Bath Safety Basics
Fundamental considerations for providing bath safety to seniors, bariatric patients and mobility patients.
If helping patients live independently lies at the core of what home medical equipment providers do for patients, then bath safety is a fundamental element of that mission. In helping create a safe bathing place for patients, a provider isn’t just preventing an accident, they are letting that patient lead an independent life with the same level of dignity that anyone else has. What could be a more self-reliant act than maintaining one’s personal hygiene?
That said providing bath safety involves serving a number of very disparate patient groups, with their own unique requirements and considerations providers must address. Key patient groups include seniors, bariatric patients and wheelchair patients; each with their own needs. Understanding these needs are the fundamentals of bath safety.
Seniors represent a doubly important bath safety market for HME providers because they are a steadily growing portion of the U.S. population subject to bathroom accidents. America is indeed growing older. According to the Department of Health and Human Services Administration on Aging Americans aged 65 years or older numbered 37.3 million in 2006 (the latest year for which data is available). Seniors represented 12.4 percent of the U.S. population, and by 2030, the AOA says there will be about 71.5 million older persons, more than twice their number in 2000.
Also, it’s impossible to discuss the population of American seniors without mentioning the Baby Boom. The Baby Boom represents the 78.2 million people born between 1946 and 1964. The first wave of the Baby Boomers turned 62 in 2008 at a rate of 365 individuals per hour, and in the next decade, there will be 15 million more seniors than there are now.
Given that more than 80 percent of home accidents occur in the bathroom, which is considered to be the most dangerous room in the house according to the National Safety Council, bath safety is a critical concern for senior patients. Among older adults, falls are the leading cause of injury deaths, and are also the most common cause of non-fatal injuries and hospital admissions for trauma, according to the Centers for Disease Control. Most fractures among older adults are caused by falls, and in 2005, 15,800 people 65 and older died from injuries related to unintentional falls; approximately 1.8 million people 65 and older were treated in emergency departments for non-fatal injuries from falls. Startling statistics indeed.
Hence the need for bath safety, and, as the data indicates the big concern is guarding against slipping and falling. Thusly, grab bars are critical. They should be strategically located in and around the bathing area, as well as around the toilet. This has two benefits: it ensures that the patient is supported and kept safe from a fall, but it also helps the patient gently lower and raise himself or herself while bathing or using the toilet.
In terms of the toilet, ideally the patient would use a raised toilet so that he or she does not have far to travel when rising or lowering. Commode lifts are another option in this case.
For the bathing area, the ideal situation would be to have a bathing stool or bench that the senior can use in conjunction with a handheld shower to protect against falls. Along with the aforementioned grab bars, the shower floor should be lined with non-slip material or strips. In general it also is a good idea to avoid having bathmats or other items on the floor that could cause a fall. Also, another bathing option could be a bath lift, which raises and lowers the client into the tub.
Ensure that the bathroom is brightly lit and that there is a bright enough night light to help the patient negotiate the bathroom at night, when poor vision could otherwise contribute to a fall. If possible, situate a chair or stool in the bathroom that the senior can use while grooming themselves or applying makeup, and ensure there are nearby grab bars, as well.
As obesity increases so does the need for providers to serve bariatric patients. The bariatric population is significant; Americans are getting heavier. While there are not solid statistics on the number of morbidly obese Americans — those weighing 300 pounds or more — there are some useful statistics on the number of American adults age 20 or older that are declared as obese.
Obese means a person has a body mass index, the statistical measure of a person’s weight scaled to their height, of 30 or more. In that regard, the Centers for Disease Control & Prevention (CDC) reports obesity rates for adults age 20 and older are 34 percent.
Most importantly, bariatric patients are subject to the same fall risks as seniors, and, in some cases, the results of their falls can be more devastating given their weight. Naturally, bath safety is a key concern.
While there are a wide range of DME products out there to support bariatric patients, when it comes to bath safety, the patient might not be aware of what’s available. That’s a key concern given that the average home store does not offer bathing products that support large homeowners, and the bathroom is an extremely dangerous place for bariatric patients. In the event of a fall, if a bariatric patient tries to grab a typical sink on the way down, it will not be able to support his or her weight.
So providers and their referral partners must make bariatric patients aware of the bath safety solutions available to them.
For starters, sturdy grab rails that can support the patient’s weight should be strategically throughout the room. For instance, when bariatric patients needs to use the toilet, they must lower and then lift themselves from the toilet, which is another reason why they will need grab rails. Grab rails need not look “institutional.” There are many offerings available to complement a patient’s bathroom furnishings.
Moreover, a toilet must be a special bariatric unit that supports their weight. Otherwise the risk of the toilet failing could be a major safety concern both because of the risk of fall and that of broken porcelain from older toilets. Fortunately there are bariatric toilets on the market that can support as much as 850 pounds. Bariatric toilets are also often taller so that the bariatric patient does not have to drop down on them. This is important given that it is difficult for very large patients to slowly lower themselves into a sitting position.
A shower chair or bench is also critical because the prospect of sitting in a tub also has injury potential. With a chair or bench, the bariatric patient can bathe with confidence, and if the patient requires bathing assistance from a caregiver, having the patient at a sitting height will not only provide better access to the patient for purposes of bathing, but also protect the caregiver from injury, since he or she will not be leaning over at odd angles in a slippery environment. Again, grab rails are a key safety element for the bathing area, and the tub bottom or shower floor should be covered in a non-slip pad or strips given the wet environment.
Providing bath safety for mobility patients can require expensive remodels to their bathtubs, showers and other fixtures — and sometime the entire bathroom. Typical modifications include replacing the bathtub or existing shower stall with a roll-in shower stall. That can mean knocking out just the tub, or possibly expanding the bathroom itself. Another option might be to remove the lip of a shower stall and replace the shower stall frame.
A key place to start with bath safety for mobility patients is to assess their needs, and their level of independence. Clients that can use the bathroom on their own, such as paraplegics or single or double amputees, can get into the room and swing themselves over or transfer themselves as needed using grab bars and similar supports.
But the bathroom has to be large enough for them to move. That often becomes the sticking point as it could well mean modifying the bathroom. Bathrooms are typically small spaces in which mobility patients can have difficulty maneuvering. (The same can hold true for bariatric patients, as well.). Needless to say, costs can quickly mount in such a scenario.
A complete bathroom remodel can range between $15,000 and $30,000, but there are less expensive options, such as removing cupboards or installing pedestal or hanging sinks. Other modifications include moving the toilet and removing the tub and installing a roll-in shower, which requires a change in drainage system and other plumbing modifications.
Typically, the tub is a major focal point in a bath safety remodel for a mobility patient, because it represents a central obstacle for the patient’s independence. In additional to replacing the bathtub or shower stall with a roll-in variety, there are other options. For instance, patients can use a special transfer chair that can be used in the shower, or they might relocate the shower altogether.
Also, a central question in a bathroom safety remodel is deciding which bathroom is the right one. This requires a look the entire household’s needs and daily activities, not just the patient’s, to see which room is best. A common bath safety remodeling projects is to covert a downstairs half bathroom into a full bath.
Patients might simply be unable to remodel their bathrooms for one reason or another (cost, they live in a rental, etc.). In that case, they could use a portable wheelchair shower, which provides patients with a private place to bathe on their own. The portable shower can be set up in a room other than the bathroom, and then stored when not in use.
That said, there are still many mobility patients that are unable to bathe on their own and need assistance from a caregiver. In this case devices such as bath hoists and special bathing chairs can be an ideal solution. Moreover, bathing chairs can be critical in terms of providing tilt and similar features to ensure proper patient positioning.
While most aspects of providing bath safety should seem par for course to HME providers, one aspect of bath safety that could be somewhat far afield for HMEs is the remodeling aspect. Obviously most HME providers do not staff certified and licensed plumbers or electricians, and tearing out a bathroom, expanding it and putting in all new fixtures sounds like a challenging task better suited for a building contractor.
Bearing that in mind, there are professionals to whom providers can turn, and with whom they can most likely partner to provide turnkey services to patients in need of heavy-duty bath safety help.
Fortunately, the National Association of Home Builders offers a Certified Aging in Place Specialist (CAPS) designation for builders who specialize in these types of modifications. Moreover that designation is geared toward ensuring that the contractor works to understand and match the solution to the patient need and organize the work in such a way as to minimize disruption.
CAPS-certified contractors could be important partners in your efforts to help ensure bath safety for bariatric, geriatric, mobility and other patients. To learn more about the certification, and to find a directory of professionals who hold the CAPS certification, visit the CAPS web site at www.nahb.org/caps.Clearly such contractors are key resources and partners for any provider offering bath safety to wheelchair patients.
Also, bath safety items represent a key retail sales category for HME providers, given that many bath safety items fall below the $200 price mark. Moreover, those devices that are more expensive are typical going to be DME that the patient specifically needs and will buy.
Providers should ensure that they approach bath safety with a complete range of solutions so that they can be a “one-stop shop.” Staff should have solid product expertise as it relates to their patients varying needs. Considering conducting bath safety evaluations for patients as a way to assess their needs and find ways to serve them. Also, considering creating floor displays that showcase the various bath safety offerings available to patients.
By forging relationships and developing a solid bath safety business strategy, a provider can gain a reputation for bath safety expertise that will resonate with not only patients, but referral partners such as hospitals and physicians, as well.