Sometimes morning staff, who generally begin their shift at 8am, 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.
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 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?