Bathing as a wellness experience: bathing area design features enhance independence and feelings of well-being.

Editor's note: Some of the suggestions the authors make herein are not intended for LTC residents with dementia or other types of cognitive impairment. This article focuses primarily on bathing for residents of nursing homes and assisted living facilities who are cognitively intact.

From the times of Hippocrates through today, bathing has been used as an effective tool to renew and revive our bodies. Because the act of bathing carries such important health and wellness benefits, showers and baths should go beyond the typical day-to-day function of only serving as personal hygiene outlets and be used as focal points of wellness promotion.

How can the bathing areas of long-term care facilities function as wellness centers and work to enhance the different aspects of senior wellness--physical, emotional, and spiritual--and break away from the conventional? What design features can facilities use to enhance resident health and happiness?

According to a report by AARP, a poor-quality physical environment is not only a barrier to independence, but it might actually increase functional loss in older adults. In this article, we explore finishes, designs, and special touches that, when incorporated into resident bathing areas, create physical environments that can contribute to a healthy and satisfying life for residents--and promote senior wellness.

Aspects of Wellness

Bathing as a wellness experience should evoke feelings of physical, emotional and, on some levels, spiritual well-being. Bathing encourages physical activity through movement and can provide a feeling of independence, self-confidence, and satisfaction with daily hygiene. For those residents with medical conditions that prevent or limit physical ability, bathing may be the one simple form of physical activity in which they can participate.

Enhancing a sense of positive personal contentment and balance, bathing serves as a stimulus for healthy emotional and spiritual well-being. Bathing encourages feelings of self-worth through taking care of oneself. The daily routine of bathing also provides a continuity of daily activities and habits formed over a resident's lifetime--helping to formulate a strong emotional foundation.

The act of releasing pent-up stress and anxiety during bathing perhaps can be one of the greatest benefits and can help ward off common depressive states. If bathing takes place in a peaceful, healing environment, spiritual wellness can be solidified through meditation, prayer, and thought, which can occur while in the relaxed setting of a bath. An elevated inner peace can parlay into a positive outlook, allowing residents to live in the moment and bring balance to life.

The Physical Environment

The physical environment is key to encouraging residents to participate in bathing as a wellness experience. The environment should offer warm, intimate spaces encompassing every function of bathing. This can be achieved through the layout, lighting, finishes, furnishings, and special touches within the bathing area.

The basic layout of a bathing space should incorporate areas for shower, bath, toilet, dressing, and grooming. These areas should open from one to the other, with visual divisions using half- to full-height walls or furnishings such as privacy drapes or screens. Privacy is essential. It allows residents to maintain dignity and alleviates their self-consciousness. Even on a tight budget, with a little creativity these divisions can create an intimate, private area, both in new construction and as modifications to existing facilities.

Lighting and Noise Reduction

Lighting is used universally to establish the mood and ambience of a space, and the bathing area shouldn't be any different. General lighting used for physical maneuvering about the space should always be on dimmers to enable residents to adjust the "mood" when they wish.

Lamps provide wonderful luminescence and warmth, adding to the comfort of a space. Place lamps on a vanity, the back of the toilet, or storage shelving to create warmth. To protect residents, caregivers should turn lamps on and off as needed. Another safety measure would be to only plug these lamps into GFI (ground fault interrupter) outlets that are connected to light switches. Coffered ceilings with pendants or close-to-ceiling chandeliers and cove lighting over the bath are also fantastic residential soft touches.

When the layout of the bathing area is designed, a window should be included to allow natural light to filter in--a necessity for normal function and emotional balance. Overall, mixing a variety of lighting types helps to create different atmospheres that can be altered based on a resident's mood.

Reducing noise in bathing areas is vital to the success of encouraging residents to participate in the bathing experience. Noise can be diminished in a multitude of ways, including the installation of a tub with a noise-reduction faucet; using soft finishes, such as slip-resistant, welded-seam sheet vinyl; and using hard-surface materials, such as tile, only where necessary on walls and floors that will become wet. Hard surfaces tend to magnify noise, while vinyl or other soft surfaces tend to absorb it.

Privacy drapes (cubicle curtains) around the tub, shower, and at the windows also absorb noise. Placing plants throughout the environment is another great way to curb noise.

Color

The use of color can help to soothe and rejuvenate the soul. If ceilings are high, they can be painted in warm, dark colors to close in a large space, creating a more intimate and less overwhelming area. Adding color for visual interest can also warm up a space and provide a comfortable environment. Wood can he used as an additional element of warmth. Around water, hardwoods (e.g., Nordic Whitewoods) or faux wood (e.g., bead board or raised panel) can be used--either in dark or light shades.

Floors and walls should be different colors so that residents can distinguish the different planes. Color can reinforce the residential environment in the form of wall tiles in decorative patterns on walls that provide points of interest for residents. Different colors of welded-seam sheet vinyl can be inset in a rug pattern to bring color to the floor, especially if the field color is neutral.

Furniture and Special Touches

Furniture used within the bathing area might include a chair with soft, waterproof cushions, a vanity and chair for grooming, a storage armoire for robes and towels, and a console for candles and flower petals. Outdoor wicker is ideal for this use, because it is immune to moisture and can be easily wiped down.

Special touches added in a bathing space will help make the experience memorable for the residents. Such touches can include fluffy monogrammed towels and bathrobes, soft music, aromas, water features (other than the tub), live banging plants and potted plants on shelves, lit candles around the bathtub, bubble bath, and/or lightly scented soaps. There are, of course, safety issues involved in using lit candles; the extent of use should be left up to the discretion of the facility.

Small details and finishes work to create a more homelike, welcoming area. For example, privacy drapes should be made from residential fabrics treated to meet appropriate codes. Outdoor-approved trims can be added for edging or tiebacks.

Other details include providing neck warmers for residents after bathing, to help keep their bodies warm and maintain their relaxation. These are aromatic fabric pillows filled with heatable rice that can be flexibly placed around the neck and shoulders. Lightly scented lotions keep the skin moist and the senses livened. Offer several different products for residents to choose from. For women, perfumes, brushes, combs, and clips are wonderful touches to add to the vanity or grooming area. As for the men, shaving kits are a great addition.

Conclusion

Facilities do well with providing well-balanced outlets for their residents' overall well-being--including offering fitness centers, pools, prayer/meditation rooms, and educational opportunities. But what many facilities fail to realize is that a well-designed bathing area can be used simply and effectively to facilitate the complete senior wellness experience. Adding color, detail, and special touches can transform a mundane, dull bath time into a rejuvenating and reviving "experience."

Julie Moller, ASID, is a senior interior designer, and Carrie Reneger is an interior designer for FreemanWhite, Inc., a senior living and healthcare design firm based in Charlotte, North Carolina. For further information, please contact Amy E. Jones at [phone] or visit www.freemanwhite.com. To comment on this article, please send e-mail to [e-mail].