Choosing equipment for bathing

Introduction
Most of us enjoy a relaxing soak in the bath and will therefore feel frustrated if
this pleasure is taken away. It may become impossible to get in or out of the
bath, or the bathroom itself may become difficult to access, particularly if it is
upstairs. However, in most cases these difficulties can be overcome using one or
more of the many items of bathing equipment currently available, and/or by
making a few alterations to the house.

The aim of this factsheet is to provide information on the type of equipment

available to help with specific difficulties, and details about the useful features
of some of the more popular items of bathing equipment. Relevant organisations
are listed at the end of the factsheet followed by an option to view references /
sources of further information. The print buttons (above to the right) let you
choose whether to download and print with or without the references.

For up-to-date product and supplier information, please contact our equipment
helpline. They are open Tuesday to Thursday 10am-4.30pm, Tel: 0300 999 0004
(calls charged at your standard land line rate even if you are phoning from a
mobile).

Alternatively you can write to our letter enquiry service or contact us via email
at advice@dlf.org.uk. To help us give you a concise and informative reply, please
provide us with as much detail as possible including information on the
difficulties you are having and any solutions you have considered, including
equipment ideas.

Where to get help and advice

Before making any decisions about buying equipment, or making alterations, it is
advisable to contact a community Occupational Therapist (OT), based at your
local social services/social work department, who may come and assess your
daily living needs. He or she will advise on possible solutions and may be able to
provide some items of equipment on loan and give advice on grants that may be
available to help with the cost of any adaptations. Find your local social services
on the GOV.UK website

Alternatively you can hire a private occupational therapist, a directory is

available on the 'College of Occupational Therapists Specialist Section
Independent practice' (COTSS-IP) website. www.cotss-ip.org.uk or phone their
enquiry Line: 020 7989 0681. All occupational therapists on this directory are
registered with the Health and Care Professions Council (HCPC). The HCPC is
responsible for the conduct, performance and ethical behaviour of its
registrants. Occupational therapist who do not meet the standards of practice,
conduct and behaviour required by the HCPC are removed ('struck off') from the
register. You can visit the HCPC website to check the registration status of an
occupational therapist .

Information and advice on design issues is available from the Centre for
Accessible Environments (CAE) which keeps a database of architects, surveyors
and similar professionals with experience of designing for disabled people, and
has a number of useful publications and design sheets (see useful
organisations).

Try equipment before you buy

If you decide to buy equipment privately it is advisable to try and compare the
different ranges first. You may have an equipment demonstration centre near you
where you can visit to view and try out ranges of equipment. You will receive
impartial advice to help you choose appropriately. However, centres may not
display examples of all the equipment in this factsheet. You will need to contact
your nearest centre to find out what they have and to book an appointment.
Contact details for your nearest Equipment Demonstration Centre can be found
on the Disabled Living Foundation's web page Equipment Demonstration
Centres in the UK.

The BHTA
Be cautious of sales people who try to persuade you to buy equipment that may
not meet your needs fully or is over-priced. Buying from a company that belongs
to a trade association, such as the British Healthcare Trades Association (BHTA)
may give you some reassurance. BHTA members have signed up to a code of
practice governing standards of customer service (see Useful organisations).

VAT relief
You don't have to pay VAT on products designed for disabled people if you have a
long term illness or disability, or are terminally ill. Mobility shops may
automatically sell you equipment without charging you VAT, but you may have to
ask. Individuals with a temporary injury such as a broken arm or hip do not
qualify for VAT relief. For more information, and to check for any changes in the
regulations visit the GOV.UK, VAT relief on products and services for disabled
people or the HM Revenue & Customs reduced rate VAT webpage (their Charities
Helpline covers VAT relief for disabled people: Telephone: 0300 123 1073)

Funding equipment
Charitable trusts may sometimes provide funding for equipment. A useful
resource is www.turn2us.org.uk , a website that allows you to search for
organisations that give grants, including for equipment and other services. You
can refine / filter your search by specific health issues such as 'physical
disability', 'ageing' or 'rheumatism'. If you're over 60, Charity Search is a free
service to help you find a grant-giving
charity www.charitysearch.org.uk Charities will only give awards in accordance
with a predetermined criteria, so it is important that you carefully select the
trusts you apply to.

Most libraries hold directories of suitable funders in their reference section, such
as the The Directory of Grant Making Trusts

The Grants for Individuals website is run by the Directory of Social Change and
lets subscribers search for grants but is intended for organisations searching for
funding for individuals. http://www.grantsforindividuals.org.uk

Provision of bathing equipment

You may be eligible for a free assessment with social services which may
include the provision of certain aids or minor adaptations. However, there are
eligibility criteria based on an assessment of need and you may have to pay
towards the cost of equipment. The criteria and charging policies vary between
authorities. If you are eligible provision may include:

 bath boards and seats;

 grab rails;

 shower seating

National catalogue prescription scheme

In some areas of the country a prescription scheme for equipment is in
operation. There is a 'national catalogue' of equipment that may be provided by
prescription although local areas can choose which of these items they will
include in their schemes. This is part of the Department of Health’s Transforming
Community Equipment Services (TCES) programme. There is a small range of
bathing equipment in the national catalogue that can be provided via
prescriptions. If you receive a prescription for one of these items you take your
prescription to a local accredited retailer who will provide you with the item.
Alternatively you can ‘top-up’ paying extra for an item that does what the
prescribed item would do but offers extra features or perhaps you prefer its
appearance. Thus the scheme is designed to encourage choice and control. The
bathing aids listed on the national catalogue website can be viewed
at https://www.londonconsortium.org.uk/index.php?
option=com_content&view=ar... This factsheet will go through a range of
equipment and mention when there is a relevant national catalogue specification
for that kind of equipment, as it may be provided by prescription.

Disabled facilities grants (DFGs)

A Disabled Facilities Grant may be available for some home adaptations
including major adaptations. This may include extensions and structural work to
accommodate fixed hoists, stairlifts, downstairs bathrooms, shower units etc. If
this type of adaptation is needed, a local occupational therapist (OT) will come
to assess your needs and then contact the relevant council departments.
Applications for grants should be made via the OT to the local councils

A means test (including household income and household savings over £6,000) is
used to decide how much financial assistance can be provided. Depending on the
outcome of the test, the amount of assistance offered can vary from 0-100% of
the cost. Disabled children under 18 can get a grant without their parents’
income being taken into account. You must own the property or be a tenant ( or
be a landlord and have a disabled tenant) and you must intend to live in the
property during the grant period (currently 5 years). A ceiling of £30,000 in
England (£36,000 in Wales) will normally be put on each DFG, irrespective of your
assessed contribution. Please note that you may not receive any grant if you
start work on your property before the council approves your application.

For more information on Disabled Facilities Grants, visit the GOV.UK website.

Before considering the building of a downstairs bathroom for someone who

cannot use the stairs, check that all other options have been considered. For
example, it may be more practical and cheaper to install a stairlift or through-
floor lift to provide easy access to the first floor.

Common difficulties related to bathing

This factsheet will now list common difficulties associated with bathing and
provide related advice and equipment information.

Difficulty stepping in or out of the bath

Bath boards

Bath boards are waterproof boards that fit across the top of the bath to provide a
secured area on which to sit. They are designed to let you transfer onto the bath
whilst sitting, which is safer than stepping into the bath. It is important to
remember that you still need to lift your legs over the bath rim whilst seated,
some people find this difficult.
Once over the bath you can either sit on the board and wash using a hand-held
shower spray, or can move from the board down onto a bath seat so that you are
nearer the bath water.

If you decide to use the shower spray whilst sat on the board check that your
shower head will reach, ideally the holder should be located in an accessible
position that you can reach. Avoid the use of a push-on type of flexible shower
hose because they can cause hot water scalds if your water pressure varies and
causes the connection to detach from the hot tap.

Before purchasing a bath board check whether your bath is suitable for use with
a bath board. Check the following:

 the rims of the bath are level and at the same height on both sides of the
bath
 the width of the bath rim is at least 2.5cm (1 inch) on each side of the bath

 the bath is strong enough to support a bath board. It is possible that some
plastic baths may crack if weight is concentrated on specific areas of the
bath, such as when using bath boards, bath seats or bath lifts. Consequently,
before using a bath board, bath seat or bath lift with a plastic bath you should
check with the documentation, or with the manufacturer of the bath that it is
strong enough to support this type of equipment. If you are unsure what your
bath is made of see if a fridge magnet sticks to the side of the inside of the
bath. If it does, it is probably made of enamel. If the bath sounds like plastic
when you tap it, then then it is probably plastic. Note that acrylic is a type of
plastic.

 The material and shape of the sitting surface as this will determine how
comfortable it is. In general, padded boards or seats will provide greater
comfort especially if you are thin or in pain. The padding may also help make
the board/seat feel less cold.

 Slatted or perforated boards will allow the water to drain away quickly, so
that drying is easier and the board is less slippery to sit on. However, ensure
that the holes are small as it has been known for male users to trap certain
body parts.

Bath boards are available in different lengths. To work out which would fit your
bath measure the width of your bath (as shown to the left). It is very important to
get the length of the bathboard correct. If the board is too long it will stick out
over the side of the bath and there is a chance it could tip up if you sit on the
end. If the board is too short it will not have sufficient support.

The board must fit securely across the top of the bath. All have an adjustable
fixing system, usually brackets on the underside, which braces the board against
the sides of the bath. The board may be perforated or slatted, so that water
drains away easily, and can be made of different materials, such as solid or
padded plastic, wood, metal or cork.

View a short demonstration of how to use a bath board when

transferring in and out of the bath.

Bath boards may not fit some baths depending on the shape of the bath, irregular
shaped sides, corner tiling etc. If this is a problem then a wall mounted bath
board may be a possibility. Some users prefer the fact that wall mounted bath
boards are secured in place and not subject to 'user error' when being refitted.

Bath boards are in the national catalogue which operates

equipment prescriptions in certain parts of the country (see the Introduction)
with the codes BA01-BA06, BA25 and BA26 (with attached handle). Bath boards
may sometimes also be called shower boards but we consider shower boards to
have greater width/depth than bathboards providing a greater area of support
(see our Showering factsheet). Whereas bathboards are narrower to provide more
room if you wish to transfer onto a bathseat (an example of a bathboard is
pictured above and shower board to the right).

Transfer benches
Transfer benches straddle the bath rims and are similar to a standard bath board
but are longer. This extra length forms a section outside the bath for you to sit
on, and has height adjustable legs that rest on the floor. When getting out you
can slide across the board, lift your legs over the side of the bath, and sit there
whilst drying yourself.

Leg lifters

The above bath boards and bath benches can be a great help to transfer over the
bath but not if you experience difficulty lifting your legs over the bath rim.
Manual leg lifters may be useful if you can sit on a bath board and hook your leg
through the reinforced loop. You can then lift your leg up and over the bath rim
with the loop. However, this task needs strength, dexterity and good sitting
balance. Some people use the crook neck of a walking stick to perform the same
action.

Bath lifts
Bath lifts are useful for getting down to the bottom of the bath and back up again
(see the section on getting to the bottom of the bath below). However they are
also included in this section as they can sometimes help if you experience
difficulty lifting your legs over the bath rim from a seated position and are
therefore unable to use a bath board or transfer bench. They may help as some
bath lifts can be raised higher than the top of the bath rims which reduces how
far you need to raise your legs to clear the bath rim.

Bath steps

Bath steps provide a step-like platform on the outside of the bath, lessening the
height you need to lift your legs to get into the bath. However, they are not
suitable for people who have difficulty keeping their balance, and they will not
help you to lift your legs out from a deep bath. If used, a slip-resistant step
provides a safer surface to stand on; and a grab rail mounted on the wall may
provide a secure handhold to grip whilst using the step. There is a specification
for a bath step on the national catalogue which operates equipment
prescriptions in certain parts of the country (see above) with the code BA16.

Baths with a transfer mechanism

Some baths incorporate a swivel seat that lifts you up, over and down into the
bath. The seat may include a leg raising mechanism to lift your feet over the bath
rim.

Walk-in baths
These baths have a door that you can step through to walk into/out of the bath.
Although there are no high sides to negotiate, there is a low step beneath the
door. Some walk-in baths are shorter in length, therefore reducing legroom, and
may well be too cramped if you experience stiffness in the hips and knees. The
bath has to be empty before you enter it and then fills when you close the door.
When exiting the water needs to be drained before you open the door. This filling
and drainage causes a short delay during which you may become cold so
consider keeping the bathroom well heated during use.

Shallow baths
Shallow baths are not as deep as standard baths, and may be easier to climb into
and out of. However, you may still experience difficulties when standing up from
the bottom of the bath (see below), and additional rails may help.

Difficulty sitting down or standing up from the bottom of the

bath
There is a wide range of equipment, ranging from simple to sophisticated items
that will help overcome this difficulty. The combination of a bath board, seat,
grab rails and a slip-resistant mat may satisfy many peoples' needs, others will
need to consider a lifting mechanism or an alternative type of bath. If the task is
still difficult or unsafe, then it may be appropriate to consider showering as an
alternative.

PROVIDING A HIGHER SEATING POSITION

Bath boards

Bath boards are waterproof boards that fit across the top of the bath to provide a
secured area on which to sit. They are designed to let you transfer onto the bath
whilst sitting, which is safer than stepping into the bath. You need to lift your
legs over the bath rim whilst seated and either sit on the board and wash using a
hand-held shower spray, or move from the board down onto a bath seat so that
you are nearer the bath water. If you decide to use the shower spray whilst sat
on the board check that your shower head will reach, ideally the holder should be
located in a position that is accessible to you. Avoid the use of a push-on type of
flexible shower hose as they can cause hot water scalds if your water pressure
varies and causes them to come detach from the tap. Before purchasing a bath
board check whether your bath is suitable for use with a bath board. Check the
following:

 the rims of the bath are level and at the same height on both sides of the
bath
 the width of the bath rim is at least 2.5cm (1 inch) on each side of the bath

 the bath is strong enough to support a bath board. It is possible that some
plastic baths may crack if weight is concentrated on specific areas of the
bath, such as when using bath boards, bath seats or bath lifts. Consequently,
before using a bath board, bath seat or bath lift with a plastic bath you should
check with the documentation, or with the manufacturer of the bath that it is
strong enough to support this type of equipment. If you are unsure what your
bath is made of see if a fridge magnet sticks to the side of the inside of the
bath. If it does, it is probably made of enamel. If the bath sounds like plastic
when you tap it, then then it is probably plastic. Note that acrylic is a type of
plastic.

 The material and shape of the sitting surface as this will determine how
comfortable it is. In general, padded boards or seats will provide greater
comfort especially if you are thin or in pain. The padding may also help make
the board/seat feel less cold.

 Slatted or perforated boards will allow the water to drain away quickly, so
that drying is easier and the board is less slippery to sit on. However, ensure
that the holes are small as it has been known for male users to trap certain
body parts.

Bath boards are available in different lengths. To work out which would fit your
bath measure the width of your bath (as shown to the left). It is very important to
get the length of the bathboard correct. If the board is too long it will stick out
over the side of the bath and there is a chance it could tip up if you sit on the
end. If the board is too short it will not have sufficient support.

The board must fit securely across the top of the bath. All have an adjustable
fixing system, usually brackets on the underside, which braces the board against
the sides of the bath. The board may be perforated or slatted, so that water
drains away easily, and can be made of different materials, such as solid or
padded plastic, wood, metal or cork.

Bath boards may not fit some baths depending on the shape of the bath, irregular
shaped sides, corner tiling etc. If this is a problem then a wall mounted bath
board may be a possibility. Some users prefer the fact that wall mounted bath
boards are secured in place and not subject to user 'error' when being refitted

Bath boards are on the national catalogue which operates equipment

prescriptions in certain parts of the country (see the Introduction) with the
codes BA01-BA06, BA25 and BA26 (with attached handle)

Transfer benches
Transfer benches straddle the bath rims and are similar to a standard bath board
but are longer. This forms a section outside the bath for you to sit on, with height
adjustable legs that rest on the floor. When getting out you can slide across the
board, lift your legs over the side of the bath, and sit there whilst drying yourself.

Bath seats

Bath seats are placed inside the bath and provide a sitting platform for you to
shower from or wash with the bathwater. The seat is often used with a bath
board.

Used with a bath board

The seat provides a lower sitting platform between the bath board and bottom of
the bath. This helps as it positions you nearer to, or in, the water. Bathing from
the seat still means you will not experience the relaxation of lying in deep water
or stretching out in the bath. If you have long legs or a short bath then you may
find your knees are bent when seated in the bath. You will need good upper body
strength to move yourself between the seat and the board. There is a risk that
you will be able to sit down on the seat but then struggle to lift your bottom back
onto the bath board.

Used on their own

Bath seats are sometimes used on their own, without a bath board. You need to
be able to step safely into the bath and position yourself onto the seat. After
bathing you will need the strength to stand from the seat.

Bath seats are available with backrests and/ or armrests and come in different
heights. The shorter the height, the more effort will be required to get out of the
bath but the lower down in the water you sit. It is recommended that bath seats
are used in conjunction with a slip-resistant bath mat. Some seats have a cut-out
section at the front to make personal cleaning easier. There are three types of
bath seat: suspended, wedge and freestanding. If you have an acrylic bath you
should consult the bath's suppliers before buying a wedge type bath seat as the
seat could crack the bath.

Bath seats are in the national catalogue which operates equipment prescriptions
in certain parts of the country (see the Introduction) with the codes BA07-BA09.

Combination boards and seats

These consist of a bath board attached to a bath seat and have the advantage of
being more stable than two separate units. However, they can be rather bulky
and heavy to remove from the bath.

Swivel seats
These seats rest across the rims of the bath and may be used in preference to a
bath board as they provide a more supportive chair-type seat. They swivel to the
left or right and many have a locking mechanism, which will secure the seat in a
fixed position when you are getting on and off. You remain sat in the swivel seat
to wash, perhaps using a hand-held shower spray.

View a short demonstration of how to use a swivel bath seat when

transferring in and out of the bath.
PROVIDING A SUPPORT TO PULL ON
Rails provide hand holds to help people get in and out of the bath independently
or with minimal assistance. Some baths have small rails built in and provide a
low level hand hold, but these may be too low to assist with getting in and out of
the bath. They can also make positioning and securing equipment such as a bath
board difficult.

Grab rails

These can be attached to the wall, ceiling or floor next to the bath. Straight or a
slightly angled rails may be fixed to the wall to provide support when getting up
and down in the bath. A floor to ceiling rail can be fixed to the floor and the
ceiling and can be helpful if a bath step is used to get in and out of the bath,
although it may get in the way if a bath board is used.
Bath-fixed rails
These clamp onto the side of the bath providing a vertical loop, which sticks up
above the bath rim. Rails that attach solely to the bath itself, especially acrylic
baths, are not recommended, as great care must be taken to ensure that the
adjustable fixing mechanism, usually a screw system, is tight enough for the rail
to remain secure, but not so tight that it damages the bath. Fixings should be
checked on a regular basis and tightened when necessary.

Floor/bath fixed rails

These rails have fixing points on the bath itself and on the floor next to the bath.
This makes them more stable than those fixed only to the bath. Most are height
adjustable. These rails can provide a handhold to assist you up from the bottom
of the bath or from a bath seat, and can help you to step into the bath. However,
they will make it difficult to transfer your legs into the bath if you are going to do
this whilst seated on a bath board.

Tap-fixed rails

These clamp around the bath taps, fold down to rest on the bath rim and can be
folded up against the wall when not required. When sitting in the bath, the rail
will be directly in front of you at about chest height. In this position it will
provide stability whilst in the bath, but may not be at an ideal level to help with
sitting down or standing up from the base of the bath.
These rails are not always recommended as they clamp around the bath taps and
are therefore only as strong as the tap fixtures. Taps are not designed to
withstand a person's body weight pulling against them.

Wall-fixed rails

Grab rails positioned beside a bath or shower can

assist you with transferring in and out of your bath or shower. However, the
position and type of rail required will depend on your individual height, reach,
strength and dexterity. It is therefore recommended that you have an
assessment with an occupational therapist or trusted assessor before having
grab rails installed (please see top of page). Grab rails in a bathroom should have
a ribbed or textured surface to give extra grip when wet.

Rails can be attached to the wall alongside the bath to assist with stepping in
and out of the bath, and to provide support when standing up from the bottom of
the bath and lowering down into it. Wall-fixed rails used in the bathroom should
have an anti-slip, coated finish, and all the fixation screws should be concealed.
The wall itself must be strong enough to bear the load (it may be difficult to fix
rails to some partition walls).

As general guidance, rails are available in three standard lengths: 30, 45 and
60cm. Positioned on the wall horizontally, they will help with movement forwards
and back, and from side to side. Positioned vertically they will assist with up and
down movements when you need to get up from the bottom of the bath and shift
your weight forwards before beginning to rise. Thus a combination of a horizontal
rail and a vertical rail may be needed.

Rails systems
These are made up of a number of component parts, enabling them to be built to
individual requirements and fitted around corners and obstructions. They may be
attached to the walls or the floor.

Further guidance is available in the DLF factsheet Choosing and Fitting Grab
Rails.

PROVIDING A LIFTING MECHANISM FROM THE BASE TO THE RIM OF

THE BATH
If you find it difficult to use a bath board or seat to move yourself up and down
from the bottom of the bath you may wish to try out a bath lift. The vast majority
are powered and can be operated either by yourself, for independent bathing; or
by a carer. For carers bathlifts may help to make the task of assisting someone
easier and safer, thus reducing the risk of back injury. Although expensive a bath
lift may be more cost effective than installing a special bath or shower.

Removable bath lifts

These fit inside the bath and can lift the person from near the bottom of the bath
up to the height of the bath rim. You must however, still be able to lift your legs
over the bath rim if you wish to bathe independently. The majority of bath lifts
have a seat and backrest unit made of either solid plastic or mesh fabric, and
some have the option of a reclining mechanism to give a more relaxing bath.
Bath lifts can be removed for relocation or to allow another member of the family
to use the bath. However, their weight and the rubber suction pads can make
them difficult to remove. Some models have detachable components making the
bath lift easier and safer to handle.

View a short demonstration of how to use an electric bath lift to get

in and out of the bath.

Bath lifts are on the national catalogue which operates equipment prescriptions
in certain parts of the country (see the introduction) with the codes BA18, BA23
(reclining backrest).

A few manual versions are available. Manual bath lifts are operated hydraulically
using the weight of the person to lower the lift and the buoyancy of the water to
help to raise the lift. The motor driven versions are usually powered by a
rechargeable battery located behind the backrest or in the handset. This must be
removed and recharged regularly.

A few bath lifts are inflatable using air pressure. You may find the seat unit on an
inflatable bathlift less stable, particularly if it has no backrest. Therefore, they
may not be appropriate if you have difficulty with your balance.
Wall/floor-fixed bath lifts

These bath lifts are also called band lifts. They consist of a fabric band on a
roller connected to the wall. The band pulls out, runs across the bath rim and
slots into a floor mounted bracket. A battery or mains powered motor gently
rotates the roller 'letting out' the band, lowering you into the bath. The roller is
rotated in the reverse direction to lift you up.

Lower you right down to the bottom of the bath.

No back support. You need good sitting balance

Their advantage is that they lower you right down to the bottom of the bath and
give you the freedom to lie back and soak. These lifts are not suitable for
everyone, as they provide no trunk or back support, and you must adjust your
position on the band at intervals during ascent and descent to keep yourself
central. Thus you need to have good sitting balance in order to use these lifts
safely.

Floor-fixed bath hoists

Floor-fixed bath hoists may be powered or mechanically operated and have a

seat (or slings) attached to a vertical column which usually slots into a base
plate at the side or end of the bath. The height of the column can be adjusted
and the seat swivels to enable you to transfer onto it from outside the bath. The
seat is then raised so that it clears the bath rim and is lowered down into the
bath.

Manual hoists are operated by a winding handle designed to be operated by a

carer, although it may be possible for the bather to use some models
independently. Powered hoists use either mains electricity and will require a
power point outside the bathroom or a rechargeable battery that will need
charging regularly. You may operate the controls independently via a handset.

Hoists which provide a sling support

Although a few of the floor-fixed bath hoists have the option of using slings, most
people who need the additional support gained from a sling will use a mobile or
ceiling track hoist. It is better to use mesh slings in the bath as they allow the
water to drain away easily.

A small mobile hoist can be used for many handling tasks in and around the
home. However, if you need to be moved from one place to another, it is better to
use an overhead track hoist or a sanichair. This is because a mobile hoist can be
heavy and difficult to manoeuvre, especially in confined spaces such as
bathrooms, and the occupant can feel particularly vulnerable in transit. The hoist
legs must fit under the bath to position the bather. This will require a minimum
space of 11cm under the bath, and the side panel will need to be removed or
have a hole cut into it. Storage space for the hoist also needs to be considered.

Battery powered hoists are easier to operate than manual hoists, as the motor
takes the person's weight, but remember that the battery needs to be charged
regularly.

Overhead track hoists are ideal in a domestic situation because, if the layout of
the house permits, a straight, jointed or curved track can be fixed so that you
can transfer in the sling from the bed and into the bathroom where you can use
the toilet and the bath or shower. It may be possible to conduct these
manoeuvres independently or with minimal assistance. However, structural
alterations may be necessary such as strengthening the ceiling, or adapting the
top of the doorframe to take the track.

An electric traversing system may enable you to transfer independently using the
hoist. A carer has to push you along the track in the sling if a manual traversing
system is used.

PROVIDING AN ALTERNATIVE TYPE OF BATH

When planning to replace a bath consider:

 the space available;

 the level of disruption in terms of both noise and mess whilst work is in
progress, and the time the bathroom will be out of action;

 the volume of water required to fill the new bath and compare this to the
capacity of the current bath. Does the hot water tank have sufficient
capacity?

 the aftercare of the equipment, particularly servicing and maintenance if

the bath has moving parts;

 the long term prospects. If your ability is likely to deteriorate a level

access shower might be a better option;

 other household members.

Baths with a built in seat

These have a seat built into the moulding of the bath so that you do not have to
sit on the bottom of the bath. They have no transfer system and, like a bath seat,
you must have fairly strong arms to move yourself up and down. Many have cut
away sides and a small corner ledge for you to perch on whilst transferring your
legs into the bath.

Baths with a built in transfer mechanism

All these have lifting seats incorporated into the structure of the bath so that
there is no need for you to get up or be helped up from the bottom of the bath.
The seat raises and lowers; all but a few seats have a fixed backrest which
makes reclining back in the bath difficult. Some seats incorporate a legrest to
lift your legs over the bath rim. When the seat has been raised above the bath
rim, it can be swivelled outwards, either manually or automatically, for easier
transfer. The height of the seat edge is important, especially if you need to brace
your knees in order to stand upright, or need a level transfer from a wheelchair
seat. A few systems have the facility to raise and lower the seat outside the
bath.

These baths are powered either by water pressure or electric. The lift can be
controlled by the bather or a helper using a handset. If the system is electrically
powered, a safe air switch is used.

Multi-adjustable baths
These are high level baths that enable you to transfer directly onto a bathing
platform. The bath side or sides are then raised so that you can bathe. The
platform can also be used as a drying/changing table in some situations. As well
as making transfers easier, this style of bath can ease back strain for a carer.

Walk in baths
Walk in baths can help people who have difficulty getting their legs over the side
of a standard bath or who have difficulty getting up from the bottom of the bath.
They have a door at the front or side for entry (but there is always a small step to
negotiate), and a seat. Their main drawback is that they cannot be filled with
water until you are inside and the door has been sealed; and you cannot get out
of the bath until most of the water has drained away. For safety, water
temperature should be thermostatically controlled.

The shape of these baths may vary. Those that are square take up less room in
the bathroom but if the door is outward opening, space will be needed to
accommodate the swing. Smaller baths will give you less leg room and so may
not be suitable if you have stiff hips or knees.

Check the height of the internal seat to make sure you are able to lower down
and stand up from it with ease. If you are unsteady on your feet, make sure the
taps, plug and door controls can be reached from the seated position if you plan
to bathe independently.

Adjustable height baths

The height of these baths can be adjusted, either mechanically or electrically.

This is designed to reduce the need for a carer to bend over the bath if you
require assistance. You may be able to step into the bath at its lowest level and
then be raised to a convenient height. However, remember that the water usually
needs to drain away before you can get out. These baths are not often used in a
domestic setting.

SUPPORT, COMFORT AND POSITIONING IN THE BATH

Inserts and Support Cushions

Cushions for comfort
Plastic covered foam cushions can be used to line the bath to make someone
who is frail more comfortable; or to increase your safety if you have involuntary
movements.
Mouldable body supports
These are large waterproof, mouldable cushions which are filled with polystyrene
beads. They are available in different shapes to support various parts of the
body. They will conform to your shape and this shape can be semi-permanently
fixed, when the air inside is removed using a pump. They are secured to the side
of the bath with suckers.

Head supports
Head cushions improve comfort when lying back in the bath. They are fixed to
the bath with suction pads.

Pressure relief cushions

If you require pressure care, it should be provided across the range of daily living
activities, i.e. not only as a pressure cushion for the wheelchair, but also in bed,
in the bath and on the commode or toilet. Bath cushions should have a
waterproof outer cover, and a heavy inner substance which enables the cushion
to remain submerged.

Safety equipment

Bath thermometers and water temperature indicators

Thermometers can be used to check the temperature of bath water before use.
They are particularly useful if you have reduced skin sensation and need an
objective way to determine temperatures. Indicator devices change colour to
indicate water temperature. Some people may find them simpler and easier to
read than a bath thermometer.

For England and Wales, from 1st April 2010 Part G of the Building Regulations
(Hot water supply and systems) has included the requirement that baths, subject
to building regulations, are fitted with a protective device (i.e. a thermostatic
mixing valve) to limit the temperature of hot water. Similar regulations have been
in force in Scotland since 2006. These thermostatic mixing valves (also called
TMVs) accurately control the temperature of water for showering and bathing.
They maintain the pre-set temperatures even if the water pressure varies when
other appliances are used. Installed and maintained correctly, they can
significantly reduce the risk of scalding in the home. Some types of thermostatic
mixing valves can be installed with existing conventional taps, e.g. hiden under
the bath, others can replace existing taps. TMV valves for domestic installation
are governed by the TMV2 scheme, TMV3 valves meet requirements for use in
public places such as Schools and Hospitals. The scheme's purpose is to monitor,
test, approve and list complying manufacturers' valves. For more information
contact the Thermostatic Mixing Valve Manufacturers'
Association www.tmva.org.uk To check whether a valve is approved as a TMV2
valve visit the BuildCert Product certification
website http://www.wrcnsf.com/Buildcert.com/check_an_approval.htm Fitting a
TMV is not a DIY job. A registered plumber should be used. For help finding local
competent traders, such as plumbers, who meet relevant standards you could
visit www.trustatrader.com

Water Level Indicators

These emit an audible warning when in contact with water and therefore can be
used to alert you when the bath is full. This can be particularly useful if you have
short-term memory loss or low vision.

Bath mats and slip resistant materials

Mats which are secured with suckers to the bottom of the bath, self-adhesive
strips and spray-on slip-resistant material will all help to reduce the risk from
slipping in a wet bath.

Taps

If you experience difficulty turning your taps on/off due

to a weak or painful grip you may wish to consider trying tap turners. These fit
on your exisiting taps heads, take care choosing a tap turner as most are
designed for a particular type of tap (e.g. for cross or bar head taps or for round
heads). They are usually colour coded red or blue for hot and cold taps.
Alternatively you could replace your taps with lever taps. The are designed to be
easier to turn as the lever can be pushed/pulled to operate the tap. On most the
lever only needs to turn a quarter of the way around the tap to go from off to fully
on. Bath taps should not be used as a support to pull up on when getting out of
the bath. Most will not be strong enough to withstand a person’s weight.
Strategically positioned grab rails should be used instead.

Long handled bathing aids

There is a range of long handled washing and personal

care equipment and hand and foot care aids available designed to help make it
easier to reach parts of your body when washing with less stretching or bending.
This long handled equipment can be used for washing your feet, back or other
hard to reach areas of the body such as between the toes. It may be best to use
this equipment whilst seated in your bath to help avoid any potential difficulty
with your balance when reaching with the equipment.

Extra Information

Is your bath suitable to use bathing equipment?

Most standard shaped baths will take a bath board, seat or lift without any
problems, but care must be taken when there is anything non standard about the
bath. You will need to consider:

 rims - if using a bath board the rims of the bath should be level and at the
same height on both sides of the bath. The width of the bath rim should be at
least 2.5cm (1 inch) on each side of the bath
 length - check whether the bath is long enough to use the equipment,
especially if a bath board and seat are going to be used to get down into the
bottom of the bath, or you have stiff hips or knees and therefore need room to
straighten your legs. A 1700mm long bath allows room for most bath
equipment;

 width - if the bath is exceptionally wide or narrow, the equipment may not
fit into/on it;

 built-in grab rails on the side of the bath - the positioning of these may
hinder the use of equipment or entry and exit to the bath. The side flaps of
some bath lifts can become stuck under the built in grab rails, some bath lifts
come with sliders that fit to the grab rails and prevent the flaps getting
caught;

 material - metal baths are strong enough to withstand most types of

bathing equipment. Most acrylic baths are not strong enough to take wedge-
in bath seats and, when free-standing bath seats and removable bath lifts are
used, the weight should be distributed over as wide a base as possible. You
should always check with the supplier of any bathing equipment if there are
any limitations on the kind of bath they can be used in, and if necessary
check with the manufacturer of your bath

 do you have a corner bath? Only a few items of equipment can be used in a
corner bath, such as specific bath lifts and bath seats (check online product
descriptions to see if they mention corner baths or contact the suppliers).
REMAP (see Useful Organisations below) may be able to build a bathboard for
a corner bath.

Bath boards
Type of fixing
It is very important that once a bath board has been securely fitted against
the sides of the bath, it is held firmly in place so that no movement occurs
during use. Once in use it should be checked frequently to ensure that the
fixings remain tight.

Adjustable brackets can be adjusted for length, and the angle of some
brackets can also be altered to wedge the board against the inside rims of
the bath. Brackets are usually made of plastic and some may be held in
position with wing nuts which people with weak or painful hands may find
difficult to tighten. The brackets usually have slip-resistant covers to provide
extra grip and to prevent marking the bath. These should be checked
periodically as they may wear after long-term use.

A wall-mounted bathboard may be required if the bath rim adjacent to the

wall is not wide enough to support a standard bath board safely. The bath
board attaches to a bracket on the wall side and the other side rests on the
near side bath rim. They fold up against the wall when not required or can be
removed.

Size of board
Depth (front to back) - a wider board, sometimes called a shower board, will
be stronger and more comfortable, especially for the larger user but will,
however, take up more space.

Length (across the width of the bath) - particularly important if it is to be

fixed into an especially wide or narrow bath. It is important that the board
does not overlap the outside edge of the bath by more than 2cm, as this could
cause the board to tip in use.

Capacity
Check the weight capacity of the board, particularly for larger bathers.

Weight
This may be important if the board is to be moved frequently or taken away on
holiday.

Additional features
o Integral handgrips - some boards have handles or hand grips built
into them which may be useful when moving onto and off the board.
o Cut-away front - some boards have a cut-away section or a dip at the
front to make personal cleaning easier.

How to use a bath board

Bath boards should always be used in conjunction with a slip-resistant bath
mat or surface.

o Sit on the edge of the board with your feet outside the bath on the
floor.
o Slide or wriggle backwards onto the board.

o Turn to swing your legs over the rim and into the bath. You may need
the help of a manual leg lifter or another person.

o Slide or wriggle to the middle of the board using wall-fixed grab rails
or integral handgrips to pull on.

o From this position you can either lower onto a bath seat or down
onto the base of the bath, or stay on the board and use a hand-held
shower.

Bath stools and seats

If you use a bath stool or seat you may find it easier to sit and stand in the
bath as you do not have as far to lower/raise yourself

Bath stools and seats still allow the curtain to hang inside the bath.

The water will not cover your legs as you are higher in the bath

All users of bath stools/seats must be able to sit up straight, i.e. be able to
bend at an angle of 90° at the hips. You will need to be able to bend further
forwards if you are going to reach and wash your feet without using a long
handled sponge. There are three main types of bath stools / seats:

1. Suspended seats

Suspended seats hang down from a framework which rests on the bath rim.
The width of the frame can be adjusted to fit different sized baths. The ends
of the frame are covered in a slip- resistant material to provide extra grip and
to prevent damage to the bath. They can generally be used in metal or acrylic
baths. Some have a backrest or support which makes them difficult to use
with a bath board.
2. Free-standing bath seats

Free-standing bath seats have feet or suction pads which stand on the bottom
of the bath. Some have adjustable side brackets, which can be tightened to
wedge against the side of the bath, reducing seat movement and providing
the user with extra stability. They can generally be used in all baths, although
those with larger bases to their legs are more suitable in acrylic baths than
those with narrow legs as the weight is spread over a larger surface area.

3. Wedge bath seats

Wedge seats often have four hinged paddles which are attached to the metal
seat frame and wedge firmly against the sides of the bath. The frame can be
adjusted to ensure a firm grip against the bath sides. Most are only suitable
for use in metal baths - some plastic or glass fibre baths may crack as the
legs push against the sides of the bath,

Bath seat height

o The height of some bath seats reaches to just below the bath rim.
o Some bath seats are only available in one height, others are
available in a range of heights, or can be fitted with leg extenders.

o Some of the wedge seats have reversible paddles which give a

choice of two seat heights.

o You will need to check how far the seat on a suspended model hangs
down in the bath and compare this with the depth of bath.

Backrests
Bath stools do not have backrests, bath seats have backrests although these
provide varying amounts of support. However the term 'bath seat' is often
used for bath stools so check whether the model has a backrest or not.

A high backrest will provide much more support than a low one, but if it
protrudes above the bath rims the seat cannot be used in conjunction with a
bath board.

Tubular backrests provide very little support and can be uncomfortable to

lean against. Padded backrests will provide more comfort if you are thin or in
pain.

Cut-away

Some seats have a cut-away section or a dip at

the front to facilitate personal cleaning.
Weight
This may be important if the seat is to be moved frequently or taken away on
holiday.

Capacity
Always check the weight capacity of the seat, particularly for larger bathers.

SWIVEL SEATS
As these are fixed on a frame across the rim of the bath, they are generally
used for showering over the bath. Check that a shower curtain can be
positioned around the seat frame.

It is often useful to have a conveniently positioned grab rail to assist with

pulling or pushing the seat and bather around into position. A carer may be
needed to lift the legs of the bather into the bath.

Swivel mechanism
Some seats swivel only when a lever mechanism is released and this may be
difficult for people with weak or painful hands. When the seat is facing
outwards for transfer, check how close the edge of the seat is in relation to
the rim of the bath. Help on and off the seat may be required if it is positioned
back from the edge of the bath.

Armrests
Check that they protrude far enough forwards to allow them to be used as
support when standing up.

Swivel seats with fold-up armrests allow for sideways transfers although,
because of the swivel mechanism, it is usually easier to transfer onto it from
the front.

Tubular armrests do not provide as comfortable forearm support during

sitting as those which are slightly padded or flattened horizontally.

Seats/backrests
Swivel seats all have moulded seats with a fixed backrest which make it
difficult to lean back, especially for people who have stiff hips.

There is a specification for a swivel seat on the national catalogue which

operates equipment prescriptions in certain parts of the country (see above)
with the code BA17.

REMOVABLE BATH LIFTS

The removal of a bath lift will enable other members of the household to use
the bath in a conventional way. However, this task should be avoided where
possible because someone has to stoop down into the bath to reach and
grasp the lift which can cause great strain on the back. Consider the
following factors.
o Weight - this will vary according to the size, the lifting mechanism
and the power source. Some can be broken down into several lighter
component parts;
o Suckers - many have large suckers which stick to the bottom of the
bath to provide stability. These need to be released before the lift is
removed. Some have pull-up tabs to make this easier; most require at least
four hands to release them all at once.

Lifting mechanism
Hardly any of the bath lifts lower right down to the bottom of the bath. The
seat level of some are as much as 8cm from the bottom in the lowest
position.

Check that the lifting height is sufficient to lift from the bottom to the rim of
the bath. Some do not lift high enough for use in deep baths. Some have
adapters that can be added when used in deep baths - check with the
supplier. Some models have a metal scissor mechanism frame which relies on
the weight of the person to lower it gently down in the bath. To get up, the
person needs to sit upright and push down on the bath rims to release a
hydraulic piston mechanism which lifts the bather back up using powerful
springs.

On some models the seat is attached to the top of a bellows mechanism into
which air is sucked in or out, thus raising or lowering the person. When not in
use it should be kept in an upright position to let it dry out. On other models
the bather has to sit directly on top of a plastic bubble. Without a solid seat
and backrest, it may not provide enough support for some bathers.

Power source and controls

The bath lift will operate by compressed air or a motor and rechargeable
battery pack.

Compressed air - air is used to inflate the bath lift. The compressor is
powered by a rechargeable battery powered portable compressor which can
be recharged outside the bathroom.

Rechargeable battery pack - many models of bath lift are motor driven and
powered by rechargeable batteries which are situated on the backrest, in the
handset or in a separate portable power unit. The following should be
considered:

o Number of lifts per charge. This varies depending on the size and
power of the battery. In general the smaller batteries situated in the
handset need to be charged far more regularly than the larger packs.
 Some models are available with an institutional power pack and recharger
for frequent use which will carry out up to 60 lifts per charge;
o Charging - as chargers have to be plugged into the mains this
activity should be carried out away from the bathroom. On some models
the handset only has to be removed and plugged into the charger; others
have large batteries which have to be removed for charging. Some
chargers can be used with non-British power sources.

Controls
Powered lifts are controlled by a handset which is waterproof and is safe if
accidentally immersed in the water. Some handsets can be attached to the
side of the bath with suckers so that they are always conveniently positioned.

Most handsets have press buttons to control the movement. Some are marked
so that they can be used by a bather with sight loss.

Rocker or toggle switches are sometimes available and are particularly

helpful for a person with weak or painful hands.

Seat
Support - very few of the seats provide any substantial support for people
who find it difficult to sit unaided, and many of the moulded plastic seats are
not easy to adapt. Some suppliers may provide a pommel or waiststrap /
harness for their bath lift.

Transfers - most seats have side flaps which drop down and rest on the rims
on the bath to assist with getting on and off the seat. Some models have a
swivelling seat or disc on the seat which helps the person to get on and off.
Alternatively, a flexible transfer disc can be placed on top of the seat to
provide a means of swivelling. Conveniently positioned grab rails will help the
users to pull or push themselves into position.

Backrest
One-piece moulded seat and backrest - requires the bather to sit in an upright
position. Reclining - some bath lifts have backrests that enable the person to
recline in the bath. A reclined position may also provide better support for
someone with poor sitting balance.

Capacity
Check the weight capacity of the lift - particularly for larger bathers.

SOURCE: http://www.dlf.org.uk/factsheets/bathing