Specialist baths: Challenges and solutions for occupational therapists

By Louise Sharp, Occupational Therapist

“Occupational Therapists appreciate the many benefits of safe access to a specialist bath for their disabled clients – in terms of improved wellbeing, dignity and care. However, when applying for a Hi-Lo bath through Local Authority facilities grant, many families are only offered funding for an accessible wet room conversion. This commonly is not the preferred solution for disabled bathers and carers.”
Abacus (2018)

 

As an occupational therapist with a decade’s experience in social services, I know first-hand the challenges faced with recommending specialist baths – and the physical and emotional stress this can put on a family who may already be struggling.

Benefits of taking a bath

First, let’s briefly explore the benefits of bathing:

  • Opportunity to relax, rest and enjoy time to yourself
  • Increased level of dignity and wellbeing
  • Improves mood, mental health and engagement
  • Allows for play, imagination, development and learning
  • Improves sleep quality
  • Releases tension, relaxes muscles, reduces spasms and improves joint stiffness
  • Improves blood flow
  • Reduces pain
  • Offers meaningful occupation for the client
  • Improves relationships and communication

Challenges OTs face

If you’re proposing to install a specialist bath, you may come across the following obstacles:

Can be expensive

A specialist bath can be more expensive than fitting a level access shower (but that’s not always the case). There are also additional costs for maintenance, servicing, and insurance. However, we should be considering cost-effectiveness rather than initial outlay.

Fighting institutionalised thinking

Very often I have been told, “We don’t do baths” by technical officers who conform to the legacy of past practices.  Remember, this is fettering of discretion and therefore unlawful.

Daunting to advocate for

Justifying why a bath is the most suitable option – and being able to argue this point with institutionalised technical officers – can be intimidating for inexperienced and less confident occupational therapists.

Inconsistencies in services

Different local authorities have different policies around bath provision, and if families move between counties they can often lose out.

Also, families of disabled children often know each other from support groups and schools, so it can be aggravating for parents to learn a disabled child living in the neighbouring authority has a specialty bath if their own request has been declined.

Takes up a large area

Specialist baths often need more space than a standard bath, as they need to be positioned away from the wall to allow for the rise and fall function. Or it may be that carers need access to both sides of the client, so the bath needs to be positioned in the centre of the room.

Space in a small bathroom is often an issue and, in some cases, an extension is required, making it a more costly provision.

Other household members’ needs

You will also have to consider other family members and their needs in the bathroom – how will a specialist bath affect them, and can their requirements still be met? This can often be an issue if a disabled adult needs a level access shower but young children in the house must have a bath.

Confined by legislation

“Occupational therapists are finding that, with regards to adaptations, the legislative framework and restricted funding for adaptations hinders their attempts to be creative and person centred” (RCOT 2020)

Solutions to meet these challenges

Firstly, you should carry out a robust assessment of the client’s needs, wants and expectations, also considering the carer, any other family members who use the bathroom and the home environment. From here, you can use your clinical reasoning skills to justify why bathing would be more beneficial than showering.

The assessment must also be client-centred – ask why bathing is a meaningful occupation to them. This allows you to establish if the bath is being provided for the right reasons and ensures the client’s wellbeing is at the centre of the recommendation.

Other strategies to help meet the challenges are:

Consider any alternatives

This doesn’t necessarily mean you have to physically try something, just make sure you clearly articulate why some of the options you’ve considered are not appropriate.  It’s as important to clinically reason why you’re not recommending something, leading to the rationale for what you are.

However, if it is safe to do so and the situation allows, trial any alternative options first to rule them out. This might involve using a shower at a family member’s house to see how the client copes or using a bath seat in a standard bath.

Do a trial run

Carry out joint visits with equipment specialists and explore the different types of baths to meet the client’s needs. Abacus will bring the baths to their home for a dry trial, offering you additional information to justify the need.

Think about other financial benefits

Consider the wider cost savings of providing a bath:

  • would the care budget be reduced if a client could bathe themselves?
  • would only one carer be needed instead of two?
  • Would it impact positively on long-term health and well-being?
  • Is it to be used as part of risk reduction and can you link that with cost savings?

Gather as much information as possible

Complete an activity analysis to identify what the barriers are and if the provision of a specialist bath will help to optimise the independence and safety of the client and carer.

It’s also helpful to know the product, its costs, installation times, guarantee duration and any add-on accessories. This can be very useful when answering any concerns from adaptation teams and technical officers. Often, providing a bath is a more cost-effective solution compared to level access showers, as tanking a wet room can be expensive and time-consuming. It can also be very disruptive for the family.

You can also research current evidence-based practice as additional information to justify the recommendation.

Work collaboratively

Effective communication with technical officers and adaptation teams is essential to creating a streamline service and effectively using resources.

Regular training for you and adaptation teams is also necessary to ensure everyone has the same understanding of best practice and is working together in the most effective way.

Demonstrate that the law is on your side

To meet the Housing Grants, Construction and Regeneration Act (DFG), adaptations must be ‘necessary and appropriate’. You can use your assessment to demonstrate that providing a specialist bath meets this requirement.

And use the legislation to the client’s advantage – quote it in assessments and use it to justify the recommendation for the bath.

So how does legislation support bathing?

The Children’s Act 1989

This minimises the effect on disabled children of their disabilities and gives such children the opportunity to lead lives that are as normal as possible. It also states that no sibling should be affected by their brother or sister’s disability.

Care Act 2014 (England)

As part of the Care Act 2014, regard must be given to the individual’s views, wishes and feelings – this doesn’t mean that people can simply get whatever home adaptations they want. But when decisions are being made, attention must be paid to what they are saying about their wellbeing.

Social Services and Wellbeing Act 2014 (Wales)

This legislation stipulates that carers (unpaid) have an enhanced and now equal right to assessment and support. It promotes independence by maximising people’s control over their day-to-day lives.

It also states that it is essential that people are enabled to identify their own personal outcomes and how they can achieve those outcomes.

Housing Grants, Construction and Regeneration Act (DFG) (1996)

This states that a disabled person should have access to a toilet, wash hand basin and a shower or bath (or, if more appropriate, both a shower and a bath).

 An option worth exploring

Having a bath is one of life’s great pleasures, and it’s something everybody should have access to. It just takes a bit of forward planning and research – and, sometimes, determination – to make it a reality for disabled clients and their carers.