Res and Rec: Toileting Accessibility Made Easy Part 2

I recently read a blog from The World of Accessible Toilets explaining for folks in the United Kingdom, who is entitled to use the accessibly-designed bathroom stall in public places.  Oh my.  Here in the States, I admit that I have often used the accessible stall!  I have not seen guidelines on this from the Americans with Disabilities Act which was revised in 2009.  Perhaps there is case law out there that will find me guilty:  of doing market research?  marveling at how ridiculously low “accessible” toilet paper dispensers can be?  musing at the narrow doorways and flimsy door latches that certainly do not meet the standards?  O.k.  I will stop TODAY.

In Part 1 of this topic, we explored how to reduce the effort, improve the ease of use, and diminish the risk for falls when using this area of the bathroom.  Since the bathroom is one of the most dangerous places in the home, it makes sense to examine how to make all of the activities completed there safer.  In future blogs we will explore bathing, grooming, hygiene, and organization of this space for persons of the Baby Boom generation.  This practical information may be of use to us or to a loved one entrusted to our care.  So let’s finish this necessary topic with Part 2!

Reservations

My first reservation is this:  If you find that you are using grab bars in public bathroom stalls, get busy on taking care of your health and joints TODAY.  For example, strengthen your quads by practicing squatting without support if it is safe for you to do so instead of risking those muscles becoming weaker by pulling yourself part of the time.  My second reservation if you are truly benefitting from simple modifications in public places, consider adding them to your own living environment.  A few changes may help you to use less effort in the bathroom (and save it for other activities), improve your body mechanics, and reduce your risk for falling.  Even our grandchildren will benefit!

And third, if a person already has a bedside commode available, try adapting it as follows before purchasing additional equipment.  If you don’t mind the aesthetics of a “potty chair,” you just may like the flexibility it provides when faced with temporary illness or surgery.  For bariatric applications, often a commode placed over the toilet is more stable than a device that is attached to the toilet.  Adding grab bars to the wall is always a great idea no matter which type of equipment you choose when making toileting more accessible.

Recommendations

For persons who are bedbound on a short or long term basis, a bedside commode is very helpful.

“All-in-one (3-in-1) bedside commodes, can be used to assist a person who has difficulty in walking to the bathroom by bringing the toilet into the bedroom. This type of commode can also be used over an existing toilet, like a raised toilet seat, which raises the seat height and assists the user in standing.” (http://www.apparelyzed.com/disability-equipment/showerchairs-commodes.html)

Often a portion of the price of a commode is reimbursable from your insurance provider when billed by a home medical equipment supplier:  1) when the person is bedbound or 2) the person cannot access the bathroom without assistance. (Check with your local Home Medical Equipment supplier for the current regulations.) Also see our Checklist for Used or Donated Bath Equipment before obtaining pre-owned equipment from a garage sale or lending closet; you can often save a great deal with these tips!

Bedside. Place the removable bucket on the frame underneath the toilet seat on the commode then adjust the height with the pins on the legs as follows. Like sitting in a desk chair, sitting with the hips/knees/ankles are at 90 degrees (think corner of a box) puts less strain on the low back and makes it easier to rise to a standing position. When the hips are lower than a person’s knees, it is harder to rise from sit to stand.   Now place the commode at a 90-degree angle right next to the bed for best use. Collapsible armrests are available to ease “transfers” to/from the commode using a scooting motion. With a collapsible armrest, you can lower the armrest down and not have to hike up your hips and bottom as high when moving from the bed to the commode and back again. If the bed and the commode are the same height, you can scoot sideways more easily with the armrest out of the way.

In the bathroom.  A very handy application of a bedside commode is use it like a toilet riser by placing it over the toilet in the bathroom.  Just lift up the toilet lid and seat first!  The commode instantly raises the seat height and provides handholds for safe transfers. To use the commode over the toilet, simply remove the bucket from underneath the commode and use the plastic splashguard instead.  (This is usually stored inside the bucket in a new bedside commode.)  The splashguard is a plastic ring that looks like the commode bucket with the bottom cut off. It is held in place by the frame of the commode and keeps things neat and tidy when the commode is in use.  Again, make sure that:

  • the toilet seat height is appropriate for the primary user with consideration to others in the home that will also use the bathroom and
  • 2) NO rug or mat is placed under the legs of the commode. It is important that the commode be level underfoot and make direct contact with the floor.

Be sure to check the weight limit for the commode and follow the manufacturer’s recommendations. Bariatric toilet risers and commodes are available; purchase a chair that is rated well above the weight of all of the users in the home.  Now you have seen the 2 primary uses of a “3-in-1” commode:  over the toilet, bedside; the 3rd is as a shower chair.  Hold that last thought for a moment!

The bedside commode when used with the lid closed may also function as a bathroom vanity chair as well. Simply place the commode in front of the sink for use as a chair during personal hygiene and grooming. Sometimes opening up the cabinets below the sink (or replacing the doors with a fabric covering) can provide extra leg room or access to storage for items in lower cabinets within easy reach.  And to use it as a shower chair, 1) remove the bucket or splash guard underneath the commode, 2) check the seat height when the person is sitting inside the tub or shower stall, 3) adjust the legs accordingly, then place it inside the bathing area.  (Be sure to “FOLLOW” us for future tips on making bathing more accessible including use of hand held showers, grab bars, non-slip mats, and more in future blogs!)

So there you have it:  an in-depth review of strategies to ease the comfort and safety using a bedside commode for toileting and more.  Refer to Res and Rec:  Toileting Accessibility Made Easy Part 1 for discussion of grab bars, safety frames, raised toilet seats, and “donut” risers too.

Please note that this information is intended to be a guide and not a replacement for an individual home safety assessment by an Occupational Therapist or Certified Age in Place Specialist.

Take care, Julie O.T.

Res and Rec: Toileting Accessibility Made Easy, Part 1

Reservations

With the aging of the 77 million folks that comprise the Baby Boom generation, I have a feeling that I am not the only one using the more accommodating toilet in a public washroom!  Many of us are noticing our stiffening joints, have had a back injury at some point in our lives, or maybe are sensing a need for a joint replacement surgery in the future.  When there is a grab bar on the wall nearby, my observation from the occupational therapy clinic is that most folks tend to use it for light support.

My first reservation in noting this:  If you find that you are using adaptive equipment, get busy on taking care of your health and joints TODAY.  For example, strengthen your quads by practicing squatting without support if it is safe for you to do so instead of risking those muscles becoming weaker by pulling yourself up with your arms.  My second reservation is that if you are truly benefitting from simple modifications in public places, consider adding them to your own living environment.  A few changes may help you to use less effort in the bathroom (and save it for other activities), improve your body mechanics, and reduce the risk of falling in one of the most dangerous areas of your home.

In this 2-part blog, I will detail several options for improving the safety and ease of use of the toilet area of your bathroom.

Recommendations:  Part 1

Whether it’s for a powder room or an “en suite,” some basic safety strategies go a long way to aid your independence. In part 1 we will look at the toilet as is.  In part 2 we will look at the many uses of a simple piece of equipment that can help in the bathroom and in more places than you ever thought possible!

Optimal positioning for toileting has come full circle over the years. Like sitting in a desk chair, sitting with the hips/knees/ankles are at 90 degrees (think corner of a box) puts less strain on the low back and makes it easier to rise to a standing position. When the hips are lower than a person’s knees, it is harder to rise from sit to stand. However, too high of a toilet seat may decrease the relaxation needed for bowel elimination. A removable stool that can be stored out of the way such as a Squatty Potty may be the answer here.

So where is the balance?   I suggest in general avoiding low toilets and either 1) attaching sturdy grab bars to the toilet itself (called a toilet safety frame) or 2) attaching grab bars to the adjacent walls (or side of a sink cabinet) for a secure hand-hold. Frames or grab bars next to your body, on both sides of the toilet allows for better support and body mechanics when sitting down and standing up. Additionally, place NO rug or mat underneath the legs of the toilet safety frame; the footers should come in direct contact with the floor.

Most folks will use the edge of the counter or sink when needing additional support.  This awkward hand positioning often places significant strain on both the shoulder and finger joints. It’s also easy for your hand to slip while holding the smooth surfaces or scratch oneself on the rough underside of the counter as well.

Further, the sudden impact of sitting down too hard can place increased compression/pressure on the hips and spine exacerbating, even causing pain and injury.  Never allow yourself to plop down onto a toilet seat!   “Lift up” or “boost” devices exist to aid in self-lowering down or rising up from sitting on a toilet (and a chair too) if absolutely necessary. Think mechanical recliner lift chair and you have the idea of a device that is now available for toilets and commodes!

A raised toilet seat (or “toilet riser”) attaches to the toilet generally with a paddle that expands inside the inner rim of the toilet bowl. They are designed with and without attached “arms;” with arms provides the best “transfer” technique.  Please avoid using a plastic toilet riser that does not have a tightening attachment as they tend to slide around on most toilets. It is almost impossible to achieve a secure attachment to the bowl without a tightening mechanism. While a “donut” shaped riser may be the least expensive option, this sliding motion of a loosely fitting riser creates an unstable, tippy surface upon which to sit and greatly increases the user’s risk to fall!

Also assess beforehand if the toilet bowl is round or oval as this will determine the exact design of toilet riser that will fit the best and tighten the most evenly, securely. There are different designs available for each type of toilet; consider and measure what is needed for all of the toilets in the home that the primary user is likely to use during the day and during the nighttime too.

Another option to improve toileting accessibility is to replace the toilet with a taller “ADA” (Americans with Disabilities Act) toilet:  which is generally 19 inches from the floor.   The only caveat is when there are shorter family members and grandchildren using this bathroom too . . . Try to be mindful of who else in the home will be using the bathroom as you make changes. However, never assume that the person needing the riser will just apply it every time they need it and remove it after each use. In my experience, this usually leads to non-compliance and increases the risk to fall when a person in need must repeatedly (day and night) move equipment around.

Alright.  So know you know more about toileting accessibility than most people on the planet!  And that is a good thing since you never know when you or a loved one will need to know this information.  But wait, there’s more!  InRes and Rec:  Toileting Accessibility Made Easy, Part 2,” we will discover how one of the most common piece of bathroom equipment you can find at a garage sale can save you money, effort, and prevent falls too.  (See the Checklist for Used and Donated Bath Equipment before making your purchase.)

Please note that this information is intended to be a guide and not a replacement for an individual home safety assessment by an Occupational Therapist or Certified Age in Place Specialist.

Stay tuned and be sure to “FOLLOW” us as we make life easier!

Take care, Julie, O.T.

Checklist for Used or Donated Bath Safety Equipment

shower chair, chair in shower, bath safety, chair with back, falls, falls in tub, fall prevention, tub safety, bathroom safety

Checklist for Used or Donated Bath Safety Equipment

Julie Horney MS, OTR/L

© 2015

Here are a few considerations when obtaining used or donated bath safety equipment from either a retail or private source.

1.  Determine if the item is being sold “As Is” or with the possibility of returning it for any reason. How long do you have to return the item?  “You may have certain consumer rights when buying secondhand; for example, the seller must accurately describe the product they are selling; and you should be made fully aware of any faults or problems that need attention. If possible, obtain a written description of the product from the seller before you buy so that, should you find any faults, you can get your money back more easily.”  (http://www.apparelyzed.com/disability-equipment/showerchairs-commodes.html)

2.  Note that you must completely sanitize all surfaces before use, soaking it or immersing it where possible. Do not accept it if the item is already heavily soiled.

3.  Plan to replace missing rubber footers, cracked rubber footers, or rubber footers of 2 different sizes/colors/materials. All footers must match those applied to the equipment when the item was purchased new.

4.  Check that the item is level when placed on a flat surface. If there are adjustable legs, adjust the legs to see if they can be made level before using it. Does the adjustment mechanism still work? If you cannot make adjustments or if the item is not level when tested, pass on it.

5.  Look to ensure that all screws, pegs, connectors and similar attachment devices are in place. Are there accessories? Are they easy to use or adjust? Replace the fittings that are missing with items that match the other connectors on the device.

6.  Check the manufacturer’s weight rating to make sure it matches the weight rating of anyone in the home who might use the equipment (even if it is not the primary user). If the label is missing, look for the manufacturer’s label and check their website or call them. Do not exceed the rating of the equipment.

7.  Check for cracks, uneven surfaces, tears, blistering or bubbling of the surfaces, rust, chipped paint, etc. Determine whether or not this can be completely restored to new condition before its first use and before accepting the equipment. Never accept cracks near a point of attachment (such as on a shower seat near where it attaches to the frame) or where it would come in contact with the user’s skin. On second thought, pass on anything that is cracked!

8.  Try it out. Sit on it, wiggle on it (when safe to do so!), step on it (when designed for stepping on), move it around, look underneath it, lift it up, walk around it, collapse it then unfold it, etc.

9.  Ask the person who used it before you, the person who is selling it, or donation source about the equipment. Who used it before you? Any idea if the user had an infectious disease? Where was it stored when not in use?

10. Do a sniff test! If it smells like motor oil then it was likely stored in a garage or shed and could continue to “outgas” a noxious odor in the enclosed confines of the user’s bathroom.

11. Know the price of a comparable piece of new piece of equipment BEFORE you go shopping for a used one. A higher price for a used item on Craig’s List doesn’t necessarily mean that it is a better one, even if the pictures look good!

12. “Prospective purchasers should satisfy themselves that the equipment being offered for sale meets current safety standards, and is the property of the seller, being free from Hire Purchase or Purchase Loan agreements etc.” (Same reference.)      

NOTES:

You may share this Checklist in its entirety if you make reference to my full name as the author and this website:  http://www.twostepsolutions.com  Leave me a note below if you would like this information as a handout in Word or pdf formats.

Take care, Julie, O.T.

Photo credit goes to James Porzio of Home Safety Makeover