Sometimes morning staff, who generally begin their shift at 6am, will expect the night staff to have showered some of the residents.
Vicki Cain, Residence Manager with Arcare Aged Care Pimpama, told HelloCare the issue of whether to shower residents overnight or very early – before 6am – has been a debate “over many years”.
“A few years ago, I was shocked to find out carers at night were waking residents up to shower them and use the bath trolley,” Cain said.
When she asked why this practice was occuring, Cain was told every resident needed to be showered every day and that morning staff expected it.
However, it should be the choice of the individual resident how and when they shower, said Cain.
Angelika Koplin, Principal Consultant Aged Care Strategies and Support, who has worked in aged care for nearly 30 years, agreed. She told HelloCare residents should have their hygiene needs met “according to their personal preferences”.
Residents should be asked their preferred time and frequency of showering, and their decision should be entirely up to them, she said.
“In my experience, most people would like to have their showers either in the morning or at night, and their preferences should be able to be met within the usual staff routines.”
Some might like to shower before breakfast, others after breakfast, or some before bed, while some like to shower everyday but others choose every second day. Some may prefer just to have a bath or a sponge bath, Koplin explained.
Standards require person-centered care
Cain said waking an elderly person from their sleep to have a shower in the middle of the night purely because that is what the staff prefer would mean the provider was “at serious risk” under the new standards.
Aged Care Quality Standard 1 requires that consumers be able to “act independently” and “make their own choices”.
Standard 3 requires that consumers receive “safe, effective and quality delivery of personal and clinical care”.
“Aged Care Quality Standard 1 is very clear about consumer choice and Standard 3 stipulates that consumers get safe and effective personal care that is tailored to their needs,” said Koplin.
Know the person
Getting to know the person’s story can also help understand their showering preferences.
“I have known residents who prefer to have a shower at 4am and 5am because in their working life, they opened business very early in the morning, so their natural sleeping pattern is for early showers,” explained Cain.
Review, renew
Just because a resident decides to have a shower daily at a certain time, there should also be enough flexibility in the roster and task lists to change the routine based on a resident’s or a family’s request – even if it is only for one day.
A resident’s preferences can also change over time, and should be continually reviewed, says Cain.
Automated systems for personal hygiene assessments often have questions around these topics built into their templates to make assessing resident wishes easier.
If a resident starts to refuse showers or baths, staff should investigate the cause and review the resident’s care, explained Koplin.
“This is all part of moving from task centred care to person centred care.”
Continence management
Continence management is also an important factor to consider when it comes to showering residents.
However, a full shower isn’t always required.
“There are many alternatives to ensure appropriate hygiene is provided,” suggested Cain.
Check skin integrity
Cain also pointed out that daily showers aren’t always recommended for older people, whose skin is fragile and susceptible to tears.
“There is scores of evidence, which identifies showering an elderly, frail person each day not only strips the natural protective oils from their skin, but increases their risk of skin injuries, including bruising and tears,” said Cain.
Aged care organisations need to provide the proper education about skin integrity and person centred care to help staff understand the options and the consequences of decisions related to showering. Only then can care be aligned with the resident’s wishes and enhance their quality of life.
Of course, many HelloCare readers will point out that the tasks outlined above are all very well in theory, but on the floor there are simply not enough staff or hours in the day to give residents this level of attention.
Aged care homes are often short-staffed, and even with a full roster, there often aren’t enough hands on deck to get all the necessary jobs done.
We hope these homes are in the minority – it goes without saying that older Australians deserve high-quality, person-centered care, including a shower whenever and however often they wish.
What do you think? Do the ideas and practises outlined in this article reflect what occurs in the aged care home where you work?
I work night shift and do not encourage my staff to shower anyone as they are the only staff on the floor and it leaves the remaining residents at risk so I do
Nit allow it. If they need a shower due to far all
Incontinence they let us know so we can cover the floor for them
What morning shift commences at 8am? More likely 630/ 7am. It’s an interesting topic, even mangers will put a directive out for a certain number of residents to be showered by nightshift. What are the obligations in terms of this? It becomes residents rights vs a file note recorded against you due to not meeting managements requirements. I do however agree with the author and I will often advise the powers that be that due to minimal staffing it is also not possible to have a member off the floor for 20 – 30 mins showering, once a resident is in the shower you can not leave them for an emergency situation as you are in turn putting that resident at risk. There are numerous reasons as to why showering a resident at night is inappropriate but residents choice/ urgent need to do so should be the only reason to attend to this
I found as a student doing my placements in residential Care- I was having too many arguments with the permanent care staff and nursing manager re getting residents up when they were asleep from 7am for their showers. I had a 102 year old lady that pleaded for her shower later that morning – the nursing manager insisted I get her up and shower her immediately. I advised her that I was on duty all day and I was happy to do it later – I always found I had to take on the fight for the residents even though I was a student – hence now I work in Community Care where clients have CDC.
Good on you Sue. I only wish more care staff would have the courage to make a stand for the residents in their care. Enough is enough!
I know for a fact that these places are not a minority, unfortunately they are the majority, whether for profit or NFP. We must all get onto our MP’s to push for change! If we all do this and keep up the pressure, we will succeed. We need them to get the message that we will not give up!
I start morning shifts between 6 am, or 7 am.
The night shift should not have to shower unless incontinence has occurred. I did have one resident who liked to be up and showered at 4 am to be seated in the lounge. But it is supposed to be a residents choice, but some will not have a shower or wash for a week. So we need to find a happy medium.
There are many research academic studies that clearly indicate an increase risk of cardiovascular events on awakening. This risk factor is multiplied when stress, temperature and environmental changes add to circadian rhythm disturbance.
Allowing natural awakening and normal routine maintenance of breakfast, medication, toileting, environment acclimatisation and mobilisation, makes the task of hygiene showering a safer and possibly enjoyable event.
https://www.sciencedaily.com/releases/2018/03/180308105211.htm
Well it often makes me wonder if they even have a shower every day. I can tell by a not to fresh smellwhen go see him. I ask my husband but he doesn’t know, as for early shower they tell me he gets up at about 6am. Today I go to see him and he has a black eye and nobody knows about it. Now I am waiting to see who knows about it and how did it come about.
I believe that our clients should have the ability to make there own choices if able to or do e for the best interests but getting up so early isn’t necessarily what they would have done at home therefore should be allowed to get up when they choose and if they want to get up not necessarily given showers just for the sake of crossing the I and dotting the ts ,we have 24 hour care for a reason as long as they are given choice what does it matter when and what time they have showers its there homes not ours we’re the visitors in their home.
There are plenty of residents up, awake and ready for a shower and breakfast early each morning for one reason or another. No need to wake those sleeping in.
Most elderly are up and awake early as has been their habit all their working life.
For starters whoever wakes a person for a shower on nite duty is really showing what respect they have for a person. If there are people agitated from reasons they need to follow on with and prompt one to have a warm shower this would help with mood swings etc but you are there to manage the care side of residents.one is not to push them into having one. One can go weeks without a shower as long as it documented on every shift and passed on there are others ways to attend hygiene where I work cleanliness is important but not to the extended thing of daily get it done move on who care if there is no shower in their say they had top/and tail wash so that’s how we deal with it today. And if families don’t like it let them attend to the needs of loved ones or work out a plan with staff members.
I’ve worked nightshift for many years and most places don’t allow showers, as we are the only 1 in that section, especially in dementia. But I’ve been in places where it’s on their care plan for a 5.00am shower, so I would shower them. I’m currently working in a place now and day shift are a pack of bullies saying I should have 2 or 3 up, and 1 is a 2 assist, who they say i should have up. 6 of the 14 in dementia, are 2 assist. No care plan state to be showered at 5 or 6 am, so if they are asleep, I let them sleep. Day shift in dementia has 2 or 3 staff, 1 being an EN doing meds plus assisting on the floor. I have worked in the section on dayshift and a girl was trying to rush me at 11am when I only had 1 more to get showered. That was on Christmas day and nearly everyone had a shower that day, most days it’s 6 at the Max. I don’t believe in waking them for showers, as it’s the residents choice, but will shower at 6am if it’s on their care plan.