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Occupational Therapy in Home Care. Part 3. Tips for Bathing and Showering
In part 3 of this 3-part series, Nicole Federman will be on safety while bathing, and how to reduce safety and fall hazards.
Featured Speaker:
Nichole Federman, COT
Nicole Federman is state and nationally certified, COTA - certified occupational therapy assistant and CLT - certified lymphedema therapist. Nicole has 24 years of experience in occupational therapy and had been with Upland Hills Health for 7 years. Transcription:
Occupational Therapy in Home Care. Part 3. Tips for Bathing and Showering
Caitlin Whyte: In the third and final episode of our series on occupational therapy, we are talking about bathing and showering. Bathing can actually be a pretty risky activity to do. And we are joined once again by Nichole Federman, an occupational therapist at Upland Hills Health.
This is the Inspire Health Podcast from Upland Hills Health. I'm your host, Caitlin Whyte. Well, in the last of our series here, Nichole, we're gonna talk about bathing and showering. I understand bathing can be one of the more risky activities to do. Why is that?
Nichole Federman: Okay. Bathing and showering is an activity that we completely take for granted as a regular everyday task for us. Statistics show that the bathroom is indeed the most dangerous room in our house. Other studies show that the vast majority of injuries in the bathroom, like 81% occur because of falls. The bathroom is full of risk due to environmental conditions. So, we got the water and the steam, which causes surfaces to become slippery. Getting into the bath can be very difficult because it requires stepping over the edge of the tub, therefore balancing on one leg and then getting the other leg over. If there is no shower, then the person would have to sit down in the tub and they have to get back up again, so people are afraid of getting stuck. But there's a lot of adaptations to make showers more safe so that you can maintain that bathing technique.
Caitlin Whyte: So then, what are some of the best ways to prevent accidents in the bath or in the shower? How can a person bathe safely and confidently?
Nichole Federman: I would say the very first thing is to just allow yourself time to shower and try not to be in a hurry. Because in a hurry, we rush and then safety usually goes out the door. So, allow ample time to shower. Make sure that bathroom's well ventilated, especially for those people that have some breathing issues. If we don't have a well ventilated bathroom, that can definitely be a huge issue for someone with COPD or any other respiratory illness. Sitting to undress and dress, I stress that, because bathrooms are small too, so just sitting down to reduce falling over, installing recommended grab bars that an occupational therapist may recommend, getting those grab bars placed. Using a bath seat or a tub bench to sit for showers. No lawn chairs and no folding chairs. I've seen a lot of these, and I will tell you that inside I'm cringing. But, you know, if someone's using it, we assess it and we go from there. But we have seen lawn chairs and folding chairs, so we try to educate on the safety of the tub bench or the seat for the shower. Yeah, that's all I'm going to say about that.
If you're using oxygen, you definitely need to use it during that shower. Again, we've got that steam that makes it a little harder to breathe already, but it helps conserve your energy because we need oxygen throughout our body in order to expend energy, so you need to use your oxygen. And I've educated that more than once where people just leave their oxygen off in the shower and then their sat drops and they come out of the shower, they get dizzy, they fall. So, we want to use that oxygen in the shower. Again, installing that handheld shower that shuts off from the handheld, that helps a lot because it avoids if you're going to set that down and it drains outside of the tub, and risking a fall when you step out of the tub or the walk-in shower. We see it most often with those walk-in showers where you hang the shower head down because you're working on washing up and all of a sudden the water's just blowing out either the back or the front of the shower. So, consider getting one that shuts off from the handheld in between when you're working on things. You don't want to rush when you're soapy and wet, because that increases the fall risk. So, you want to make sure too, that that soap is rinsed off as well as rinsed from the floor of the shower or the tub because it can be slippery.
And then, making sure that the bottom of the tub or the shower is non-slip. It is difficult sometimes to find a mat, especially, you know, almost every shower or tub has a textured surface, so the non-skid strips sometimes work and stick a little better. Also, at the end of the shower, we have had people placed like a towel in the bottom of the tub because it it becomes damp. And then, when they go to stand up, their feet aren't sliding, so that's just that damp towel won't slide on the surface of the floor. But they're able to stand up without their feet slipping when they're attempting to stand.
Wearing that emergency response button, if you have one, or having that phone as nearby as possible to reach. And we work on a lot of individuals. We'll have family members, they know someone that sews and they make them just a little pouch or a little carry case that they can hang off their walker or whatnot. But again, that emergency response button, if you have one, wear it. Don't hang it out of your shower. Make sure it's one that's waterproof. But most of them are, they're made to be in those showers with you.
Lowering the water heater temperature to like 120 degrees Fahrenheit to prevent those burns from water, because as we know our sensation changes. So, most people that as we get older, we don't want as hot of a shower. That may sound, "Really?" Like everybody loves their hot shower, right? But it's not really as hot as you think it is because our sensation changes throughout our body as we age. So, I always recommend just making sure that that can't get any hotter than a certain amount of degrees.
So, when working with a loved one with dementia, you really want to try to follow the individual's lifelong habits as much as you can. So an example, like the time of day that they bathe. Did they dress in the bathroom or outside the bathroom at the bedside? You know, what was their routine before that makes it a little easier for the person to maintain that shower habit?
Caitlin Whyte: Gotcha. Well, Nichole, one last question for you in this series. If I am the caregiver helping a family member, how can I, as the caregiver, protect myself so I can continue to care for my loved one?
Nichole Federman: I'm going to start off with that again with communication. So, making sure that you communicate with your loved one and provide time. So, I said, you know, if you're showering yourself, you want to make sure you provide yourself time. So, give yourself time and make sure you're communicating with that person for every step. You know, to encourage as much as active safe participation as that person can participate, so that they can remain as independent as able to.
Using the medical equipment that is recommended by the occupational therapist, it might be something that is the shower seat, the bench, even a gait belt, which is, you know, placing that around the person's body so you have a hold of that person and you're not holding them from underneath the arm. Using that medical equipment as recommended will definitely help keep you as safe because, you know, a lot of falls, the caregiver can get hurt as well. You know, setting up the bathroom so that you have all those items within reach, so you're not having to leave the person alone, you know? You don't want to get them in and then be like, "Oh, I don't have a towel," or "I don't have the shampoo" even, you know, that might be out on the kitchen sink because you helped them wash their hair in the sink, you know, the day before. So, making sure you have everything right there, so that you do not have to leave them is really important.
When you're assisting, if you are helping them to get undressed or dressed, be sure you're in an area that allows, because our bathrooms are small, many bathrooms are small. Make sure it allows you room so you can protect your back if you're needing to like bend or crouch. So, you have to protect yourself too in order to help your loved one.
Don't run the water before your loved one steps over the edge of the tub. I know that's a tough one because we want it warmed up. But you know, you want to have that dry surface, so having them step over or to sit on a chair. We don't want to run the water. We turn it on and, you know, try to run that in the corner there. You can keep the person's shirt on or even a type of top to keep them warm until you get that water warmed up. But try not to step into already a wet surface.
Using that handheld shower again. You want to make sure that, again, you're not stressing and trying to hold it and use one hand and overstressing your body. So, using the proper body mechanics and making it as easy for yourself as well.
A long-handled sponge. If the person can't bend down and wash below their knees, you may very well need to crouch and do that for them. So, a lot of times we'll recommend just a long-handled sponge for the caregiver, even for the back of someone, so you're not having to reach and stress your back for reaching around, so that helps as well. And then using the a shower pouf. And when I say pouf, you know the mesh ball that you can put that soap in and that it lasts throughout the shower to wash all the areas without having to stop. And a person usually gets chilly in the shower. So if you're having to stop and re-soap, it does help to use that as well, just a simple little thought of keeping that person as comfortable and as warm as possible.
If you're needing to really help wash the individual, more like they're not able to do that themselves, if you have a pump, there's lots of pumps that are made that like go right on your shower wall now that we've recommended. So using those pumps where you can put your conditioner, your shampoo, and your body wash in there with that liquid soap so that it's close to you and you can just pump that out and you're not bending and twisting and doing that as much, so that helps the caregiver. It also helps the patient, of course, but looking at the caregiver side of it, not having to reach across into the shower, down into a shower caddy on the floor of the shower, things like that. So, that is something that can be definitely helpful.
Assisting and washing their hair. When you're helping your loved one, and it just depends on how tired you know they may get, because if you're helping them, the person obviously needs help. So, I a lot of times will recommend that that person has help with their hair because the minute we have to raise our hands up over our head, that reaching overhead, it does use more energy, more cardiac output. So ,washing the person's hair for them can reduce the amount of fatigue they have and more safety when getting out of the tub, because you still got to get dried and dressed and things once you're out of the tub. So, thinking about ways to save their energy.
And again, I have talked in the past about wearing that oxygen. Make sure that individual has their oxygen on if they're supposed to be wearing the oxygen. If there's not good ventilation in the bathroom, and I know again, that becomes sometimes heat and wanting to stay warm, but you might need to crack that door to allow that good ventilation, so they can breathe properly. And then, you know, getting out and drying, if it's difficult for your loved one to dry themselves, offer that assistance, assist in drying for yourself. You know, you can help them get that terry cloth robe on. And again, just giving them time. That person may need to lie down for a little bit, they have that robe on and they can rest for 10, 15 minutes, you know, while you're cleaning up the bathroom and things like that just to ensure they're rested up. Also, it helps with drying areas of their body that it's harder to reach to keep them dry and reduce the risk of skin breadown. So, those are ways that you can keep them as safe as possible.
Caitlin Whyte: Wonderful. Well, Nichole, it has been such a joy learning from you in these last three episodes. Thank you so much for being with us. This is episode three in a three-part podcast series where we are learning more about what occupational therapy is and how it can help people remain independent in their homes longer.
If you miss the first two episodes, you can find them in the Upland Hills Health Inspire Health Podcast Library on your favorite podcast app, or head to uplandhillshealth.org/podcast. And if you would like to work with an occupational therapist, start by discussing it with your doctor and ask for the home care staff at Upland Hills Health.
It is important to know you have a choice. So if you want to work with Upland Hills Health, you may call them directly at 608-930-7210, or you must ask for Upland Hills Health by letting your provider know Upland Hills Health is your preference. This has been the Inspire Health Podcast from Upland Hills Health. I'm Caitlin Whyte. Be well.
Occupational Therapy in Home Care. Part 3. Tips for Bathing and Showering
Caitlin Whyte: In the third and final episode of our series on occupational therapy, we are talking about bathing and showering. Bathing can actually be a pretty risky activity to do. And we are joined once again by Nichole Federman, an occupational therapist at Upland Hills Health.
This is the Inspire Health Podcast from Upland Hills Health. I'm your host, Caitlin Whyte. Well, in the last of our series here, Nichole, we're gonna talk about bathing and showering. I understand bathing can be one of the more risky activities to do. Why is that?
Nichole Federman: Okay. Bathing and showering is an activity that we completely take for granted as a regular everyday task for us. Statistics show that the bathroom is indeed the most dangerous room in our house. Other studies show that the vast majority of injuries in the bathroom, like 81% occur because of falls. The bathroom is full of risk due to environmental conditions. So, we got the water and the steam, which causes surfaces to become slippery. Getting into the bath can be very difficult because it requires stepping over the edge of the tub, therefore balancing on one leg and then getting the other leg over. If there is no shower, then the person would have to sit down in the tub and they have to get back up again, so people are afraid of getting stuck. But there's a lot of adaptations to make showers more safe so that you can maintain that bathing technique.
Caitlin Whyte: So then, what are some of the best ways to prevent accidents in the bath or in the shower? How can a person bathe safely and confidently?
Nichole Federman: I would say the very first thing is to just allow yourself time to shower and try not to be in a hurry. Because in a hurry, we rush and then safety usually goes out the door. So, allow ample time to shower. Make sure that bathroom's well ventilated, especially for those people that have some breathing issues. If we don't have a well ventilated bathroom, that can definitely be a huge issue for someone with COPD or any other respiratory illness. Sitting to undress and dress, I stress that, because bathrooms are small too, so just sitting down to reduce falling over, installing recommended grab bars that an occupational therapist may recommend, getting those grab bars placed. Using a bath seat or a tub bench to sit for showers. No lawn chairs and no folding chairs. I've seen a lot of these, and I will tell you that inside I'm cringing. But, you know, if someone's using it, we assess it and we go from there. But we have seen lawn chairs and folding chairs, so we try to educate on the safety of the tub bench or the seat for the shower. Yeah, that's all I'm going to say about that.
If you're using oxygen, you definitely need to use it during that shower. Again, we've got that steam that makes it a little harder to breathe already, but it helps conserve your energy because we need oxygen throughout our body in order to expend energy, so you need to use your oxygen. And I've educated that more than once where people just leave their oxygen off in the shower and then their sat drops and they come out of the shower, they get dizzy, they fall. So, we want to use that oxygen in the shower. Again, installing that handheld shower that shuts off from the handheld, that helps a lot because it avoids if you're going to set that down and it drains outside of the tub, and risking a fall when you step out of the tub or the walk-in shower. We see it most often with those walk-in showers where you hang the shower head down because you're working on washing up and all of a sudden the water's just blowing out either the back or the front of the shower. So, consider getting one that shuts off from the handheld in between when you're working on things. You don't want to rush when you're soapy and wet, because that increases the fall risk. So, you want to make sure too, that that soap is rinsed off as well as rinsed from the floor of the shower or the tub because it can be slippery.
And then, making sure that the bottom of the tub or the shower is non-slip. It is difficult sometimes to find a mat, especially, you know, almost every shower or tub has a textured surface, so the non-skid strips sometimes work and stick a little better. Also, at the end of the shower, we have had people placed like a towel in the bottom of the tub because it it becomes damp. And then, when they go to stand up, their feet aren't sliding, so that's just that damp towel won't slide on the surface of the floor. But they're able to stand up without their feet slipping when they're attempting to stand.
Wearing that emergency response button, if you have one, or having that phone as nearby as possible to reach. And we work on a lot of individuals. We'll have family members, they know someone that sews and they make them just a little pouch or a little carry case that they can hang off their walker or whatnot. But again, that emergency response button, if you have one, wear it. Don't hang it out of your shower. Make sure it's one that's waterproof. But most of them are, they're made to be in those showers with you.
Lowering the water heater temperature to like 120 degrees Fahrenheit to prevent those burns from water, because as we know our sensation changes. So, most people that as we get older, we don't want as hot of a shower. That may sound, "Really?" Like everybody loves their hot shower, right? But it's not really as hot as you think it is because our sensation changes throughout our body as we age. So, I always recommend just making sure that that can't get any hotter than a certain amount of degrees.
So, when working with a loved one with dementia, you really want to try to follow the individual's lifelong habits as much as you can. So an example, like the time of day that they bathe. Did they dress in the bathroom or outside the bathroom at the bedside? You know, what was their routine before that makes it a little easier for the person to maintain that shower habit?
Caitlin Whyte: Gotcha. Well, Nichole, one last question for you in this series. If I am the caregiver helping a family member, how can I, as the caregiver, protect myself so I can continue to care for my loved one?
Nichole Federman: I'm going to start off with that again with communication. So, making sure that you communicate with your loved one and provide time. So, I said, you know, if you're showering yourself, you want to make sure you provide yourself time. So, give yourself time and make sure you're communicating with that person for every step. You know, to encourage as much as active safe participation as that person can participate, so that they can remain as independent as able to.
Using the medical equipment that is recommended by the occupational therapist, it might be something that is the shower seat, the bench, even a gait belt, which is, you know, placing that around the person's body so you have a hold of that person and you're not holding them from underneath the arm. Using that medical equipment as recommended will definitely help keep you as safe because, you know, a lot of falls, the caregiver can get hurt as well. You know, setting up the bathroom so that you have all those items within reach, so you're not having to leave the person alone, you know? You don't want to get them in and then be like, "Oh, I don't have a towel," or "I don't have the shampoo" even, you know, that might be out on the kitchen sink because you helped them wash their hair in the sink, you know, the day before. So, making sure you have everything right there, so that you do not have to leave them is really important.
When you're assisting, if you are helping them to get undressed or dressed, be sure you're in an area that allows, because our bathrooms are small, many bathrooms are small. Make sure it allows you room so you can protect your back if you're needing to like bend or crouch. So, you have to protect yourself too in order to help your loved one.
Don't run the water before your loved one steps over the edge of the tub. I know that's a tough one because we want it warmed up. But you know, you want to have that dry surface, so having them step over or to sit on a chair. We don't want to run the water. We turn it on and, you know, try to run that in the corner there. You can keep the person's shirt on or even a type of top to keep them warm until you get that water warmed up. But try not to step into already a wet surface.
Using that handheld shower again. You want to make sure that, again, you're not stressing and trying to hold it and use one hand and overstressing your body. So, using the proper body mechanics and making it as easy for yourself as well.
A long-handled sponge. If the person can't bend down and wash below their knees, you may very well need to crouch and do that for them. So, a lot of times we'll recommend just a long-handled sponge for the caregiver, even for the back of someone, so you're not having to reach and stress your back for reaching around, so that helps as well. And then using the a shower pouf. And when I say pouf, you know the mesh ball that you can put that soap in and that it lasts throughout the shower to wash all the areas without having to stop. And a person usually gets chilly in the shower. So if you're having to stop and re-soap, it does help to use that as well, just a simple little thought of keeping that person as comfortable and as warm as possible.
If you're needing to really help wash the individual, more like they're not able to do that themselves, if you have a pump, there's lots of pumps that are made that like go right on your shower wall now that we've recommended. So using those pumps where you can put your conditioner, your shampoo, and your body wash in there with that liquid soap so that it's close to you and you can just pump that out and you're not bending and twisting and doing that as much, so that helps the caregiver. It also helps the patient, of course, but looking at the caregiver side of it, not having to reach across into the shower, down into a shower caddy on the floor of the shower, things like that. So, that is something that can be definitely helpful.
Assisting and washing their hair. When you're helping your loved one, and it just depends on how tired you know they may get, because if you're helping them, the person obviously needs help. So, I a lot of times will recommend that that person has help with their hair because the minute we have to raise our hands up over our head, that reaching overhead, it does use more energy, more cardiac output. So ,washing the person's hair for them can reduce the amount of fatigue they have and more safety when getting out of the tub, because you still got to get dried and dressed and things once you're out of the tub. So, thinking about ways to save their energy.
And again, I have talked in the past about wearing that oxygen. Make sure that individual has their oxygen on if they're supposed to be wearing the oxygen. If there's not good ventilation in the bathroom, and I know again, that becomes sometimes heat and wanting to stay warm, but you might need to crack that door to allow that good ventilation, so they can breathe properly. And then, you know, getting out and drying, if it's difficult for your loved one to dry themselves, offer that assistance, assist in drying for yourself. You know, you can help them get that terry cloth robe on. And again, just giving them time. That person may need to lie down for a little bit, they have that robe on and they can rest for 10, 15 minutes, you know, while you're cleaning up the bathroom and things like that just to ensure they're rested up. Also, it helps with drying areas of their body that it's harder to reach to keep them dry and reduce the risk of skin breadown. So, those are ways that you can keep them as safe as possible.
Caitlin Whyte: Wonderful. Well, Nichole, it has been such a joy learning from you in these last three episodes. Thank you so much for being with us. This is episode three in a three-part podcast series where we are learning more about what occupational therapy is and how it can help people remain independent in their homes longer.
If you miss the first two episodes, you can find them in the Upland Hills Health Inspire Health Podcast Library on your favorite podcast app, or head to uplandhillshealth.org/podcast. And if you would like to work with an occupational therapist, start by discussing it with your doctor and ask for the home care staff at Upland Hills Health.
It is important to know you have a choice. So if you want to work with Upland Hills Health, you may call them directly at 608-930-7210, or you must ask for Upland Hills Health by letting your provider know Upland Hills Health is your preference. This has been the Inspire Health Podcast from Upland Hills Health. I'm Caitlin Whyte. Be well.