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Part I: Putting a Therapy Pool in an Extended Care Facility (published in Advance for Post-Acute Care)

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  • Andrea Salzman
    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
    Message 1 of 1 , Aug 29, 2002
      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
      (assisted living).

      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
      Villa's Crown.

      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....
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