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Designing bathing rooms that comfort

January 1, 2005
by Margaret P. Calkins, PhD, President of I.D.E.A.S.
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explains how using a sensory approach can help to create an elder-friendly bathing environment

Many caregivers find giving baths or showers one of the most difficult aspects of caregiving. It's a time when residents with dementia are often most combative. But it doesn't have to be that way. While both the caregiver approach and the design of the bathing room are important, this article focuses on the latter. Because the environment is experienced primarily through our senses, this article is organized by the different sensory modalities. The greatest emphasis is always given to how the resident is experiencing the setting, with a secondary focus on the ways the environment can support the caregiver.

Visual Environment

Bathing rooms in most long-term care settings are sterile, institutional, and frightening spaces filled with unfamiliar equipment—tubs with mechanical lifts or sides that open up and look like they might swallow you, chairs on wheels, or gurneys with arms that look like construction cranes. Soiled utility carts, lifts, scales, extra wheelchairs, and boxes of supplies may also be stored here and there. It's not surprising that the person who needs some assistance with bathing resists.

The first step is to keep it simple. Find another location to store the extra equipment and supplies. If absolutely no other room is available for the carts and lifts—or if they are necessary for bathing purposes—find a way to hide those visual distractions behind a partition or curtain. They can still be physically accessible, just not visually accessible.

Once you've eliminated the clutter of extra equipment and supplies, the next step is to make the room itself more visually pleasing. Think about where the resident's eyes focus throughout the bathing process. What do you see as you first enter the room, as you get into the tub or shower, as you are being bathed, and as you are getting out and being dried? Do signs and notices about how to use different pieces of equipment constitute the only “art” in the room? If so, make them less conspicuous to the person being bathed. Laminate any attractive posters or prints that might be hanging to keep them dry in the moist atmosphere of the room, and hang them where the resident is likely to see them during different stages of the bathing process (undressing, bathing, and dressing). Add small decorative shelves with knickknacks such as shells, decorative bottles, pretty hand towels, or tissue boxes.

Pay particular attention to where people look during the bath or shower. If they are reclined, could you put a print on the ceiling? In the shower, laminated photos may provide something more interesting to look at than bare walls. Some facilities even put up photos or drawings of the different steps in the bathing process to cue the resident as to what will happen next.

Another strategy that can help—both in downplaying institutional features and highlighting residential-looking features—relates to using visual contrast. Many older people, and particularly those with dementia, have decreased contrast perception. Therefore, when necessary institutional features are present (such as signs or equipment), the more you can make them the same color as the background, the less they will be perceived. For residential features—such as art or knickknacks—that you are adding to the environment, make sure they stand out visually in the environment by giving them a brighter color that contrasts with the background color of the walls.

Finally, lighting is very important in bathing rooms. It needs to be sufficient—particularly near the tub and shower—so you can see that the person is getting clean. If the person being bathed is looking up (in a reclined position or lying supine on a bath gurney), be sure no lights shine directly into the bather's eyes. Get into the tub or lie on the bath gurney yourself and see what the bather is looking at. If you need to add lights, consider cove lighting, which bounces light off the ceiling (this is called indirect lighting), or wall sconces. While lighting needs to be adequate, it should not be so bright that it feels overly clinical. Some people may actually be more comfortable in a room with softer lighting. Therefore, the best solution is to put the lights on a rheostat so they can be individually adjusted for each person's preference.

Auditory Environment

With tile or solid-surface floors and walls, noise reverberates in bathing rooms. These hard surfaces can also cause echoes, which may make noise even more overwhelming. There are two basic techniques to minimize noise in the bathing rooms. The first is to stop the noise at its source. For example, don't let others walk into the bathing room when someone is being bathed. This is why it is so important to try to get extra carts and equipment out of the bathing room when possible. Even if the carts and equipment can't be seen, just the sound of someone opening the door and coming in to retrieve them is enough to set some people off, fearing even more for their already compromised privacy.

The other basic technique to minimize noise is to add materials that will absorb sound. More fabric in window and shower curtains and lined window or shower curtains will absorb more noise. As a general rule of thumb, the fabric should be three to four times the width of the opening to have sufficient folds to make an acoustic difference. Alternatively, add water-resistant acoustic panels. These can be plain or decorative.