If you are an occupational therapist involved in designing bathroom adaptations, many of your recommendations will focus on the motor, processing, and sensory needs of the older and disabled person. But how often do we step back and consider the ‘occupation’, the everyday activities people want, need and have to perform in the bathroom?
Occupations are influenced by our developmental stage of life. Several developmental psychology theories attempt to explain these changes – including the changes in the everyday activities people want, need, and have to perform as they age. So in this blog, we take a step back and reflect on how five different life stages might influence the everyday activities an older or disabled person might perform and how this might influence what you recommend when supporting the design of a bathroom adaptation. While not an exhaustive list, the following hints and tips are helpful reminders of factors to consider when designing a bathroom. The five life stages we discuss are:
- Infancy to toddlerhood
- Preschool and early Years
- Adolescence and young adulthood
- Middle adulthood
- Late adulthood.
1. Infancy to toddlerhood
In infancy and toddlerhood, the bathroom is an essential space in the home for parents and carers to spend bonding time with their children. While it is unlikely that an occupational therapist will redesign a whole bathroom for a disabled infant or toddler, they may be working with disabled parents and problem-solving around how they bathe and interact with their infant during bathtime. Adapting tasks tends to be easier when the child is small, as it is possible to use portable baths that can be positioned at a height to suit the disabled parent. But as the child grows, it may be necessary to consider bathing equipment that will help the parent lift an infant or toddler in and out of the bath.
2. Preschool years and early school years
As the child moves into preschool and early school years, the bathroom is still an important place for them to play. But, again, it is unlikely that an occupational therapist will recommend a significant remodelling of the bathroom. Instead, practitioners will need to consider the equipment required to support those children with reduced sitting balance or postural control to engage in play.
Parents may also be thinking about helping the child experience and develop the skills needed to perform personal care tasks in the bathroom, such as getting in and out of the bath, cleaning teeth, and toileting. For parents and occupational therapists, it is not always possible to predict the skills a disabled child will be able to achieve. However, young children must be allowed to experience those tasks if they are to have the opportunity to develop those skills. Although adaptations may not be required, an occupational therapist will need to consider what space is required for any specialist equipment the child will need to experience and participate in personal care tasks in the bathroom.
3. Adolescence and young adulthood
Developing independence in personal care tasks becomes integral to adolescents developing their identity as they move into adulthood. Bathroom adaptations can provide an effective solution for achieving independence at this development stage. For example, removing a bath and installing a wetroom shower area can provide a solution that makes an adolescent independent in maintaining their personal hygiene needs. And even where a young person cannot achieve complete independence, it is essential to carry out a strength-based activity analysis. This analysis can help the occupational therapist and adolescent to consider how using space and choosing the ‘right’ fixtures & fittings, and equipment can maximise their dignity, choice and control over those activities of daily living.
4. Middle adulthood
Parenthood influences the occupations people perform in middle adulthood. So when designing a bathroom for a disabled parent, it is vital to balance their needs alongside those of the whole family. For example, there might be need to accommodate both a bath for the children of the family and a shower for the disabled parent. Or having adjustable height fixtures and fittings means that each family member can adjust features such as the sink and toilet to accommodate their needs.
Depending on the parent’s needs, it might be necessary and appropriate to recommend a separate bathroom for the disabled parent, particularly if they need time to perform personal care tasks, which might impact the routine of other family members. Again, this is where a thorough activity analysis can help the occupational therapist articulate why separate bathroom facilities are essential and not just desirable.
5. Late adulthood
Finally, late adulthood. As with the adolescence stage, choice and control in activities of daily living, including those performed in the bathroom, becomes increasingly important as we age and experience those age-related changes. Designing ‘out’ common environmental barriers in the home environment is one of the most effective ways to support people to age in place. Even before a person develops motor, processing and sensory changes associated with very late adulthood, removing barriers such as baths and recommending stylish grabrails and inclusively designed fixtures and fittings will help to accommodate the changes associated with the ageing process.