Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients’ Homes

Abstract

In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.

Assisting Frail Seniors With Toileting in a Home Bathroom: Approaches Used by Home Care Providers

“…Assisting with toileting is commonly identified by home care providers and family caregivers as a frequent and physically demanding task (Czuba et al, 2012; Darragh et al, 2015; Katz et al, 1963; King et al, 2018, n.d. ; Owen & Staehler, 2003).…”

“…Providing assistance with posterior perineal care led to the highest levels of most calculated risk factors. This task has been described by home care providers as one of the most challenging elements of assisting with toileting (King et al, 2018). In combination with replacing the pants, Hjalmarson's (2014) toileting simulation also found that providing hygienic care was associated with very high frequencies of nonneutral trunk postures.…”

“…Both paid and unpaid caregivers identify providing toileting assistance as one of their most challenging and frequent activities (Czuba, Sommerich, & Lavender, 2012; Darragh et al, 2015; Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963; King, Holliday, & Andrews, n.d., 2016; Owen & Staehler, 2003). Despite frequent step-by-step descriptions on how to transfer clients in nursing and care support handbooks, very limited information is available on how to perform the actual toileting activities to provide optimal care for the patient while ensuring the safety of the caregiver, or on how to adapt techniques when space is limited.…”

“…Despite frequent step-by-step descriptions on how to transfer clients in nursing and care support handbooks, very limited information is available on how to perform the actual toileting activities to provide optimal care for the patient while ensuring the safety of the caregiver, or on how to adapt techniques when space is limited. Home care providers report that instability associated with toileting transfers is common among their clients, and adds hugely to the difficulty and risk of toileting for both care providers and care recipients (King et al, 2016). Regardless of the care recipients’ stability, providers report that small bathroom spaces make it difficult to position themselves appropriately and preclude the use of assistive devices like sit-to-stand aids that are common in long-term care homes.…”

“…Regardless of the care recipients’ stability, providers report that small bathroom spaces make it difficult to position themselves appropriately and preclude the use of assistive devices like sit-to-stand aids that are common in long-term care homes. Furthermore, the wide variation in home bathroom layouts requires providers to problem-solve in each specific care encounter to find a way to provide care (King et al, 2018). To our knowledge, the existing literature does not identify the specific toileting assistance subactivities that present the most difficulty.…”