Customer Service

Pedicures for the Elderly: A Test of Compassion

Providing pedicures to an elderly client requires special knowledge and skill and the ability to look beyond infirmity.

Getting a pedicure is not a luxury for many elderly clients. It’s a necessity. Some elderly clients find it difficult to bend down to touch their toes, which makes caring for their feet themselves nearly impossible. They must seek professional help, and that’s where you come in. You may present one of the few opportunities they have for maintaining healthy feet.

“I saw a man sitting with his feet up in a wheelchair; his toes were black and blue,” recalls Tina Reyes, a nail technician who provides services for the elderly at Bixby Knolls retirement community in Long Beach, Calif. “He had open sores on his feet made me feel weak.” Working with the elderly is unlike any other job. You have to have the heart to serve people with illnesses and the will to look past their physical problems.”

“Things can’t disgust you easily,” warns Doreen Bastian, president of Facialgram (Branford, Conn.), a mobile manicure service. When you’re in a hospice situation the smell isn’t sweet and the sight isn’t pleasant, she says. Bastian works with several clients who have Parkinson’s disease, cancer, and diabetes. She says that to serve the needs of elderly clients best, you must educate yourself about their illness.

Health Watch

Before you begin working on an elderly client, ask her if she has any health problems that could affect the service you provide for her. Ask her what medications she is taking and make a note of them on your client card.

“If someone has a history of heart problems or strokes, physicians will put them on blood thinners so their blood clots less rapidly,” says Dr. Kevin Pinski, a dermatologist in Chicago, III. “If you cut them, they’re going to have prolonged bleeding.”

Some clients won’t admit they’re on medication so you may need to be assertive to get them to talk about it. Shirley Thomas of Nail Technicians America says that 99% of the time her elderly clients don’t acknowledge they have a medical problem. “I’ve had clients who said they weren’t diabetic and later admitted to taking insulin twice a day,” she says.

Since you can’t always rely on your clients to inform you of their medical condition, you’ll have to watch for specific signs. “I look at the skin, which tells a lot about a client’s health,”says Carolyn McCormick, owner and manager of Beauty Boutiquein Beaverton, Ore. “Once I looked at a woman’s leg, which was discoloured and felt hot, like she had a temperature. I told her she looked she was in extreme pain and suggested she see a doctor. It turned out she had a broken leg.”

There are certain warning signs you should be aware of, particularly when working with elderly clients.

Dry, brittle nails. Aging nails are more permeable to water, says Dr. Alexander Miller, assistant clinical professor of dermatology at the University of California at Irvine. “As we age, we don’t seal in water as well and our nails become more brittle. They also tend to grow irregularly. You may see vertical lines from the base to the tip of the nail, for example. The nails will split shear, peel, and crack more easily. Always soak brittle nails in warm water; Miller advises. Once the nail is softened, it’s much less likely to crack or peel.

Poor circulation. If a client has poor circulation her skin may appear purple or red, or pale. The nails may be very thick and difficult to cut. Giving your client a good massage will help stimulate circulation.

Ingrown toenails. This condition often results from improper nail cutting. Your client may have tried to give herself a pedicure and cut the nails improperly. Advise her to see you regularly to prevent the pain caused by ingrown nails and untended feet.

Irregular nail growth. This stems from neglect. It can occur when a nails grow long and begin to curves. Simply trim the nails.

Fungal infection. You’ll see dryness and scaling between or underneath the toes. There may be some discoloration or lifting of the toenails. The nails may appear white. A nail fungal infection is caused by a fungus that grows underneath the nail plate in a moist environment. Refer the client to a physician.

Split cuticles. This condition is caused by irregular nail growth. “I don’t recommend too much cuticle pushing for elderly clients,” says Miller. “When you get rid of the cuticle, you destroy the seal between the skin and the nail. Sometimes people will get yeast or bacterial infections that can swell and be very painful if the cuticle is removed.” Recommend lotion or cuticle cream to keep the cuticles supple between salon visits.

Thinning skin. As a person ages the skin loses its elasticity and becomes thinner. The skin is more delicate and bruises more easily. You have to use extreme care and gentleness.

Inability to feel pain. People with diabetes have decreased nerve sensation in their toes and feet, Pinski says. A diabetic may be prone to mild trauma such as burns or pressure ulcers, which can develop into sores and become infected without her realizing it. A client may suffer burns from having her feet soaked in water that’s too hot. In this case, you can’t depend on her to tell you when it hurts. You’ll have to make sure the water is comfortable for a client with the most sensitive skin.

Any condition that decreases sensation or circulation increases the chance of infection, says Dr. Wesley Kobayashi, a dermatologist in Huntington Beach, Calif. Be very cautious. If you see an open sore, refer your client to a health professional immediately. Otherwise, use conservative care if your client has circulatory problems or diabetes. The key is to handle your client gently. Having a soft touch can prevent a disaster in the salon and demonstrate to your client that you care about her health.

 Those Little Extras

Some nail technicians provide additional services to their clients to make their pedicure experience more pleasant.

“We have a hydraulic chair for our clients,” says McCormick. “It’s like a dental chair, except it has a longer base from the buttocks to the foot area.” The chair reclines, providing maximum comfort, especially for clients with back problems. It has a locking position for elderly clients or for people with small body frames so clients don’t fall off while their feet are soaking.

Talk to your client as you would a friend, McCormick suggests. If your client is hearing-impaired look her directly in the eye and speak to her in a slow, low tone. A person who has difficulty hearing can often read lip movements and facial expressions. Don’t worry about what to talk about. Striking up a conversation shouldn’t be too difficult. Remember to listen patiently. McCormick suggests. Let your client talk if she wants to talk. “Elderly clients often have interesting stories to tell and you can learn from them.”

Have compassion. Understand that an elderly client may be lonely and enjoy her salon visit for your company as much as your service. Be a friend to her. Reyes believes both you and your client will benefit in the long run: “It’s a very rewarding job because you’re helping people who need help.”

Mastering the Pedicure

Once you’ve obtained information about your elderly client’s health condition, you can begin the pedicure. You may need to make a few changes to your standard pedicure to accommodate your client. Begin by soaking the feet 10-15 minutes in warm water. The length of time depends on the condition of your client’s feet.

Remove the polish and apply cuticle remover, gently push back the cuticles with an orangewood stick. Try using scissors instead of clippers when trimming the nails to prevent them from shearing.

“Scissors cut one edge of the nail at a time, while clippers grab a larger surface of the nail, causing it to shear more easily,” says dermatologist Dr. Alexander Miller. Trim and file the toenails in one direction. Frequently changing directions can crack the nail.

Use a foot file or pumice stone instead of a blade or rasp for excess skin on the bottom of the foot. Using a pumice stone is safer and less likely to cause bleeding. Be careful if your client has coms and calluses. Trim them down without eliminating them. “The buildup of rough skin is there to protect the foot,” says salon owner Jackie Randolph. “Just buff them enough to make them smoother.” After buffing, use an exfoliating lotion to help peel away the dead skin.

Begin the foot massage. Be gentle on the leg and shin areas. “Sometimes you’ll see varicose veins on the legs, says salon owner Carolyn McCormick. “If you massage too roughly, it can be painful for your client.”

Polish the toenails. Use clear nail hardener in addition to colored polish to keep the nail from shattering.

If your client has particularly dry skin, give her feet a paraffin dip. “We wrap up the leg and foot in a piece of plastic to hold in the warmth,” says Randolph. “Then we place them in a terry cloth glove, which retains the heat for five minutes. It helps to deeply penetrate moisturizers into the skin.”

Don’t immerse the entire foot in paraffin, advises nail technician and salon owner Doreen Bastian, and be sure your state board allows feet paraffin dips. Only soak the soles of the feet. You don’t want the paraffin to get between the toes where it is already moist.

Remove the foot from the wax, dry the foot, and spray antifungal foot powder between the toes and on the soles of the feet. Limit the pedicure to one hour and schedule your client’s next appointment within four to six weeks.

Incorporating the Massage

The massage is the best part of the pedicure for many clients. It can relieve stress and make your client feel pampered. There are several types of massage you can do during a pedicure. One of the most common is the European massage. Using your thumb, apply pressure to the heels and toes as you rub, explains nail technician Tina Reyes. Massage around the ankle, twisting it back and forth very gently. Use your fist in a rolling motion to work out the knots on the soles of the feet. Rub the back of the legs in a circular motion.

Some technicians incorporate reflexology with the massage treatment.

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