollo Corp., notes that residents weighing up to 400 lbs can be cared for in a standard facility.“Planning to care for obese residents is an organizational decision. Today, facilities are being built with larger bathing areas and larger doorways,” he says. These design trends have improved the ability to provide a comfortable and safe bathing experience for the resident and the caregiver, he adds.

Jim Bollinger, national sales manager for Aquatic Bath, says there are no standards for bariatric bathing design. “Right now facilities have to meet Americans with Disabilities Act (ADA) design standards. While its recommendations are not compulsory, the Facilities Guidelines Institute offers guidelines to architects in designing bathing areas or individual bathrooms. For example, they indicate that floors should be able to support 300 pounds.” While bathroom floors are generally reinforced with concrete underneath, he believes the load allowance should be higher, especially if the resident and caregiver are working together.


Whether in a tub or shower, caregivers must pay particular attention to proper cleansing when bathing a person who is extremely overweight. “The challenges of providing a complete bath may vary given the health of the resident and the equipment available,” says Jennifer Humble, RN, a representative of Standard of Care, Inc.

Skin folds are a big problem because the area beneath the fold provides an ideal environment for bacterial growth. “Bacteria flourish in this warm, moist environment,” Godfrey explains. “The resident risks self-infection as bacteria enter the body either through a normal path or a crack in the skin.” Some facilities employ bathing tubs with ultraviolet (UV) purification systems to combat bacteria, he adds.

Water purification reduces the risk of self-infection. “One technology is UV purification. Water circulates through UV tubes to destroy bacteria and return clean water to the bath,” says Godfrey. He notes that UV technology can reduce the risk of urinary tract infections by 50 percent and respiratory infections by 35 percent.

Humble emphasizes that safety is the number one priority when transferring bariatric residents. “Transfers should be kept at a minimum, and devices like a transfer glide system promote safety for the resident and caregiver.”


The shower. The resident’s preference of one bathing method over another should be respected, if possible. “Bathrooms in resident suites generally have showers, and if a bath is preferred, that equipment is installed in a larger bathing room in the facility,” Bollinger explains. “Showers take up less space and have a low threshold (about ½”) than an in-room tub, making it easier for the resident to transfer to a shower chair,” he adds.

Converting from tub to shower provides more room in a resident bathroom for navigation, according to Bollinger. Safety is always a first concern. Tile might look nice in a bathroom, but it can be a sanitation hassle. Bacteria can build up in the grout, and tile requires a lot of regular housekeeping maintenance. “To eliminate this problem, many manufacturers offer simulated tile that provides the ‘look’ and without the worries of mold, mildew and bacterial buildup,” Bollinger says.

Accessories play a big part in the shower equation. Most shower seats can accommodate up to 300 lbs, but larger seats and styles are available, including fold-down seats in the shower stall. “To attack the bacteria trapped in skin folds, there are a variety of handheld showerheads that can twirl, pulse or stream water into these vulnerable areas to wash the debris away,” Bollinger says.

Grab bars are extremely important for everyone—not just people with weight issues. They provide stability for both the resident and the caregiver. “Grab bars, whether diagonal, horizontal or vertical, no longer have an institutional look,” Bollinger says. Shower rails with contrast are easier to see. 

The bath. A whirlpool tub can also bubble away at the bacteria gathered under the skin folds. “Soapy water circulates around the body, and skin care can be enhanced with the addition of bath oil,” Godfrey explains.

Humble believes that a bath has therapeutic value when it is combined with a whirlpool. “The overall experience,” she notes,“is more pleasant and relaxing.” A variety of tub designs can accommodate a facility’s needs. From side-door entry to whirlpool therapy installations, the tub room can be functional or a spa experience. “Many tubs incorporate transfer-glide systems to make tub access easier for both the resident and the caregiver,” Godfrey says.