The Power of the Pool: Why Water for Our Seniors?

Byline: Andrea Salzman, MS, PT

Chris Kost knows how to get seniors excited about aquatic exercise.

Working as (Past) Director of Programs for Summit Place (Eden Prairie, Minnesota), Kost tried almost everything to get residents into the pool.

“Many seniors feel abandoned,” stated Kost. “They say ‘My kids put me here. What is there to do with my day?’ I would see them drawing back into themselves.”

“That can change with exercise. I saw lives transform when I would get my residents into using the health club and the pool at Summit.”

Kost recalled one of his favorite stories. He was working in Summit’s HydroWorx specialty pool with a Minnesota Vikings football player (Summit Place had a working relationship with the NFL team which is located in the area).

“Here I’ve got this elite 25 year old all-pro running back working his butt off in the pool. We look up and standing on the deck is a 94-year old resident waiting to get in and start her workout. I tell her that the pool isn’t that big, that the NFL player is using it. She tells me that that’s the very reason she wants to get in!” Hey, motivation is a beautiful thing.

After-Care Options

Many long-term care settings offer physical therapy and occupational therapy services. But there can be a tremendous sense of loss to residents if there is not some continuation of care after discharge from formal therapy.

After-care options can be a wonderful “bridge” from therapy to independence. And when these options occur in a therapeutic pool, there is even more to celebrate.

Meg Esry, MS, ASCM cPT, worked in one long-term care setting where the pool made the difference. Carol Woods facility, located in Chapel Hill, North Carolina, provided its residents the spectrum of care, from an on-site nursing facility to a dementia unit for seniors with memory problems.

Esry was able to use the pool to her advantage in designing after-care programs. “I would go to the PTs on staff and run some exercise ideas past them. With their blessing, I could create fitness modifications for the pool.”

The pool sloped from 3'8" to 5' allowing it to be used for vertical aquatic exercise. A bar wrapped around 3 of the 4 pool walls, allowing residents to hold onto the bar for wall exercises and for safety.

“Additionally, the pool was in constant demand for lap swimming. The pool was around 15 feet wide but much longer, so 3 people could swim abreast at a time. It was so popular, we had to implement a sign-up sheet and limit swimming to 30 minute sessions so arguments wouldn’t break out.”

Lap swimming is one way facilities can use their pools for post-rehab care. Another easy idea to implement? Water walking.

Barb Batson is an Aquatic Specialist who worked as Interim Acting Aquatic Director at McKendree Manor in Hermitage, Tennessee. The pool was used not only for therapy sessions, but it was open for independent exercise and group classes. She tells of the culture of exercise that grew up around their therapy pool.

“The cornerstone of the program, however, was the fact the every morning, the residents were welcome to come and start their day water walking. And they came in droves, walking the perimeter of the oval pool with their covered morning coffee mug in hand. For a while there, I was doing coffee duty, but I quickly removed myself from that responsibility! I could never get the sugar or creamer levels right!”

(Facility Ed) Intro to Aquatics: "The Aquatic Therapy Bootcamp" (video+manual)

Buy Now

A therapeutic pool can become the lynch-pin for fitness in many long-term care facilities.  For instance, Summit Place makes use of its two pools for after-care.

“We kept the water a little cooler (86-90° F) than most therapy pools because we had such an active after-care program,” reported Kost. “Just because people live in a senior setting doesn’t mean they want to just lie around in the pool. Most of our residents come to the pool to work up a sweat.”

At Summit, the pool is open to all residents for no additional fee. Their “membership” in the fitness center includes use of the therapy pool and that membership is paid for as part of every resident’s rent. There is no additional fee.

And that has a lot to do with how popular the pool has become.

Summit Place includes 165 independent living apartments, 10 town-homes, 85 assisted living apartments, and 20 memory care units and all its residents have access to after-care programming at the therapy pool.

Kost thinks the pool is used by at least 40% of the senior residents at least once a week.

“Our pool hours were typically 7-5PM. By 5 PM, most of our residents were going to eat or winding down for the day, so we would typically close up shop by suppertime. Our most popular after-care programming happened in the mornings anyway.”

Summit offered several levels of after-care options to meet the needs of the spectrum of fitness levels. Many residents would first go through physical therapy in the pool. They would be seen 1:1 for several weeks and then would graduate to classes or to independent exercise in the water.

Popular Programming

After-care programming options can include the spectrum from independent exercise to highly structured group classes. Here are some of the more popular options seen in long-term care facilities.

• Circuit Training. This loosely formed “class” is geared for residents who want less interaction and more independence. The pool is set up with exercise stations. Each station is marked by 1-2 laminated signs illustrating exercises such as step-ups, single leg squats, light jogging, or upper body work using AquaLogix bells, tubing, or other equipment. A staff person on deck rotates class members to a new station every 1-2 minutes.

• Water Aerobics. This group class incorporated calisthenics and other higher level aerobic drills in both 4’ and deep water.

• Aquatic Conditioning Class. This group class is built around the idea of progression. Each week, residents are challenged to integrate additional equipment into their workouts, thus increasing the difficulty.

• Arthritis Foundation classes, both standard and advanced versions.

• Water walking.

• Lap swimming.
  

Typically, after-care classes are run by personal trainers, athletic trainers, or fitness instructors, not physical or occupational therapists.

Even residents in Assisted Living and Memory Care units can be encouraged to participate in aquatic after-care. Residents in the memory care units can participate in group classes if they are able to interact socially. If they require a quieter atmosphere, pool time can be blocked out several hours just for that reason. Residents, accompanied by a staff person, could use the pool for independent exercise or lap swimming several times each week.

Pools in long-term care settings can also be offered as a resource to seniors in the surrounding community. For instance, Summit Place offered membership in its fitness center to the senior population in Eden Prairie for $35 per month.

“Because it is the only warm water pool around here, we had to police the age limit,” laughed Kost. “We had 53 year olds trying to pass for 55 just so they could use the pool!”

To increase participation, long-term care facilities can encourage residents to serve as pool volunteers. Summit utilized the buddy system for residents who were a little fearful in water or for those who had difficulty hearing or seeing well. Other volunteers folded towels or worked the front desk. However, safety monitoring or life-guarding should never be left to volunteers.

Mary Essert, BA, ATRIC, understands well the need for onsite pool supervision by staff members.

“The pool can be a dangerous setting,” stated Essert. “I worked in a place in DuPage County, Illinois where the pool and hot tub were monitored by video only. A resident went to sleep in the hot tub and slept overnight (almost 12 hours) without being observed. She was very hard-of-hearing and had removed her hearing aids and slept peacefully through the night. Thankfully the water wasn’t too warm and she was fine after the fact, but that’s one of the horrors which can happen when monitors are used instead of personnel for guarding and supervision.”

Conclusion

The therapeutic pool can offer a splendid exercise opportunity for residents of long-term care facilities. The power of the pool can be even more dramatic for the senior population. Consider some of the programming tips in the sidebar to expand the world of after-care for your population.

SIDEBAR: Programming Tips

Long-term care facilities should consider expanding their pool options to include post-rehab or after-care services. The Aquatic Exercise Association1 offers some tips for sites looking to expand the appeal of their water exercise classes. These tips may be used to help improve the caliber of after-care programming in senior facilities.

The classic "water aerobics" class is not necessarily the most popular. Try alternatives in your programming, such as Ai Chi (or T'ai Chi in the water), aquatic Pilates, Arthritis Foundation stretching classes, lap swim or water walking options.

The most common excuse for not exercising is "lack of time." Develop programs that give residents flexibility. Consider timing of classes and length of classes. Plan peak programming for early morning and early evening. Know that senior oriented programming usually occurs during daylight hours, especially during the shorter winter days.

Play up the three primary factors motivating respondents to exercise:  to "build muscle," "stay healthy" and "reduce stress."

Keep in mind that most participants prefer not to get their hair wet.

Offer group “independent exercise” times. In other words, open the pool up for independent exercise, but have a staffer on hand during those hours to offer tips, procure equipment and encourage consistency in attendance. There is nothing so compelling to the exerciser as knowing that someone will notice if he/she does not come.

Evidence-Based Aquatic Therapy for the Total Knee Replacement (1 hr)

Buy Now

References

1.  Krist P and Lindle J. Aquatic Survey. Aquatic Exercise Association: Nokomis, Fla.; 1999.