Managing toileting activities is an essential daily living task that should be carried out independently when ever possible to maintain privacy and dignity. There are many issues to consider including access to toilet facilities; transferring on and off the toilet; and tending to oneself. Solutions can generally be found by altering the approaches to the required tasks; using special equipment; or if a simpler solution cannot be found, altering the home environment.
This Information Sheet aims to help you choose toileting equipment and suggests toileting equipment and methods that might work for you.
Where to get help and advice
Before making any decisions about buying equipment, or making alterations to your home, it is strongly recommended to contact an occupational therapist (OT). An OT is qualified to assess your daily living needs. The OT will advise on possible solutions and will arrange for the provision of suitable equipment to those who are eligible eg medical card holders. The OT can also advise on home modifications, where appropriate, and on grants that may be available to help with the cost.
You can contact the OT for your area through the Community Care section of your Health Services Executive area. Contact details for your local services are in your local area phone book or online.
A public health nurse can offer advice on the treatment and management of incontinence and can be contacted through the local health centre. A continence advisor is a specialist public health nurse who can give advice and support on all aspects of continence care and can be contacted through the local health services. General information on managing incontinence is also available from the Continence Promotion Unit in Dr Steeven’s Hospital in Dublin (see Useful addresses).
If you decide to buy equipment privately it is strongly recommended that you seek the advice of an occupational therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.
Provision of equipment
Medical Card Holders
Equipment for people with disabilities, sometimes referred to as aids and appliances, is usually supplied free of charge to medical card holders. The card holder must first be assessed by the relevant therapist who can recommend and prescribe the most suitable equipment.
Long Term Illness Card Holders
People who have one of the conditions listed as qualifying under the Department of Health’s Long Term Illness Scheme may be eligible to receive items of equipment, essential for the primary condition, free of charge. Assessment by the relevant professional is required.
Hospital Treatment
People in hospital may have aids and appliances provided free of charge when they are prescribed as part of in-hospital treatment in a public hospital.
Health Insurance Schemes
The main companies offering private health insurance in Ireland are:
- Voluntary Health Insurance (VHI)
- Irish Life Health
- Laya Healthcare
- GloHealth (taken over by Irish Life Health in 2016)
- HSF Health Plan (provides cash benefit plans but not in-patient health insurance)
Some policies provide members with cover for a limited number of aids and appliances under their out-patient schemes. A list of approved appliances is available on request. A claim for the reimbursement (part or full) will be subject to a member’s out-patient excess. Medical certification is usually necessary. Contact your health insurance company’s Customer Services to check if a particular appliance is covered by your policy.
Some employers have their own special health insurance schemes which provide cover for their employees. The employee’s family is also often covered. Check with the employer to see what, if any, equipment is covered under the scheme.
Private Purchase of Equipment
Private purchase may be necessary if the user is not eligible to obtain the necessary equipment from the local area health office. Some people may also choose to buy privately because they want the wider choice of equipment available on the private market.
The purchaser has the option of:
- personally funding the cost of the equipment
- applying to charities/benevolent funds etc for funding
- buying second-hand
- checking with your health insurance company, if a member, to see if, or what, reimbursement is available
Private Purchase – Applying for a VAT Refund
VAT paid on certain equipment which is privately purchased for use by a person with a disability can be reclaimed from Revenue. The relief applies to VAT on the purchase of goods which are aids and appliances designed to assist a disabled person to overcome a disability in the performance of their daily functions. Most aids to daily living and communication aids are included. Goods designed for leisure purposes are not. An invoice clearly stating the VAT content of the total amount paid must be included with the application. Contact Revenue’s Central Repayments Office to request Form VAT 61a (see Useful Addresses), or you can apply online for a VAT refund using eRepayments in Revenue’s myAccount service.
Assessment
Depending on the type of equipment required, a qualified therapist will assess the individual and make a recommendation to the body responsible for the provision of the equipment or to the person or agency who has requested the assessment. Generally the following applies, but the assessment process and provision may vary in different parts of the country.
- Occupational therapists will assess for aids to daily living – these include wheelchairs, mobility aids, specialised chairs, bath, shower and toilet aids, stairlifts, hoists etc
- Physiotherapists will assess for movement, strength and balance training equipment, walking aids and exercise devices
- Speech and language therapists will assess for communication, speech therapy, and training aids
- Other relevant therapists and specialists may also be involved in carrying out assessments, depending on the equipment or appliance required.
All the different therapists described above are based in hospitals, community care areas, and with various voluntary agencies. For more information, contact the Community Care section of your Health Services Executive area or the relevant hospital department as appropriate.
Private Occupational Therapists
Occupational therapists in private practice can carry out assessments in the home or workplace, and if home modifications are being considered, provide a report detailing the recommendations. It is important to ensure the therapist is experienced in relation to your particular needs. Make sure to discuss fees before engaging anyone’s services, and also check what the assessment fee includes (or does not include). The profession’s representative body, the Association of Occupational Therapists in Ireland (AOTI), keeps a list of contact details of member occupational therapists working in private practice in Ireland (see Useful addresses), and this information is also available on its website www.aoti.ie.
Private Physiotherapists
Physiotherapists can assess for movement, strength and balance training equipment, walking aids and exercise devices and recommend accordingly. If you wish to consult a physiotherapist you can go directly to your local chartered physiotherapist or ask your GP to refer you. It is important to ensure the therapist you consult is experienced in relation to your particular needs. Chartered physiotherapists work in hospitals and in the community where treatment is covered under the public health service. They also work in private practice and can be contacted through the profession’s representative body, the Irish Society of Chartered Physiotherapists (see Useful addresses), and their website www.iscp.ie.
If you do decide to buy assistive equipment privately, it is strongly recommended to seek the advice of an appropriate therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.
Funding for adaptations
Housing Adaptation Grant for People with a Disability
The Housing Adaptation Grant for People with a Disability may be applied for to assist in the carrying out of works that are reasonably necessary for the purposes of making a house more suitable for the accommodation of a person with a disability (who is a member of the household). This scheme replaces what was previously known as the Disabled Person’s Housing Grant.
The types of works allowable under the new scheme can be varied and include the provision of access ramps, stairlifts, downstairs toilet facilities, accessible showers, adaptations to facilitate wheelchair access and extensions. In general, people who require grant aid for minor works eg ramps, grab rails, accessible showers and stairlifts, and who satisfy the means test provisions, should apply for assistance under the new Mobility Aids Grant Scheme (see below), also administered by your local authority.
All applications for grant aid under the Housing Adaptation Grant Scheme are assessed on the basis of household means. The maximum grant available under this scheme is €30,000 or up to 95% of the cost of the works.
How to apply
The Housing Adaptation Grant Scheme for People with a Disability is administered by your local authority. All applications must include two written itemised quotations from contractors indicating the cost of the adapation. The local authority will decide whether it is necessary to refer the application to an Occupational Therapist. This decision is based on the report of the authority’s Inspector, the applicant’s General Practitioner, and the long term needs of the applicant. For full details of the Housing Adaptation Grant Scheme for People with a Disability, contact the Housing Department of your local authority. You can also find information on the Housing Adaptation Grant for People with a Disability on www.citizensinformation.ie
Mobility Aids Housing Grant Scheme
For smaller scale projects, the Mobility Aids Housing Grant Scheme is available. The scheme is designed to fast track grant aid to cover basic adaptations to address mobility problems primarily associated with ageing. The work allowed under the scheme can be varied and can include grab rails, access ramps, level access showers, and stairlifts. All applications for grant aid under the Mobility Aids Housing Grant Scheme are assessed on the basis of household means. The maximum grant is €6,000. This may cover 100% of the cost of the works and is available to those with gross annual household incomes of up to €30,000.
In cases where grant aid is required for larger work and where the cost of the work is expected to be in excess of €6,000, applicants should apply for grant aid under the Housing Adaptation Grant for People with a Disability (see above).
How to apply
The Mobility Aids Housing Grant Scheme is administered by your local authority. All applications must include one itemised quotation from a contractor indicating the cost of the adaptation. The local authority will decide whether it is necessary to refer the application to an Occupational Therapist. This decision is based on the report of the authority’s Inspector, the applicant’s General Practitioner, and the long term needs of the applicant. For full details of the Mobility Aids Housing Grant Scheme, contact the Housing Department of your local authority.
Toilet Design and Layout
In Ireland, the Building Regulations 2000, Part M provide for the health, safety and welfare of people with disabilities in and around buildings. Technical Guidance Document, Part M, Section 2a addresses buildings other than dwellings to ensure that if sanitary conveniences are provided in a building, adequate provision shall be made for people with disabilities.
Technical Guidance Document, Part M, Section 2b concerns new dwellings setting out the minimum standards required to ensure that sanitary conveniences are available and accessible by people with disabilities, and therefore compliant with legislation for both ambulant disabled people and wheelchair users.
In addition to Part M, advice and information on bathroom design and layout is also available from the National Disability Authority in its 2012 publication, ‘Building for Everyone’ (see Useful Publications).
To make compliance with these building regulations easier, some companies actually supply equipment packages comprising of a toilet, washbasin and grab rails etc.
Accessible public toilets are often fitted with a special lock to give access to disabled people only. Information on how to get these keys is available from Assist Ireland.
In someone’s own home, invariably there is a need to make the most of existing facilities; and layout and modifications are to cater for the needs of usually just one disabled person (rather than having to be universally accessible). Although consideration of other people living in the home is important as they too will need to use the toilet facilities, the position of handrails, the height of the toilet seat etc can be determined by carrying out an individual assessment of the disabled person’s needs.
Safety
Safety is a major consideration. Basic advice includes:
- Give yourself enough time to avoid rushing
- Ensure lighting is adequate
- Avoid having a toilet pedestal mat as it can cause people to trip
- Don’t use fixtures to hold on to (eg a toilet roll holder or wash basin). Fit grab rails instead.
- Keep everything you need within reach
- Don’t lock the door if you may need assistance, or use a lock that can be opened from the outside with a coin or screwdriver.
- An outward opening door provides better access in an emergency, should for example, you fall behind the door.
It may be prudent to fit an alarm to make it easier to summon help in an emergency. It is also essential that any specialist equipment is checked routinely for signs of wear and tear, and that fittings are tightened.
Common difficulties and solutions
For people with walking difficulties
- Do not leave getting to the toilet to the last minute. Try to anticipate when you might need to go, for example when you wake up or after lunch.
- Consider having facilities downstairs where they are more easily accessible during the day.
- Make sure your route through to the toilet is kept clear of obstructions.
- If you use equipment to assist your walking, can it be used easily and safely in the confined space of a toilet? Consider fixing hand rails or grab rails.
For people who have difficulty with sitting down and standing up
- Check the height of your toilet is appropriate to your needs.
- Avoid using the bathroom furniture eg the sink, to help yourself move around the bathroom
- Use a raised toilet seat or frame.
- If you use walking equipment, avoid using the equipment to help you get up or down.
- Attach grab rails to adjacent walls.
- If you sit in a chair for long periods of time, raise your lower legs occasionally to keep your muscles in use.
For people who use a wheelchair
- Consider how you can maintain your independence, for example, by installing equipment to help with transfers on and off the toilet; by positioning grab rails in strategic places; by using a sanichair.
- Does your wheelchair have features to help with transfers, for example, removable or flip up armrests and footrests?
- Is the height of your toilet the same as the seat height of your wheelchair?
For people restricted in hand/arm function
- Choose clothing that can be handled/adjusted easily, for example, Velcro fastenings.
- Use a bottom wiper or bidet to clean yourself.
- Consider using a toilet seat lift
- Look at alternative flush controls.
For people with poor sitting balance
- Check the height of your toilet – make sure your feet are flat on the floor when seated.
- Look at equipment that provides additional support, eg toilet backrests, gated grab rail systems and over toilet chairs.
For people who have urgency
- Consult your doctor – urgency can be caused by a medical problem such as a urinary tract infection.
- Try to anticipate when you may need to go, for example when you wake up or after lunch.
- Consider having facilities downstairs where they are more easily accessible during the day.
- Choose clothing that can be handled/adjusted more easily.
- Seek advice from a continence nurse.
For people who have frequency
- Consult your doctor – there may be a medical reason such as an infection that is causing your frequency or the medication you are taking.
- You may have developed a habit of frequently emptying your bladder. Retraining the bladder and tightening your pelvic floor muscles may help. Seek advice from a continence nurse.
- Consider having facilities downstairs where they can be more easily accessed during the day.
Equipment to help with getting up from and down to a toilet
Difficulty getting up and down off the toilet is often a problem associated with arthritis and stiffness in the joints. It can be made easier by:
Providing grab rails
Rails can be used to push up from or to pull yourself up with. They are generally fixed to the wall alongside the toilet, but if this is not possible structurally, then a rail that extends from the wall behind the toilet could be used.
As a general rule, if a rail is required to push up from, it should be positioned mid way between the back wall and the front of the toilet bowl at approximately waist level and extending forwards away from the user. If the user has weak or stiff wrists, they may prefer to rest their forearm along the rail and push up in this way. If this is the case, a slight deviation of the rail from horizontal may support the forearm better.
If a rail is used to pull up with they are generally fitted level with the front toilet pan, at approximately waist height and at an angle running forwards and upwards away from the user. Sometimes, a horizontal rail followed by a vertical rail (or a right-angled rail) might be preferred to give two handhold levels.
You must check the distance between the toilet pan and the wall. If the user has to lean sideways to reach the rail, it will not provide sufficient support and a fold-down rail fitted to the back wall or a toilet surround frame may be more appropriate.
Toilet surround frames are metal frames that are often height adjustable to suit the user’s requirements. They surround the toilet and provide a handhold either side of the user to push up from. They can be floor-fixed to provide more stability.
Drop-down toilet rails provide support on a second side, if not wall is present for fixed rails. They also allow the rail to be lifted out of the way when not needed, or if a carer needs to move closer to the individual on the toilet.
Providing a higher seating position
Ideally, when seated, your hips, knees and ankles should be at 90 degrees or a right angle, with feet flat on the floor. Standard height toilets are 15-16 inches (38cm-40cm) high. This may not be high enough for a taller person.
You can raise the sitting position by:
- Permanently raising the height of the toilet by inserting a plinth between the floor and the toilet pedestal.
- Using a raised toilet seat.
- Using a raised toilet seat frame.
- Installing a high seat toilet.
- Installing a wall-mounted toilet at a suitable height.
Toilet plinths
These are usually made of fibreglass or clay and can be shaped and coloured to match your existing toilet pedestal.
Raised toilet seats
A raised toilet seat usually replaces the existing toilet seat and provides a raise of 5cm, 10cm or 15cm depending on the model. The seat either clamps onto the toilet bowl or is fitted using the standard toilet seat fixings. Less flexion is required in the hips and knees if a higher seat is used, making it easier to sit down and stand up. A seat that is too high however, can leave a person feeling unsupported. Ideally, feet should be flat on the floor to give stability. Raised toilet seats are available with armrests for extra support when seated and when standing up from the toilet.
Raised toilet seat frame
These are toilet seats attached to a metal frame that surrounds the toilet and can usually be adjusted in height to set the seat at the height required for individual use. The frames can either be freestanding or fixed to the floor. They have the added advantage that they provide a handhold on either side, but they are more obtrusive.
High seat toilets
These provide a higher sitting position and may assist people who have difficulty bending at the hips. However they also present issues for people who use a wheelchair since the difference in transfer height may be too great.
Adjustable height toilets
These are replacement toilets that are usually mounted on wall fixings that allow the toilet to be adjusted up and down, powered via a low voltage electrical supply or water pressure.
A toilet seat lift
If you are unable to stand up even with the use of rails or a raised toilet seat, consider installing a powered self-lift seat. This helps you to stand by rising and tilting forwards, much like a riser armchair. Some have integral handrails.
Equipment to improve stability
If the user has poor balance then it is essential that they are able to place their feet flat on the floor to give themselves a solid base. The style of seat can also help.
- A dish-shaped seat is shaped to accommodate the buttocks and tapers down towards the aperture.
- A contoured seat is shaped to support the buttocks but is also raised slightly at the centre front to help keep the legs apart and to better support the thighs.
- Padded seats can provide a degree of compression under the heavier areas such as the buttocks, providing support in a similar way to a dish-shaped seat.
Back supports
A standard toilet does not provide any back support. Therefore if the user leans backwards, they will be more inclined to slip forwards on the seat. A simple back support pad fitted onto a horizontal rail on the wall behind the toilet, positioned at waist level can help to maintain an upright position.
Backrests
A full-length backrest fitted with a harness can provide support to someone with insufficient muscle tone to maintain an upright position independently.
Rail systems
Rails either side of the user, provided by a toilet surround frame or by wall-fixed rails will provide handholds to assist the user in stabilising their trunk. If rails are required at both sides, a fold-down rail fixed to the back wall can be swung clear to provide better access when transferring. Some systems have the addition of front rails (gated rails) that fold down in front of the user once they are positioned on the toilet.
Over-toilet chairs/sanichairs
These chairs are either freestanding or mobile and are placed over the toilet. They have two advantages: they provide better sitting support; and they avoid the need to make awkward transfers within the confined space of a toilet compartment/bathroom.
Multi-function chairs, often called sanichairs can be used over the toilet, in the shower and as a commode. These chairs are mobile and can be attendant or self-propelled.
Toilet chairs can support the weight of a heavier user where a ceramic toilet may not. Ensure that any equipment used is designed for your weight.
Independent wheelchair transfers on/off the toilet
Transferring on and off the toilet from a wheelchair is made easier if the seat heights of the wheelchair and the toilet are comparable. Different techniques may be employed:
- Front transfer – the user positions their wheelchair facing the toilet and slides forwards to straddle the toilet bowl, facing the cistern.
- Front-pivot transfer – the user faces the toilet with their feet on the floor. They then pull themselves up and pivot 180 degrees to sit on the toilet in the conventional way.
- Side transfer – the user positions their wheelchair alongside the toilet, removes the armrest and slides themselves across.
The strategic placing of grab rails can help in these transfers to provide a secure handhold to pull up or across with. In addition, the following may help:
Transfer boards
These are smooth surfaced solid boards, tapered at either end to assist sideways transfers by bridging the gap between the wheelchair seat and the toilet seat. Some are specifically shaped at one end to allow for the toilet aperture.
Turning discs
These comprise two circular discs that rotate one against another. They can be used to place the feet on when doing pivoting transfers.
If further assistance and/or support is needed, then it may be necessary to use a mobile over toilet chair or an overhead hoist.
Mobile and self-propelled over-toilet chair
Self–propelled over toilet chairs enable the wheelchair user to transfer themselves into the chair from, for example, the bed, propel themselves into the bathroom/toilet and manoeuvre themselves over the toilet. Features such as removable or fold-up armrests, retractable or flip-up footrests can make transferring on and off the chair easier.
Multi-function chairs/sanichairs can also be used and have the advantage that they can be used as a commode and shower chair, making for a less cluttered environment.
Overhead hoist
These hoists run on overhead tracking, usually attached to the ceiling, but sometimes on a freestanding gantry. They are electrically powered so can be operated by the hoist user to lift, lower and track sideways. Used with a divided leg sling that can be put into place whilst seated in a wheelchair, an overhead hoist can be used without the need for assistance from a carer.
Ceiling tracking can be straight, jointed, curved, and run from room-to-room as required. However, structural alterations such as strengthening the ceiling, or adapting the top of the door frame may need to be made.
Equipment to help with transfers
Small transfer equipment such as the sliding boards and turning discs can be used to help a carer assist with transfers. However, it is imperative that the carers position themselves correctly when assisting with transfers to minimise back strain. If your carer has never received any advice on helping a person to transfer, speak to your public health nurse or occupational therapist.
Handling or transfer belts
Reach and grip may be improved by using a handling belt. A handling belt is worn by the person being transferred and is basically a belt with handholds. It allows the carer to have a firm grip, without holding your clothing or body. Manual lifting should be avoided, so if the carer finds that he/she is supporting the person’s body weight at any time throughout the manoeuvre then an alternative solution to transferring should be sought.
Attendant propelled over-toilet chairs/sanichairs
These are mobile chairs that can be wheeled by the carer and positioned over the toilet. The user can be transferred into the chair in the bedroom directly from bed where there is more space and scope to transfer.
Turners
A turner or patient turner, often called an Etac turner after one manufacturer, enables assisted standing transfers. It would only be useful if you are able to pull yourself up to standing and then maintain your own weight. The carer also needs to be relatively fit and able to manoeuvre the equipment.
Mobile hoists
Mobile hoists eliminate the need for lifting. They basically comprise a wheeled chassis; a boom that is raised to lift the user up and lowered to position them on the toilet. In the domestic environment however, there may be insufficient space to use a hoist for direct toilet transfers. It may be necessary to use the hoist in the bedroom where space is less restricted, and transfer onto a mobile over-toilet chair.
There are three styles of mobile hoist:
Sling hoists have a spreader bar to which slings are attached. For toileting purposes, it is essential that the user’s bottom is kept clear of the slings and therefore slings with an aperture or a toileting (divided leg) sling should be used.
Standing or toileting hoists have a specially designed sling arrangement that enables the user to be lifted in a semi-standing position. To use this style of hoist safely, the person being lifted must place their feet on a footboard, be able to partially weight bear through their legs and have reasonable muscle tone around their shoulder girdle as the lifting sling is positioned halfway down their back, under their arms. The advantage of these hoists is that they make it easy to adjust trousers, skirts and underwear.
Seat hoists have an aperture seat instead of slings, so the user is transferred in a sitting position. Some may have the option of a commode pan. The hoist lifting mechanism is operated manually using a winding handle or hydraulic pump; or it is battery powered.
Overhead hoists attach to overhead tracking and can be used for independent transfers (see above), but may also be used for assisted transfers if a mobile hoist is not practical.
Equipment to help with personal cleaning
Wherever possible, personal cleansing should be an independent task. Positioning of the toilet roll holder where it can be reached without over-stretching is essential. For people who have the use of one hand only, a dispenser that takes packs of separate leaf paper, or a toilet roll lock to allow sheets to be torn off will help.
Bottom wipers
These are long-handled devices designed to assist people with limited reach.
Portable bidet bowls
These are moulded plastic bowls that fit over the toilet seat. They have a dish at the front to hold soap and a plughole or pouring lip at the back to empty the used water into the toilet pan.
Add-on bidet
Add-on bidets are used with an existing toilet bowl. They are electrically powered and provide a jet of warm water to clean and warm air to dry the area afterwards.
Combined WC/bidets
These replace the existing toilet and combine the features of a standard toilet with that of an automatic bidet providing a warm water douche and a stream of warm air for drying.
It may be necessary to ensure hand-washing facilities can be accessed from the toilet to enable a person who has difficulty standing to rinse their hands after using the toilet.
Improving comfort
Someone who is frail or very thin, or who needs to sit on the toilet for a while may need a more comfortable seat to sit on. Padded toilet seats that replace the existing seat, either standard height or as a raised toilet seat are available.
Another option is to use a toilet seat cushion. These might be air inflated, or made of foam or polyester fibre covered in a wipe-clean material. Similar cushions are available for a commode seat. These cushions are designed primarily for comfort rather than pressure relief. If you are at risk of pressure ulcers, talk to your public health nurse or occupational therapist about toilet seats for pressure relief.
Flush controls
Someone who has weakness or stiffness in their wrists or hands may find a lever flush difficult to manage. To make flushing the toilet easier, a lever that has a wider, flatter area to accommodate the palm of the hand can be fitted. High-level cisterns have a pull chain. Replacing the handle with a large ring will make grasping the handle easier.
If a hand-operated flush is too difficult to use, alternative controls can be operated by touch sensitive or foot-operated switches.
Providing alternative facilities
Sometimes, it is not possible to access existing facilities. For example, managing stairs might be too difficult or unsafe, or the circulation space may be too tight. If managing stairs is the problem, see the Assist Ireland Information Sheet Equipment to get up and down stairs. Circulation space within a room can sometimes be improved by changing an inward opening door to an outward opening one.
Portable receptacles
Bedpans
Bedpans are more commonly used by people who are being nursed in bed and who cannot, or should not for medical reasons, be moved out of bed. Bedpans can be fairly easily ordered through local pharmacies. Lifting the buttocks free of the mattress can sometimes be a problem and lifting blocks or an overhead lift pole can be of help, see the Assist Ireland Information Sheet Beds and bed accessories.
Urinals
A portable urinal is a simply way of providing a person with mobility difficulties a means to empty their bladder. Styles are available for both men and women. For women in particular, it is necessary to shuffle forwards on their seat so that the head of the urinal can be held close to the body. Clothing styles may influence the ease with which a portable urinal can be used. Mens’ trousers with a low opening fly can help when using a bottle; loose fitting knickers such as Cami-knickers that can be pushed to one side may help women.
Some women may find it easier to use a device (such as a She-wee) which allows them to urinate whilst standing or sitting forward in a chair, without removing any clothes, combining this with a urinal for collection.
Commodes
One of the easiest ways of providing alternative facilities is to use a commode. A huge range of different styles is available. Features that you may need to consider are:
- Wood or metal frame
- Fixed or adjustable height
- Freestanding or mobile
- Standard or chemical
- Armrest style
- Folding
- Style of seat
Wooden commodes tend to be fixed height and may fit in better within the home environment, looking more like a standard chair or disguised as an armchair. Metal commodes can be fixed or adjustable in height, static or mobile and tend to be easier to wipe down.
Mobile commodes make it easier to position the commode close to the user for transfers. They can also be used as a transfer chair and some can be positioned over the toilet with the commode pan removed. The user and carer must ensure that the brakes are used when transferring on and off a wheeled commode.
A multi-purpose commode is a simple, lightweight meal frame with a plastic seat and armrests. There is no back support. It can be used as a commode with a plastic pan, as a toilet frame over a toilet to assist with transfers, or as a shower stool.
Folding commodes also tend to be more lightweight. This can be useful for moving and positioning the commode, but may be less suitable for a heavier person who needs the security of a sturdier commode frame for transfers.
Commodes are used with a plastic commode pan that must be emptied at regular intervals. The commode pan is removed either by lifting it out from the top or by sliding it out from underneath. An overfull pan can be difficult to remove without spillage. If the commode is to be positioned against a wall it would be wise to choose one that does not have a pan that slides out from the back of the seat.
If there is nobody to carry out the emptying task, then a chemical commode might provide a solution because it needs emptying less frequently. The commode pan is deeper and contains liquid disinfectant to help neutralise odours and kill bacteria. The larger capacity will mean that the pan is heavier and more difficult to manage.
Seat height and style is important. The user should ideally sit with their feet flat on the floor so that they are stable. A larger person might be more comfortable sitting on a seat that is square with a central aperture rather than a toilet-style seat. If you are a heavier person, check the manufacturer’s details to ensure that the weight limit of the commode is suitable.
Some commodes have a padded seat for greater comfort. This may be beneficial to someone who needs to be seated on the commode for a longer time. If sitting balance is poor, a more specialised commode that has a higher backrest and positioning supports may be needed.
Some commodes can have armrests that can be removed, dropped down or flipped up to make sideways transfer possible.
Alternative toilets
Portable toilets
This style of toilet is commonly seen in boats and caravans. They have a reservoir of water to flush the toilet, and a lower chamber containing neutralising chemicals into which the waste is directed when flushed. They may be too low to sit down on if used on their own, but they can be supplied with a frame that includes a platform to place the toilet on and support rails either side. Their advantage over chemical commodes is that the waste is shut off within the lower compartment. The waste compartment needs to be emptied at regular intervals.
Macerating toilets
Macerating toilets are useful in situations where permanent plumbed-in facilities are required but due to space restrictions or the distance of the stack pipe, a conventional toilet cannot be installed. These toilets incorporate a macerator that pulps the solid waste to make it small enough to pass through small bore piping that will eventually link up with the main stack.
Showerloos or shower/toilet cubicles
These are shower cubicles that have a toilet included within the unit and provide a good way of providing both washing and toileting facilities if space is limited. The person may sit on the toilet to shower or, as it has a ramped or level access, use an over toilet chair/sanichair for the two functions. Some units also include a washbasin.
Showerloos are useful for people who cannot access the bathroom as the toilet can function using a macerating unit so that the cubicle can be sited virtually anywhere in the home.
Out and about
Anxiety about access to the toilet and managing activities associated with toileting when out and about can spoil a person’s enjoyment. With the requirements of the Equal Status Act, 2000-2004 it should be easier to access to public facilities, including better toilet facilities for people with mobility disabilities.
Remember drinking is important to maintain fluid balance in the body and to regulate body temperature. It can be dangerous to avoid drinking purely because of anxieties about managing the toilet.
Planning before a journey or trip out can help, for example:
- Use the toilet at home before setting off on a journey.
- Think about the journey time and whether you will need to plan stops.
- Wear clothing that is easier to manage.
- Phone ahead to find out about facilities.
- Source a key for access to accessible public toilets
- Carry a portable urinal with you for emergencies.
Useful publications
- Building for Everyone (2012)
Publication which examines buildings and the external environment to achieve equality and inclusiveness for everyone. Available from:
National Disability Authority
25 Clyde Road
Dublin 4
D04 E409
Tel: 01-608 0400
Email: nda@nda.ie
Website: www.nda.ie
Useful addresses
- Association of Occupational Therapists of Ireland (AOTI)
Office 1 & 2
1st Floor
Haymarket House
Smithfield
Dublin 7
Tel: 01-874 8136
Email: info@aoti.ie
Website: www.aoti.ie - Irish Society of Chartered Physiotherapists (ISCP)
Royal College of Surgeons
St Stephen’s Green
Dublin 2
D02 H903
Tel: 01-402 2148
Email: info@iscp.ie
Website: www.iscp.ie - Revenue Commissioners
FREEPOST
Central Repayments Office
M: TEK II Building
Armagh Road
Monaghan
LoCall: 1890 60 60 61
Email: cromon@revenue.ie
Website: www.revenue.ie - National Disability Authority (NDA)
25 Clyde Road
Dublin 4
D04 E409
Tel: 01-608 0400
Email: nda@nda.ie
Web: www.nda.ie - Continence Promotion Unit
Dr Steeven’s Hospital
Dublin
Tel: 01-635 2775 - Disabled Living Foundation (DLF)(UK charity providing advice and information and a comprehensive up-to-date database of disability equipment available in the UK)
England
Tel: 0044 207 289 6111
Email: info@dlf.org.uk
Website: www.dlf.org.uk - Research Institute for Disabled Consumers (RIDC) (independent research body in UK which produces guides for older and disabled consumers based on professional research – formerly known as RICA)
England
Tel: 0044 207 427 2460
Email: info@ridc.org.uk
Website: www.ridc.org.uk
