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Choosing a shower and shower accessories

Showering may be chosen because it is a personal preference or because getting in and out of the bath has become too difficult or hazardous. If help is needed for bathing, showering may offer the possibility of washing independently once again.

Taking a shower can also reduce the risk of injuring a carer's back as it will eliminate the need to lift or help the bather to get in and out of a low bath.

It may be necessary to build a new bathroom, either because of space restrictions or because it is difficult to access an upstairs bathroom. However, if this is the case, check that all other options have been considered. For example, it may be more practical and cheaper to install a stairlift or through-floor lift to provide easy access to the first floor.

The aim of this factsheet is to provide first stop information on the type of equipment available to help with specific difficulties, and details about the useful features of some of the more popular items of showering equipment.

For up-to-date product and supplier information, please contact our equipment helpline, open Monday to Friday 10am - 4pm, tel: 0845 130 9177 or if you use a textphone 020 7432 8009 (all calls charged at standard rate). See also www.bathingmadeeasy.com.

Alternatively, you may wish to write to our letter enquiry service. In order to help us send you a concise and informative reply, please provide us with as much detail as possible about the difficulties you are experiencing and perhaps an idea of the type of equipment you are looking for.

WHERE TO GET HELP AND ADVICE

Before making any decisions about buying equipment, or making alterations, it is advisable to contact an occupational therapist (OT), based at the local social services, who may come and assess your daily living needs. He/she may be able to provide some items of equipment on loan, or give advice on grants that may be available to help with the cost of any adaptations.

Alternatively you can hire a provate occupational therapist – a directory can be obtained from the British Association of Occupational Therapists.

Housing associations will provide small fixed equipment and minor adaptations for residents.

Information and advice on design issues are available from the Centre for Accessible Environments (CAE) which keep a database of architects, surveyors and similar professionals with experience of designing for disabled people, and has a number of useful publications and design sheets.

For further information on adaptations and equipment, see: www.direct.gov.uk/en/Disabled People/HomeAndHousingOptions

DISABLED FACILITIES GRANTS

A Disabled Facilities Grant (DFG) may be available for some home adaptations to owner occupied and housing association properties including major adaptations such as extensions and structural work to accommodate ceiling track hoists, stairlifts, shower units. If major adaptations are required, an OT from your local council will assess what you need, and then contact your local environmental health or housing department.

DFGs are available as part of the general renovation grant system. A means test (similar to that used for housing benefit) is applied to decide how much financial assistance can be made available to the applicant. Depending on the outcome of the test, the amount of assistance offered can vary from 0-100% of the cost. A ceiling of £25,000 (England) or £30,000 (Wales) will be put on each DFG, irrespective of the applicant's assessed contribution.

Parents of children with disabilities are not means tested.

For a leaflet explaining DFGs see: www.communities.gov.uk

PROVISION OF SHOWERING EQUIPMENT

Showering equipment is generally regarded as daily living equipment, and can therefore be provided by your local council either directly or through the DFG system. Provision may include:

• shower trays;

• shower units;

• toilet/shower units;

• showers with suitable controls;

• shower panels

• shower seats (fixed or free-standing);

• mobile shower chairs;

• shower rails.

If you decide to buy equipment privately, it is best to try it out first. If you can, arrange a visit to one of the Disabled Living Centres. It will have a range of showering equipment on display, and the staff will be able to give advice and information on what may be most suitable for you. Make sure beforehand that the centre has the equipment that you want to see on display.

For details of your nearest centre contact Assist UK.

Relevant DLF factsheet on shower rails; Choosing and fitting grab rails.

DIFFERENT TYPES OF SHOWER BASES

The choice of base will depend largely upon:

? the facilities and the amount of space available; and

? the ability of the person.

OVER A BATH

This position allows the use of a standard wall-fixed shower or mixer bath/shower taps. A perforated bath board, or a swivel bath seat, will provide the person with a platform across the top of the bath to sit on whilst showering. In order to contain the water within the bath area, a shower curtain will be needed. Check that it will drape adequately around the board or seat.

This type of shower is relatively cheap to install but may not make washing any easier than bathing, as access in and out of the bath may be a problem and the person may still need assistance.

SHOWER CUBICLES/ TRAYS

Shower cubicles

? Corner cubicles - situated in a corner with the tiled bathroom walls forming two of the sides.

? Full cubicles - can be situated anywhere as they have three solid sides and a cubicle door, thus enclosing the person fully. It is advisable to have some waterproof flooring immediately outside the area of the cubicle.

Although many cubicles are installed with sealed shower doors to minimise water spillage into the surrounding area, a pump will often be added to draw the water actively towards the drain.

Cubicles can be bought with a choice of shower seat, shower controls and hand spray, and rails, according to the person's needs.

Care should be taken over the choice of other equipment used on plastic shower trays, especially stools with four separate legs, because of the risk of puncturing the tray. Flat based shower chairs should be chosen in preference.

Check the maximum weight limit of the tray. Some companies will strengthen them for heavy users.

Shower Trays

Stepped access trays

These are the most common type of shower tray available from most standard plumbers merchants. However, they may not be suitable for many disabled or frail elderly people. They have a small retaining 'barrier' at the lower front edge to stop the water from flowing out onto the floor. The person must have sufficient balance and mobility to step over this. Although it is possible to transfer from a wheelchair onto an extended or swivel seat, a ramped or level access tray is usually much easier and safer.

Ramped access trays

These trays are placed on top of the existing flooring and can be installed almost anywhere - even if it is not near to the main drains. The trays are raised at the front so that the water drains towards the back and is usually pumped above floor level down a narrow pipe to the main drains.

A small ramp provides easy access for the person to walk in, or he/she may be pushed in by a helper in a sanichair or a mobile shower chair or trolley.

However, consider the following:

? not all provide sufficient floor area to allow the use of a mobile chair, so always check the measurements carefully;

? if a mobile chair is used, check that there is enough space around the shower to allow sufficient 'run up' and that the ramp is not too steep;

? the chair has to be reversed into some small trays so that it can be conveniently positioned.

Level access trays

Level access showers have an entrance threshold of less than 1cm. They are therefore easy to negotiate independently, and put less stress on a helper's back when he/she is pushing the person into the cubicle. However, there is more risk of water falling outside the tray with level access shower trays. Try to ensure that the tray is sufficiently large to take account of the fact that the shower curtains will billow outwards slightly as the shower water hits them.

Some level access bases are designed to fit in the space where a bath stood, so that the drainage from the bath is already in place. Others require under floor drainage to be installed. They often have a pump over the drainage hole to draw the waste water towards it.

SHOWER AREA

Part or all of the bathroom is converted for showering either by laying a shower tray or sloping the floor and covering it with a suitable slip-resistant, waterproof flooring. It is also necessary to waterproof the adjacent walls, usually by tiling.

Since there are no steps or ramps to negotiate, it is easy for a person to walk or wheel in with little or no assistance and to shower on a chair or stool. It also puts less stress on a carer's back when assisting the person into the area.

If the person needs assistance to shower, the carer will get rather wet if there is no protection against the water. Waist height, wall-fixed or portable shower screens may be useful in this situation.

CHOOSING A SHOWER SYSTEM

TEMPERATURE CONTROL

Wherever possible there should be a guard against sudden water temperature changes, especially if scalding could occur. Therefore, the following are not recommended:

? a shower spray simply fitted over the taps of a bath, unless the hot water available is at a constant temperature.

? a variable heating source, e.g. from an ascot type water heater.

It is recommended that you choose a system with thermostatic controls so that the water temperature remains constant even if other water outlets in the same circuit are turned on. It is also advisable to have a safety cut off at specific temperaatures. The following types of shower are commonly available through DIY outlets as well as plumbers' merchants, although specialist shower companies sell a good range with easy-to-use controls.

Thermostatic mixer showers

This type of shower uses pre-heated water from the tank, but has thermostatic controls which automatically compensate for any changes in water pressure. This ensures that, if someone turns on the cold water tap elsewhere in the house, the person in the shower will not get scalded.

However, if a thermostatic mixer valve is fitted to a shower, it must be at least 3m below the water head if it is to work efficiently. Alternatively, a pump can be used to increase the water pressure.

Some models will shut off completely if either supply fails.

Instant or electric showers

These run off the cold water supply. They have an element (like an electric kettle) connected to a 30 amp electricity supply which heats the water as it flows through the unit. The water temperature is controlled by a manual valve which adjusts the flow rate of water. The slower the flow, the hotter the water. An even temperature will therefore depend on a steady flow of cold water. Safety devices are incorporated to help prevent scalding if the water flow falls below the minimum.

Some units have a switch to select various electrical loadings to give cool, warm and hot water.

SHOWER CONTROLS

Depending on the person's needs, it may be worth considering the models which have pre-set controls or one control which regulates the rate of flow and temperature. The following types are available:

? lever controls

? dial control;

? push button control;

? rocker switch.

For people who shower independently it is always safer to have controls that are easy to reach from a stable sitting position.

MAINTENANCE

In hard water areas, shower heads need to be descaled regularly if they are to work efficiently. This usually involves dismantling the shower head before applying a descaler. The person will need to have the ability to do this independently or arrange for someone to carry it out. However, on some models a lever can be operated to force a series of pins through the holes in the shower head to descale it. This eliminates the need to take it apart. Pumps which assist drainage also need regular cleaning and maintenance. Also, accumulated debris has to be removed from waste pumps.

OVERCOMING LACK OF SPACE

SHOWERLOOS

These are shower cubicles which have a toilet included within the unit. The person either sits on the WC to shower or, as it has a ramped or level access, uses a sanichair for the two functions. Some units also include a wash basin.

These are ideal 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 house.

FOR PEOPLE WHO NEED HELP TO GET IN AND OUT OF A SHOWER AREA

Although ramped or level access shower areas are much easier to get into and out of, some users will require additional help.

WHEELED SHOWER CHAIRS

Mobile shower chairs are made from non-corrodible materials so that it does not matter if they get wet. They enable people to push themselves, or be pushed, into a shower cubicle or area - avoiding the need to transfer onto a wheelchair and from there onto a shower stool or fixed seat.

Consider the following:

? the larger the wheels, the easier the chair is to push, whether by the user independently or by a helper;

? make sure that there is enough space to manoeuvre the chair into position. Swivel front castors will make turning easier;

? smooth surfaced floors are easier to push over than carpet;

? chairs with removable or foldaway armrests are easier to transfer on to than those with fixed armrests;

? footrests that fold up and/or swing away will also make transfers easier;

? chairs with a folding frame can be useful for storing and for taking on holiday..

Large rear wheeled shower chairs

These enable people to propel themselves independently into a shower area or cubicle. They may also be used as an attendant-propelled chair where the floor surface is difficult to push across, e.g. thick carpet, since large wheels offer less rolling resistance and are therefore easier to push. Check that the brakes are accessible to independent users.

Shower chairs with castor base

These small wheeled chairs enable a person to be pushed into a shower area or cubicle. They may be difficult to push over some floor surfaces, e.g. thick carpet, since the small wheels offer more rolling resistance and are therefore more difficult to push. However, because of their smaller overall dimensions, they take up less space.

Sanichairs

Some sanichairs can be used in a shower although they are primarily designed as mobile chairs with an aperture or hinged toilet seat for use over a toilet. They are available with large and small wheels.

OVERHEAD TRACK HOISTS

Overhead track hoists are ideal in a domestic situation because, if the layout of the house permits, a straight, jointed or curved track can be fixed so that the person can transfer in the sling from the bed and into the bathroom where he/she can use the toilet and or shower.

An electric traversing system may enable a person to transfer independently; a manual traversing system requires the helper to push the person along the track in the sling. The design of the wheels on the hoist motor trolleys makes this easy to do.

Structural alterations may need to be made such as strengthening the ceiling, or adapting the top of the door frame to take the track.

The power for the hoist will be supplied via a step-down transformer. Those that have a rechargeable battery will need to have the charger situated above the track.

SHOWERS INCORPORATING A SEAT FOR TRANSFER

These are specifically designed shower cubicles with a seat that swings/slides outside the shower to enable people to transfer from their wheelchair directly onto it and can then swing/slide back inside. This feature may enable people to transfer independently or, if assistance is needed, it will provide much more space for carers to manoeuvre and position themselves when providing assistance.

The cubicle should have built in grab rails to help the person move along the seat.

FOR PEOPLE WHO NEED SUPPORT WHILST IN THE SHOWER

Most older or disabled people like to sit down whilst in the shower. Some only need a platform to perch on; others will need more supportive or contoured seating.

PROVIDING A STABLE SEATED POSITION

It is just as important that people have a stable seating base during personal care activities as it is at any other time of the day.

For people with mild to moderate seating difficulties, the right shaped seat should provide sufficient support to allow them to sit up straight without continually sliding forward.

The shape of the seat

These will provide a person with a more stable seating position than a flat seat. Dish seats tend to have a slightly higher back, are raised at the sides and slope down towards a central aperture. This type aims to be 'human shaped' so that the shape of the buttocks are accommodated, whilst the raised edges provide a certain amount of stability.

These have a cut-out at the front and a central aperture which allows users to wash themselves more easily.

Although they are not dish-shaped or contoured, the padding allows a certain amount of compression under the heavier areas such as the buttocks, and this leads to 'shaping' which should provide a certain amount of stability.

Seat height

This plays an important part in achieving a stable seating base because, if users can sit comfortably with their feet supported, they are less likely to slide forwards in the chair. Wall-fixed shower chairs can be fixed at the appropriate height; free-standing chairs and stools may have height adjustable legs. Many mobile chairs have adjustable height footrests to provide support.

Backrests

They should support the person in the lower lumbar region. A padded backrest will provide more support and be more comfortable than plastic moulded or tubular backrests.

It is possible to get wall fixed backrests which can be used with a folding shower seat.

Armrests

These provide a useful rest and support while the person is seated. They should not, however, be used to help someone stay in the chair. If, without the arm supports, the person would slide or fall, then it will be necessary to look for a supportive system that will provide a more stable seat.

FREE-STANDING SHOWER STOOLS OR CHAIRS.

These stand on the base of the shower area and are not fixed in any way. Care should be taken when using these on plastic shower trays, as there is a risk that those with 4 separate legs may puncture the tray; flat based stools should be chosen in preference.

Stools tend to have little or no back support, although may have tubular armrests or side handles. Many have height adjustable legs. Some are tall perching stools which are specifically for people with stiff hips.

Shower chairs have a higher, more supportive backrest.

When considering whether to use a shower chair or seat ensure that the shower tray/ cubicle is large enough to accommodate the seated person and his/her knees and feet.

HINGED SHOWER SEATS – WALL- OR FLOOR-FIXED.

These are attached to a tubular frame which fixes to the wall via hinged brackets. Optional floor consoles are available if the wall fixings are not strong enough.

The seat folds up against the wall when not in use. Some have a support leg(s) which transfers some of the weight through the floor. The seat can be fixed at a height to suit the person's needs.

Hinged down stretchers are available which fold down over a bath and will rest on the bath rim. They usually have perforated fabric, and the water flows through into the bath. There is a type without holes which can be used to dry and dress a person who is hoisted into a bath or shower.

WHEELED SHOWER CHAIRS

Many of these provide the person with quite a lot of support as they usually have a backrest, armrests and footrests. However, they also take up more space than hinged shower seats.

SHOWER TROLLEYS

These are large wheeled platforms which enable the person to be pushed into a shower area in a lying or semi-lying position. However, because of their length, they are not often used in a domestic situation. Most would not fit into a shower cubicle, but may fit in a wet shower area.

The horizontal models make transfers easier since sliding equipment can be used to transfer the person in a horizontal position directly from the bed onto the trolley. This type of trolley can also be used as a changing table.

The height of most trolleys can be adjusted so that they can be positioned at a comfortable height for the helper.

SHOWER CRADLES

Shower cradles are shaped so that the user is in a more upright position with knees and hips flexed. This will not only help to inhibit extensor spasm and provide a more stable position, but it will also reduce the overall length of the cradle so that it can be used in some shower cubicles. However, the individual will need to be lifted/hoisted into the cradle.

FOR PEOPLE WHO NEED HELP WITH DRYING

BODY DRIERS

Wall-mounted body driers can be positioned in the shower cubicle or on the wall in a shower area. They produce a jet of warm air that can be used to dry a person. .It is not possible to dry all areas of the body from a seated position.

SHOWER SEATS/CHAIRS OUTSIDE THE SHOWER AREA.

If space is available it may be possible to create an area adjacent to the shower area or have an extended cubicle which provides a dry area for dressing. This is often accessed via a long bench seat which the person can slide across.

USEFUL ORGANISATIONS

British Association/College of Occupational Therapists

106-114 Borough High Street,

Southwark

London

SE1 1LB

Tel: 020 7357 6480

Website: www.cot.org.uk

Centre for Accessible Environments (CAE)

70 South Lambeth Road

London

SW8 1RL

Tel: 020 7840 0125

Fax: 020 7840 5811

Email: consultancy@cae.org.uk

Website: www.cae.org.uk

ASSIST UK (formerly DLCC)

Redbank House

4 St Chad's Street

Manchester M8 8QA

Tel: 0870 770 2866

Textphone: 0870 770 5813

Fax: 0870 770 2867

Email: general.info@assist-uk.org

Website: www.assist-uk.org