Assisting people with disabilities to bathe and shower

1 Clinical Assisting people with disabilities to bathe and shower Julie Swann Some people with disabilities require advice, assisitive equipment or adaptations to their homes in order to be able to wash their bodies. A wide range of bathing and showering aids and specialist baths and showers is available to help with this personal care activity and it is important for occupational therapists to know what equipment is available so they can help service users to make an informed choice. This article explores some of the bathing and showering equipment currently available. It emphasizes the importance of empowering individuals to make the right choice for themselves. The key to providing a good service is to ensure that advice provided follows an appropriate assessment that takes into account individual needs. Key words: equipment, assessment, bathing, showering, adaptation Swann J (2006) Assisting people with disabilities to bathe and shower .

2 Int J Ther Rehabil 13(1): 36 40. F. or most people , washing themselves is an Assistive equipment automatic routine and is taken for granted. and adaptations However, people with disabilities or with increasing frailty may experience mild to There is a wide range of equipment available to substantial problems with showering or bathing. help people bath or shower . This can be obtained Before recommending any intervention, it is vital from specialist companies such as Nottingham for occupational therapists to carry out a full assess- Rehab Supplies ( ) or Invacare ment of need and to take into consideration indi- ( ), or from local retailers such vidual preferences. A clinical diagnosis will enable as chemists and supermarkets. Alternatively, equip- therapists to forward plan and to consider various ment can be loaned from some charities such as the options to overcome future physical and cognitive Red Cross.

3 Equipment can be grouped under differ- problems. ent headings, as follows. There are four main dimensions to consider when offering assistance with bathing: Transfers n General advice Several assistive devices have dual uses for bathing n Assistive equipment and adaptations and showering: n Alternative baths and showers n Handrails: These provide additional support n Personal care assistance. when moving from sitting to standing or trans- Each of these will be considered in turn. ferring. Smooth, ribbed and contrasting hand- rails are available. Plastic rails are quicker to Offering general advice install than metal, as they do not need earth bonding. Approved Document M Access to Before recommending any equipment or adapta- and Use of Buildings (Office of the Deputy tions, therapists need to consider whether guid- Prime Minister, 2004) provides details and ance can resolve the problem.

4 Sometimes, people diagrams of recommended handrail positions. struggle with bathing merely because they have not Guidelines are useful but individual anthro- learned techniques to overcome specific problems. pometrics should be applied; for example, Julie Swann is an Advice needs to take into consideration the individ- looking at the reach and hand function of independent occupational ual's preferences and compromises may be needed. individuals. therapist. For example, using different techniques, more n Floor-to-ceiling poles: These can assist with manageable clothes and small assistive equipment standing and balancing, particularly when a Correspondence to: can help. Readers should refer to the Disabled carer is helping with clothing. However, they can Beaumaris, 64 Close Lane, Alsager, Stoke-on- Living Foundation's (2003) website, which has impede transfers, particular when using a bathlift Trent, Staffordshire ST7 downloadable booklets on aspects of dressing, bath- or bathboard, because they can restrict access 2JT, UK ing and showering.

5 Beside a bath. 36 International Journal of Therapy and Rehabilitation, January 2006, Vol 13, No 1. 36_40_IJTR_13(1).indd 2 19/12/05 10:19:36. n Rails attached to the taps: These can give secu- rity when stepping into a bath, but should not be used to pull up on or to rise from the bottom of the bath. Detachable rails can impede transfers in and out of the bath and integral bath rails or wall-fixed rails are safer. n Bathboards: Some of these are slatted or have drainage holes to allow use as a shower board and to be dried upon. Following several adverse incidents, apertures must now be less than 8 mm or more than 75 mm (Medicines and Healthcare products Regulatory Agencies, 2003). Several have handgrips to assist with balance and transfers. n Bath seats: These enable a person to sit about halfway down a bath, at the water level.

6 Full immersion is impossible, unless the seat is Figure 2. The Revolution removed and replaced to assist egress. bathlift from Nottingham n Bathlifts: Standard baths can accommodate Rehab Supplies. removable bathlifts. Some have side flaps to n Bath steps and step stools: These are rarely rec- assist safe transfer and avoid flesh being trapped, ommended, as the problem of getting down to such as the Bathmaster from Homecraft (www. the water level still arises and a bathboard and ) (Figure 1). They bath seat will provide a safer method of access- transport a person from the top of the bath to ing. They are, however, useful in helping a client below the water level. A safety strap provides to access a shower with a high step. added security when the bathlift is moving and n Hoisting devices: There is a wide range of a vertical rail will give stability when a carer hoisting devices, from turning discs and port- is helping with washing and security when the able hoists to wall-fixed hoists and ceiling track bathlift is operating.

7 Other examples are the hoists. Ceiling tracks are useful if space is lim- Neptune bathlift from Mountway ( ited, and can transfer a user from the bed to the ), the Aquatec Beluga from Invacare bath to a chair. Many baths are designed to allow and the Revolution from Nottingham Rehab either end-on' or side access by a portable hoist, Supplies (Figure 2). but a dripping hoist sling can be a safety haz- n Shallowbaths: These are lightweight resin baths' ard on flooring. Equipment should be regularly with drainage plugs, which fit over a standard checked and the manufacturer's service sched- bath. They are suitable for children or adults and ules should be maintained. raise the person higher than when using a normal bath and equipment. Additional equipment for showering Figure 1. The Bathmaster bathlift from Homecraft. n shower seats: These can be fixed to a solid wall and many can be folded away when not in use.

8 Some have integral armrests and can be adjusta- ble in height for example, Pressalit ( ) and Chiltern Invadex ( ) have a range of shower seats. n shower controls: These should be easily reach- able from a seated position and from the carer's position. n shower chairs can be wheeled into the shower area or can be static, such as the Aquatec Pico from Invacare (Figure 3). Wheeled shower chairs reduce the need for transferring into the shower area. Porcelain and modern acrylic bases will support most shower chairs; however, if bariatric equipment is used, it is advisable to check the maximum load with the base manufacturer. n shower tray: High shower bases can be replaced with a lower-height tray or level-access tray. If International Journal of Therapy and Rehabilitation, January 2006, Vol 13, No 1 37. 36_40_IJTR_13(1).

9 Indd 3 19/12/05 10:19:57. Clinical drainage is a problem, waste pumps can be fitted bath preparations can irritate the skin. Nazarof externally (some are integral to a unit). (2005) notes that prolonged soaks in a bath can n shower trolleys and showering plinths: These are lead to macerated skin' and advises on products to very useful for frail or severely disabled people . use to prevent skin damage. Assistance is given at the carer's waist height Many people could wash themselves with the pro- and bending is avoided. All have drainage holes vision of some long-handled equipment or larger- and can be used in conjunction with hoists. They grip equipment. Examples are: can double as a dressing table'. Chiltern Invadex n Long-handled brushes and sponges produces a range of easy-steer shower trolleys n A wash mitt with hydraulic height adjustment.

10 N Suction nailbrushes n Towels with loops. Washing and drying the body Several companies manufacture body dryers; for Bathing can be medicinal, particularly if prepara- example, the Apr s shower (Apres shower Dryers tions are used, although care is needed as perfumed Ltd, ) can be placed strategi- cally to enable independent bathing and drying. Alternative baths and showers Baths There are several different types of baths, includ- ing those with integral lifting devices for disabled people . Preferably, baths should be sited to allow access at either side by a wheelchair or a carer with room to allow hoisting, if needed. However, a stand- ard bath with strategically placed handrails and a removable bathlift may be more effective, and may Figure 3. The Aquatec be cheaper. Table 1 gives an outline of some of the Pico shower chair from many baths available.