Putting a Therapeutic Pool in a Post-Acute Care Facility: Part I
By Andrea Salzman, MS, PT
Copyright 2002. All rights reserved.
Every year, the Aquatic Resources Network (ARN), an Internet -based
clearinghouse of information on aquatic therapy, hosts a conference
entitled "How to Successfully Launch an Aquatic Therapy Practice" (for this
October's conference schedule, log onto www.aquaticnet.com). Much of the
information provided with this article is compiled from this year's
The single greatest fear many people have of moving out of their own home
is the loss in their independence. Too often, assisted living and nursing
facility staff are so fearful for the safety of their residents, they don't
allow any element of risk into life. It's a caregiver Catch-22. Sadly, what
results is a slowly narrowing funnel of independence that one day ends in
The Wellness Concept
Well, Charlotte Donaho, COTA, wants none of that. Donaho is the Wellness
Coordinator at Epworth Villa Life Care Facility (Oklahoma City, Okla.). She
wields a secret weapon in her toolbox. Epworth Villa put in a
custom-designed therapy pool about 11 years ago and it's proven to be one
of their greatest assets.
"The best thing about having a pool right here is the independence it gives
people," reports Donaho. " Yes, [our PT/OT] rehab staff use the pool for
1:1 therapy. But a lot of people would fall between the cracks without a
wellness program. Many people are just 'too functional' for skilled
therapy, and others are 'too plateaued' to continue in therapy. We think
those people still need our attention and the pool is a great place to give
Epworth Villa is a 5-level living community. It includes 240 independent
living apartments and 8-12 independent living duplexes, an assisted living
floor, a nursing care floor (non-skilled), and a 48-bed Alzheimer's unit
The 30,000 gallon rectangular pool has two sets of stairs (with rails) on
either end of the pool. The depth is 3' at each end and 4' in the middle.
The water temperature is 86 degrees, except for on Arthritis Exercise class
days, when the temperature is raised to 89 degrees. The room air is kept
around 89-90 degrees in the winter, and in the summer, the roof is
retracted and the pool essentially becomes an outdoor swimming pool.
One problem? There is no lift for adapted entry -- this is on Donaho's
short wish list. There are chairs around the pool deck and two benches
located at the bottom of the entry steps, to allow people to rest
immediately after entering the water.
"I call them my 'therapy couches'," jokes Donaho. "People who can't
tolerate standing exercise can get a jump-start by doing their exercises
sitting down. For some people, it's a way to ease into water work. They
feel safer, more grounded on the bench."
So who can use the pool? "Our independent living residents have a key and
have access 24/7," reports Donaho. Otherwise, the pool is kept locked and
is only assessable with staff. The rehab therapists use the pool as a
modality for their 1:1 sessions with patients from assisted living or the
nursing floor. Donaho uses the pool the most: for wellness classes,
arthritis classes, even a "men's only" water exercise class that includes
three men from the Alzheimer's floor. "The men would never come to the
women's class -- we had to make it a guy's thing," laughs Donaho.
The facility tries to maintain a 1:2 ratio of staff/volunteers for the
assisted living classes. "There's only so much bingo a resident can play,
so we rotate water exercise classes into the schedule and the activities
staff are nice enough to get into the water with the residents." Group
classes for the independent living residents run 12-15 people with 1
instructor. All in all, the pool has become quite a jewel in Epworth
Donaho is available for follow-up questions. You may reach her at Epworth
Villa Life Care Facility
by phone (405/ 752-1200 x 252) or e-mail (Irelandgrl53@...
The Skilled Nursing Care Concept
If your resident population is predominately the "skilled nursing care"
kind, there are other factors to consider when putting in a therapy pool.
Gina Cutler, OTR/L, is a staff occupational therapist at Maplewood Nursing
Home, a 150-bed skilled nursing facility that also has an intermediate care
and assisted living option (Westmoreland, New Hampshire). They have a
prefabricated pool (brand name SwimEx) available for use by their OT and PT
staff. The pool is 6' by 12' and has depth options of 4' and 5' (Maplewood
only uses the 4' option). The water temperature is maintained at 94
degrees, predominately for its beneficial effect for pain patients.
"There's a lot of arthritis pain in the geriatric population. The pool is a
great medium for pain management," reports Cutler. "But in order for this
to be effective, you have to consider the fear factor." Cutler says that
sometimes it is difficult to get residents to agree to try pool therapy.
"There are a lot of people we would love to take into the water. Sometimes
gravitational insecurity makes that impossible."
Cutler reports that they use a lift to take residents from the pool edge
into the water. On occasion, the entire first two treatments are performed
with the resident still sitting in the lift sling (in the water). "It all
depends on the person's past history -- did they grow up around water? If
they did, the water is a wonderful thing. They are free from the pains of
daily life while in the pool."
Cutler also suggests that facilities that are thinking of putting in a pool
consider who will do all the prep work and pool maintenance. "You don't
want to have a situation where a ½ hour patient treatment takes 2 hours of
your therapist's time."
Maplewood Nursing Home offers its residents many extras. One of them comes
in a 6 by 12 foot box and makes you feel good all over.
Cutler is available for follow-up questions. You may reach her at Maplewood
Nursing Home by phone (603/399-4912) or e-mail (rehab@...
Author Bio: Andrea Salzman, MS, PT is the Founder of the Aquatic Resources
Network, an international, multidisciplinary clearinghouse of information
on aquatic therapy. For more information on putting a therapy pool into
your facility, or on the upcoming October 2002 conference "How to
Successfully Launch an Aquatic Therapy Practice" (or make an existing one
more profitable), log onto www.aquaticnet.com. Salzman may be reached by
e-mail at asalzman@...
Part II will follow....