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.

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s