Choosing a Bath and Bath Accessories
INTRODUCTION
Most of us enjoy a relaxing soak in the bath and will therefore feel frustrated if this pleasure is taken away. It may become impossible to get in or out of the bath, or the bathroom itself may become difficult to get to, particularly if it is upstairs. However, in most cases these difficulties can be overcome using one or more of the many items of bathing equipment currently available, and/or by making a few alterations to the house.
Before considering building a downstairs bathroom for someone who cannot use the stairs, check that all other options have been considered. For example, it may be more practical and cheaper to install a stairlift or through-floor lift to provide easy access to the first floor.
The aim of this Information Sheet is to provide first stop information on the type of equipment available to help with specific difficulties, and details about the useful features of some of the more popular items of bathing equipment.
For up-to-date information on specific products and suppliers in Ireland, visit the ‘Products and Suppliers’ section of the Assist Ireland online database (www.assistireland.ie). The information in this resource can also be accessed using the telephone support service on Lo-Call 1890 277 478 during office hours.
The information contained in this document is strictly for information purposes only. There are hazards with all equipment and the suitability of any solution is totally dependent on the individual. It is strongly recommended to seek professional advice and assistance before you consider buying any type of equipment mentioned in this Information Sheet.
WHERE TO GET HELP AND ADVICE
Before making any decisions about buying equipment, or making alterations to your home, it is strongly recommended to contact an occupational therapist (OT). An OT is qualified to assess your daily living needs. The OT will advise on possible solutions and will arrange for the provision of suitable equipment to those who are eligible eg medical card holders. The OT can also advise on home modifications, where appropriate, and on grants that may be available to help with the cost.
You can contact the OT for your area through the Community Care section of your Health Services Executive area. Contact details for your local services are in your local area phone book.
If you decide to buy equipment privately it is strongly recommended to seek the advice of an occupational therapist regarding the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.
You can arrange to visit a supplier’s showroom (if they have one). Contact details of suppliers can be found under ‘Disabled Persons Products & Services’ in the Golden Pages and some may have a website with details of their products and services which you can view online. Another source of information on suppliers of assistive technology, aids and appliances is the Access Directory. This directory is produced commercially each year and copies are widely available (see Useful Publications).
Sometimes suppliers organise exhibitions of different types of equipment in various locations around the country allowing people to see and try equipment. These exhibitions are often advertised in the local paper or on local radio. You can also request to be put on a supplier’s mailing list so you will be notified if there is an event being held in your area.
Some companies will give equipment for a try-out period before purchase. Enquiries should also be made about maintenance (if it will be required), maintenance contracts (if relevant) and whether a user manual is provided with the equipment (essential).
When purchasing from any supplier, it is important to remember that it is their business to sell. There may be several suppliers of that particular piece of equipment or different manufacturers of the same type of equipment, so always shop around.
ASSESSMENT
Depending on the type of equipment required, a qualified therapist will assess the individual and make a recommendation to the body responsible for the provision of the equipment or to the person or agency who has requested the assessment. Generally the following applies, but the assessment process and provision may vary in different parts of the country.
- Occupational therapists will assess for aids to daily living – these include wheelchairs, mobility aids, specialised chairs, bath, shower and toilet aids, stairlifts, hoists etc
- Physiotherapists will assess for movement, strength and balance training equipment, walking aids and exercise devices
- Speech and language therapists will assess for communication, speech therapy, and training aids
- Other relevant therapists and specialists may also be involved in carrying out assessments, depending on the equipment or appliance required.
All the different therapists described above are based in hospitals, community care areas, and with various voluntary agencies. For more information, contact the Community Care section of your Health Services Executive area or the relevant hospital department as appropriate.
Private Occupational Therapists
Occupational therapists in private practice can carry out assessments in the home or workplace, and if modifications are being considered, provide a report detailing the recommendations. It is important to ensure the therapist is experienced in relation to your particular needs. Make sure to discuss fees before engaging anyone’s services, and also check what the assessment fee includes (or does not include). The profession’s representative body, the Association of Occupational Therapists in Ireland (AOTI), keeps a list of contact details of member occupational therapists working in private practice in Ireland. This list is available from the AOTI (see Useful Addresses).
Private Physiotherapists
Physiotherapists can assess for movement, strength and balance training equipment, walking aids and exercise devices and recommend accordingly. If you wish to consult a physiotherapist you can go directly to your local chartered physiotherapist or ask your GP to refer you. It is important to ensure the therapist you consult is experienced in relation to your particular needs. Chartered physiotherapists work in hospitals and in the community where treatment is covered under the public health service. They also work in private practice and can be contacted through the profession’s representative body, the Irish Society of Chartered Physiotherapists (see Useful Addresses), or through the Golden Pages.
If you decide to buy equipment privately it is strongly recommended to seek the advice of an appropriate therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.
Private Purchase – Applying for a VAT Refund
VAT paid on certain equipment which is privately purchased for use by a person with a disability can be reclaimed from Revenue. The relief applies to VAT on the purchase of goods which are aids and appliances designed to assist a disabled person to overcome a disability in the performance of their daily functions. Most aids to daily living and communication aids are included. Goods designed for leisure purposes are not. An invoice clearly stating the VAT content of the total amount paid must be included with the application. Form VAT 61a is available from Revenue or can be downloaded from their website (see Useful Addresses).
HOUSING ADAPTATION GRANT FOR PEOPLE WITH A DISABILITY
From 1st November 2007, the Housing Adaptation Grant for People with a Disability may be applied for to assist in the carrying out of works that are reasonably necessary for the purposes of making a house more suitable for the accommodation of a person with a disability (who is a member of the household). This scheme replaces what was previously known as the Disabled Person's Housing Grant.
The types of works allowable under the new scheme can be varied and include the provision of access ramps, stairlifts, downstairs toilet facilities, accessible showers, adaptations to facilitate wheelchair access and extensions. In general, people who require grant aid for minor works eg ramps, grab rails, accessible showers and stairlifts, and who satisfy the means test provisions, should apply for assistance under the new Mobility Aids Grant Scheme, also administered by your local authority.
All applications for grant aid under the Housing Adaptation Grant Scheme are assessed on the basis of household means. In November 2007, the maximum grant available under this scheme is €30,000.
How to apply
The Housing Adaptation Grant Scheme for People with a Disability is administered by your local authority. All applications must include two written itemised quotations from contractors indicating the cost of the adapation. The local authority will decide whether it is necessary to refer the application to an Occupational Therapist. This decision is based on the report of the authority's Inspector, the applicant's General Practitioner, and the long term needs of the applicant. For full details of the Housing Adaptation Grant Scheme for People with a Disability, contact the Housing Department of your local authority.
FOR PEOPLE WHO ARE UNABLE TO GET DOWN INTO OR UP FROM THE BOTTOM OF THE BATH
There is a wide range of equipment, ranging from simple to sophisticated items that will help overcome this difficulty. The combination of a bath board, seat, grab rails and a slip-resistant mat may satisfy many peoples’ needs, others will need to consider a hoisting/lifting mechanism or an alternative type of bath. If the task is still difficult or unsafe, then it may be wise to think about showering.
PROVIDING A HIGHER SEATING POSITION
Bath boards
These wedge between the rims, providing a platform seated area over the bath for a person who is unable to step in and sit down in the usual way. The user can sit on the board to transfer his/her legs into the bath and can either sit on the board and wash using a hand-held shower spray, or can move from it down onto a bath seat so that he/she can be nearer the bath water. It is recommended that a slip-resistant mat is also used.
For maximum safety, the board must fit securely across the top of the bath. A standard board should not extend beyond the rims as it may tip when it takes the person's weight. All have an adjustable fixing system, usually brackets on the underside, which braces the board against the sides of the bath. The board may be perforated or slatted, so that water drains away easily, and can be made of different materials, such as solid or padded plastic, wood or cork.
Extended bath boards straddle the bath rims and are similar to a standard bath board. However, they are extra long, forming a section outside the bath for the person to sit on and this end has height adjustable legs which rest on the floor. When getting out users can slide across the board, lift their legs over the side of the bath, and sit there whilst drying themselves.
Bath seats
Bath seats are usually used in conjunction with a bath board, and provide a sitting platform halfway down for those people who wish to shower or sit near to, or in, the water. Bathing from the seat will still deny people the pleasure of lying in deep water or stretching out in the bath, although it may be possible to move down onto the bottom of the bath and move the seat out of the way until it is needed again for getting out. This is not recommended. Users need fairly strong arms to move themselves up and down between the board and seat. It is recommended that they are used in conjunction with a slip-resistant mat. Some seats have a cut-out section at the front to make personal cleaning easier. There are three types of bath seat: suspended, wedge and freestanding (see later section on choosing and using equipment for the bath). If you have an acrylic bath you should consult the suppliers before buying a wedge type bath seat.
Swivel seats
These seats rest across the rims of the bath and may be used in preference to a bath board as they provide a more supportive chair-type seat. They swivel to the left or right and many have a locking mechanism, which will secure the seat in a fixed position when the user is getting on and off. He/she sits to wash using a hand-held shower spray.
Combination boards and seats
These consist of a bath board attached to a bath seat and have the advantage of being more stable than two separate units. However, they can be rather bulky and heavy to remove from the bath.
PROVIDING A SUPPORT TO PULL ON
Rails provide hand holds to help people get in and out of the bath independently or with minimal assistance. Some baths have small rails built in and provide a low level hand hold, but these may be too low to assist with getting in and out of the bath. They can also make positioning and securing equipment such as a bath board difficult. Conveniently sited grab rails positioned next to the bath will ensure that the person does not lean on a basin rim or towel rail for support.
Grab Rails
These can be attached to the wall, ceiling or floor next to the bath. Straight and angled rails are fixed to the wall to provide support when getting up and down in the bath. A floor to ceiling rail is fixed to the floor and the ceiling and can be helpful if a step is used to get in and out of the bath, however it may get in the way if a bath board is used.
Bath-fixed rails
These clamp onto the side of the bath providing a vertical loop, which sticks up above the bath rim. Rails that attach solely to the bath itself, especially acrylic baths, are not recommended, as great care must be taken to ensure that the adjustable fixing mechanism, usually a screw system, is tight enough for the rail to remain secure, but not so tight that it damages the bath. Fixings should be checked on a regular basis and tightened when necessary.
Floor/bath fixed rails
These have fixing points on the bath itself and on the floor next to the bath. This makes them more stable than those fixed only to the bath. Most are height adjustable. These rails can provide a handhold to assist you up from the bottom of the bath or from a bath seat. They can also help you to step into the bath. However, they will make it difficult to transfer your legs into the bath if you are going to do this whilst seated on a bath board.
Tap-fixed rails
These clamp around the bath taps, fold down to rest on the bath rim and can be folded up against the wall when not required. When sitting in the bath, the rail will be directly in front of the person at about chest height. In this position it will provide stability whilst in the bath, but it may not be at an ideal level to help with sitting down or standing up from the base of the bath.
These rails are not always recommended as they clamp around the bath taps and are therefore only as strong as the tap fixtures. Taps are not designed to withstand a person's body weight pulling against them.
Wall-fixed rails
Rails can be attached to the wall alongside the bath to assist with stepping in and out of the bath, and to provide support when standing up from the bottom of the bath and lowering down. Wall-fixed rails used in the bathroom should have an anti-slip, coated finish; and all the fixation screws should be concealed. The wall itself must be strong enough to bear the load (it may be difficult to fix rails to some partition walls).
As general guidance, rails are available in three standard lengths: 30, 45 and 60cm. Positioned on the wall horizontally, they will help with movement forwards and back, and side to side. Positioned vertically they will assist with up and down movements. When the user needs to get up from the bottom of the bath and has to shift his/her weight forwards before beginning to rise, a combination of a horizontal rail and a vertical rail (or a single rail positioned at an angle rising away from the users) may be needed.
For further information, see the Assist Ireland Information Sheet ‘Choosing and Fitting Grab Rails’.
Rails systems
These are made up of a number of component parts, enabling them to be built to individual requirements and fitted around corners and obstructions. They may be attached to the walls or the floor.
Wall fixed/ceiling mounted lifting poles
An option to help with getting out of the bath independently is to pull on an overhead handle attached to a wall or ceiling-fixed lifting pole. Care should be taken to ensure that it is securely fixed. A moulded handgrip is more comfortable to hold. The strap from which the handhold is suspended can usually be adjusted.
PROVIDING A LIFTING MECHANISM FROM THE BASE TO THE RIM OF THE BATH
People who find it difficult to use a bath board or seat to move themselves up and down from the bottom of the bath may wish to try out a bath lift or hoist. Many are powered and can be operated either by the user for independent bathing; or by a carer to make the task of assisting someone easier and safer, thus reducing the risk of back injury. If motor driven, the controls are air operated, usually on a handset, and are therefore safe if accidentally immersed. Although expensive, a hoist or lift may be more cost effective than installing a special bath or shower.
A bath lift raises the person from underneath, a hoist lifts the person from above.
Removable bath lifts
These fit inside the bath and can lift the person from near the bottom of the bath up to the height of the bath rim. Users must however, still be able to lift their legs over the bath rims if they wish to bathe independently. 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. 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. Some models have detachable components making the bath lift easier and safer to handle.
Manual and powered versions are available. Manual lifts are operated hydraulically using the weight of the person to lower the lift and the buoyancy of the water to help to raise the lift. The motor driven versions are usually powered by a rechargeable battery located behind the backrest or in the handset. This must be removed and recharged regularly. Occasionally, bath lifts are powered by mains electricity via a step-down transformer, and connected to the mains via a plug located outside the bathroom.
A few bath lifts use air pressure. User's may find the seat unit, particularly if it has no backrest, less stable. Therefore, they may be inappropriate for someone with balance difficulties.
Wall/floor-fixed bath lifts
These lifts are also called band lifts. They consist of a fabric band on a roller connected to the wall. The band pulls out, runs across the bath rims and slots into a floor-mounted bracket. A battery or mains-powered motor gently rotates the roller 'letting out' the band, lowering the user into the bath. The roller is rotated in the reverse direction to lift the user up. Their advantage is that they lower the user right down to the bottom of the bath and give him/her the freedom to lie back and soak. In addition, they are relatively discrete. These lifts are not suitable for everyone, as they provide no trunk or back support, and users must adjust their position on the band at intervals during ascent and descent to keep themselves central. The bather therefore needs to have good sitting balance in order to use these lifts safely.
Floor-fixed bath hoists
Floor-fixed bath hoists may be powered or mechanically operated. They have a seat (or slings) attached to a vertical column which usually slots into a base plate at the side or the end of the bath. The height of the column can be adjusted and the seat swivels to enable the person to transfer onto it from outside the bath. The seat is then raised so that it clears the bath rim and is lowered down into the bath.
Manual hoists are operated by a winding handle designed to be operated by a carer, although it may be possible for the bather to use some models independently. Powered hoists use either mains electricity that will require a power point outside the bathroom or a rechargeable battery that will need regular charging. The controls may be operated independently by the bather using a handset.
Hoists which provide a sling support
Although a few of the floor-fixed bath hoists have the option of using slings, most people who need the additional support gained from a sling will use a mobile or ceiling track hoist. It is better to use mesh slings in the bath as they allow the water to drain away easily.
A small mobile hoist can be used for many handling tasks in and around the home. However, if the person needs to be moved from one place to another, it is better to use an overhead track hoist or a sanichair because a mobile hoist can be heavy and difficult to manoeuvre, especially in confined spaces such as bathrooms; and the occupant can feel particularly vulnerable in transit. The hoist legs must fit under the bath to position the bather. This will require a minimum space of 11cm under the bath, and the side panel will need to be removed or have a hole cut into it. Storage space for the hoist also needs to be considered.
Battery-powered hoists are easier to operate than manual hoists, as the motor takes the person's weight, but remember that the battery needs to be charged regularly.
Overhead track hoists are ideal in a domestic situation because, if the layout of the house permits, a straight, jointed or curved track can be fixed so that a person can transfer in the sling from the bed and into the bathroom where he/she can use the toilet and the bath or shower. It may be possible to do these manoeuvres independently or with minimal assistance. However, structural alterations may be necessary such as strengthening the ceiling, or adapting the top of the doorframe to take the track.
An electric traversing system may enable a person to transfer independently. The carer has to push the person along the track in the sling if a manual traversing system is used.
PROVIDING AN ALTERNATIVE TYPE OF BATH
When planning to replace a bath consider:
- the available space
- the level of disruption in terms of both noise and mess whilst work is in progress, and the time the bathroom will be out of action
- the volume of water required to fill the new bath and compare this to the capacity of the current bath. Does the hot water tank have sufficient capacity
- aftercare of equipment, particularly servicing and maintenance if the bath has moving parts
- the long term prospects of the bather. If his/her ability is likely to deteriorate a level access shower might be a better option
- other household members.
Baths with a built-in seat
These have a seat built into the moulding of the bath so that the bather does not have to sit on the bottom of the bath. They have no transfer system and, like a bath seat, the user must have fairly strong arms to move him/herself up and down. Many have cut away sides and a small corner ledge for users to perch on whilst transferring their legs into the bath.
Baths with a built-in transfer mechanism
All these have lifting seats incorporated into the structure of the bath so that there is no need for the person to get up or be helped up from the bottom of the bath. The seat raises and lowers; all but a few seats have a fixed backrest which makes reclining back in the bath difficult. Some seats incorporate a legrest to lift the legs over the bath rim. When the seat has been raised above the bath rim, it can be swivelled outwards, either manually or automatically, for easier transfer. The height of the seat edge is important, especially for people who need to brace their knees in order to stand upright, or who need a level transfer from a wheelchair seat. A few systems have the facility to raise and lower the seat outside the bath.
These baths are powered either by water pressure or mains electricity. The lift can be controlled by the bather or a helper using a handset. If the system is electrically powered, a safe air switch is used.
Multi-adjustable baths
These are high-level baths that enable the bather to transfer directly onto a bathing platform. The bath side or sides are then raised so that bathing can commence. The platform can also be used as a drying/changing table in some situations. As well as making transfers easier, this style of bath can ease back strain for a carer.
Walk-in baths
Walk-in baths can help people who have difficulty getting their legs over the side of a standard bath or who have difficulty getting up from the bottom of the bath. They basically have a door at the front or side for entry (but there is always a small step to negotiate); and a seat. Their maindraw back is that they cannot be filled with water until the user is in and the door has been sealed; and he/she cannot get out of the bath until most of the water has drained away. For safety, water temperature should be thermostatically controlled.
The shape of these baths may vary. Those that are square take up less room in the bathroom but if the door is outward opening, space will be needed to accommodate the swing. Smaller baths will give the bather less leg room so may not be suitable for someone with stiff hips or knees.
Check the height of the internal seat to make sure the user is able to lower down and stand up from it with ease; and, if he/she is unsteady on their feet, make sure the taps; plug and door controls can be reached from the seated position if independent bathing is planned.
Adjustable-height baths
The height of these baths can be adjusted, either mechanically or electrically. They are designed to reduce the need for a carer to bend over the bath if the person needs assistance. The bather may be able to step into the bath at its lowest level and then be raised to a convenient height. However, remember that the water usually needs to drain away before the bather can get out. These baths are not often used in a domestic setting.
FOR PEOPLE WHO FIND IT DIFFICULT TO STEP OR LIFT THEIR LEGS INTO THE BATH
Unfortunately this is a very common difficulty with no easy solution. Those people unable to find a successful solution may wish to consider showering.
LEG LIFTERS
Manual leg lifters may be useful for people who can sit on a bath board and hook their leg through the reinforced aluminium loop. They would then need to lift their leg up and over the bath rim with the loop. However, this task needs strength, dexterity and good sitting balance. Some people use the crook neck of a walking stick to perform the same action.
BATH LIFTS
The column on some of the floor-fixed bath lifts is high enough to enable the seat and occupant to be lifted so that the bather need not raise his/her legs very far in order to clear the bath rim before being swivelled and lowered into the bath. A similar action can be performed to get out. Some may also have a leg extension that supports the user's legs in a horizontal position.
BATHS WITH A TRANSFER MECHANISM
Some baths that incorporate a swivel seat can include a leg rest.
WALK-IN BATHS
Although there are no high sides to negotiate, the bather must still be able to manage a low step on entry and exit. As difficulties are likely to be caused by stiffness in the hips and knees, square shaped walk-in baths that have limited legroom may well be too cramped.
SHALLOW BATHS
These baths, which are not as deep as standard baths are easier to climb into and out of. However, the user can still experience difficulties when he/she has to stand up from the bottom of the bath, and additional rails may be necessary.
BATH STEPS
Bath steps provide a platform on the outside of the bath, lessening the height over which people need to lift their legs to get into the bath. However, they are not suitable for people who have difficulty keeping their balance, and they will not help bathers to lift their legs out from a deep bath. If used, a slip-resistant step provides a safer surface to stand on; and a grab rail mounted on the wall will give a secure handhold.
FOR PEOPLE WHO REQUIRE SUPPORT, COMFORT AND POSITIONING IN THE BATH
INSERTS AND SUPPORT CUSHIONS
Cushions for comfort
Plastic covered foam cushions can be used to line the bath to improve comfort for someone who is frail; or to increase the safety of a bather who has involuntary movements.
Mouldable body supports
These are large waterproof mouldable cushions which are filled with polystyrene beads. They are available in different shapes to support various parts of the body. They will conform to the shape of the bather and this shape can be semi-permanently fixed, when the air inside is removed using a pump. They are secured to the side of the bath with suckers.
HEAD SUPPORTS
Head cushions improve comfort when lying back in the bath. They are fixed to the bath with suction pads. If head control is poor, swimming flotation aids can be used to support the head of the user above water.
PRESSURE RELIEF CUSHIONS
It should be remembered that anyone who needs pressure care should be provided with it across the range of daily living activities, ie not only as a pressure cushion for the wheelchair, but also in bed, in the bath and on the commode or toilet. Bath cushions should have a waterproof outer cover, and a heavy inner substance which enables the cushion to remain submerged.
SAFETY EQUIPMENT
BATH THERMOMETERS
These can be used to check the temperature of bath water before use. They are particularly useful if the bather has reduced skin sensation and needs an objective way to determine temperatures.
WATER TEMPERATURE INDICATORS
These devices change colour to indicate water temperature. Some people may find them simpler and easier to read than a bath thermometer.
WATER LEVEL INDICATORS
These emit an audible warning when in contact with water and therefore can be used to alert someone when their bath is full. This can be particularly useful when someone has short-term memory problems or a visual impairment.
BATH MATS AND SLIP-RESISTANT MATERIALS
Mats which are secured with suckers to the bottom of the bath, self-adhesive strips and spray-on slip-resistant material will all help to prevent a person from slipping in a wet bath.
TAPS
Bath taps should not be used as a support to pull up on when getting out of the bath. Most will not be strong enough to withstand a person's weight. Strategically positioned grab rails should be used instead.
CHOOSING AND USING EQUIPMENT FOR THE BATH
The most commonly used types of bathing equipment are:
- bath boards
- bath seats
- bath lifts.
This section compares their different features.
IS MY BATH SUITABLE TO TAKE BATHING EQUIPMENT?
Most standard shaped baths will take a bath board without any problems, but care must be taken when introducing other items. You will need to consider:
- length - check whether there is enough room to use the equipment, especially if a bath board and seat are going to be used to get down into the bottom of the bath or the bather has stiff hips or knees and therefore needs room for straight legs. A 1700mm long bath allows room for most bath equipment.
- width - if the bath is exceptionally wide or narrow, the equipment may not fit into it.
- space - it is often helpful to have a small area of flat tiled surface between the end of the bath and the wall. Some equipment can be placed on it and it can provide additional space for the bather to sit or lean on to when moving up and down in the bath.
- built-in grab rails - the positioning of these may hinder the use of equipment or entry and exit to the bath. Some bath lifts come with sliders that prevent the flaps of the seat from getting caught under the built-in handles.
- material - metal baths are strong enough to withstand all types of bathing equipment. Most acrylic baths are not strong enough to take wedge-in bath seats and, when free-standing bath seats and removable bath lifts are used, the weight should be distributed over as wide a base as possible.
Only a few items of equipment can be used in a corner bath. Because of the increasing width, boards and seats cannot be firmly wedged in and could slide forwards towards the wider part.
WHICH TYPE OF SEAT OR BOARD?
The material and shape of the sitting surface of any board, seat or bath lift will determine how comfortable and easy to use it is. In general, the edges and corners should be smooth and the surface should be easy to clean.
Moulded plastic
Generally quite lightweight, easy-to-clean and resistant to damage.
Wooden - polished top
The smooth surface enables the person to easily slide across onto the board or seat. However, since the polish may wear away after prolonged use, it should be checked periodically.
Wooden - cork top
The rough cork surface provides good friction whilst people are sitting on it, but bathers will have to lift up their bottom to get on and off. The surface may chip and stain after prolonged use. They are quite lightweight and feel warm to sit on.
Wooden - painted or plastic coated
The smooth surface enables the person to slide across onto the board. However, the coating may chip with heavy use and should therefore be checked periodically.
Coated metal
These tend to be stronger and heavier, and will withstand prolonged use by a heavy bather, eg some metal boards have a capacity of 222kg (35 stone). The smooth surface enables the person to slide across the board.
Padded
These will provide more comfort especially for people who are thin or in pain.
Slatted/perforated
These will allow the water to drain away more easily, so that drying is easier and the board is less slippery to sit on. However, ensure that the holes are small as it has been known for male users to trap certain body parts!
Cutaway front
Some seats have a cut-away section or a dip at the front to facilitate personal cleaning.
BATH BOARDS
Type of fixing
It is very important that once a bath board has been securely fitted against the sides of the bath that it is held firmly in place so that no movement occurs during use. Once in use it should be checked frequently to ensure that the fixings remain tight.
Adjustable brackets can be adjusted and the angle of some can also be altered to wedge the board against the inside rims of the bath. Brackets are usually made of plastic or metal and are held in position with wing nuts, which people with weak or painful hands may find difficult to tighten. Some adjust along one central column, whilst others have two fixings - which tend to be stronger. The brackets usually have slip-resistant covers to provide extra grip and to prevent marking the bath. These should be checked periodically as they may wear after long-term use.
Some models have four small grooved pillars which are positioned and tightened independently. They are positioned at each corner and can be moved within a slot or to different locations on the board as required to give a firm hold against the sides of the bath.
Wall-hung brackets are particularly useful when the bath rim adjacent to the wall is not wide enough to support a standard bath board safely. The bath board attaches to the bracket on one side and rest on the near side bath rim on the other. They fold up against wall when not required or can be removed.
Size of board
Depth (front to back) - a wider board will be stronger and more comfortable, especially for the larger user, but will, however, take up more space.
Width (side to side) - particularly important if it is to be fixed into an especially wide or narrow bath. It is important that the board does not overlap the outside edge of the bath by more than 2cm, as this could cause the board to tip when used as an aid to seated transfer into the bath.
Capacity - check the weight capacity of the board, particularly for larger bathers. In general the metal covered bath boards tend to be the strongest.
Weight - this may be important if the board is to be moved frequently or taken away on holiday.
Additional features
- Integral handgrips - some boards have handles or handgrips built into them which help the bather to independently move onto and off the board.
- Soap dish - some boards have an integral soap dish.
- Cutaway front - some boards have a cut-away section or a dip at the front to make personal cleaning easier.
How to use a bath board
Bath boards should always be used in conjunction with a slip-resistant mat.
- Sit on the edge of the board with the feet outside the bath on the floor.
- Slide or wriggle backwards onto the board.
- Turn to swing the legs over the rim and into the bath. You may need the help of a manual leg lifter or from another person.
- Slide or wriggle to the middle of the board using wall-fixed grab rails or integral handgrips to pull on.
- From this position you can either lower onto a bath seat or down onto the base of the bath, or stay on the board and use a hand-held shower.
BATH SEATS
All users of bath seats must be able to sit up straight, ie be able to bend at an angle of 90° at the hips. They will need to be able to bend further forwards if they are to be able to reach and wash their feet without using a long handled sponge.
Suspended seats
Suspended seats hang down from a framework which rests on the bath rim. The width of the frame can be adjusted to fit different sized baths using wingnuts to ensure that it wedges firmly against the sides as the person sits on it. The ends of the frame are covered in a slip- resistant material to provide extra grip and to prevent damage to the bath. They can be used in metal or acrylic baths. Some have a backrest or support which makes them difficult to use with a bath board.
Free-standing bath seats
Free-standing bath seats have feet or suction pads which stand on the bottom of the bath. Some have adjustable side brackets, which can be tightened to wedge against the side of the bath, reducing seat movement and providing the user with extra stability. They can be used in all baths, although those with two U-shaped legs are more suitable in acrylic baths than those with four separate legs as the weight is spread over a larger surface area.
Wedge bath seats
Wedge seats have four hinged paddles which are attached to the metal seat frame and wedge firmly against the sides of the bath. The frame can be adjusted to ensure a firm grip against the bath sides. Most are only suitable for use in metal baths - some plastic or glass fibre baths may crack as the legs push against the sides of the bath, although thick rubber paddle caps are available on some models which reduce the stress on the bath sides. Wedged seats are usually easiest to move if more space is needed during bathing.
Seat height
- The height of some bath seats reaches to just below the bath rim. The seats are used for showering and still allow the curtain to hang inside the bath.
- Some bath seats are only available in one height.
- Some free-standing models are available in a range of heights, or can be fitted with leg extenders.
- Some of the wedge seats have reversible paddles which give a choice of two seat heights.
- You will need to check how far the seat on a suspended model hangs down in the bath and compare this with the depth of bath.
Backrests
Not many bath seats have backrests, and those that do provide varying amounts of support.
A high backrest will provide much more support than a low one, but if it protrudes above the bath rims the seat cannot be used in conjunction with a bath board.
Tubular backrests provide very little support and can be uncomfortable to lean against.
Padded backrests will provide more comfort especially to people who are thin or in pain.
Some seats have an all-in-one moulded seat and backrest so that the bather has to sit in an upright position.
Weight
This may be important if the seat is to be moved frequently or taken away on holiday.
Capacity
Always check the weight capacity of the seat, particularly for larger bathers.
SWIVEL SEATS
As these are fixed on a frame across the rims of the bath, they are generally used for showering over the bath. Check that a shower curtain can be positioned around the seat frame.
It is often useful to have a conveniently positioned grab rail to assist with pulling or pushing the seat and bather around into position. A carer may be needed to lift the legs of the bather into bath.
Swivel mechanism
Some seats swivel only when a lever mechanism is released and this may be difficult for people with weak or painful hands. When the seat is facing outwards for transfer, check how close the edge of the seat is in relation to the rim of the bath. Help on and off the seat may be required if it is positioned back from the edge of the bath.
Armrests
Check that they protrude far enough forwards to allow them to be used as support when standing up.
Swivel seats with fold-up armrests allow for sideways transfers although, because of the swivel mechanism, it is usually easier to transfer onto it from the front.
Tubular armrests do not provide as comfortable forearm support during sitting as those which are slightly padded or flattened horizontally.
Seats/backrests
Swivel seats all have moulded seats with a fixed backrest which make it difficult to lean back, especially for people who have stiff hips.
REMOVABLE BATH LIFTS
The removal of a bath lift will enable other members of the household to use the bath in a conventional way. However, this task should be avoided where possible because someone has to stoop down into the bath to reach and grasp the lift which can cause great strain on the back. Consider the following factors:
- Weight - this will vary according to the size, the lifting mechanism and the power source. Some can be broken down into several lighter component parts.
- Suckers - many have large suckers which stick to the bottom of the bath to provide stability. These need to be released before the lift is removed. Some have pull-up tabs to make this easier; most require at least four hands to release them all at once.
Lifting mechanism
Hardly any of the lifts lower right down to the bottom of the bath. The seat level of some are as much as 8cm from the bottom in the lowest position.
Check that its lifting height is sufficient to lift from the bottom to the rim of the bath. Some do not lift high enough for use in deep baths. Some have adapters that can be added when used in deep baths - check with the supplier.
Some models have a metal scissor mechanism frame which relies on the weight of the person to lower it gently down in the bath. To come up, the person needs to sit upright and push down on the bath rims to release a hydraulic pistons mechanism which lifts the bather back up using powerful springs.
On some models the seat is attached to the top of a bellows mechanism into which air is sucked in or out, thus raising or lowering the person. When not in use it should be kept in an upright position to let it dry out. On other models the bather has to sit directly on top of a plastic bubble. Without a solid seat and backrest, it may not provide enough support for some bathers.
Many of the powered lifts have a metal coated lifting column on which the seat raises and lowers. They require no special drying instructions, as they will not go mouldy.
Power source and controls
Powered lifts can be used independently.
Compressed air - air is used to inflate a bubble or bellows lifting mechanism. The compressors can either be powered by a battery powered portable compressor or a mains powered compressor. The latter type is perfectly safe to use as the power point for this type is situated outside the bathroom which in turn powers an air compressor box. This remains outside the bathroom and a rubber tube will carry only air into the bathroom. However, this means that it may be impossible to close the bathroom door completely during bathing.
Rechargeable battery pack - many models of bath lift are motor driven and powered by rechargeable batteries which are situated on the backrest, in the handset or in a separate portable power unit. The following should be considered:
- Number of lifts per charge. This varies depending on the size and power of the battery. In general the smaller batteries situated in the handset need to be charged far more regularly than the larger packs. Some models are available with an institutional power pack and recharger for frequent use which will carry out up to 60 lifts per charge.
- Charging - as chargers have to be plugged into the mains this activity should be carried out away from the bathroom. On some models the handset only has to be removed and plugged into the charger; others have large batteries which have to be removed for charging. Some chargers can be used with non-British power sources.
Controls
Powered lifts are controlled by a handset which is waterproof and is safe if accidentally immersed in the water. Some handsets can be attached to the side of the bath with suckers so that they are always conveniently positioned.
Most handsets have press buttons to control the movement. Some are marked so that they can be used by a bather with a visual impairment.
Rocker or toggle switches are sometimes available and are particularly helpful for a person with weak or painful hands.
Seat
Support - very few of the seats provide any substantial support for people who find it difficult to sit unaided, and many of the moulded plastic seats are not easy to adapt. Some suppliers may provide a pommel or waiststrap/harness for their bath lift.
Transfers - most seats have side flaps which drop down and rest on the rims of the bath to assist with getting on and off the seat. Some models have a swivelling seat or disc on the seat which helps the person to get on and off. Alternatively, a flexible transfer disc can be placed on top of the seat to provide a means of swivelling. Conveniently positioned grab rails will help the users to pull or push themselves into position.
Backrest
One-piece moulded seat and backrest - requires the bather to sit in an upright position.
Reclining - Some bath lifts have backrests that enable the person to recline in the bath. A reclined position may also provide better support for someone with poor sitting balance.
Capacity
Check the weight capacity of the lift - particularly for use with larger bathers.
FLOOR/WALL-FIXED BATH LIFTS
These lifts are called band lifts and retract into the wall-fixed unit, freeing the bath for other users. Consider the following factors:
Lifting mechanism
The advantage of these lifts is that they can lower right to the bottom of the bath. They have no backrest so that the person can fully recline in the bath.
Fixing
Some bathroom walls will need reinforcing to ensure they can bear the weight of the wall-fixed unit and the weight of the person being lifted. The companies who supply and install these lifts can check the suitability of the wall and carry out any necessary work.
Power source
Some lifts are electrically connected to the mains via a transformer. They have a back-up power supply in case of electrical failure.
Other models are powered by a rechargeable battery pack. Recharging of the batteries should take place outside the bathroom, via a plug top charger. The batteries can charge overnight and it is possible to get 5-6 lifts per charge.
Controls
These lifts have push button controls on the wall-fixed unit. Some also come with a handset that is waterproof and safe if accidentally immersed in the water.
Seat
As these lifts only consist of a band of reinforced material, they offer no back or trunk support. They may not be suitable for people with poor sitting balance and trunk control as the user has to adjust his/her sitting position several times during the lowering and raising process.
Capacity
Check the weight capacity of the lift; most can take up to 20 stone/ 127kg.
FLOOR-FIXED BATH HOISTS
Position
Floor-fixed bath hoists can be sited either at the side or the end of the bath, depending on the space and layout of the bathroom. It may not be possible to use them in a small bathroom. The fixing position will be influenced by:
- the position of the bath,
- how far the seat will swivel,
- the part of the bath into which the person needs to be lowered.
The seat is fixed to an arm which swivels outside the bath to enable the person to transfer onto it. Some hoists only have a single joint which pivots around the vertical floor-fixed column; the seat is in a fixed position. Others are double jointed, ie they have two-pivot points - one around the vertical column and the other where the seat is joined to the arm. The latter are more flexible to transfer onto.
The seats on some of the end fixed hoists do not swing round far enough to clear the side of the bath. This can make it difficult for the person to transfer onto them. Corner or side-fixed hoists usually pivot to a more convenient position.
Since the hoist has to be strongly bolted to the floor, ensure that no services are running below the area of fixing. Check periodically for stability.
Lifting mechanism
The height of column adjusts manually or electrically.
Manual operation - the column height adjusts by using a winding handle usually sited at the top of the column. A fair amount of effort is required. They are more commonly operated by a carer, but sometimes the bather can reach and manage the mechanism independently.
Powered operation - these may be mains operated requiring a power point outside the bathroom; or battery powered. Control is usually via a push button handset which is waterproof and safe if accidentally immersed in the water.
Seats/backrests
All have an all-in-one moulded seat and backrest which means that the person has to sit in an upright position. They provide very little support for people who find it difficult to sit unaided, especially as many of the moulded plastic seats may not be easily adapted. Some, however, can be fitted with a harness.
Armrests
Check that they protrude far enough forwards to allow them to be used as support when standing up.
Those with fold-up armrests allow for sideways transfers. Tubular armrests do not provide as comfortable forearm support during sitting as those which are slightly padded or flatten horizontally.
Capacity
Check the weight capacity of the lift - particularly when used by larger bathers.
USEFUL PUBLICATIONS
- The Access Directory
A directory of assistive technology, aids and appliances suppliers and services published annually. Available from:
Access and Mobility Ltd
6 Ticknock Dale
Sandyford
Dublin 18
Tel: 01-206 3387
Email: accessandmobility@gmail.com
Website: www.accessandmobility.ie
- Building for Everyone
Publication which examines buildings and the external environment to achieve equality and inclusiveness for everyone. Available from:
National Disability Authority
25 Clyde Road
Dublin 4
Tel: 01-608 0400
Fax: 01-660 9935
Email: webmaster@nda.ie
Website: www.nda.ie
USEFUL ADDRESSES
Association of Occupational Therapists of Ireland (AOTI)*
Ground Floor Office
Bow Bridge House
Bow Lane
Kilmainham
Dublin 8
Tel: 01-633 7222
Email: aoti@eircom.net
Website: www.aoti.ie
Irish Society of Chartered Physiotherapists (ISCP)*
Royal College of Surgeons
St Stephen's Green
Dublin 2
Ph: 01-402 2148
Fax: 01-402 2160
Email: info@iscp.ie
Website: www.iscp.ie
*It should be noted there is currently no statutory system of registration to either an independent chartered institute or representative professional body for allied health professionals eg occupational therapists, chartered physiotherapists and speech and language therapists in Ireland. This is likely to change soon as the Health and Social Care Professional Bill published in October 2004 sets out a system of legal registration for health and social care professionals irrespective of whether they work in the public or private sector or are self-employed.
VAT (Unregistered) Repayments Section
Revenue Commissioners
Kilrush Road
Ennis
Co Clare
Tel: 065-684 9000
LoCall: 1890 202 033
Fax: 065-684 9248
Email: unregvat@revenue.ie
Website: www.revenue.ie
Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Liffey Valley Shopping Centre
Quarryvale
Clondalkin
Dublin 22
Tel: 01-620 8731
Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Mahon Point Shopping Centre
Mahon
Cork
Tel: 021-431 3033
- Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Red Car Park (Level 2M)
Dundrum Town Centre
Dundrum
Dublin 14
Tel: 01-298 7982
- Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Green Car Park
Whitewater Shopping Centre
Cutlery Road
Newbridge
Co Kildare
Tel: 045-450736
Irish Wheelchair Association (IWA)
Áras Chúchulainn
Blackheath Drive
Clontarf
Dublin 3
Tel: 01-818 6400
Fax: 01-833 3873
Email: info@iwa.ie
Website: www.iwa.ie
Disabled Living Foundation (DLF)(UK charity providing advice and information and a comprehensive up-to-date database of disability equipment available in the UK)
380-384 Harrow Road
London
W9 2HU
England
Tel: 0044 207 289 6111
Email: dlfinfo@dlf.org.uk
Website: www.dlf.org.uk
Ricability(independent research body in UK which produces guides for older and disabled consumers based on professional research)
30 Angel Gate
326 City Road
London
EC1V 2PT
England
Tel: 0044 207 427 2460
Fax: 0044 207 427 2468
Email: mail@ricability.org.uk
Website: www.ricability.org.uk
