This section is concerned with accessible and assisted showering for the residential care and nursing environments.
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Accessible shower enclosures
For many people with reduced mobility, showering is much easier than bathing, and may be achieved more independently.
Accessibility is the first consideration, and there is a very wide choice of shower trays available which are easy to enter either on foot or in a showerchair. They may be chased into the floor for completely level access, or if this is not possible, then a surface-mounted tray with a ramp is a solution. A longer, more gentle ramp is easier to manage than a short steep one. It is quicker and more economical to install a tray on the surface rather than excavating the floor. If the floor is uneven, look for a tray with self-levelling feet to compensate.
The tray must be sturdy enough to support the combined weight of the user and any chair, and a non-slip surface is also important.
Many trays now have anti-bacterial and anti-fungal protection built-in, to assist with infection control.
Doors and / or curtains complete the enclosure. Half-height doors allow a carer to assist with washing, while protecting them from getting wet. Curtains are considerably cheaper than doors, but don’t do nearly such a good job of keeping water in. Many installations combine half-height doors with a curtain for more privacy.
Doors must be strong and shatter-proof, to prevent nasty accidents if someone should fall against them. Doors and tray are probably best sourced together from one supplier, so that you are sure they fit properly. There is a really wide choice of door configurations, to provide the most convenient access for each installation. Make sure the doors open outwards and wide enough to allow a showerchair to be moved in and out of the enclosure.
For large rectangular trays, sliding doors may be more convenient. A sturdy door for a large tray can be heavy, so look for an air-assisted or hydraulic mechanism to make lifting and sliding easier (left). Contrast colour handles and hinges can be helpful for visually impaired users.
As well as door / tray combinations, several manufacturers provide complete cubicles, with a back and side wall(s). This solution can be useful for providing shower facilities in an area where the walls are not tiled, for example.
Wet floor showering
As an alternative to fitting an enclosure, a wet floor facility has gained hugely in popularity in recent years, particularly in new-build situations.
The advantages are: a spacious area for showering, with easy, completely level access.
Several manufacturers now provide wet floor formers, to make installation of a wet floor area more straightforward. These are essentially shallow shower trays with a drainage gradient, that sit level with the existing floor, under the waterproof covering that forms the surface of the wetroom.
The fitting of the non-slip vinyl floor covering is key to the success of a wet floor room: it is important that it is professionally installed, with careful attention paid to the joint around the drainage gulley, where problems can occur if it is not tightly clamped.
Shower chairs and seats
There is a good choice of shower chairs to meet different needs. All have been designed to wheel into a shower enclosure, where the user can remain seated while they wash. Corrosion resistance is obviously a key feature.
There are self-propelled and carer-assisted models. Ease of manoeuvring in a confined space is important, as well as features such as wipe-clean waterproof covers. Depending on individual needs, armrests and footrests may be required. Any armrest should lift out of the way for side transfers.
Seat options available include a centre cut-out or horseshoe shape, which makes personal hygiene easier. Showerchairs often also combine the function of a commode chair (see assisted toileting section).
Wall-mounted seats, such as the one shown on the left, often push up vertically against the wall so that they are out of the way.
Whether wall-mounted or free-standing, it is important that the stool is sturdy enough to support the user safely: in the case of a wall-mounted seat, this means ensuring that the fixings are adequate, and that the wall it is attached to is strong enough to offer support. Legs at the front reinforce the strength of the seat. Many people need armrests to push against to help them stand up – again, these will take considerable pressure, and need to be sturdy.
Thermostatically controlled showers are widely available, and many now also have a built-in safety cut-out, so that if the water temperature rises above a preset level, the flow will stop completely, preventing the user from being scalded.
More complex units can be pre-programmed to run at a particular temperature, so the user doesn’t have to touch the controls once the water is running.
Other features to look out for are clear visual markings and controls that are easy to use with reduced dexterity. An audible high temperature warning is also useful for anyone with visual impairment.
Shower waste pumps
Dealing with shower waste water can cause problems, particularly with a level access shower tray, where the waste pipe may be at a lower level than existing waste services.
The answer in this case is to fit an automatic waste pump, which will pump away water while the shower is running, and stop when it has been cleared.
Filter-free pumps which can pass dirty water without getting clogged are the best for minimising maintenance. In the past, they have been rather noisy – but recent developments in both pumps and gully design, promise efficiency without noise.
For clients who are confined to bed, an inflatable bath or basin together with a portable shower which can be suspended from a bedpost or IV pole, is a cost-effective solution.
Removing the need to use a hoist, or other transfer aid, this is a safe and comfortable way for a carer to bathe an immobile patient in their bed.