Practical Guides #4: bathing equipment

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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 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 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).

On my last home visit day, the OT assistant and I spend a lot of time in the bathroom.  Noooo, we didn’t get locked in the toilet, we spend a lot of time fitting equipment to help our clients bathe.  This rotation is the first one where I spend a one full day per week on home visits. It’s been very beneficial to my development, and my knowledge of the finer points of equipment. I felt a bit general on the wards, but since visiting peoples homes and seeing the different sizes and shapes of baths, showers and bathrooms,  I realised that I needed to be more specific on the different makes and models of equipment that can fit these spaces. I produced this guide primarily to help me but I thought it would make a good blog post. I am so indebted to my OT assistant who has been an absolute mine of knowledge and a complete superstar. This guide is not an exhaustive guide to equipment, it focuses on the main ones that we issue in our locality.

It must be noted that a lot of local authorities who supply us OT’s with our equipment, consider bathing equipment, apart from a perching stool, to be a non-essential pieces of equipment. Unless the patient has issues with skin integrity, incontinence or severe neurological or rheumatological conditions. Luckily the authorities I mainly work with this is not the case.  Please take note of the weight limits for the equipment. An assessment in the home is essential to check it fits with the patients requirements. It will also need to be fitted by an appropriately trained person, either an OT, OTA or equipment stores person.

OK, let’s go. So how do you want to get clean?

 

The bath

All of these are dependent on the patient being able to lift their legs over the bath.

Bath step

It’s a step to get into the bath (or shower). It helps people lift their leg over the bath as you don’t need to raise it as high because you are in a higher position.  Also can help with the height differential from the floor to the inside of the bath which is higher  which needs leg strength and flexibility.  Different models have different heights, dependent on what you need for your patient. Can be used in conjunction with a bathboard and a bath seat. Put them against the bath and check they are not going to slip on the flooring.

Ashby 2 step

ashby-2-step-stool-multicare6

Sounds like a dance but it’s not, it’s a reversable bath step with 2 heights; 4 inches and 6 inches. The maximum weight limit is 30 st.

Adjustable height bath step

Adjustable-Height-Bath-Step

Modular in design, comes in blocks of 4, each block being 1 inch high. The maximum height you can go to is 12 inches. Wow that seems high. Maximum weight 30 st.

Bath seat

The bath seat sits the client higher in the bath so they don’t need to rise or lower themselves as far into the bath.  They can be used in conjunction with a rail, see below.  The client needs a certain amount of upper body strength  to lower or rise from the seat. They’ll also need sitting balance as it doesn’t have a back for them to lean on. It has suckers that stick to the bottom of the bath. Please advise your client not to use oil-based products as this will rot the suckers and can be dangerous as they can then slip.  It can be used in conjunction with a board, you’ll have to check that people have the upper body strength to be able to do this. Get them to sit in the bath and raise and lower themselves from the bath board to the seat. The bath seat needs to be placed side by side to the bathboard.

Merlin bath seat 

Merlin_Bath_Seat

Again, the same slatted design seen in the bath board which allows water drainage, see below.

VITAL STATISTICS 

Width:11

Length: 18

Height: comes in 3 heights: 6, 8, 12 inches.

Weight limit:25 st.

Surefoot bath seat 

surefoot_bath_seat_1

Has a very sturdy locking mechanism for stability, can fit onto difficult contours of the bath.I’ve been told it is designed to fit most baths.

  • Max User Weight: 160kgs (25 Stone)
  • Seat Size: 40 x 30cm (15.75 x 11.75″)

 

Crosby bath seat 

crosby bath seat

Has large seat area, which apparantly makes it better for larger users. It’s wider than the merlin but not as long. It only comes in one height.

Width 14 inches

Length 16 inches

Height: 8 inches

Weight limit: 30 st.

Bath lifts

Bath lifts are very expensive, therefore can only be issued in very specific circumstances;

  • When they can’t use bath board, bath step, perching stool, swivel bather or bath step
  • They don’t have access to a shower
  • If the patient has skin or continence issues or need pain relief from severe neurological or rheumatological conditions
  • OR Short life expectancy
  • OR a carer’s assessment has been conducted and it’s needed to assist the carers

You’ll need to check your locality’s guidelines on prescribing bathlifts.Certain localities will issue specific bath lifts for example, Aquajoy or Neptune.

You need to check it’s going to fit in the bath, that the person or the carer can operate the controls. The battery needs to be charged constanly so it will need to be plugged in all the time, so check no one is going to trip over the wires. There’s more to assessing for a bath lift, but this is a basic guide so I’m not going to go into lots of detail.

mountway_neptune_bath_lift

Bath board

The bathboard spans the width of the bath and is secured by brackets or suckers. Can also be used with a shower over a bath. Different models are suitable for different types of bath and come in a variety of widths, lengths and weight limits.  You’ll need to measure the width of the bath from outer edge to outer edge. Ensure that the board doesn’t hang over the side of the bath as people can catch themselves on it, no more than an inch.  You’ll need a decent rim on the side of the bath otherwise it could slip off as it won’t have a big enough ledge to support it, probably about an inch and a half. If the board is going to be taken off regularly ensure that whoever will be taking it on and off can do it safely.

Bath boards MUST be used in conjunction with bath seats if the patient will be using it to get a bath but not necessary if they are using it just to shower. It can also be used with bath steps and grab rails. The client must have decent sitting balance or will fall back, consider a swivel bather if this is the case.

Merlin Bath Board

6b1000_merlin_bath_baord_1

 

Is a simple, slatted bathboard, great for drainage.

VITAL STATISTICS

Length: comes in 26, 27 or 28 inches high

Width: 9 inches

Weight limit: 30 st.

Comes in an extra wide model: has 6 slats instead of 4 (15 inches instead of 9). Get your tape measure out, 9 inches isn’t that wide.  It has the same weight limit as the standard Merlin.

 

Surefoot bath/shower board

surefoot shower board

The great thing about a Surefoot  board is that it comes with an integral rail. This is great if the wall won’t take a rail.  This would be my first go-to for bath boards as its adjustable sucker design means that it fits most baths, but it does have a little knack to fit. It has an adjustable width of 26 and a quarter to 28 and a quarter inches  If it’s going to be taken on and off, check that the person (or someone in the house) can do this. As with all bath boards, once you’ve fitted it give it a little push just to check it’s secured firmly.

The shower

Shower board

See bath board, Some makes call them bath boards, some call them shower boards. The main difference between them is what the patient is going to use them for.

Swivel bather

swivel bather

It’s a seat with arms which swivels round into the bath. It has a handle which acts like a brake which needs to be off when swivelling and on when stationary. We tend to issue this if the client can’t use a bath/shower board or bath seat. The client MUST be able to operate  the locking mechanism effectively or it will be dangerous.  Check when you have installed it in the bath that it fully locks and unlocks in the bath. This piece of equipment is great for people whose sitting balance isn’t good. It’s secured by 4 screws to the rim of the bath. Don’t screw it to tight to the bath as it may puncture the side of the bath. You’ll need a decent rim round the edge of the bath to secure approx 1 1/2 inches.  Check nothings going to be in the way when they swing their legs over, such as a shower screen.

Level access shower

level access shower

Us NHS OT’s don’t issue these, this has to be done by social services OT’s.  Although you can advise your patients that they need to have tried all other options first before social services will consider assessing for a level access shower.  I mainly issue shower stools or chairs for level access showers if the patients needs have changed since social services have been in and their current set up isn’t working for them anymore. Check that people aren’t using the foldable shower screen to steady themselves, they are not meant for weight bearing but I have seen a lot of patients use it for this purpose. We don’t recommend this, I once had to catch someone who attempted to do this and became unsteady as the shower screen folded back in on itself.

Shower stools and chairs

These are good if people can’t stand up in the shower (otherwise known as standing balance) and help to reduce falls. Again, good for energy conservation, fatigue and breathlessness. They need to be adjusted to the right height; the patient’s feet need to be flat on the floor but at a good height to be able to stand from it. Consider a grab rail to assist. Check the placement of the stool, most people don’t want it directly under the shower as they can feel a breathless, drowning sensation.  They need to be able to reach the shower controls and preferably not over the plug hole as it can be a bit slippy here due to soap scum and the collection water here. You’ll also need to check whether the stool is not going to be a trip hazard in the shower.

Corner shower stools 

corner shower stool

Fit in the corner of a shower cubicle, great if space is limited. It can feel a bit wobbly due to the 3 leg design.

Shower stools 

shower stool

Can be better for level access showers or roomier shower cubicles. A sturdier option.

Shower chairs

shower chair

Better if the patient needs back support or has poor sitting balance. Again a chair design can be better for fatigue or breathlessness. Suits a roomier shower cubicle or level access shower.

A stripwash: The Perching Stool

perching stool

In this case, we’ve got the trusty perching stool. It can be adjusted for the height of the client, ensure both feet are on the ground and that they can rise from it.  You can get it with or without a back or arms. A back is good if your clients sitting balance isn’t great or the fatigue or get breathless easily as some of their energy will be spent keeping themselves upright.  The arms of the PS may get in the way of them reaching round to clean certain areas of their anatomy but the arms can also help them push themselves up to standing. The perching stool is  a good option as you can get patients into their homes quicker and then plan for an bathing assessment at home. It’s the only piece of equipment that is generally regarded as essential to be able to wash. It also means  You need to consider that they’ve got space to house it and it’s not going to be a trip hazard. Also, some people don’t get a shower or bath every day as they can find it exhausting, this gives them a less tiring option for when they are having a bad day.

 

Grab rails

As a quick rule;

Vertical ones are good for holding standing in the shower

Diagonal ones are good to raising out of the bath, the lowest part being at where the person is sat.

Grab rails are discussed in more detail in my practical guide to toileting equipment

Small aids and tips

Long handled sponges 

long handled sponge

Reduce the need for bending in the shower. They can get to their feet sat on a bath board or stool and reach for their back. Can be picked up cheaply from pound stores.

Bath robes (toweling) 

This is a really good energy conservation measure; some people find it tiring or get breathless drying themselves with a towel. You can recommend that they try a terry toweling robe which they can step into after bathing which does all the drying for them. Ensure they don’t use one of those fleecy ones as they don’t absorb the water as well.

 Children/Grandchildren 

I don’t work with children, this section is more about the psychological and practical impact having a piece of bathing equipment and having children who live or regularly visit the home.  Be mindful many clients feel that they want to remove equipment if the child bathes there or how it may affect the child seeing equipment in the house. I suppose this can be said for many types of equipment but I’ve certainly noticed it more when discussing bathing and toileting equipment with clients.

 

Hope you find it useful, until next time…

Related posts:

Practical Guides #1: Game of Thrones

Practical Guides # 2: Taking the heat out of kitchen assessments

Practical Guides #3: Hand-y small aids

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5 thoughts on “Practical Guides #4: bathing equipment

  1. Brilliant guide. I would say from experience bath board used with bath seat not a good option unless client has excellent upper body strength, good co-ordination and cognitive ability.
    Not an option for a elderly medical patient returning home after period of ill health. If carer present still unsafe as if physical assistance required terrible position for carer to help safely.

    • Hi Jen, thanks for reading the blog and your comments. Yes, I agree-cognitive ability is essential when assessing for any piece of equipment. I also agree that when I was on general medecine working with elderly patients, I never issued a bath board with a bath seat. Thanks for reading!

  2. Pingback: Practical guides #8: How to do a washing and dressing assessment and introduction to dressing aids | The OT process

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