Bathing Difficulties

A common difficulty a disabled or elderly person has is accessing their bath. The bathroom is full of risks due to the environmental conditions. There is water and steam which causes surfaces to become slippery. Getting into the bath can be very difficult as it requires stepping over the edge and therefore balancing on one leg and then getting the other leg over. Once this has been achieved, if there is no shower, a person then still has to get down into the bottom of the bath, and then, back up at the end. A lot of people become very afraid of getting stuck in the bottom of the bath and end up strip washing to avoid this risk all together.
There are several options that can be considered to enable a person to access bathing facilities safely.  If you access OT services through the NHS or Social care, they will look at the most cost effective solution to meet your bathing needs.  This will begin with looking at the bathroom. If you have a standard bath with an over bath shower, you will likely be required to trial a bath board or swivel bather which give you safe access into the bath by sitting on them and swinging legs over. You would then stay sitting on it to use your over bath shower. Grab rails can also be fitted to the wall.

If you have a bath only, and have good upper body strength and trunk control, you may be asked to try a bath board with a bath seat. You would sit on the board and then lower yourself onto the seat.

 If these options are not possible, a bath lift is often trialled. This raises to the top of the bath where your sit on it and swing your legs over. You then press a button on the hand set and it lowers you down. When finished, you press the button to raise it up, swing your legs over the edge of the bath and stand up. The battery is completely safe in the water and is charged off the mains in another room with a charger that plugs into the wall much like a mobile phone charger.

Or sometimes an inflatable bath cushion is used. This is more often when other people need to use the bath as it is easier to remove. This is pumped full of air to raise it using a compressor. Once sitting on it, the air is released with a hand control to lower you to the bottom of the bath. Once done, you press the button on the hand control to fill it with air again and raise you up. You then swing your legs over the side of the bath and stand up. You do need have good sitting balance to use this.

An over bath shower is often not fitted by local authorities. The reason for this is that you would still need to access the bath to use the shower, and equipment can be provided for this rather than fitting a shower. However, an over bath shower is sometimes fitted. This could be because the bath is too short to take equipment and a person. Or the client is very tall, and could not fit into a standard bath with the equipment as well. Or if a person has severe epilepsy and is at risk of having a seizure in the bath, an over bath shower would be considered to reduce the risk of having a seizure in a bath full of water.

If you are unable to manage any of this equipment, a level access shower (wet room) will be considered.  If you have had your OT assessment through the public routes, it will be your local authority that will need to make the assessment for the shower and assist you through this process. If you live in a council owned property, it is likely that the local authority will fund your shower adaptation if you have had an OT recommendation. If you live in a housing association property, the OT will request them to fit the shower. If they do not have funding, they will ask you to apply for a Disabled Facilities Grant (DFG). This grant is also how owner occupiers will apply for funding for any adaptations.  The DFG is means tested. Therefore, depending on your financial circumstances, you may need to pay a contribution toward the cost. If you are deemed to have a significant income or savings you may not get any assistance. However, if you need several adaptations, or are likely to need more in the future, it might be worth still going through this route, as it will be offset against future adaptations, i.e. if you have to pay £7000 toward your works, but the cost of the bathroom you are having done now is £5000, you would pay the £5000. In the future if you may need a stair lift and ramp for £8000, you would then only to pay another £2000 to total £7000 contribution and the rest would be grant funded. It can be a very complicated process, so I always advise you speak to the local authorities grants team for further advice and recommendations.

Often, people will ask for a walk in bath. As an OT, I do not recommend this. My reasons for this are:

1. You still have to step over a ledge where the door is to gain access. This is quite a high step and can cause you to trip on it.
2. You have to sit undressed on the seat in the bath till it fills up, and then let the water out before you get out as you can’t open the door with the water still in there. This means sitting there wet and cold while the water drains.
3. You require a lot of water to fill the bath.

Local authorities will not fund this type of bath adaptation as it is not seen to meet the long term needs effectively enough.
If a person can no longer access their current bathing facilities or use equipment to enable access, whether it is a bath, or a shower cubicle with a high step etc, I would recommend they had a level access shower. This will meet the need long term.
Here is an example of someone’s bathroom who had their bath removed and replaced with a level access shower.