In The Bathroom
Being able to use and get around the bathroom is one of the keys to being able to live independently. There are certain modifications that can be made in order to make a bathroom more accessible but the level of changes required will obviously depend on the user.
As with all rooms in the house, the door handles can be easily changed to lever types if you have knob type or difficult to grip handles. Doorways for wheelchair users will need to be at least 32 inches wide and doors should open outwards in case the bathroom user has a fall and the door becomes blocked with their body.
Showering may be chosen because of personal preference or because getting in and out of the bath has become too difficult or hazardous. Showers take up less space and can be faster, easier and more economical than a bath. As a general rule, the shower tray should be as shallow as possible to make it easier to get in and out of without having to lift the legs too high, and it should have a textured surface to help prevent slipping. If is planned to use a shower seat or stool in the shower, it is important that the shower tray is made of reinforced material to prevent it being punctured by the legs of the seat, particularly if they are for heavier users.
For a person using a wheelchair, there are level access shower trays that have little or no edge at all making it possible to bring a shower chair on a wheeled frame directly into the showering area or to gain access in a wheelchair and then transfer onto a shower seat.
Alternatively, a ramped access tray can be used. This means the shower tray has a ramped section on one or two sides to make wheeled access possible. For wheelchair access, the dimensions of the shower tray should be 1000mmx1000mm and a turning space for a wheelchair in the room should be included. For more information and guidelines, see Building for Everyone published by the National Disability Authority.
Slip resistant flooring with a sloping gradient towards the drain can be installed as an alternative to a shower tray in some situations, but only if structural supports in the house allow or incorporated when planning a ground floor extension. This kind of flooring can provide a more solid base than a shower tray which can break. Ensure the builder has appropriate guidelines from an architect or planner about the measurements for the gradient in the floor for this system as incorrect installation can result in water spreading over the bathroom floor.
If the person needs assistance to shower, the carer will get rather wet if there is no protection against the water. Waist high, wall-fixed or portable shower screens may be useful in this situation.
It is important that the shower system itself is appropriate and it is recommended, at a minimum, it has thermostatic controls to prevent the user being scalded by water being used elsewhere in the house. The shower chosen should be easy-to-use with the most appropriate style of controls considered eg levered, push-button, dial control or rocker switch.
If the shower head is adjustable rather than fixed, it can be raised or lowered or hand-held offering greater options for the user/s. Think about where to position the shelf or container to hold soap, shampoo etc so that it is within easy reach. Washing accessories like a long-handled sponge can help reach the awkward places when washing in the shower or bath.
For more information on the equipment described in this section, see Choosing a Shower and Accessories.
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Shower doors can be replaced with half-height doors if someone needs assistance washing. These can be wall-fixed or portable. Weighted shower curtains can help to ensure they reach the ground and do not cling to the person in the shower.
Shower seats can be permanently installed in the shower unit if the user will be using the shower frequently, or a portable seat can be used which can be removed when not in use or needed. Make sure that the seat you choose has legs with fixtures such as rubber ferrules at the end to prevent it puncturing the shower tray over time. A reinforced shower tray will be necessary for heavier users. Wall-mounted seats in a range of sizes and materials are also available and these can be fixed in position or can fold out of the way when not needed. Shower chairs are also available with a wheeled frame so that you or your carer can move from the shower area to the bedroom or elsewhere with ease.
Shower trolleys allow a person to be in a lying or semi-reclined position and as they are long, more space than an average shower cubical is required to use a shower trolley. They can be useful if a person needs head support or full body support. A shower trolley can be on a wheeled frame or attached to a wall and can be height-adjustable to help with transfers on and off and to raise it to a height that a carer can comfortably help with washing. For more information on the equipment described in this section, see Choosing a Shower and Accessories.
Grab rails placed in key positions in the shower can help ensure the user has something steady to grip onto when getting into or out of the shower. They can also help with safely sitting down or getting up from a shower seat and can be reassuring for a users who are unsteady on their feet. There are grab rails that are more suitable for the shower with textured surfaces and contoured finger grips.
For more information on the equipment described in this section, see Choosing and Fitting Grab Rails and Choosing a Shower and Accessories.
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While showers are convenient and take up less space, for many, the bath is still the favourite and most familiar way of washing. But there is no doubt that getting into and out of the bath can be challenging for some. There are ways in which these difficulties can be overcome and these solutions range from something as simple as a bath board or bath seat, to a specially adapted bath with a side door for easier access. A bath mat is an essential accessory for any bath or shower as it can help to reduce the possibility of slipping in the bath.
Grab rails positioned near the bath can offer support when getting in and out of the bath. Some rails can be attached to the bath itself, near the tap end or on the side. One way of deciding where grab rails should be fitted is to break down the task of getting into and out of the bath into small steps to see where rails might be of help.
Bath boards fit across the top of the bath so that a person can sit and then lift their legs over the side into the bath. The user can sit on the board and wash using a hand-held shower head, or can move from the bath board down onto a bath seat so that they can be nearer the bath water. It is worth noting that users do need fairly strong arms to move themselves up and down between the bath board and bath seat. Bath seats are available in different heights and some also come with a cut-out section at the front to make personal cleaning easier if the user prefers to remain on the seat when in the bath.
For more information on the equipment described in this section, see Choosing a Bath and Bath Accessories or visit www.ricability.org.uk/consumer_reports/personal_care/bath_boards_and_seats/
A bath lift fits inside the bath and can lift the person from near the bottom of the bath up to the height of the bath rim. The majority of bath lifts have a seat and backrest unit made of either solid plastic or mesh fabric, and some have the option of a reclining mechanism to give a more relaxing bath. Bath lifts can be operated manually or powered. Lifts can be removed for relocation or to allow another member of the family to use the bath. However, their weight and the rubber suction pads can make them difficult to remove.
There are many different varieties of bath lifts and among the factors to consider is the amount of support required by the person and the amount of assistance they will need (if any). The size and shape of the bath is another factor to consider when choosing a bath lift. Great care is needed when using this equipment as there is always a danger where water is concerned, particularly if a person has difficulty with balance when sitting or when standing. A child should never be left in the bath unattended.
For more information on the equipment described in this section, see Choosing a Bath and Bath Accessories. For a checklist on things to look for when buying a bath lift, visit www.ricability.org.uk/consumer_reports/personal_care/ins_and_outs_of_bathing
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People of all ages can have difficulties with continence and use of the toilet. For some, it may be an issue with access and adaptations and equipment can help. For others, it may be a loss of bladder or bowel control and many continence problems can be resolved or helped. A continence advisor may be able to help and can be contacted through your GP or public health nurse.
For information on continence for adults and children and choosing products for bladder and bowel control, visit www.ricability.org.uk/consumer_reports/personal_care/. For other relevant information, see Clothing for Continence and Incontinence.
The height of the toilet is important when considering sitting and moving from sitting to standing from the toilet. For some people who have difficulty sitting and standing, it needs to be higher. For some using a wheelchair, the toilet needs to be same height as wheelchair for transfer. Therefore, it is very much dependent on individual.
A raised toilet seat is attached to the toilet bowl and must be fitted securely so that it does not move when the person sits on it. A raised toilet seat can be useful if you have limited hip movement or restricted movement as less bending is required in the hips and knees. Raised toilet seats are available at different heights and can come with an integrated lid as the original toilet lid cannot be used once it is fitted.
If the person needs to move from their wheelchair to the toilet, considerable space will be needed around the toilet and grab rails may be helpful. The space and positioning of rails is dependent on the way the user moves. Some people move sideways from their wheelchair and therefore require space to the side of the toilet. Others may move forwards requiring extra space in front of the toilet. If the height of the toilet is the same as the height of the wheelchair, movement across will be smoother so the height of the chair can be used as a guide for what is required in this situation.
Rails can be fitted to the wall next to the toilet and/or to the wall behind. Hinged, fold down rails can be fixed to the back wall so that they can fold up out of the way when moving sideways from the toilet. If the walls are not strong enough to support rails, they can be mounted from the floor. For more information, see Choosing and Fitting Grab Rails.
A back support can be fitted to the toilet cistern or to the wall behind the toilet to provide some support for the user to lean back on. For those who require more support, there is a wide range of toilet chairs that can be wheeled or fixed over the toilet to provide extra support. If there are a number of people in the household using the toilet, then a toilet chair with a wheeled frame will mean the chair can be moved out of the way when it is not required.
This type of chair can also be useful if the person using it needs assistance with lifting allowing that to take place in another room. Toilet chairs come in childrens and adult sizes and with a variety of additional supports such as footplates, head rest and trunk supports.
For those who require a high level of support, a tilt-in-space option can be helpful for someone and can be used in combination with a hoist and sling if they need to be lifted into and out of the chair. The chair can then be tilted forward in to a good position when using the toilet. These toilet chairs can also be used as commodes if required. A commode can be placed near the bed at night to reduce the journey to the toilet during the night if needed.
A washing and drying unit can be fitted on to the toilet or as a complete new toilet unit which washes and dries the person using the toilet. These can be fully automatic or require the user to press a button for water and another button for the drier. A toilet paper holder with a long is another useful but simple aid that can help for any toilet user that has difficulty reaching.
For more information on the equipment described in this section, see Choosing Toilet Equipment and Accessories.
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Some taps can be more difficult than others to turn on and off. Smaller, round taps tend to be more difficult for people who have problems grasping. Lever taps are available in different lengths; the longer the lever, the less effort involved in turning it. There are also taps which operate by sensor so all you have to do is place your hands under them to turn on the water but can be a more costly solution.
If you use a wheelchair, the washbasin should be set at a height that you can reach comfortably from the wheelchair, with access underneath the sink for the wheelchair to go. Alternatively, washbasins can be height-adjustable to suit a number of individuals with different height needs. The height can be adjusted by turning a handle or by pressing a switch.
A small wash basin may be an option if space is a problem but sometimes they can be a too small causing water to splash from the basin all over the user. Larger washbasins are available with a wide frame to allow a person using a wheelchair to lean their upper body over the basin. However, using the basin as a support to hold on to should be avoided in the bathroom, and instead, consider if grab rails are required.
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