Adapting your home: the bathroom

If you are finding it difficult moving around and/or using your bathroom, you may need to consider:

• changing your home environment
• adapting or building a bathroom which will meet your needs
• installing equipment that will help you and a carer, if you require one.

There are a number of conditions that can impact on your ability to access or use your bathroom. For example, if you have a problem that affects your hip joints, you may not be able to lift your legs over the bath's side. Or if you have problems with your upper body, you may find it difficult to wipe yourself after using the toilet. The average person uses the toilet six-seven times a day (Bladder and Bowel.Org 2018), so access to a bathroom and toilet is an important part of daily life.

Typical aspects of the bathroom that can make it difficult or unsafe to access and use can include one or more of the following.

• Getting in and out of the bath can become difficult or impossible, especially when you are wet and the surfaces are slippery. There is a higher risk of injury if you fall in the bathroom
• You may not be able to lift your legs over the bath to use simple bathing equipment
• You may not be able to see and/or operate traditional taps if you have weak grip or poor sight
• You could experience difficulty in getting up from a low toilet if you have stiff knees or a painful back
• You may have difficulty in getting to the toilet in time if you have problems with continence
• You may have difficulty in getting into your bathroom if you are using a wheelchair or a walking frame
• There could be a lack of sufficient space or a suitable layout that could enable a carer to provide support
• The location of the toilet can make it difficult to get to - i.e. if the toilet is upstairs you may hold off for as long as possible or struggle to get to the bathroom due to poor mobility.

If you are unsure about the best way to maintain your safety and independence whilst bathing, you are advised to seek a formal assessment of your needs from your local authority social services department or from a private or independent occupational therapist.

If you are planning a new purpose-built accessible bathroom, be aware of the requirements of building regulations (HM Government 2016) and design standards Building Regulations Doc M AD (British Standards Institution 2018).

Installing a new bathroom can potentially be an intrusive and stressful experience, but if well planned out could provide you with a long-lasting solution.

Before you consider a major adaptation, such as installing a level access shower, you may find that smaller pieces of equipment will enable you to continue using a bath. Examples include:

• Assisted baths/baths with integral lifts
• Fixing support rails
• Perching stools, shower seats, stalls and benches
• Bath and shower boards
• Bath stools
• Swivel bath seats
• Bath lifts
• Non slip bath mats
• Lever taps
• Lighting
• Installing a shower over the bath

You need to consider your current and future level of mobility when designing a bathroom adaptation.

• If the bathroom is located upstairs, will you be able to continue to access this in the long-term? Can your home be adapted in the future - for example with additional rails, a stairlift or through floor lift?
• Do you currently use a walking aid? Will this change in the future?
• How much space will you require to use you walking aid, and move around with it, inside the bathroom? (E.g. a walking stick will need less space than a walking frame.)
• Is your bathroom door sufficiently wide enough to allow you access with your walking aid?
• Will you require the help of a carer to wash or dry yourself?

A toilet located on the ground floor can be advantageous, as this can limit the number of stair climbs you have to undertake in a day. If your bedroom is located upstairs and the bathroom and toilet are downstairs, you will need to consider how you will get up and down the stairs at night if you should need to use the bathroom. If you have difficulty in accessing the bath or bathroom, you may find you are struggling with getting up and down stairs. 

It is a good idea to invest in some appropriate lighting.

If you are a wheelchair user, or may be in the future, the width of the door into the bathroom is an important factor to accessing the bathroom. The recommended minimum width of an internal door is 800mm (31.5 inches), but 825mm (32.5 inches) is ideal (Doc AD M Vol 1 2016). When in the bathroom, you may need space for a turning circle or the space to carry out a three-point turn. When adapting the bathroom for a wheelchair user, it is important to consider the location of the bath and basin on a pedestal, as they can reduce the amount of space in which to turn. Also remember that a child’s wheelchair will get larger as they grow, so allowance for an ‘adult-size’ wheelchair should be factored in when planning a bathroom adaptation.

Although some wheelchair users can move from the chair into a bath, its presence in a bathroom can reduce the amount of space. To maximise the turning circle it would be worth considering a ‘wet room’ shower.

If your toilet is in a room adjacent to the bathroom, it may be an advantage to remove the wall when redesigning the bathroom - this further increases the amount of space in the bathroom and allows for a more favourable layout.

It is important to ensure that adequate heating is supplied to the bathroom, as wet skin can reduce body temperature very quickly. Heat can also potentially be lost through 

outside walls and window(s). If you are fitting additional radiators, your builder or plumber will need to ensure that your boiler has the capacity to heat them. Thermostats fitted to individual radiators allow for room temperatures to be adjusted during use.

Alternative sources of heat for your bathroom include:

• Under floor heating. This is usually controlled by wall mounted panels. This has the advantage of reducing the space taken up by conventional radiators and will heat the entire room evenly. It can also be used to assist in keeping the floor dry, thereby reducing the risk of falls.
• Electric heated towel rails are not connected to the hot water system and so they can be used independently to provide additional heat when the central heating system is not in use. They can also be used to dry out and warm towels. The rails can be placed on the wall rather than be floor mounted. N.B. care should be taken when fitting - these should not be positioned in a way that they could enable them to be used a grab rail. They are not designed to offer support and they have the potential to cause burns if gripped.
• Mains heated towel rails are connected to the central heating system in the same way a radiator is.
• A surface temperature radiator does not usually exceed 43 degrees Celsius and therefore reduces the risk of scalding. They are particularly useful for households with children or people with dementia or other cognitive issues.
• A wall mounted fan heater can provide a small amount of heat in the summer months when the full central heating system is not is use.

A high number of people experience falls in the bathroom (Stevens, Mahoney and Ehrenreisch, 2014) so it is important to ensure that should you get into difficulty, you have a way of summoning help. Portable alarms (usually worn around the neck or on the wrist) are very often not waterproof and so it's advisable to consider either placing the pendant nearby when bathing or having an alternative method of raising an alarm. 

If you have sensory problems which affect your ability to detect the temperature of the water in the bath, or need to ensure the water temperature is correct for babies and young children, guidance on how to prevent scalding with the use of equipment can be found under ‘Guide to choosing a product’ in the bathing and toileting page .

The choice of accessories in the bathroom is important for people with dementia or sight loss. The RNIB (2018) recommend that wall tiles should be matt and a different colour to the floor and advise that grab rails and washbasins are a contrasting colour to the wall. They also recommend that contrasting colours are used for the toilet seat. You should also consider fitting anti-slip flooring which is matt in colour to reduce glare. The Alzheimer’s Society (2015) suggest that switches and controls are familiar and easy to use, a flood prevention plug is fitted to the bath and basin and in addition door locks should be able to be easily opened in the case of an emergency. More information can be found in DLF's fact sheet, Living with dementia: showering and bathing.

Appropriate lighting within a bathroom could help to keep you safe and the lighting level required will differ from person to person. The Pocklington Trust (2018) have produced guidance on lighting for people with sight loss.

If you only have one bathroom in your property, you need to consider how you will access toileting and bathing facilities whilst the work is being carried out. Any major adaptation will create a level of noise, dust and disruption and it is therefore necessary to plan ahead before any of the work undertaken.

There may be several reasons why you may wish to have a bath inside a bathroom adaptation.

• You may prefer to have a bath rather than a shower
• You may have complex needs which mean that using a shower with equipment is not possible – even with level access
• You may be sharing the bathroom with other people who would prefer to keep a bath
• The bathroom may be used by multiple people who have different needs.

Some people prefer to keep a bath as they find the warm water helps with pain relief. However, accessing a bath in the future, even with equipment could become difficult. When thinking about fitting a bath, it is helpful to consider the following:

• Do you have a condition which makes bathing unsafe, for example epilepsy?
• Where is the bath located in your property and how you will access it?
• Can you maintain your balance when getting into the bath?
• How is the strength in your upper body? For example being able to take some weight though your arms to push up into a standing position, or using a firm grip to turn taps on and off.
• Do you have a condition that is likely to worsen over time affecting your ability to access the bath or bathroom in the future (even with the use of equipment)?
• Do you need to use emollients or bathe in certain liquids? This can cause slipping or difficulties with the fitting and use of some aids.

If you are concerned about any of these issues, you may wish to consider installing a shower tray (see section on showers below).

If you are re-designing a bathroom or perhaps adding an en-suite to a property, it is important to consider the layout of the bathroom to ensure you can easily access the bath. A bath placed next to a solid wall for example would mean any grab rails fixed to the walls would be more secure. Also, be aware of sloped or low ceilings, especially if a bathroom is on the first floor, as this can restrict head room and make getting in and out of a bath difficult. If you are considering a shower screen on the bath, you need to be aware that this could prevent some equipment being fitted to the top of the bath. Also be mindful that a wash hand basin placed next to a bath could restrict the shower screen from opening, meaning you would have less room to exit the bath.

If you struggle to access the bath because of poor balance or have difficulty with stepping over the bath side, you may wish to consider using equipment that can assist you with this. More information can be found in DLF's fact sheet, Choosing equipment for bathing.

If you are replacing a bath, or fitting one to use with bathing aids and wish to have the flexibility to replace any equipment as your needs change, then you may want to 

consider a standard bath.

Unusually shaped baths, for example a corner, sunken, or ‘P’ shaped bath, can be difficult to access. The shape of the bath can also make it difficult to fit bathing aids. It is advisable to check that there are no ripples or ridges at the bottom of the bath (designed to aid with gripping with your feet) as this can prevent some equipment with suckers being fitted safely. In addition, the rim of the bath should be parallel and at least 37mm or 1.5 inches wide so equipment such as bath boards can be fitted safely.

Also the type of taps used, and where they will be fitted to the bath, should be considered. Depending on your needs, it may be easier to have the taps placed in the middle, on the far side of the bath, so they can be accessed more easily, however this position may restrict some bath equipment. If you have a weak grip and find taps difficult to turn, you may wish to choose to have lever taps fitted, which can be lifted or turned more easily.

N.B taps should never be used as aids to get in and out of the bath - you should use a properly positioned and fitted grab rail instead

If you have more complex needs, or would prefer to keep using a bath but not necessarily with the addition of separate bathing aids, then a specialist bath could offer a solution.

Specialist baths are typically designed to either allow the user to step or walk-in to the bath or access by using an integrated seat. Some models have fold down sides to form a changing surface, or an integrated changing stretcher.

Many people feel that a walk-in bath will meet their needs. However before choosing a specialist bath, it is worth considering the following:

• You will need to step up and down to access and exit the bath, some may find this difficult
• Integral seats are either static or swivel types, generally made from moulded plastic. Some may not adjust to individual needs
• Some baths have small door cutaways, which can be helpful if there's a difficulty in lifting the legs over the side of the bath
• If you have difficulty maintaining your body temperature, bear in mind you will need to sit in the bath while it fills and empties
• A bath with high sides can make if difficult for a carer to give assistance to someone who may need help with washing. An adjustable height bath may help.
• Height adjustable options may be suitable for those who are able to get into a bath from a standing position or for where there are multiple people using the bath with a varying levels of mobility
• These types of baths are often used in combination with a ceiling track hoists or other pieces of equipment to assist a carer.

Further information and advice on specialist baths can be found in DLF's factsheet, Choosing equipment for bathing

A specialist bath can be a costly adaptation and it is recommended that you obtain an assessment by an occupational therapist to discuss your needs and requirements. An assessment can be requested through your local authority. Alternatively, if you wish to obtain private assessment or advice

If you have a condition that affects your ability to access the bath, you may wish to consider installing a shower.

• An electric shower or mixer shower can be fitted over a bath.
• Shower trays can be step in or offer low/ramped access. They can be fitted to a concrete or wooden floor and are usually straightforward to install.
• Wet room trays offer close to level access and allow for maximum space in the bathroom.

If you are able to access the bath and want to keep disruption to your bathroom at a minimum, you may wish to install an over-bath shower. Typically, these can be fairly easy to install, but it is worth considering if this is a viable long-term option.

Showers fitted over the bath are generally either electric units or mixer taps.

An electric shower unit works off the mains pressure cold water. Water passes over an element in the shower unit that heats the water.

Mixer showers are used with a combi-boiler or pressurised hot water system. The flow and temperature are usually controlled separately through the taps; lever taps are available if help with grip is required.

Either type of shower can be fitted over a bath, in a shower cubicle or as part of a level access shower.

When deciding on where to position a shower unit, it is important to consider who will be using it, and how it will be used. If you sit down to shower for example, you may wish to have the controls set at an accessible height. If the bath is rectangular in shape, the shower is traditionally located above the taps (this is mostly due to the location of the hot and cold water feeds). Placing the shower unit on the long wall may make it more accessible to the user or carer, but it can involve a more complex installation. If you require assistance with showering, the hose attached to the shower head should be long enough to be taken off the slider bar and used by a carer.

When choosing a unit, ensure that you are able to switch it on and off and adjust the heat settings as necessary. Larger buttons and/or a grip dial may aid ease of use if a person's hand and wrist function is reduced. Some electric shower units have been approved by the RNIB as they have features that can make them easier to operate. For example, an audible ‘click’ will sound when the dial is turned, or contrasting colours, or matt or glossy finishes to the shower units can help visually impaired users to see the controls.

Check for the BEAB Approved Mark. This electrical safety mark that demonstrates that independent specialists have evaluated the electrical safety of a product to the highest European and International standards.

If you decide to fit a shower over the bath, consider the type of equipment you need now, or may need in the future, that enables you to get into the bath and access the shower safely. Do you need assistance from a carer to get into the bath and how long you will be able to undertake this task? If you are concerned about your ability to access an over bath shower over time, a shower tray may be a more appropriate solution. An occupational therapist will be able to assess your needs and advise further.

You may decide to remove the bath altogether and replace it with a shower tray. Or your bathroom may be large enough to accommodate a shower tray and a bath. Depending on your needs and preferences, there are a number of shower trays you can choose from. Further information is available in DLF's fact sheet, Choosing equipment for showering.

Factors to consider when choosing a shower tray

• The size of the shower tray may depend on the space in the bathroom. The minimum size is usually 900mm by 900mm, larger trays can be 1500mm by 1200mm or longer. It is important to consider what equipment will be required in a shower area. For example, a person using a self-propelled shower chair will take up much more space than an ambulant (walking) person using a drop-down shower stool.
• A ‘step-in’ shower tray (also known as ‘shower cubicle’) is usually square in shape, though larger rectangular sizes are available. Some step-in shower trays are low level, which means the height of the tray is as low as 32mm (approx. 1.25 inches). Other shower trays can have a step of 150mm (6 inches) or more, which may make access to the shower cubicle more difficult for those with mobility problems.
• The type of shower tray and the amount of work involved will be dictated by the plumbing and drainage of the property. Many pre-formed shower trays are only suitable for gravity waste drains. In some circumstances a pump may be required to draw the water away down the plug holes if gravity waste cannot be achieved. Once installed the pump may take up more room and create more noise when waste water is being pumped away. You would need to speak with your installer about the type of shower tray that can be fitted in your bathroom.
• If you are replacing the bath with a shower tray, it may be possible to choose a size that fits in the space where the existing bath is. This has the advantage of being able to use the drainage and plumbing that is already installed for the bath (the installer will need to assess what the requirements are for your particular house).
• If the shower tray is hidden, it should always be covered with a safety-type flooring to reduce the risk of slipping. It is beneficial to cover the whole of the bathroom floor in this type of flooring and not just the shower area.

When planning a bathroom adaptation, it is important to take into consideration the need for and location of a shower screen. A shower screen is designed to keep the water within the area of the shower tray and to prevent water splashes from hitting the floor. There are a number of different shower screens available.

Fixed screens can be half or full height.

A half height screen allows a carer to reach over to help with washing. These types of screens can also be fitted with a shower pole and curtain and used for times when assistance isn't required.

Full height fixed screens come in a range of configurations; for example they can be installed in wet rooms or level access showers or step-in shower trays. Some full height screens include a door, which helps to seal the shower area. The majority of full height screens are made of toughened glass.

Doors can also be bi- or tri-fold; the decision for one or the other will be based upon size and tray compatibility.

When deciding which door or screen to fit, consider the following:

• Ensure the opening is wide enough for someone to walk through safely
• If using a fixed door, ensure there is enough space to get in and out of the shower when it is opened
• An outward opening door will not restrict movement inside the tray like an inward opening door. However it may drip water onto the floor when opened
• Ensure the door handle is easily identifiable and easy to grip.

These can be purchased separately to the shower tray.

They can suit people who require assistance from a carer when using the shower - they can be placed where they are needed and can prevent the carer from getting wet.

The majority of half-height screens are made of polycarbonate, which is designed to be tough and light. They can usually be folded down for transportation/storage. Depending on the needs of the carer and/or if space is restricted, a portable shower screen may be a more appropriate choice than a fixed screen.

You may opt to have a shower curtain fitted in addition to half height carer screens, or you may prefer to have a shower curtain instead of full height screens. Whichever the case, you will need to have a rail that the shower curtain will fit to.

The track or rail for the curtain can be purchased in a range of different lengths a shapes:

• L shaped track – for where the shower enclosure is in a corner of a bathroom
• U shaped track – for where a shower curtain is required on three sides of the shower area
• Flexible track – a track which can be trimmed to size and bent to the required shape
• T shaped window spanning track – for where a window encroaches onto a shower area
• Swingaway tracks - can be used with a ceiling track hoist which covers the shower area.

Shower curtains can be readily found on the high street or online, however there are different types and widths, so it is important to consider the size of the shower area and length of track required before ordering a curtain.

• The width of a shower curtain can range from 900mm to 2500mm (35.5 inches to 98.5 inches)
• A weighted shower curtain is designed to lie more easily on the floor and prevent water escaping underneath. To create an effective barrier it should finish 5mm above the floor level, but not drag on the floor. It will also prevent any movement of the curtain which can occur when a shower is running
• ‘Standard’ and ‘heavy duty’ shower curtains are made of woven polyester, the ‘heavy duty’ version is a thicker curtain.

If you require a very high level of support and are not be able to use a shower chair, you may benefit from a shower bench or shower trolley. Further information on shower trolleys, cradles and benches can be found in DLF's factsheet, Choosing equipment for showering.

Shower trolleys enable a person to be wheeled in and out of the shower area. These are often used in care homes or other residential settings where there is sufficient space to push a shower trolley through doorways and hallways; if there isn't the space within the home to use a trolley, a wall mounted or foldable shower bench could be fitted within the shower area.

Shower benches can be used to wash, dry and dress the user. The user can also be assisted off the bench by an appropriate method (e.g. hoisting) if required. More on the different types of hoists available can be found in DLF's fact sheet, Choosing a hoist and slings for lifting people.

Depending on the model, shower stretchers and benches can be wall-mounted, height adjustable and/or folded away after use. Shower stretchers and benches can also be installed in a ‘dry’ area and just used for changing or personal care.

Before installing a shower bench, careful consideration needs to be given to the layout of the shower area, the strength of the wall (if wall-mounted) the type and size of the shower bench required and how the user will access this (e.g. by a ceiling track hoist). There is a huge range available and they can be a costly item. Therefore, it is recommended that you seek advice from an occupational therapist before purchasing one for your bathroom adaptation.

There are several factors to consider when choosing a wash basin for your bathroom adaptation.

General considerations

• Who will be using the wash basin? How will they be using it (e.g. washing hands, shaving, or a strip wash etc)?
• Will they be standing, seated or both.(e.g. does the user stand, but use a perching stool or wheelchair when fatigued)?
• Is wheelchair access required? And if so, can the user access the basin and is there knee space underneath?
• Consider the size of the space that is required. If the adaptation is a small en-suite toilet for example a cloakroom basin (typically a smaller sized bowl) may be more applicable.
• Where will toiletries be located and are they accessible to the user/s?
• How is the plug operated? If the user is accessing the wash basin independently, can they fit a plug and remove it again?
• Will any equipment need to be fitted at the time of the adaptation or in the future? To allow for this, ideally the wash basin should not be located too close to the toilet.

Pedestal
A standard pedestal wash basin does not usually have any features specifically designed for disabled or older people, unless it is fitted with lever taps. You may wish to consider installing this type if the user has cognitive difficulties and has used a basin of this type of basin in the past (changing to a different type of basin could cause confusion.)

Counter top basin
This type of basin is situated on top of a surface e.g. a worktop or vanity unit . Again, it does not have any features specifically for older or disabled people and it can be difficult for wheelchair or seated users to lean over to turn the taps on and off.

Wall mounted wash basins
A fully wall mounted basin has minimal plumbing below the level of the basin. This is especially helpful if the user is washing from a seated position, as the knees can fit underneath the basin. The position of the tap or taps on a basin should be considered - could they be more accessible if they were positioned to the side of the basin for 

example? This is especially important for wheelchair users.

Half pedestal wall mounted wash basins can be fitted with flexible plumbing to allow the basin to be raised or lowered if necessary in the future. However, this style can restrict access for wheelchair users.

Height adjustable wash basins
These basins can be adjusted to a range of heights, which make them suitable for most seated and standing users. Some models include a mirror and lights which move in tandem with the wash basin and can therefore be utilised by a standing and seated person.

A wash basin bracket can allow for a basin appropriated for the user and the environment to be fitted. The bracket and the height of the wash basin can be manually adjusted, usually with a socket wrench. This option is usually only recommended for situations where the height needs to be adjusted only occasionally.

Manual height adjustments with a gas assisted spring enable the wash basin’s height to be adjusted with a button or lever and locked into place. It is usual for the height to be adjusted in increments, usually around 12mm (0.5 inches) at a time. Consideration should be given to the potential on-going costs of servicing and maintenance of the working parts. It is also important to review the warranty that is supplied with the product.

A powered height adjustable wash basin can be operated by lever, button or hand control. They allow a continuously variable height for greater accuracy. However, they can be expensive to purchase and consideration should be given to the potential on-going costs of serving and maintenance of the working parts. It is also important to review the warranty that is supplied with the product.

The shape of a basin may offer support for some users. For example children with Muscular Dystrophy and those with reduced muscle strength or stamina in their arms may find a basin design with wide side sections can help to support the forearms. Some wash hand basins have hand holds moulded into them, which can also help to provide a secure grip

The use of a plug is not always necessary with a wash basin - many people may only use running water to wash their hands and face or brush their teeth. However, if a plug is necessary, consideration should be given to the user’s dexterity and ability to place and remove a plug from the plug hole.

Plugs with a large handle attached to them or a ‘pop up’ or a ‘flip top’ waste may be easier to operate. Alternatively, a plug that automatically empties if the capacity of the wash basin is reached can be useful for people who may forget to turn the taps off (e.g. cognitive impairments).

Body dryers are usually vertical units, fitted near to a shower or bath and use hot air or infra-red heat to dry the body. They can have the advantage of heating the bathroom as well as drying the user.

If a user becomes fatigued when using a towel, or wishes to have privacy when drying, then a body dryer may be appropriate. Body dryers can also be beneficial for particular medical conditions, e.g. if skin is sensitive or damaged.

Considerations

• Some dryers have to be positioned in the corner of a room and this will affect the location of other items within the bathroom adaptation
• Body dryers may not be suitable for someone who is sensitive to sound. Although the sounds vary, 70 decibels on some models is the equivalent noise to a vacuum cleaner in use
• Check the location of any switches and the dexterity required of the user. Some body dryers use infra-red controls and are switched on by movement
• A UV panel dryer can be considerably more expensive than an air body dryer
• Consideration must be given to the seated user; it will not be possible to dry all areas of the body from a seated position
• Some dryers can be located over a changing table/shower stretcher to dry the user whilst in a lying position. N.B - this will only dry the side of the body facing the dryer
• Always check the manufacturer’s warranty and factor in a budget for any on-going service costs.

Toileting is an essential part of our daily activities and it is important to ensure the toilet in your bathroom meets your needs. When planning a bathroom adaption in the home, the location and features of a toilet are an essential part of this.

You will need to consider the following:

• Is the toilet in the bathroom or in an adjacent room? Where within the room is the toilet positioned? Some people may have the need to use the toilet at short notice and the most efficient way of reaching the toilet should always be planned for. It is also important to ensure that the toilet is accessible and usable by all members of the household.
• If a walking aid is used (for example a walking frame) where will this be positioned while the toilet is being used? If the person is a wheelchair user, they may need to face the toilet and pivot to move onto the toilet seat, or position the wheelchair to one side of the toilet and use a transfer board. Space to allow for this should be included when planning the bathroom. Also good practice guidance recommends that the door to the bathroom (regardless of whether it opens inwards or outwards) should not encroach upon the turning space of the wheelchair or minimum activity space. If a ceiling track hoist is used to help a person onto a toilet, consideration should be given to the space where they will be transferred from.
• Does the user need to use grab rails? If so where will they be placed? And are the walls solid and able to have rails fitted to them? Further information on the type of grab rails available can be found on DLF’s fact sheet, Choosing and fitting grab rails.
• If a carer is required to assist with toileting, consideration should be given to where the carer will stand and sufficient room should be allowed for the carer to provide the necessary support (Lindahl, 2004).

An individual assessment with an Occupational Therapist is advisable as there are many factors that may affect what is appropriate for you. A needs assessment can be applied for through social services. If you’d prefer to book a private appointment, visit the Royal College of Occupational Therapists’ website or call their enquiry line on 020 7989 0681.

Getting the right height toilet is crucial in providing safe use, comfort and independence within the bathroom. It is particularly important if a transfer board is used. If other people will be using the toilet, the height will need to be suitable for them too.

If your thighs are horizontal (with your knees and hips at the same height) when sat on the toilet and your feet flat on the floor, then the toilet is probably a good height for you. The diagrams show a toilet that is likely to be too low (the person's knees are higher than their hips) and too high (the person's hips are higher than their knees and their feet are off the floor).

If you wish to check this, then the toilet height most likely to suit an individual is approximately the same as the distance between the floor and the bottom of their thigh behind their knee, as shown in the diagram. The toilet height should be measured from the floor to the top of the seat. The height to the person's thigh should be measured when they are wearing their usual shoes or slippers. When being measured they should be sat on a chair at a height at which their thighs are horizontal with their knees and hips at the same height, their knee and ankle joints should be roughly at a right angle, as shown in the diagram. When rounding the measurement to the nearest centimetre, round down rather than up.

Most models of raised toilet seats clamp on to the rim of the toilet bowl and the original seat remains in place, stuck in the 'up' position. Some models replace the original seat. When using a raised toilet seat, it is important to check that it is fastened securely and does not move. If you are raising the only toilet in the house, then consider other users, including children, who may struggle to use the raised toilet safely. Other users of your toilet may need to, or prefer to, remove a raised toilet seat when using the toilet. Consider whether they will be able to remove it and replace it ready for your use. If they remove it, they must know how to refit it correctly (Pain, McLellan, and Gore, 2003).

Raised toilet seats with frames and toilet seats with armrests provide handholds that you may wish to use if you feel unsteady or unsupported when sat on a toilet. These should not be considered if you have a one sided weakness unless it can be fixed to the floor. Always check that the weight capacity of any toilet equipment you use exceeds your weight.

There are a range of handles that can be fitted to the toilet to help those with problems with dexterity or grip to flush the toilet. The location of the flush is also important; it needs to be accessible for the user in order to promote independence. Cisterns that will be used by wheelchair users should have their flushing mechanism positioned on the open or transfer side of the space (Part M of the building regulations Doc AD M 2 Vol 2016).

Flush controls such as levers, which are wider and flat, can make them easier to push with the palm of your hand or elbow. Alternatively no-touch infra-red flush controls can be activated with the wave of a hand. These can sometimes be located to the side of the toilet or on the floor to meet the needs of the user.

Difficulties with upper limb movement, balance, dexterity, cognitive function and a user’s weight can all affect the ability to manually clean themselves after using the toilet. Wash/dry toilets and seats provide automatic flushing, warm water washing and warm air drying after using the toilet. It is usually operated with a hand control which can be held by the user or carer, or mounted onto a wall. Some suppliers provide touch sensitive switches which can be operated with a fist, elbow or under the armpit if dexterity is an issue. It is important to note that a wash/dry toilet can be used as a standard flushing toilet without using the wash/dry feature.
 

The provision of a wash/dry toilet can remove the need for a carer's assistance, helping to promote independence and dignity in toileting for the user.

Points to consider:

• A wash/dry toilet requires a mains electrical connection to work. This, along with any space requirements, will need to be considered when designing the bathroom
• You may need to source your own plumber to fit or service the unit. Some companies offer an extended warranty and have a dedicated team of engineers on-hand to fit their products
• WRAS (Water Supply Regulations) approval is important, as it shows regulations relating to installation and performance have been complied with
• The wash/dry toilet can be operated without the washing and drying functions if it is to be used by other members of the household
• Consider any additional adaptations that may be required, either now or in the future - for example integral arms, a plinth to raise the toilet, lateral supports - and its compatibility with other equipment. Not all wash/dry toilets can be adapted
• Toilets, as with other devices, have a safe working load – check with the supplier before ordering
• Consider any cognitive impairment and the ease of use of the product – especially if it is to be operated independently. Complex hand controls can be confusing for some people
• Wall mounted models enable them to be positioned at a height to suit the user and offer more clearance under the bowl. These features may be particularly advantageous if you are using the device from a wheelchair, mobile toilet chair or commode
• As there are many features of a wash dry toilet, a demonstration prior to purchase is recommended to ensure the product is right for you. Contact the manufacturer for more information
• These toilets are sometimes available via your local authority under a DFG. An assessment by an occupational therapist would be required to proceed with this.

A wide range of equipment is available for children, dependent on the level of support they require, including commodes, non-standard toilet seats, toilet frames and urinals.

Supportive toilet seats fit to the toilet, but this may limit use by other family members. The size and shape of a toilet bowl may mean that the aperture position for some toilet supports, especially for smaller children, does not align fully with the toilet bowl. A splash guard or ‘skirt’ may limit prevent urine splashing outside of the toilet. Pipes, boxing in and toilet bowl size and shape may all prevent wheeled commodes being used.

A bathroom floor is likely to become wet and therefore increase the risk of falls in that area. Tiles for example can become especially slippery when wet. The correct flooring in a bathroom can help to prevent fall-related injuries (Lachance et al, 2017):

• The bathroom or WC flooring should have an adequate slip resistant rating which is suitable for the use of the room
• Floor surfaces should be firm, flush, non-directional and firmly fixed
• If any of the users of the bathroom have a visual impairment, it is important to ensure that the floor covering does not produce a glare when reflecting the light as this can be disorientating. Patterned flooring should also be avoided
• Sudden changes in colour can be perceived as a step
• Threshold strips should be carefully chosen so as not to cause a trip hazard or an obstacle for wheelchair users

If you are paying privately, it may be one of the largest investments you will make in your home and so it's important that the final result suits both your needs and tastes. In some situations you may be able to receive assistance with modifications. You may wish to approach your local social services Occupational Therapy Team via your local council in the first instance to see if you can obtain an OT assessment. However please be advised that waiting lists and eligibility vary greatly from area to area.

If you are self funding, you may wish to seek the advice from a specialist housing OT who can work with you to design the best possible kitchen to meet your individual needs.

There are a few options available for funding of equipment and minor adaptations; this can vary across the UK. We provide an overview of the options available here, but it is worthwhile checking what arrangements are in place locally.

In England, if you are assessed as requiring preventative intervention, equipment under £1000 would be free of charge to you (Department of Health 2014, section 2.9). In Scotland, Local Authorities make their own arrangements for provision of minor adaptations and details can be accessed via your Council website. If the equipment or adaptation costs more that £1000, you may have to apply for a Disabled Facility Grant (Mandelstam 2016).

The Money Advice Service has some useful information about funding for adaptations.

It is recommended that you seek advice from an occupational therapist before considering which equipment is suitable to you. You may be entitled to an assessment by a Local Authority Social Services Occupational Therapist. Alternatively a list of independent Occupational Therapists can be found on The Royal College of Occupational Therapists' website.

If you need advice before you buy, contact your local equipment demonstration centre where you would have the opportunity to try out a range of equipment. There are several of these around the country where you can go for impartial advice. Your local authority will also be able to supply information about where your nearest centre is located. Also Disabled Living Centres and some retailers have showrooms which have areas set up so you can try out items of equipment to see if they will suit you before you commit to making a purchase.

If you are unsure if you can afford the equipment or any of the associated costs, requesting an assessment or advice from an Occupational Therapist or local well-being service (local areas may have different titles for support services) will help with decision-making. It may be that another way of accessing equipment is more suitable for you.

Also consider if you can afford a service contract for more complex items of equipment. These may seem expensive at first but in the long run call out costs or replacements may prove to be costly. Some items such as hoists and slings need to be ‘LOLER’ (Lifting Operations and Lifting Equipment Regulations, 1998) checked. This is because they are used to move people mechanically and these checks are a legal requirement every six months. Others with moving parts or electrics will have a service schedule recommended by the manufacturer which is included in the instruction manual.

Before purchasing, look for a sales company that belongs to a trade association, such as the British Healthcare Trades Association (BHTA). BHTA members have signed up to a code of practice governing standards of customer service (further details are given in the Useful organisations and resources section).

Some suppliers will fit equipment, but some is sold ‘supply only’. Finding a tradesman to fit items may not be easy. There may be a local arrangement for fitting small items such as a care and repair service or Home Improvement Agency or there may be a list of ‘trusted traders’ provided. Websites such as Checkatrade provide feedback from previous customers which can help you find a reputable service provider and Trading Standards may be able to advise if there are concerns over a company you are considering using.

Equipment which is specifically designed for those with disabilities may be purchased ‘VAT free’. N.B - this is not claimed back via the personal tax system / HMRC, but during your purchase. If you have purchased something which should have been VAT free, it is not possible to claim this back from the supplier or HMRC.

Equipment suppliers may have the VAT exemption form on their website or you can download a general form from the GOV.UK website. You will need to fill in a form for each supplier you use, but you will only need to do this for the first purchase with them.

A local authority Disabled Facilities Grant, often referred to as a DFG, may be available for essential home adaptations for you as a disabled person, if they are deemed ‘necessary to meet your needs’ and the work is ‘reasonable and practical’. This can 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 will come to assess your needs and then contact the relevant council departments. The occupational therapist’s recommendations are taken as evidence that the work proposed is appropriate and meets all the requirements for funding.

The occupational therapist will be able to explain the application process. Information is also available from your local authority and on the Government website.

Disability Rights UK have some very comprehensive online information about DFGs and other housing grants.

DFGs operate across England, Wales and Northern Ireland. Conditions for DFGs will vary according to the country in which you live. For details of schemes in Scotland see Disability Information Scotland and Scottish Government (2009) Help with adaptations to your home: A guide for disabled people in private housing in Scotland. Edinburgh: Scottish Government.

Please note that you may not receive any grant if you start work on your property before the council approves your application.

If you do not have the funds to buy equipment it may be possible to request support from a charity. They will usually have criteria which they will apply, and most will not consider equipment which should be provided by the NHS or Social Services.

Some charities will only consider requests which are supported by an involved professional, usually an occupational therapist, physiotherapist or a nurse. This may require them to be present during the assessment for an item of equipment. This is to ensure that the equipment is appropriate and will not have an impact on planned treatment or rehabilitation programmes.

Equipment is not always purchased outright and gifted to you. Some items are provided on loan, either for a specified length of time, or to be returned when no longer needed or appropriate for use.

A number of charity websites that offer funding are listed here:

• Community Care A list of charities giving grants
• Turn2us Turn2us is a national charity that helps people in financial hardship gain access to welfare benefits, charitable grants and support services.
• My grants Accessibility grants for disabled and older people
• Grants for individuals The Grants for Individuals website is run by the Directory of Social Change and lets subscribers search for grants. It is intended for organisations searching for funding on behalf of individuals.

Following an assessment some local authorities will issue you with prescription for the equipment that you need. This can be taken to a local retailer (usually a pharmacy or independent equipment retailer) and you can collect the equipment and begin to use it immediately. Usually there is the option to have the equipment delivered to your home if you have difficulty accessing your local retailers.

If your need is short term it may be cost effective to hire equipment.

Mobility Hire for example is a national source for mobility and assistive equipment on hire or purchase. They offer short or long term rental solutions to meet most requirements – equipment ranges from wheelchairs to bathroom aids.

If the equipment is required for a holiday it is advisable to look for a supplier near to your destination – they will be able to respond to any issues such as a breakdown / breakage.

NB - equipment from Social Services is provided for use at your home address and should not be used elsewhere as:

• it is assessed as suitable for use in your home and selected to work with your bath / bed / toilet type
• they will not be able to respond to breakdowns or repairs.

However, if you are permanently moving home into the area of another local authority, you can take the equipment with you if you still need to use it and it is the most cost effective solution. You will need to discuss this with the service that issued the equipment to you.

This is available via an NHS employee (Nurse / Occupational Therapist or Physiotherapist) or via a Social Services Occupational Therapy Service.

Loans can either be short term to assist after an operation or illness or longer term to promote independence or support care-giving.

Long term loans are usually the responsibility of Social Services (Adult Social Care / Children’s Services) and will be provided following an assessment by an Occupational Therapist. Straightforward items, such as raised toilet seats or bath seats and boards can be provided by an occupational therapy assistant. Arrangements vary across the UK and you may find that local arrangements allow different services to provide equipment on behalf of each other.

Also, equipment may be offered as an alternative to an adaptation. Your occupational therapist will explain why they are making this suggestion.

Disability Living Allowance, Personal Independence Payments and Attendance Allowance are benefits available for those who need support with activities of daily living. Which of these can be claimed depends on the age of the person claiming the benefit. Information on claiming these is available from GOV.UK (https://www.gov.uk) and the Citizens Advice Bureau (https://www.citizensadvice.org.uk/ ); this website has advice specific to each of the home nations and enables you to check your eligibility if you are not already claiming one of these benefits.

For clear, practical advice and information on products and suppliers of daily living equipment, please have a look at our Living made easy website.

If you would like further advice related to choosing equipment for everyday living you could try relevant sections of AskSARA, our free online guided advice tool. AskSARA will ask you questions about yourself and your environment and then offer relevant advice, product suggestions and supplier details.

You can contact the DLF Helpline, which is open Monday to Friday from 9am to 5pm. Tel: 0300 999 0004 (calls charged at your standard land line rate even if you are phoning from a mobile).

Alternatively, you may wish to contact us via email: enquiries@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, such as equipment ideas.

Another source of advice is a disabled or independent living centre where you would have the opportunity to try out a range of equipment. There are several of these around the country where you can go for impartial advice. Your local authority will also be able to give you details of centres in your area.