Restoring Dignity to Bathing

Of all activities performed by nursing assistants, bathing is the most time consuming and strenuous. Often, battles must be fought with resistant residents so that, by the time the bath occurs, both resident and attendant are in well-earned states of agitation. Bathing facilities tend to be noisy, cramped and, contrary to their purpose, unhygienic. Privacy is compromised and, in the hurry to “get it done,” one of life’s more genteel pleasures is lost.

This is the current state of bathing in nursing homes everywhere and, if asked about their bathing experiences, many residents would rightfully say that their dignity has been stripped away. Some skilled care residents have asserted that they feel they don’t even have the right to dignity while bathing.

The Fitzgerald Health Center at Arbor Acres United Methodist Retirement Community in Winston-Salem, North Carolina, a continuing care retirement community, was built in 1985. Along with most other facilities serving a skilled nursing population, its “central bathing” area offered a rather sterile, cold environment-hardly the warm, comforting experience most people today associate with bathing. Bathing in America has taken a gigantic leap. Garden tubs (i.e., large, whirlpool-style tubs), shower massagers, steam rooms, and bathrooms occupying significant square footage have become the norm in private homes. Thus, when it came time to update the bathing facility at Arbor Acres, we believed it was time to think beyond traditional skilled nursing bathing, and provide residents with the experience that bathing has come to mean in mainstream America.

The Spa (Soothing Pleasures Alternative) at Arbor Acres, a new 2,000-square-foot facility, seeks to restore to residents, particularly in assisted living and skilled nursing care, the luxury of true bathing. The goals are:

• to enhance quality of life and dignity for every resident;
• to serve the physical, mental, emotional, social, and spiritual needs of residents;
• to appeal to and to encourage the use of all senses, with emphasis on touch, smell, and sight;
• to make bathing, one of the primary activities of daily living, into an opportunity for pleasure and the indulging of the senses;
• to relieve the trauma of residents who experience general agitation and stress, including, but not limited to, stress associated with bathing;
• to employ techniques of aromatherapy and massage as a seamless part of the bathing experience for each resident; and
• to use light, music, water, and other natural elements to create an environment that residents will find soothing, relaxing, and nourishing.

Achieving these goals requires reference to both the modern and the ancient. Touch and scent have for ages been recognized as healing both to the body and to the soul. Water, in most religious traditions, is associated with purity and holiness. Thus, in addition to three private bathing rooms (Figure 1), the Spa houses a massage room and a spacious common area surrounding a large water feature (Figure 2). This area is furnished so that residents may linger to enjoy soft music and the soothing sound of water cascading down a granite column (Figure 3).

This area also is used for programmed activities such as foot, hand, and neck massage, as well as other special programs designed to appeal to the senses. Residents who desire full body massages may receive this service in the massage room from a licensed massage therapist. Aromatic oils are used throughout The Spa as an invisible but powerful source of pleasure and relaxation.

A team of six full-time and two part-time CNAs is dedicated to The Spa. These CNAs, already experienced in bathing techniques, receive intensive training by a certified aromatherapist and a licensed massage therapist, and continuing education through in-services presented by experts in these areas. Team members are also exposed to ancient wisdoms that underlie these techniques so they are able to use them with heart and soul.

All health center residents may use The Spa and remain as long as they desire; it is their regular bathing facility. There is no additional fee to the residents. Robes and towels specifically selected for The Spa are provided (Figure 4), and are luxurious and consistent with the quality of the total experience. The bathing rooms offer state-of-the-art equipment, including side-opening tubs for easier transfer, whirlpool baths, and seated showers, with a sense of privacy and soft music piped into each room.

Through The Spa, Arbor Acres seeks to elevate the standard for bathing in skilled nursing care and assisted living. Although this is a costly model-the facility invested nearly $1 million, funded partially through benevolent donations-the techniques used to create the spa experience are, in many cases, low-cost or even no-cost. Arbor Acres believes that as life grows more limited for the frail and impaired elderly, their pleasure, dignity, and quality of life must come through their activities of daily living or they won’t come at all. Just as feeding has, over many years, evolved into the creation of dining experiences for residents, bathing must rise above the purely hygienic to become an experience that serves the whole person. This is the essential mission of The Spa at Arbor Acres. NH