Contact COS Equipment and Technology staff for more information in relation to bath and washing aids.
You will need to ensure that your bath is strong enough, of the right dimensions, and safe for the installation of bathing equipment.
You will need to consider:
To use bath boards and seats you will require reasonable grip and muscle strength to transfer on and off the board/seat. You should be able to maintain your balance whilst sitting and be able to bend at an angle of 90° at the hips. You will need to be able to bend further forwards if you wish to reach the bath controls or wash your lower limbs/feet without using a long handled sponge.
Bath boards are waterproof boards that fit across the top of the bath (the opposite end to the taps) to provide a secured area on which to sit. They are often combined with bath seats. Once seated on the board you can support yourself on the bath sides to lower yourself down onto a lower bath seat.
Some boards are designed with integral handgrips which may be useful when moving onto and off the board. Some boards have a cut-away section or a dip at the front to make personal cleaning easier.
The board may be perforated or slatted, so that water drains away easily, and can be made of different materials, such as solid or padded plastic, wood, metal or cork. In general, padded boards or seats will provide greater comfort and feel less cold.
Slatted or perforated boards will allow the water to drain away quickly, so that drying is easier and the board is less slippery to sit on. However, ensure that the holes are small as it has been known for male users to trap certain body parts.
Bath boards may sometimes also be called shower boards. Shower boards have greater width/depth than bath boards providing a greater area of support whilst sitting under a shower, whereas bath boards are narrower to provide more room if you wish to transfer down onto a bath seat. Bath boards can be used to sit on whilst showering.
Bath boards are available in different lengths. To get the right length, measure across the width of your bath, including the bath rims. If the board is too long it will stick out over the side of the bath and there is a chance it could tip up if you sit on the end. If the board is too short it will not have sufficient support.
The board must fit securely across the top of the bath. All have an adjustable fixing system, usually brackets on the underside, which braces the board against the sides of the bath. The angle of some brackets can also be altered to wedge the board against the inside rims of the bath. These should be checked on a regular basis, especially if the board is regularly removed for others to use the bath. The brackets are usually made of plastic and some may be held in position with wing nuts which people with weak or painful hands may find difficult to tighten. The brackets usually have slip-resistant covers to provide extra grip and to prevent marking the bath. These should be checked periodically as they may wear after long-term use.
Bath boards may not fit baths with irregular shaped sides, corner tiling etc. If this is a problem then a wall-mounted bath board may be an option.
Before purchasing a bath board check that the rims of your bath are level and at the same height on both sides of the bath and that the width of the bath rim is at least 25mm on each side of the bath .
To transfer into the bath you reverse towards the board and sit down on it before swinging your legs over the edge to place them on the floor of the bath. It is strongly advised to have grab rails fitted to the wall to hold whilst completing the transfer. Some people find it difficult to lift their legs over the bath rim whilst seated, but this can be helped by using a leg lifter.
These are mounted to the wall beside the bath and can fold up against the wall when not in use. They provide a seated area over the bath which can provide a safe method of transfer in/out of the bath. Some users prefer the fact that wall-mounted bath boards are secured in place and not subject to 'user error' when being refitted.
A transfer bench is a four legged seat which spans over the outer edge of the bath. They usually have a back rest and a single arm/handle on the end inside the bath.
They are used in the same way as a shower/bath board, by reversing towards the bench, sitting down and swinging your legs over the edge to place them on the floor of the bath. Some people may find it easier to use than a board and it offers more support.
A transfer bench does not require support on the bath rim on the far side of the bath, so may be useful when this is not available.
Bath seats are often used in combination with a bath board. It provides a lower sitting platform between the bath board and bottom of the bath. It positions you nearer to, or in, the water. Bathing from the seat still means you will not experience the relaxation of lying in deep water or stretching out in the bath. If you have long legs or a short bath then you may find your knees have to remain bent when seated on the board. Good upper body strength is needed to move yourself between the seat and the board.
Bath seats are sometimes used on their own, without a bath board. You need to be able to step safely into the bath and position yourself onto the seat. After bathing you will need the strength to push yourself up to standing from the seat.
If more able, you may choose to use the bath board and seat to move down, step by step, into the bath. The board and seat can then be removed by a carer, to allow you to stretch out in the bath. Significant effort is required to reverse the process to get out of the bath.
Bath seats are available with backrests and/or armrests and come in different heights. The shorter the height the lower down in the water you sit, but the more effort will be required to stand up from the seat. It is recommended that bath seats are used in conjunction with a slip-resistant bath mat.
There are three types of bath seat:
Some bath seats have backrests, although these provide varying amounts of support. You are advised to check whether the model has a backrest or not. A high backrest will provide much more support than a low one, but if it protrudes above the bath rims the seat cannot be used in conjunction with a bath board. Padded backrests will provide more comfort if you are thin or in pain. Some seats have a cut-out section at the front to make personal cleaning easier. The term 'bath seat' is often used for bath stools.
These consist of a bath board attached to a bath seat and have the advantage of being more stable than two separate units. However, they can be rather bulky and heavy to remove from the bath.
Swivel bath seats fit over the bath and swivel to aid transfers over the bath. These seats have a back support and armrests. Most have a lever to lock the swivel mechanism in place whilst you are sitting down on the seat and when over the bath. These seats do not lower you into the bath.
If you have difficulty lifting your legs over the bath rim when using a bath board or swivel chair, a leg lifter may help.
Manual leg lifters consist of a reinforced strap with a loop on the end. You hook your foot through the loop and then, with your arms, physically lift the loop (and thereby your leg) up to the edge of the bath rim and then down into the bath.
Grab rails will give you secure anchor points with which to steady or manoeuvre yourself. Grab rails in a bathroom should have a ribbed or textured surface to give extra grip when wet.
When standing from a sitting position in the bath you may find it helpful to hold one horizontal wall-fixed grab rail (placed above the bath) with one hand and use the outer rim of the bath with the other hand to push against. There needs to be a 50-60mm clearance between the wall and all handrails.
A rail can be fixed horizontally to the wall 75-100mm above the bath rim. It should start 200mm from the tap end of the bath.
Part of the rail can be fixed at an angle of 13 degrees upwards towards the head end of the bath to provide an inclined support.
The horizontal rail can be used in combination with a bath board. The user may benefit from holding the rail while they sit on the board, then turn and lift their legs in/out of the bath.
When stood in the bath: A rail (at least 500mm long) can be fixed vertically on the wall, 600mm from the tap end of the bath (dimension b in above diagram), with its lower end 200mm above the bath rim . This is most likely to be of use when stood in the bath (perhaps whilst showering) or when standing up from a bath board.
Transferring into the bath: A rail which attaches to both the floor and the ceiling on the outer edge of the bath may provide support when the person is turning round to step in or out of the bath. It is recommended that it should be sited 400mm from the tap end of the bath where it can be reached from a sitting position in the bath. However, its position is likely to be in the way of someone using a bath board, or bath transfer bench, when they swing their legs in/out of the bath. These rails should be fitted by experienced installers, as they take a lot of weight and ceiling fixation can be complicated.
These rails can provide a handhold to assist you up from the bottom of the bath or from a bath seat, and can help you to step into the bath. However, they will make it difficult to transfer your legs into the bath whilst seated on a bath board.
These are screwed to the floor and also clamp onto the side of the bath. They can be adjusted to the thickness of the bath sides and some models are adjustable in height. A vertical loop projects above the bath's sidewall and is held when stepping in/out of the bath. The fixings need to be checked on a regular basis and tightened when necessary.
These only clamp onto the side of the bath and can be adjusted to the thickness of the bath sides. Some models are adjustable in height. As with the floor mounted bath side rails, a vertical loop projects above the sidewall.
As these rails attach solely to the bath itself, great care needs to be taken to ensure that the fixing mechanism - usually a screw system - remains secure. This needs to be checked on a regular basis and tightened when necessary. They are not recommended for attaching to a plastic/acrylic bath as there is a possibility that the surface may crack.
If possible, rails should be both bath- and floor-fixed for full stability.
These fix to the wall behind the taps and rest on the bath rims. When sitting in the bath, the rail will be directly in front of you at about chest height. In this position it will provide stability whilst in the bath. The rail should only have downward pressure applied so the weight is taken by the bath rim; it is not designed for you to pull on to sit down or stand up from the base of the bath.
Ensure that the wall is strong enough to take the weight of this type of rail. Care should be taken that you never bend down underneath the rail (e.g. to reach your feet) when sat in the bath as you could trap your head under the rail.
These also rest on the bath rims, but clamp around the bath taps and are therefore only as strong as the tap fixtures. Taps are not designed to withstand a full body weight pulling against them. The rail should only have downward pressure applied so the weight is taken by the bath rim - it is not designed for you to pull on to sit down or stand up from the base of the bath. These rails fold down to rest on the bath rim and can be folded up against the wall when not required.
If you find it difficult to use a bath board or seat to move yourself up and down from the bottom of the bath, you may wish to try out a bath lift. The vast majority are powered and can be operated either by yourself, for independent bathing, or by a carer. (For carers, bath lifts may help to make the task of assisting someone easier and safer, thus reducing the risk of back injury.) Although expensive, a bath lift may be more cost-effective than installing a special bath or shower.
If you experience difficulty lifting your legs over the bath rim when in a seated position, some bath lifts can be raised higher than the top of the bath rims, which reduces how far you need to raise your legs to clear the bath rim.
These fit inside the bath and can lift you from near the bottom of the bath (approx 80mm) up to the height of the bath rim. You must however still be able to lift your legs over the bath rim if you wish to bathe independently. The majority of bath lifts have a seat and backrest unit made of either solid plastic or mesh fabric, and some have the option of a reclining mechanism to give a more relaxing bath. Some bath lifts do not provide back support. These are not safe for use unless you have very good core stability and strength.
Most seats have side flaps which drop down and rest on the rims on the bath to assist with getting on and off the seat. Some models have a swivelling seat or disc on the seat which helps the person to get on and off. Alternatively, a flexible transfer disc can be placed on top of the seat to provide a means of swivelling.
You will need to ensure that the bath lift of your choice raises to the height of the edge of your particular bath, to provide a smooth transfer over the rim of your bath. Some have adapters that can be added when used in deep baths - check with the supplier.
These bath lifts can be removed for relocation or to allow another member of the family to use the bath. However, their weight and the rubber suction pads can make them difficult to remove. Some models have detachable components making the bath lift easier and safer to handle.
Bath lifts can be powered in a number of ways.
Watch a short demonstration of how to use an electric bath lift to get in and out of the bath.
These use a rechargeable battery to power the lifting motor. The battery must be recharged regularly. Some have a safety system which will not allow the seat to lower to the bottom of the bath if there is not enough remaining battery power to raise the seat fully to the top again. Some have an emergency stop mechanism.
Powered lifts are controlled by a handset which is waterproof and is safe if accidentally immersed in the water. Some handsets can be attached to the side of the bath with suckers so that they are always conveniently positioned. Most handsets have press buttons to control the movement. Some are marked so that they can be used by a bather with sight loss. Rocker or toggle switches are sometimes available and are particularly helpful for a person with weak or painful hands.
As chargers have to be plugged into the mains this activity should be carried out away from the bathroom. On some models the handset only has to be removed and plugged into the charger; others have large batteries which have to be removed for charging. Some chargers can be used with non-British power sources.
Manual bath lifts are operated hydraulically, using the weight of the person to lower the lift and the buoyancy of the water to help to raise the lift. When you are ready to get out of the bath, you sit upright and push down on the bath rims. This releases the hydraulic piston, which is pre-set for your weight. The effort of you pushing down, the hydraulic piston and the water buoyancy is enough to raise you up to the rim of the bath. You would need arm strength and flexibility, plus good core stability and strength, to use a hydraulic bath.
These are inflatable cushions, inflated using an electric pump. You may find the seat unit on an inflatable bath lift less stable, particularly if it has no backrest. They may not be appropriate if you have difficulty with your balance.
NB - For any type of bath lift, check its weight capacity, particularly if you are a large person.
These bath lifts are also called band lifts. They consist of a fabric band on a roller connected to the wall. The band pulls out, runs across the bath rim and slots into a floor-mounted bracket. A battery or mains powered motor gently rotates the roller 'letting out' the band, lowering you into the bath. The roller is rotated in the reverse direction to lift you up.
Their advantage is that they lower you right down to the bottom of the bath and give you the freedom to lie back and soak.
These lifts are not suitable for everyone as they provide no trunk or back support, and you must adjust your position on the band at intervals during ascent and descent to keep yourself central. Thus you need to have good sitting balance in order to use these lifts safely.
A hoist is usually a strong metal frame which may be static (fixed) or mobile. The frame has a lifting mechanism operated manually or powered by electricity. From the frame, or lifting arm/boom, is suspended a sling (on a spreader bar) or a chair, to support and carry a person as they are moved from one place or position to another.
Bath hoists fully support you as the user as they mechanically lift/lower you in/out of the bath. They will usually require the assistance of a carer. Please be aware that there are certain legal health and safety requirements regarding the use of hoists, especially if you employ a private carer.
Floor-fixed bath hoists
Floor-fixed bath hoists have a strong metal vertical column which usually slots into a base plate at the side or end of the bath. This has a seat or slings which pivot from the frame and can be raised or lowered. When raised it clears the bath rim and is lowered down into the bath.
The hoist usually lifts a rigid plastic bath chair with simple arm rests/bars which raise and lower each side. On some models the seat is detachable from the hoist and will fit onto a mobile chassis frame once out of the bath, allowing the person to be wheeled from the bathroom. The chassis may also be designed to allow the seat to be positioned over a toilet.
The hoisting mechanism may be manual or electronically powered, controlled with a remote handset. Manual hoists are operated by a winding handle designed to be operated by a carer. Powered hoists most often use a rechargeable battery which will need charging regularly. You operate the controls independently via a handset.
Hoists which provide a sling support
Although a few of the floor-fixed bath hoists have the option of using slings, most people who need the additional support gained from a sling will use a mobile or ceiling track hoist. It is better to use mesh slings in the bath as they allow the water to drain away easily.
A small mobile hoist can be used for many handling tasks in and around the home. However, if you need to be moved from one place to another, it is better to use an overhead track hoist or a sanichair. A mobile hoist can be heavy and difficult to manoeuvre, especially in confined spaces such as bathrooms, and the occupant can feel particularly vulnerable in transit. The hoist legs must fit under the bath to position the bather. This will require a minimum space of 11cm under the bath and the side panel will need to be removed or have a hole cut into it. Storage space for the hoist also needs to be considered.
Battery powered hoists are easier to operate than manual hoists as the motor takes the person's weight, but the battery needs to be charged regularly.
A ceiling track hoist is a permanent installation into a home, or other environment, which allows a service user, held in a sling, to be moved along a single or network of tracks between locations. It may be possible to create a track which allows you to move in the sling from the bed to the bathroom, where you can use the toilet and the bath or shower. It is more expensive to install, but it requires less space and less effort from the carer.
Ceiling track hoists provide a powered lift of the service user, but may then be powered or manually moved between locations (traversed). The motor is usually at track height. In order to charge it has to be moved to a charging station when not in use.
A structural survey is always required before a ceiling track hoist can be installed. Structural alterations may be necessary to enable the installation, such as strengthening the ceiling, or adapting the top of the doorframe to take the track.
When planning to replace a bath consider:
Depending on the kind and design of the alternative bath, you are advised to consider the need for installing additional grab rails.
Baths are available which incorporate an integral swivel seat that lifts you up, over and down into the bath. The seat may include a leg raising mechanism to lift your feet over the bath rim. Most have a moulded seat, limiting your ability to recline.
When the seat has been raised above the bath rim, it can be swivelled outwards, either manually or automatically, for easier transfers. The height of the seat edge is important, especially if you need to brace your knees in order to stand upright, or need a level transfer from a wheelchair seat. A few systems have the facility to raise and lower the seat outside the bath.
The lifting mechanism is either manual or mains powered, controlled by the bather or a carer using a handset.
These baths have a door in the side or front that you can step through to walk into/out of the bath. Although there are no high sides to negotiate, there is a low step beneath the door. Full length baths with a door are available, but will then require you to be able to sit down/get up from the bottom of the bath. A bath board and seat might also be required.
Walk in baths are also available with an integral seat moulded into the shape. These tend to be shorter in length, therefore reducing legroom, and may well be too cramped if you experience stiffness in the hips and knees. Those that are square take up less room in the bathroom, but if the door is outward opening, space will be needed to accommodate the swing.
The bath has to be empty before you enter it and then filled when you close the door. When exiting, the water needs to be drained before you open the door. This filling and drainage causes a delay during which you may become chilled, so consider keeping the bathroom well heated during use.
Check the height of the internal seat to make sure you are able to lower yourself down and stand up from it with ease. The moulded seat is supportive, but will limit your ability to recline. If you are unsteady on your feet, make sure the taps, plug and door controls can be reached from the seated position if you plan to bathe independently.
The bottom of a shallow bath is higher than a standard bath. This may make it easier for you to negotiate getting in and out.
These baths have a seat built into the moulding of the bath so that you do not have to sit on the bottom of the bath. They have no transfer system and, like a bath seat, you must have fairly strong arms to lift yourself up and down. Many have cut away sides and a small corner ledge for you to perch on whilst transferring your legs into the bath.
These combined function pieces of equipment provide a height-adjustable platform with sides which can be raised and lowered. With the sides lowered they can be used as a drying or changing platform, raised they can be used for showering and with the sides in the highest position they can function as a shallow bath.
The height of these baths can be adjusted, either mechanically or electrically. This is designed to reduce the need for a carer to bend over the bath if you require assistance.
You may be able to step into the bath at its lowest level and then be raised to a convenient height. However, remember that the water usually needs to drain away before you can get out. These baths are not often used in a domestic setting.
In these designs, the concept of a height adjustable bath has been combined with the benefits of a step-in bath. The interior of the bath is moulded to provide a supportive, reclined seated position. It also has a swing-up side panel. The whole bath is able to tilt forward, bringing the moulded seat into an upright position. With the side panel lifted, you are able to transfer sideways into the bath. Once the side is lowered, the bath can be tilted back, putting you in a reclined position.
As with a walk in bath, the bath can only be filled once the user is in the bath and must be drained before they leave the bath, giving a time period when they may possibly get chilled.
Care must be taken when using any bath cushion or insert that they will not slip accidentally. Check all fixing mechanisms regularly and replace when they are looking worn or broken.
Plastic covered foam cushions can be used to line the bath to make someone who is frail more comfortable, or to increase your safety if you have involuntary movements. Shaped cushion inserts are also available for some of the moulded plastic bath seats and lifts.
These are large waterproof, mouldable cushions which are filled with polystyrene beads. They are available in different shapes to support various parts of the body. They will conform to your shape - this shape can be semi-permanently fixed when the air inside is removed using a pump. They are secured to the side of the bath with suckers.
Head cushions improve comfort when lying back in the bath. They are fixed to the bath with suction pads.
If you require pressure care, it should be provided in all daily living activities, i.e. not only as a pressure cushion for the wheelchair, but also in bed, in the bath and on the commode or toilet. Bath cushions should have a waterproof outer cover and a heavy inner substance which enables the cushion to remain submerged.
Certain groups of people are more vulnerable to scalding from hot water, including:
If hot water used for showering or bathing is above 44 °C there is increased risk of serious injury or fatality, especially where large areas of the body are exposed to high temperatures. (Health and Safety Executive 2012).
The Department of Health (2016) recommends the temperature for bathing should be no higher than 44oC and showering at no higher than 41oC. For babies, the temperature should be no higher than 37oC.
Thermostatic mixing valves
A ‘point of use’ or ‘outlet’ thermostatic mixing valve (TMV) is a valve that blends hot water with cold water to ensure constant, safe shower and bath outlet temperatures, preventing scalding. They may be called thermostat taps. They maintain the pre-set temperatures even if the water pressure varies when other appliances are used and provide a high level of protection against scalding and thermal shock.
When looking at thermostatic mixing valves check for TMV2 certification. This means that the product meets national and international standards (BS EN 1111:2017 and BS EN 1287:2017) and is considered suitable for installation in domestic properties. Purchasing a TMV2 compliant valve is an assurance that a new bathroom will meet the requirements for safe use.
The BEAB Care Mark has been developed to demonstrate that water heater products comply with additional requirements to existing safety standards, which take into account the needs of people in care situations such as older people and people with disabilities. It is a useful indicator when considering a shower system for anyone who has additional needs in their own homes.
A BEAB CARE Mark approved product will ensure stable outlet water temperatures under normal supply variations. In addition, the product will protect from scalding under rapid and abnormal supply variations, without adjustment by the user.
Bath temperature indicators show when the temperature of the bath is above a safe level by changing colour or giving a reading of the water temperature. Some are preset within a safe range, which is usually 34-37oC for the bath. When the temperature of the water goes higher than this, they may emit a warning such as a change of colour or sound an alarm.
Some can also sound an alarm to warn of a dangerous water level which could lead to flooding.
These emit an audible warning when in contact with water and can therefore be used to alert you when the bath is full. This can be particularly useful if you have short-term memory loss or low vision.
Mats which are secured with suckers to the bottom of the bath, self-adhesive strips and spray-on slip-resistant material will all help to reduce the risk from slipping in a wet bath. Before every use the mat should be checked to ensure it is securely fixed.
Bath steps provide a step-like platform on the outside of the bath, lessening the height you need to lift your legs to get into the bath. However, they are not suitable for people who have difficulty keeping their balance, and they will not help you to lift your legs out from a deep bath. If used, a slip-resistant step provides a safer surface to stand on, and a grab rail mounted on the wall may provide a secure handhold to grip whilst using the step.
If you experience difficulty turning your taps on and/or off due to a weak or painful grip, you may wish to consider trying tap turners. These fit onto the top of your existing taps. Most are designed for a particular type of tap (e.g. for cross or bar head taps or for round heads). They are usually colour coded red or blue for hot and cold taps.
Alternatively you could replace your taps with lever taps. These are easier to turn as the lever can be pushed/pulled to operate the tap. On most the lever only needs to turn a quarter of the way around the tap to go from off to fully on.
Bath taps should not be used as a support to pull up on when getting out of the bath - most will not be strong enough to withstand a person’s weight. Strategically positioned grab rails should be used instead.
There are long handled washing and personal care equipment and hand and foot care aids available, designed to help make it easier to reach parts of your body when washing with less stretching or bending. This equipment can be used for washing your feet, back or other hard to reach areas of the body such as between the toes. It may be best to use this equipment whilst seated in your bath, to help avoid any potential difficulty with your balance when reaching with the equipment.
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