Activities of Daily Living: Bathroom Edition

Created 10/2019

The bathroom is one of the places in your home where the ability to do things independently is extremely important. While in the bathroom, most people want to be alone if at all possible.

Many activities of daily living such as showering, bathing, shaving, brushing your hair, and brushing your teeth are tasks that many people take for granted. On the contrary, people with limb differences may find these tasks very difficult to do alone. Your daily grooming routine may be made up of movements that require hand and wrist dexterity and flexibility, arm extension and rotation, and more global skills such as balance, strength, and coordination. When these movements are difficult or painful, grooming can be a frustrating or even risky experience when done without the aid of assistive devices.

This reality can be seen by the fact that more accidents occur in the bathroom than in any other room in the house. In fact, the U.S. Consumer Product Safety Commission reports that within a year more than 110,000 accidents occur in bathtubs and showers alone.

With a little thought and ingenuity, however, you can find ways to do these activities with either at-home DIY projects or easily available and comparably inexpensive aids. Ultimately, you should never neglect safety for convenience.

Unfortunately, because assistive devices for independent living are produced by only a small number of manufacturers, there is not a large market for these devices and, therefore, they can be expensive. Medicare Part B covers some Durable Medical Equipment, but this coverage primarily concerns devices that increase stability while walking such as canes and other support items. To have Medicare cover bathroom safety devices, you must have a prescription for

• Durable Equipment
• That is useful only when sick or hurt
• That must be for in-home use only
• That is required by medical necessity and
• Is for a device that has a lifetime of at least three years

Even when Medicare covers these devices, the program pays only 80%, meaning that you, the consumer, are responsible for the remaining 20%. When considering a remodel of your bathroom, it is highly recommended that you contact your insurance carrier directly. While Medicare covers medically necessary durable devices, the program DOES NOT cover “convenience items.”  Only your insurance carrier can outline how they define each category.

In addition to contacting your insurance carrier, the Amputee Coalition highly recommends that you reach out to your state’s SHIP department (State Health Insurance Assistance Program). SHIPs provide free, in-depth, unbiased, one-on-one health insurance counseling and assistance to Medicare beneficiaries, their families, and caregivers. These professionals are third-party experts on your state’s Medicare and Medicaid programs, but these professionals do not work for any of these programs or affiliated companies. They work for you! Their purpose is to empower consumers like yourself to get the most out of their coverage. Also, SHIP professionals can offer insight on how to navigate the appeals and denial process. Find your state’s SHIP department at https://www.shiptacenter.org/about-medicare/regional-ship-location.

Prosthetic hands and hooks often do not grip small or thin items as well as the human hand does. As a result, these items might be difficult to control or might slip out of your prosthesis. A simple and inexpensive solution for this problem is to add thicker, less slippery handles to such items as your toothbrush, comb, hairbrush, bath brush and flossing device.

If you can’t find these items with readymade built-up handles, you can make their handles larger and easier to grip by wrapping them with a short section of foam rubber tubing. Alternatively, you can simply insert the item into a bicycle handle grip.

An easy technique for brushing your teeth without arms is to use a battery-powered toothbrush. If you can get toothpaste on it, turn it on, and get it in your mouth, you can use your mouth to move it around inside and let the vibrating toothbrush do the rest.

Flossing with the traditional string-style floss would clearly be difficult for onehanded persons. Today, however, onehanded persons can take advantage of the newer “tuning fork” flossing tools, which do not require two hands.

If you have no hands and normally dry your hair with a hairdryer, you can mount the hairdryer on the wall and simply move your head around in front of it until your hair is dry. The bracket that holds the dryer should allow movement, however, so that the dryer can be tilted in various directions.

When it comes to shaving, an electric rotary razor is much kinder and gentler than a straight-edge blade. Flexible-headed razors require less hand movement to reach awkward places and are often bulky enough to be used with a prosthesis.

If you use a wheelchair at the sink, any exposed pipes underneath should be wrapped to avoid burning your legs. Whether you’re seated or on your knees in a locked wheelchair, a folded towel or a thin pillow on the front edge of the counter will make long periods at the sink much more bearable.

Finally, you’ll probably like to look at yourself in the mirror to make sure you don’t leave toothpaste on your chin or unknowingly leave the house with “bad hair.” Two simple ways to make sure that you have access to a mirror where you need it is to either install a full-length mirror or to mount a magnifying mirror in a convenient location — preferably next to an electrical outlet.

Grab bars help support you while you are getting in to and out of the bathtub. They are a tool to help reduce your risk of a fall. They can be installed on to walls or on to the side of the tub. Properly installed wall-mounted grab bars are considered to be more stable than tub-mounted bars. Tub-mounted bars don’t require structural support from a wall and have the advantage of easy removal, but they must be used with caution because they can easily (and suddenly) detach if fastened incorrectly. Test any set of grab bars carefully in advance by applying force in several directions before relying on them for support.

Although they come in different shapes and sizes, grab bars have common safety characteristics and requirements. Flanges on the ends of the wall-mounted bar should have sturdy screws for installation — preferably into wall studs. There should be enough room between the bar and the wall for you to get a good grip. Any set of grab bars should be made of plastic or rust-resistant metal with a rough surface to prevent slipping.

A bath seat or transfer seat can help if you have difficulty with your balance. A water-resistant chair or bench is ideal for shower or bath use because it allows you to sit at a normal height while washing. A bench that extends to the outside of the tub will enable you to sit down and then slide to the inside of the tub. You can also use a regular plastic camper seat or patio chair – ideally one with openings in the seat to allow drainage. Nonslip pads glued to the feet of the chair will help to stabilize it as well as protect the tub enamel.

A bench or chair placed beside the tub can be helpful too. You may want to cut the legs shorter so that the bench or chair matches the height of the tub. A rubber mat on the side of the tub may also help to prevent slipping during transfer.

Bathing is easier if everything you need is close at hand. If you bathe in a tub rather than showering, you can buy or make a shelf to sit firmly on the edges of the tub to hold soaps, brushes, shampoos or even a magazine or candle.

Another option is a wire-frame shower caddy with suction cups that can be attached to whatever surface and at whatever height is most comfortable for your use. You can also find a variety of rings and hooks to add more items to the caddy such as liquid soap and a loofa. Other helpful tools can be items such as squeeze bottles of soap and shampoo which are designed to hang on a hook, a long-handled back brush, or wearable “bath mitts.”

One of the most common problems that amputees encounter is maintaining balance while bathing and climbing in and out of the bathtub. Most tubs don’t have adequate slip-resistant finishes. To reduce the chance of a slip injury, your bathtub floor should have either a rubber mat anchored with suction cups or nonslip adhesive strips. Bath strips should be placed close to each other so that very little of the bathtub floor comes in contact with your foot.

You may want to try one of the many hand-held showerheads on the market, particularly if you shower in a seated position. Handheld units also allow getting into the tub without stepping directly into the stream of water which may reduce the chance of slipping. Some models are made of rubber to fit over the tub tap, while some require installation but allow more freedom of movement. Make sure you can reach the mounting bracket from your seat and that the hose is long enough for you to spray all parts of your body. The handle should be easy to grip, and any knobs or controls should be easy to use (even when wet).

Various floor materials respond differently to being wet. Some new ceramic tiles and rubber-based linoleum have better slip-resistance. Keep the floor clear of rugs or small objects on which you could slip or trip and use cleaning products that don’t leave a slippery film. If you do use a bathmat, you should make sure it is firmly affixed to the floor in the same way described above – with suction cups or adhesive strips.

Scalding is another hazard of showering. Always check the water temperature before you get into the shower. This is particularly important for people with diabetes. Diabetic nerve damage can leave your feet numb and unable to feel heat, cold, or even pain. If you can’t feel pain, you may not immediately notice blisters until they worsen, which can lead to open wounds or infection.

For more ideas, consult an occupational therapist or independent living specialist in your area. These professionals are trained to work with people of all ages and levels of ability to identify and recommend assistive devices or methods to help them cope with daily living activities.

American Occupational Therapy Association
301/652-2682
http://www.aota.org

Center for Independent Living Locator
http://www.ilru.org/projects/cil-net/cil-center-and-association-directory

Special Considerations for Multiple Limb Amputation
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228106/

Special Considerations – Rehabilitation Without Prostheses: Functional Skills Training
http://www.oandplibrary.org/alp/chap30-01.asp

It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care.

© Amputee Coalition. Local reproduction for use by Amputee Coalition constituents is permitted as long as this copyright information is included. Organizations or individuals wishing to reprint this article in other publications, including other websites must contact the Amputee Coalition for permission to do so, by emailing a request to rc@amputee-coalition.org.