Bathroom Modifications for Orthopedic Patient

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Table of Contents

Patient Information and Condition Requirements
Risks, Needs, and Modifications
Bathroom Layout
Implementation of the Modifications
Conclusion
References

This paper provides a detailed report of the bathroom modifications answering to the clinical needs of the patient, Mrs. Edwards. The recommendations comply with the Australian Standard 1428.1 (2009) for bathroom modifications as to the requirements of the patient based on her medical history. Also, the proposed modifications are aligned with the layout and size of the patient’s bathroom and with the SWEP regulations as to the subsidizing.

Patient Information and Condition Requirements

The patient is Mrs. Betty Edwards, a 79-year old woman undergoing orthopedic rehabilitation after a left total hip joint replacement (THJR), secondary to osteoarthritis. The prior medical history of Mrs. Edwards included such conditions as depression and anxiety, and gastroesophageal reflux disorder (GORD). Besides, fifteen years ago, Mrs. Edwards had the right total hip replacement. Also, she has suffered multiple fractures of her left and right wrists as well as left patella.

According to Messinger-Rapport and Thacker (2003), at least 5% of injuries received by individuals older than 65 years occur due to falls. Due to the diminished healing capacity of the senior people falls are associated with increased morbidity and mortality (Messinger-Rapport & Thacker, 2003). The individuals with OA are characterized by such abnormalities of balance and gait as difficulty rising, poor balance while seated, instability while walking or standing, the need for support; as a result, such individuals are in need of environment modifications and tools that would help them sit, stand, and walk with more confidence and less fear (Messinger-Rapport & Thacker, 2003).

As pointed out by Stevens (2010), the CDC suggests measuring the hazards present at the patients’ homes using a specialized checklist; the prioritized rooms include those used by a patient during a normal week. Based on this approach, the bathroom is one of the first and most important home environments in need of modifications. The guidance outlined by Care and Repair (n. d.) mentions that persons with walking difficulties are to create more space in their homes for better mobility. The Australian Standard 1428.1 (2009) specifies that no objects should be situated within the circulation space in the patient’s bathroom.

Also, the Australian Department for Communities and Social Inclusion (n. d.) insists that a combination of slippery and hard surfaces is a potential hazard for senior citizens with mobility issues. The Department (n. d.) provides a list of easy to apply interventions such as benches and chairs for shower and tubs, handheld showerheads to direct the stream of water, and slip-resistant mats. Another recommendation concerns the taps that may be difficult to turn for a patient such as Mrs. Edwards with multiple fractures in the wrists – a level-style handle and quarter-turn taps are recommended (Department for Communities and Social Inclusion, n. d.).

In addition, Absher (2016) provides the following instructions for the caregivers of the elderly persons in need of support due to mobility issues: the improvement of lighting in the bathroom for better visibility, the elimination of slipping-hazard via the removal of floor rugs that are not slip-resistant, the appropriate marking of the hot and cold water taps in order to avoid scalding that can cause spontaneous fast movements and result in falls.

Finally, the author also recommends removing all the doors that complicate a person’s entrance of the tub or shower, the placement of mirrors on the level suitable for the seated individuals, and to ensure that no objects are on an individual’s way around the bathroom. Since Mrs. Edwards uses a pick-up-frame for support while walking, she requires a sufficient amount of space in order to move without freely.

Risks, Needs, and Modifications

When it comes to bathing toileting, Mrs. Edwards requires a more spacious showing area and some supportive tools such as chairs, rails, rubber ramp, and holders. Mrs. Edwards is able to walk as long as 20 meters independently and without support. That way, the main modifications that are required in order to satisfy her needs involve the provision of support, elimination of the obstacles preventing her movement around the bathroom, and removal of the objects that may carry threats and risks contributing to falls.

Bathroom Layout

The bathroom of Mrs. Edwards is rather small. It contains a single shower cabin, a washbasin, and a toilet. According to the effects inflicted by the condition of the patient, the main areas of problem in her bathroom are the shower cabin and the toilet.

The main inconveniences of the shower involve the step Mrs. Edwards is to manage entering the cabin, the need to stand for a significant amount of time while showering, the small size of the cabin that limits the patient’s movement, the unstable construction of the cabin that may present danger in case of a fall, and the absence of a surface preventing the risk of slipping on the wet floor. As to the toilet, the major challenges for Mrs. Edwards are the absence of rails and holders and the need to lift herself up and sit herself down without reliable supportive tools. Also, the height of the toilet is to be adjusted so that the patient did not have to bend 90 degrees to sit down.

Implementation of the Modifications

Shower

The cabin that is currently present in Mrs. Edward’s bathroom is to be removed completely. It is possible that the patient is able to use it to date, manage the step, and even stand for several minutes. However, the risk of falling is extremely high. Besides, OA is a progressive condition that may deteriorate at any moment, so the need for modification is realistic. The small shower cabin limits the movements of the patient and may cause a fall.

That is why its walls are to be removed. In order to create privacy and also to prevent the water from splashing on the floor wound the shower, the walls are to be replaced by a surrounding curtain. According to the Australian Standard 1428.1-2009, the overall wet areas of the shower is to be 1160 by 1100 mm minimum. The size of the shower cabin is 820 by 830 mm. The wet area surrounded by the curtain is to cover a perimeter of 1100 (the wall where the shower is attached) by 1600 mm.

Also, the wet area should be surrounded by a rubber ramp on the floor for the safer transition from wet to dry floor. Besides, the inside of the shower is to be adjusted to the Australian Standard 1428.1 (2009) and include only the permitted and necessary objects (taps, holders, and showerhead support located at least 600 mm above the grabrail and 900 mm above the floor). The shower hose length is to be at least 1500 mm. The floor of the wet area should be retiled, and have a self-draining waste outlet with a slope in the floor between 1 in 60 and 1 in 80 in the wet area and 1 in 80 and 1 in 100 in the bathroom area.

Also, a self-draining and slip-resistant upwards folding chair with the rounded front corners (10-15 mm radius) is to be installed in the shower. The grabrail and the hooks for clothes are to be within the reachable distance from the seat.

Toilet

Mrs. Edwards’ toilet requires some minor modifications. According to the needs of the patient such as the complicated and painful movement and sore limbs, the height of the toilet seat is to be raised with the help of an over-toiler frame or an elevated toilet seat equipped with the rails for the patient to be able to lift herself up and sit down easier. The proposed model of the seat is called Extra Wide Tall-Ette Elevated Toilet Seat. It comes in two designs – with aluminum and steel frames (the latter is suitable for overweight patients and can support the weight of 274.2 kg). The overall width of the seat is 570 mm, and the width between the grab bars is 460 mm. the seat adds 100 mm to the overall height of the toilet and weights 4.1 kg. SWEP provides the maximum subsidy amount of 90 dollars for all the basic and shower equipment (shower chair and toilet seat).

Conclusion

The modifications proposed for the bathroom of Mrs. Edwards are relatively minor and do not require much intrusion and change. Toiler equipment is easy to install and use. The shower modifications are more complex and time-consuming; however, they ensure the patient’s safety preventing falls and accidents that could endanger her life and health.

References

Australian Standard 1428.1. (2009). Web.

Care and Repair. (n. d.). Making your home a better place to live with arthritis. Web.

Department for Communities and Social Inclusion (n. d.). Bathroom Safety. Web.

Messinger-Rapport, B. J. & Thacker, H. (2003). Mobility: A practical guide to managing osteoarthrosis and falls. Geriatrics, 58(7), 22-29. Web.

Stevens, J. A. (2010). A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. (2nd ed.). Atlanta, GA: CDC. Web.

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