Practical Guides #1: Game of Thrones

Hi readers

My husband suggested that I do a post on toilet equipment called ‘Game of Thrones’, just because he thought I would get a lot of views, but it got me thinking.  What about focusing more on the practical stuff about being an OT? So I thought I would start some practical guides to equipment for you to refer to while you are on placement. This is a basic introduction to standard toilet equipment that OT’s use.

N.B. This is intended a rough guide only and should only be used in conjunction with a qualified OT. If you are not an OT or competent Therapy Assistant do not use unless supervised by a qualified person.

Also all patients should be assessed with the equipment before issueing (don’t just dish it out, it may not be suitable).

If you’re not an OT or aspiring OT and you’re reading this I would always advise getting professional assistance when purchasing toilet equipment (or any equipment). I’ve known people pay privately for unsuitable aids and expensive mistakes can be made. People can use equipment incorrectly and put themselves at risk.  OT’s take lots of things into account to make that piece of equipment work for the person in question, adjust it to the correct height and educate people on it’s proper use.  You may have a local independent living centre that can assist with this if you do want to purchase things privately.

This guide is intended for OT students and is not a replacement for seeking professional advice. It is not intended to help you purchase privately toilet equipment and you could risk the safety of the person you are purchasing it for.

If you’ve got something from an OT and you’re wondering why you’ve not been issued a different piece of equipment that’s been discussed here, there will be a reason for this (often based on client size, health conditions and home layout).

OT’s issue toilet equipment, well basically if someone is struggling to get on and off the toilet. That’s it. Although It can also be considered as  an energy conservation measure if someone’s finding it difficult and fatigues easily.  It’s a compensatory approach which means that if people don’t have the power in their lower limbs, then they can use the power in their upper body to compensate. Remember these all have weight limits which you’ll need to take note of. Bariatric equipment is available. All equipment needs to be delivered to home and assessed within the patient’s environment by a qualified member of the therapy team.

1. The Free-Standing Toilet Frame (FSTF)

FSTF

Ahhh the FSTF, your first go-to.  This basically gives the toilet arms to push up from. The height can be adjusted by pins at the bottom. This needs to be adjusted to the right height for the person.

Advantages

  • fitted easily
  • temporary, can be removed for guests or as a temporary measure while grab rails are waiting to be fitted.

Disadvantages

  • requires more space that the other toileting equipment, you’ll need approx 10cm each side. If you’re short of space, try the Scandia frame (needs approx 8cm either side although takes up more floor space as the legs are more splayed than the FSTF)
  • not fixed to ground so can topple if too much weight is put through on one side, this is important if someone has a weakness or fracture in one of their arms
  • They can move, although floor fixing kits are available
  • if you have a boxed in unit behind toilet it won’t fit, as they nearly go all the way back to the wall. Try the Scandia (below)
  • doesn’t raise the toilet seat

Scandia Frame

The Scandia is a frame and raised toilet seat combined. Height can be adjusted by the pins at the bottom.

scandia

Advantages

  • temporary, as above
  • It’s a raised toilet seat and frame combined, thus not needing two pieces of equipment
  • needs less space than the FSTF
  • Does’t go all the way back to the wall, which is helpful if you have a boxed in cistern unit

Disadvantages

  • moveable, as above
  • still need a fair bit of space to accommodate them
  • The lowest setting is about 19 inches high. If this is too high for your patient try a FSTF and a RTS.

Raised Toilet Seats (RTS)

Differing from frames, RTS’s help people get on and off the loo as a person does not need as much strength in their lower limbs to get on and off as they make the toilet higher.  This places the hips above the knees. They come in 2, 4 and 6 inch sizes so you need to assess what height people need. They have two screws on the side to fix tightly to the toilet bowl. Never use if the screws are broken. Check it doesn’t wiggle once you’ve secured it onto the toilet.

RTS

Advantages

  • hey, what do you know, it adjusts the height of the toilet
  • can be used it space is limited and you can’t put a frame in
  • can be used in conjunction with FSTF or grab rails

Disadvantages

  • some people absolutely hate it as they can’t put their toilet seat down, however ones with lids can be purchased privately
  • Family members may want to remove it and may not put it back on properly. If they are going to remove the RTS, show them the correct way to fix it back on and get them to do it while you supervise to make sure they can do it correctly
  • people may still want to use their arms and pull up from radiator, sink, towel rail etc., which we don’t recommend as these are not weight bearing fittings and could come off the wall with regular use. If this is the case, consider a frame or grab rails with it

Static Commode

static commode

These are a good idea if someone’s only got a toilet on one level of their house as these reduce the amount of times needed to climb stairs.  ALWAYS should be placed with a wall behind them so it doesn’t move back with use.

Advantages

  • reduces number of times people need to do stairs, good if people are on ‘water tablets’ (diuretics) and need frequent trips to the toilet
  • Also good for by the bed for night time use if someones mobility or energy is limited.
  • Helpful to avoid ‘accidents’ when people need the toilet urgently (e.g. urge incontinence or an irritable bowel).

Disadvantages

  • People can find them undignified.
  • someone has to empty them for the person, they may need carers to do this
  • privacy-make sure the room’s blinds/curtains can be easily drawn by person for use or placed in a discreet location

Glideabout commode

glideabout commode

  • A commode with wheels! Make sure the brakes are on before people use them. The one pictured is the standard one we have in hospital
  • You can issue this when a person can no longer use their toilet or a static commode due to reduced mobility.
  • They are useful for assisting with moving and handling issues. Often carers request that we order them  to help them care for their patients. Bear in mind that  people still need to make sure that they are maintaining their mobility(if they have it) and not getting pushed around the house on it all the time. A phrase we use all the time in OT is: ‘if you don’t use it, you lose it’
  • 13/08/15, Edited to add: I found out today, people also issue glideabout commodes when they are unable to put a static commode against the wall, because they have brakes. Also, some people like to be wheeled on them and use them over the toilet, taking the pan out, as they would prefer to use the toilet. Thanks to a therapy assistant for this pearl of wisdom. See, we are always learning.

urinal bottles

urinal bottle

  • Great for men, not so brilliant for women! Female urinals are available but I’ve never ordered one, I’d just order a commode
  • good if people don’t want a commode on one level of their house.
  • Check with them how often and when they need to (sorry) open their bowels for this option. You don’t want people getting caught short throughout the day.

Grab Rails

Doc-M-Pack-Disabled-Bathroom-Toilet-Basin-and-Grab-Rails-White-l

  • You can get diagonal, vertical, horizontal grab rails and drop-down levers. Diagonal grab rails are not pictured (A quick Google should do it). the drop down lever is the one fixed to the back wall, that, er, drops down when needed. This is good if a person needs two rails either side but hasn’t got a wall at one side to fix it on. Again, see the picture. Or if someone is a wheelchair user and they need to get close to the toilet to transfer
  • Diagonal are more useful if people need more leverage to rise from the toilet.
  • All rails can be used in conjunction with RTS.
  • Grab rails are a more permanent option, people need to wait for them to be installed. Often you’ll need to issue a FSTF, Scandia or RTS in the meantime while you are waiting for it to be fitted so it doesn’t delay discharge.
  • As a rule, they need load bearing wall, not a partition or studded wall to mount.
  • Needs a visit to the home to measure for rails in the bathroom. You’ll need to say what type or rail, length of rail (usually come in standard sizes: e.g. 12 and 18 inches), location, and how high you want it placed and pass this on to your local minor adaptations service.

HEIGHTS

popliteal height

If a person is having difficulty getting on and off the toilet you can raise the toilet seat (either by Scandia or RTS) to make it easier, but you want the person to be able to place their flat feet on the floor while using it (no tip-toes please). Technically the height of the toilet seat should be the distance from the floor to the crease on the inside of the leg while seated (popliteal height). If they are still having difficulty with leverage a rough guide is to add another 5cm to the popliteal height, making sure that the person can still sit flat-footed on the toilet. If someone is observing hip precautions, i.e. a total hip replacement or a half hip replacemet (hemi-arthroplasty). There are very specific heights this will need to be, please consult with your OT (just in case these vary) but usually it’s +5cm to the popliteal height.

Ok, so there you have it. Let me know if you find these sorts of guide useful and I’ll do some more. To be honest, it’s helped me, just by writing it. Please bear in mind that I’ve only be qualified a year so I’m not the font of all knowledge and you’ll need to refer to your educator or supervisor. It’s only meant to be an introduction, not a how-to. If I’ve missed anything please let me know and I will do my best to include it.

USEFUL RESOURCES

http://www.invacare.co.uk/doc/Selecting%20equipment%20to%20help%20with%20the%20toilet.pdf

http://www.livingmadeeasy.org.uk/scenario.php?csid=337

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3 thoughts on “Practical Guides #1: Game of Thrones

  1. Pingback: Practical Guides # 2: Taking the heat out of kitchen assessments | The OT process

  2. Pingback: Practical Guides #4: bathing equipment | The OT process

  3. Pingback: Practical Guides #6: Raising chairs, settees and beds. | The OT process

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