Single Handed Care: Toilet guidance for professionals

The Office of National statistics report of 2018 stated that by 2041 they project that over 25% of the UK population will be over 65. A Kings Fund report in 2019 stated that the average life expectancy for men and women is set to rise to 83 and 87 years respectively. This ever-growing elderly population places a massive strain on the UK health and social care infrastructure and services.

Additionally, social care in the UK has twice the average turnover of staff at 31% than compared to the national average across industries of 15% (The Health Foundation 2019). Being able to provide care packages and maintain consistency for clients in the community can therefore be a challenge; some authorities still struggling to provide toilet calls longer than 15 minutes (Albert 2017). Single handed care packages would mean more flexibility in care provision as well as reducing costs and providing value/efficiency. Understandably, local authorities are keen to invest in this, in order to secure long term resources for its residents requiring support at home.

Simply put it is looking at a particular care package to establish if through risk assessment, moving and handling tasks can be modified to enable one carer to perform a task where traditionally two had assisted.

In the last few years improvements in moving and handling equipment design, such as the Closomat Aerolet and Palma Vita wash & dry toilet, has meant that more than ever before care packages that might have required two people could potentially be reduced following a review and risk assessment.

Using a Person, Environment & Occupational model (Law et al 1996) we consider how Closomat equipment can help support the care of people in their own homes and also support reducing care packages as well as a single-handed care approach.

In figure 1 we see the occupational therapy Person, Environment, Occupation (PEO) model which represents the relationship between a person, their environment and the impact on occupational engagement. It highlights that individuals should not be labelled as disabled, more that environments are disabling.

PEO sees the person as more than just a medical condition but rather what motivates them, interests, their degree of autonomy, physical and cognitive level relative to their relationship to the environment.

The environment does not just refer to physical boundaries but also relatives, carers, friends, professionals and it is the relationship between these two domains that effects the person’s occupational performance within self-care, productivity and leisure. (Law et al 1996)

This model alongside using a risk assessment can help us determine in a holistic way the best way to support a person and achieve their maximum Occupational performance, by improving the fit between the person and their environment. This can have a positive effect on the number of carers required on a toilet call for example if the fit between the person and the environment is improved.

Improving the fit between the person and the environment in order that a person can better carry out the occupation of self-care is what Closomat products such as the Aerolet and Palma Vita wash & dry toilet are designed to do.

Discover how the Closomat Aerolet and wash & dry toilet can improve the fit and improve an individual’s occupational performance, leading to a reduced need for carer support and increased likelihood of single-handed care.

Mobile
Not Mobile
Poor Grip

Mobile

Person
Mobile; needs some assistance with standing. Balance problems and a history of falls. Difficulty cleaning themselves after opening their bowels. No family available to support. The person’s confidence has been negatively affected.

Environment
Two carers required to support with standing, and to assist with cleaning after bowel opening. Raised toilet seat and frame in situ. Calls can be as short as 15 minutes.

Occupation
Despite some equipment being in place the person still needs help to stand from the toilet and to clean himself and his confidence is not improving due to a dependence on carer support. The poor fit between the person and the environment is affecting the person’s ability to confidently carry out self-care. The person remains at risk of falls and dependent on care staff.

Closomat
The Aerolet would be ideal in this circumstance. The height adjustment features of the Aerolet would enable the person to more easily extend their legs to stand; the arm controls would give the user greater control and confidence.The cleaning and drying function of the Closomat wash & dry toilet would eliminate the need for a carer to support to do this. Potentially only requiring one carer to assist with clothing. Ultimately improving the fit between the person and their environment.

Not mobile

Person
This person is not mobile and is hoist transferred for all transfers including toileting. The person does not like the intrusion of carers and the varying times of carer’s calls and the often rushed manner with which they attend to personal care.

Environment
The person lives with their partner who would like to support with care and is physically fit enough to support, however at present the number of transfers needed to support with toileting, cleaning and showering mean that on their own this would take too long.

Occupation
The person is hoisted using a conventional mobile hoist, onto a shower chair which is used for toileting and shower and hoisted back onto the bed often to be cleaned after. This is a large number of transfers, which take time and two carers to manoeuvre the hoist.

Closomat
A Closomat wash & dry toilet, such as the Palma Vita, would reduce the number of transfers needed, to assist with personal care and showering. The installation of a Likorall™ ceiling track hoist and training for the person’s partner could open up the feasibility of the partner attending to the care on their own. A Likorall™ ceiling track hoist could run between rooms or simply have separate Likorall™ ceiling track hoists which make hoisting easier, using a compatible separate shower chair such as the Prism T40.

Poor grip

Person
The person has poor grip and needs help with meal preparation, shopping, and all aspects of personal care including toileting. The person would like to be able to attend to his own personal care after toileting, rather than depend on someone else.

Environment
The person lives with his partner who assists with personal care after toileting, however works part time.

Occupation
The person’s poor grip means they are dependent on care support for cleaning as they cannot grip toilet paper or flush the toilet. Availability of support is not constant throughout the day, causing problems for the person needing to access the toilet through the day.

Closomat
A Closomat wash & dry toilet with specialist controls such as elbow controls would improve the fit between the person and his environment, as a power grip or pinch grip will not be required to complete the task, allowing them to use the toilet independently. The Closomat wash & dry toilet will clean and dry the person. They would then only be required to stand and adjust their clothes.

Advances in equipment design and technology such as Closomat’s Palma Vita wash & dry toilet, availability of Lokorall™ ceiling track hoists and bed manoeuvrability equipment, for example has made single handed care a more practical option for therapists completing risk assessments and handling plans. The option of single handed care is something local authorities are having to look at given the ever growing population and demands on its services, this set against a back drop of a higher than national average staff turnover.

The right equipment can improve the fit between the person and their environment, giving them more independence and choice. This is evident in the analysis in fig 2, which shows how wash & dry toilets can improve the fit between the person and the environment, increasing independence and reducing the need for support. The same can be said of the Aerolet which can aid in transfers, potentially reducing the need for a carer to assist with standing, or Likorall™ ceiling track hoists which can also reduce the need for a second carer. However, despite the advances in equipment and design, a thorough moving and handling risk assessment is the foundation of every care plan.

• Albert A (2017) “‘Undignified’ 15 minute home care visits: still the norm for 34 councils” – homecare.co.uk
• Dudley council (2018) “A guide to single handed care” – dudley.gov.uk
• Health and Safety Executive (2016) “Manual Handling. Manual Handling Operations Regulations 1992 4th Edition (as amended)” HSE
• Law, M., Cooper, B, Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23
• The Office of national statistics (2017) “Overview of the UK population: November 2018” – ons.gov.uk
• Sefton Council (2018) – sefton.gov.uk
• Randal M (2017) “Overview of the UK Population” – ons.gov.uk
• The Kings Fund: Future trends: – kingsfund.org.uk
• The Health Foundation (2019) – health.org.uk