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Choosing a Shower and Accessories

INTRODUCTION

Showering may be chosen because it is a personal preference or because getting in and out of the bath has become too difficult or hazardous. If help is needed for bathing, showering may offer the possibility of washing independently once again.

Taking a shower can also reduce the risk of injuring a carer's back as it will eliminate the need to lift or help the bather to get in and out of a low bath.

It may be necessary to build a new bathroom, either because of space restrictions or because it is of difficult to access an upstairs bathroom. However, if this is the case, 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.

This Information Sheet provides 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 showering 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 0761 079 200 during office hours.

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.

PROVISION OF SHOWERING EQUIPMENT

Showering equipment is generally regarded as daily living equipment, and may therefore be provided by the local authority through the Housing Adaptation Grant Scheme for People with a Disability or theMobility Aids Housing Grant Scheme.

PROVISION MAY INCLUDE:

  • shower trays
  • shower units
  • showers with suitable controls
  • shower seats
  • mobile shower chairs

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 (see below), 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.

Mobility Aids Housing Grant Scheme

From 1st November 2007, the new Mobility Aids Housing Grant Scheme is available. The scheme is designed to fast track grant aid to cover basic adaptations to address mobility problems primarily associated with ageing. The work allowed under the scheme can be varied and can include grab rails, access ramps, level access showers, and stairlifts. All applications for grant aid under the Mobility Aids Housing Grant Scheme are assessed on the basis of household means. The maximum grant is €6,000. This may cover 100% of the cost of the works and is available to those with gross annual household incomes of up to €30,000.

In cases where grant aid is required for larger work and where the cost of the work is expected to be in excess of €6,000, applicants should apply for grant aid under the Housing Adaptation Grant for People with a Disability (see above).

How to apply
The Mobility Aids Housing Grant Scheme is administered by your local authority. All applications must include one itemised quotation from a contractor indicating the cost of the adaptation. 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 Mobility Aids Housing Grant Scheme, contact the Housing Department of your local authority.

Private Purchase of Equipment

Private purchase may be necessary if the user is not eligible to obtain the necessary equipment from the local area health services. Some people may also choose to buy privately because they want the wider choice of equipment available on the private market.

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 the website (see Useful Addresses).

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.

DIFFERENT TYPES OF SHOWERBASES

The choice of base will depend largely upon:

  • the facilities and the amount of space available,
  • the ability of the person.

OVER A BATH

This position allows the use of a standard wall-fixed shower or mixer bath/shower taps. A perforated bath board, or a swivel bath seat, will provide the person with a platform across the top of the bath to sit on whilst showering. In order to contain the water within the bath area, a shower curtain will be needed. Check that it will drape adequately around the board or seat.

This type of shower is relatively cheap to install but may not be much easier than bathing, as access in and out of the bath may be a problem and the person may still need assistance.

SHOWER CUBICLES/TRAYS

Shower cubicles

  • Corner cubicles - situated in a corner with the tiled bathroom walls forming two of the sides.
  • Full cubicles - can be situated anywhere as they have three solid sides and a cubicle door, thus enclosing the person fully. It is advisable to have some waterproof flooring immediately outside the area of the cubicle.
  • Half panel cubicles - these have one or more waist height sides which enable a helper to lean into the cubicle to assist, without getting too wet. Can have curtains to cover the top space.

Although many cubicles are installed with sealed shower doors to minimise water spillage into the surrounding area, a pump will often be added to actively draw the water towards the drain.

Cubicles can be bought with a choice of shower seat, shower controls and hand spray, and rails, according to the person's needs.

Care should be taken over the choice of other equipment used on plastic shower trays, especially stools with four separate legs, because of the risk of puncturing the tray. Flat-based shower chairs should be chosen in preference.

Check the maximum weight limit of the tray. Some companies will strengthen them for heavy users.

Shower Trays

Stepped access trays

These are the most common type of shower tray available from most standard plumbers merchants. However, they may not be suitable for many disabled or frail elderly people. They have a small retaining 'barrier' at the lower front edge to stop the water from flowing out onto the floor. The person must have sufficient balance and mobility to step over this. Although it is possible to transfer from a wheelchair onto an extended or swivel seat, a ramped or level access tray is usually much easier and safer.

Ramped access trays

These trays are placed on top of the existing flooring and can be installed almost anywhere - even if it is not near to the main drains. The trays are raised at the front so that the water drains towards the back and is usually pumped above floor level down a narrow pipe to the main drains.

A small ramp provides easy access for the person to walk in, or he/she may be pushed in by a helper in a sanichair or a mobile shower chair or trolley.

Shower cubicle featuring a ramped access tray

However, consider the following:

  • Not all provide sufficient floor area to allow the use of a mobile chair, so always check the measurements carefully.
  • If a mobile chair is used, check that there is enough space around the shower to allow sufficient 'run up' and that the ramp is not too steep.
  • Some small trays require that the chair has to be reversed in so that it can be conveniently positioned.

Level access trays

Level access showers have an entrance threshold of less than 1cm. They are therefore easy to negotiate independently, and put less stress on a helper's back when he/she is pushing the person into the cubicle. There is more risk of water falling outside the tray with level access shower trays. Try to ensure that the tray is sufficiently large to take account of the fact that the shower curtains will billow outwards slightly as the shower water hits them.

Level access tray

Some level access bases are designed to fit in the space where a bath stood, so that the drainage from the bath is already in place. Others require under floor drainage to be installed. They often have a pump over the drainage hole to draw the waste water towards it.

SHOWER AREA

Part or all of the bathroom is converted for showering either by laying a shower tray or sloping the floor and covering it with a suitable slip-resistant, waterproof flooring. It is also necessary to waterproof the adjacent walls, usually by tiling.

Since there are no steps or ramps to negotiate, it is easy for a person to walk or wheel in with little or no assistance and to shower on a chair or stool. It also puts less stress on a carer's back when assisting the person into the area.

If the person needs assistance to shower, the carer will get rather wet if there is no protection against the water. Waist height, wall-fixed or portable shower screens may be useful in this situation.

CHOOSING A SHOWER SYSTEM

TEMPERATURE CONTROL

Wherever possible there should be a guard against sudden water temperature changes, especially if scalding could occur. Therefore, the following are not recommended:

  • A shower spray simply fitted over the taps of a bath, unless the hot water available is at a constant temperature.
  • A variable heating source, for example from an ascot type water heater.

It is recommended that you choose a system with thermostatic controls so that the water temperature remains constant even if other water outlets in the same circuit are turned on. It is also advisable to have a safety cut-off at specific temperatures. The following types of shower are commonly available through DIY outlets as well as plumbers' merchants, although specialist shower companies sell a good range with easy-to-use controls.

Thermostatic mixer showers

This type of shower uses pre-heated water from the tank, but has thermostatic controls which automatically compensate for any changes in water pressure. This ensures that, if someone turns on the cold water tap elsewhere in the house, the person in the shower will not get scalded.

However, if a thermostatic mixer valve is fitted to a shower, it must be at least 3m below the water head if it is to work efficiently. Alternatively, a pump can be used to increase the water pressure.

Some models will shut off completely if either supply fails.

Instant or electric showers

These run off the cold water supply. They have an element (like an electric kettle) connected to a 30 amp electricity supply which heats the water as it flows through the unit. The water temperature is controlled by a manual valve, which adjusts the flow rate of water. The slower the flow, the hotter the water. An even temperature will therefore depend on a steady flow of cold water. Safety devices are incorporated to help prevent scalding if the water flow falls below the minimum.

Some units have a switch to select various electrical loadings to give cool, warm and hot water.

SHOWER CONTROLS

Depending on the person's needs, it may be worth considering the models available which have pre-set controls or one control which regulates the rate of flow and temperature. The following types are available:

Shower unit with lever controls

  • lever controls
  • dial control
  • push button control
  • rocker switch

For people who shower independently it is always safer to have controls that are easy to reach from a stable sitting position.

Shower unit with rocker switch

MAINTENANCE

In hard water areas, shower heads need to be descaled regularly if they are to work efficiently. This usually involves dismantling the shower head before applying a descaler. The person will need to have the ability to do this independently or arrange for someone to carry it out. However, a lever can be operated to force a series of pins through the holes in the shower head to descale it. This eliminates the need to take it apart. Pumps which assist drainage also need regular cleaning and maintenance. Also, accumulated debris has to be removed from waste pumps.

OVERCOMING LACK OF SPACE

SHOWERLOOS

Showerloo- showr unit with built-in toilet

These are shower cubicles which have a toilet included within the unit. The person either sits on the WC to shower or, as it has a ramped or level access, uses a sanichair for the two functions. Some units also include a wash basin.

These are ideal for people who cannot access the bathroom as the toilet can function using a macerating unit so that the cubicle can be sited virtually anywhere in the house.

FOR PEOPLE WHO NEED HELP TO GET IN AND OUT OF A SHOWER AREA

Although ramped or level access shower areas are much easier to get into and out of, some users will require additional help.

WHEELED SHOWER CHAIRS

Mobile shower chairs are made from non-corrodible materials so that it does not matter if they get wet. They enable people to push themselves, or be pushed, into a shower cubicle or area - avoiding the need to transfer onto a wheelchair and from there onto a shower stool or fixed seat.

Consider the following:

  • The larger the wheels, the easier the chair is to push; whether by the user independently or by a helper.
  • Make sure that there is enough space to manoeuvre the chair into position.
  • Swivel front castors will make turning easier.
  • Smooth surfaced floors are easier to push over than carpet.
  • Chairs with removable or foldaway armrests are easier to transfer onto than those with fixed armrests.
  • Footrests that fold up and/or swing away will also make transfers easier.
  • Chairs with a folding frame can be useful for storing and for taking on holiday etc.

Large rear wheeled shower chairs

These enable people to propel themselves independently into a shower area or cubicle. They may also be used as an attendant-propelled chair where the floor surface is difficult to push across, eg thick carpet, since large wheels offer a less rolling resistance and are therefore easier to push. Check that the brakes are accessible to independent users.

Shower chairs with castor base

These small-wheeled chairs enable a person to be pushed into a shower area or cubicle. They may be difficult to push over some floor surfaces, eg thick carpet, since the small wheels offer more rolling resistance and are therefore more difficult to push. However, because of their smaller overall dimensions, they take up less space.

Shower chair with castor base

Sanichairs

Some sanichairs can be used in a shower although they are primarily designed as mobile chairs with an aperture or hinged toilet seat for use over a toilet. They are available with large and small wheels.

OVERHEAD TRACK HOISTS

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 the person can transfer in the sling from the bed and into the bathroom where he/she can use the toilet and or shower.

An electric traversing system may enable a person to transfer independently; a manual traversing system requires the helper to push the person along the track in the sling. The design of the wheels on the hoist motor trolleys makes this easy to do.

Structural alterations may need to be made such as strengthening the ceiling, or adapting the top of the door frame to take the track.

The power for the hoist will be supplied via a step-down transformer. Those that have a rechargeable battery will need to have the charger situated above the track.

SHOWERS INCORPORATING A SEAT FOR TRANSFER

These are specifically designed shower cubicles that have a seat that swings/slides outside the shower to enable people to transfer from their wheelchair directly onto it and can then swing/slide back inside. This feature may enable people to transfer independently or, if assistance is needed, it will provide much more space for carers to manoeuvre and position themselves when providing assistance. The cubicle should have built in grab rails to help the person move along the seat.

Shower incorporating a seat for transfer

FOR PEOPLE WHO NEED SUPPORT WHILST IN THE SHOWER

Most older or disabled people like to sit down whilst in the shower. Some only need a platform to perch on, others will need more supportive or contoured seating.

PROVIDING A STABLE SEATED POSITION

It is just as important that people have a stable seating base during personal care activities as it is at any other time of the day.

For people with mild to moderate seating difficulties, the right shaped seat should provide sufficient support to allow them to sit up straight without continually sliding forward.

The shape of the seat

These will provide a person with a more stable seating position than a flat seat. Dish seats tend to have a slightly higher back, are raised at the sides and slope down towards a central aperture. This type aims to be 'human shaped' so that the shape of the buttocks are accommodated, whilst the raised edges provide a certain amount of stability.

These have a cutout at the front and a central aperture which allows users to wash themselves more easily.

Although they are not dish-shaped or contoured, the padding allows a certain amount of compression under the heavier areas such as the buttocks, and this leads to 'shaping' which should provide a certain amount of stability.

Seat height

This plays an important part in achieving a stable seating base because, if users can sit comfortably with their feet supported, they are less likely to slide forwards in the chair. Wall-fixed shower chairs can be fixed at the appropriate height; free-standing chairs and stools may have height adjustable legs. Many mobile chairs have adjustable height footrests to provide support.

Backrests

They should support the person in the lower lumbar region. A padded backrest will provide more support and be more comfortable than plastic moulded or tubular backrests.

It is possible to get wall fixed backrests which can be used with a folding shower seat.

ARMRESTS

These provide a useful rest and support while the person is seated. They should not, however, be used to help someone stay in the chair. If, without the arm supports, the person would slide or fall, then it will be necessary to look for a supportive system that will provide a more stable seat.

FREE-STANDING SHOWER STOOLS OR CHAIRS

These stand on the base of the shower area and are not fixed in any way. Care should be taken when using these on plastic shower trays, as there is a risk that those with four separate legs may puncture the tray; flat-based stools should be chosen in preference.

Stools tend to have little or no back support, although may have tubular armrests or side handles. Many have height adjustable legs. Some are tall perching stools, which are specifically for people with stiff hips.

Shower chairs have a higher, more supportive backrest.

When considering whether to use a shower chair or seat ensure that the shower tray/ cubicle is large enough to accommodate the seated person and his/her knees and feet.

Shower chair

HINGED SHOWER SEATS - WALL OR FLOOR FIXED

These are attached to a tubular frame, which fixes to the wall via hinged brackets. Optional floor consoles are available if the wall fixings are not strong enough. Strict adherence to the maximum user weight specified by the manufacturer is essential.

Wall-fixed hinged shower seat with support leg

The seat folds up against the wall when not in use. Some have a support leg(s) which transfers some of the weight through the floor. The seat can be fixed at a height to suit the person's needs.

Hinged down stretchers are available which fold down over a bath and will rest on the bath rim. They usually have perforated fabric, and the water flows through into the bath. There is a type without holes which can be used to dry and dress a person who is hoisted into a bath or shower.

WHEELED SHOWER CHAIRS

Many of these provide the person with quite a lot of support as they usually have a backrest, armrests and footrests. However, they also take up more space than hinged shower seats.

SHOWER TROLLEYS

These are large wheeled platforms which enable the person to be pushed into a shower area in a lying or semi-lying position. However, because of their length, they are not often used in a domestic situation. Most would not fit into a shower cubicle, but may fit in a wet shower area.

The horizontal models make transfers easier since sliding equipment can be used to transfer the person in a horizontal position directly from the bed onto the trolley. This type of trolley can also be used as a changing table.

The height of most trolleys can be adjusted so that they can be positioned at a comfortable height for the helper.

SHOWER CRADLES

Two shower cradles

Shower cradles are shaped so that the user is in a more upright position with knees and hips flexed. This will not only help to inhibit extensor spasm and provide a more stable position, but it will also reduce the overall length of the cradle so that it can be used in some shower cubicles. However, the individual will need to be lifted/hoisted into the cradle.

FOR PEOPLE WHO NEED HELP WITH DRYING

BODY DRIERS

Wall-mounted body driers can be positioned in the shower cubicle or on the wall in a shower area. They produce a jet of warm air that can be used to dry a person. It is not possible to dry all areas of the body from a seated position.

Wall-mounted body drier

SHOWER SEATS/CHAIRS OUTSIDE THE SHOWER AREA.

If space is available, it may be possible to create an area adjacent to the shower area or have an extended cubicle, which provides a dry area for dressing. This is often accessed via a long bench seat which the person can slide across.

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
    Tel: 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

  • 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