Problem Solvers

5 Bariatric Bath Fundamentals

Simple, but important techniques, products HME providers can leverage to ensure bath safety for bariatric patients.

Bathing is something that many people consider to be a basic, everyday task. However, forpatient groups with special needs, such as bariatric patients, bathing isn’t always so basic.

According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults are obese, which is defined as a body mass index of 30 or higher. Many of these adultsmany fall into the morbidly obese category—with a BMI of 35 or higher.

In addition to the health problems that bariatric patients may face, the home, and in particular the bathroom, can be a stressful, dangerous place. Bariatric patients are subject to the same fall risks as seniors and other patient groups, and, in some cases, the results of their falls can be moredevastating given their weight.

“People with that much weight and size, it is more difficult for them to get around in every way, shape and form, whether it be the physical space constraints of where they are trying to get into or the lack of balance and mobility they have because of their size,” explains John O’Callaghan, vice president of home accessibility and personal care services at Premier HomeCare in Louisville, Ky.

However, there are simple things providers can do to help ensure their bariatric patients canbathe independently, comfortably, and most important, safely.

1. Products must be rated for bariatric weights

It should go without saying, but there is no cutting corners when it comes to weight limitations on bath safety products. To be considered a grab bar adequate for bariatric needs, the product needs to have to a 500 lb. rating. However, things can get tricky with products like bath seats or bathbenches. Bath benches typically start at 250 lbs. and go up to 350 lbs.

“Above 350 is bariatric, and once you get into that sometimes they are hard to fit into your standard tub,” O’Callaghan explains. “Then you have to go to a transfer bench, which is wherehalf the bench sits outside the shower.”

In the event of a fall, if a bariatric patient tries to grab a typical sink on the way down, it will not be able to support his or her weight. There are pedestal sinks on the market, rated to be able to be leaned on, that can be installed into reinforced walls and but a lot of homeowners don’t havemoney or don’t want to do that.

Bariatric patients often turn to the towel rack and toilet paper holder that came installed with the home, but these are NOT the right solutions and are ripe with hazards. The right types ofbariatric rated grab bars and transfer devices in the bathroom are a much safer solution.

“A lot of people use the towel rack and toilet paper holder to help people navigate their bathroom as their safety bars and they are falling off or loose or jittery,” says O’Callaghan. “There are tons of products that are toilet paper holders and towel bars rated as grab bars. They serve a dual purpose. They are a grab bar, first and foremost, with a 500 lb. rating if installed correctly, but they are also a towel rack, toilet paper holder, soap dish holders, shampoo holders. That’s what wesee a lot of around the sink and toilet area.”

Also it’s important to keep in mind that a lot of times you can’t install a grab bar on a typical vanity because it’s made of pressed wood. For those cases, there are transfer devices that can be put in the middle of the floor, such as a floor-to-ceiling pole, between the toilet and tub that makeit easier for a bariatric person to grab, stand up and move around the bathroom.

2. Use some non-bariatric products

All it takes is one look around a bariatric person’s bathroom for O’Callaghan to recommend twoproducts that make bathing easier and safer.

“We walk into a house and we’ll see a handheld shower that’s, in your typical bathtub, hanging straight down from the shower head that’s about 4 inches above the drain, and then we’ll see a bath chair or a bath bench that’s about 6 to 12 inches from the water spigot,” he says. “That tells us a whole lot right there. It tells us that they’re doing that because they don’t want to have to get up and down to turn the water on and off, and they don’t want to have to get up and down toreach their shower head.”

That’s when he recommends a shower head with a pause control on it and an extra handheldshower holder either on the bath seat/bench itself or on the wall.

“It just opens up a whole world for somebody because they don’t have to sit 6 inches from their water spout, they can turn the water on, adjust the temperature, put the handheld shower by their bath bench, pause it so it’s not spraying all over the place, get in, sit down, unpause it and wash.It just makes a big difference for independent bathing, whether you’re bariatric or not.”

3. Give patients some slack

A quick-fix safety measure is the addition of an inexpensive longer shower hose. It should be long enough to allow the patient to bath safely without having to stretch, lean, or adopt an awkwardpose or posture that could lead to a fall.

“The other thing that is a constraint that you see a lot of times in those scenarios is the hose on the shower isn’t long enough. You can’t really reach them behind your back, it comes to about your shoulder, and that’s it so you’re contorting yourself trying to get it all around you,” says O’Callaghan. “That’s what we call simple and affordable bath safety. You don’t have to spend a million dollars. We say for $400 we can get someone to independent bathing or a little morecomfortable bathing. That applies to everybody, but particularly bariatric folks.”

4. Consider replacing the bathtub with shower only

After addressing some of the more simple issues with inexpensive products and bariatric rated grab bars, the next level up from there would be to take out the bathtub and install an accessible shower. For the bariatric patient, this would be a shower that’s rated for 500 lbs. O’Callaghan alsorecommends showers with a curtain as opposed to a door.

“With a bariatric person you have a physical space constraint of them getting in and out, even if it’s a current shower with a door on it, it might be hard for them to navigate through that doorand then sit down on a bench and things like that,” he explains.

5. Use a higher height toilet that supports bariatric weights

Higher height commodes help with what O’Callaghan calls “a controlled fall” onto the toilet.

“Your typical commode might be 14 or so inches off the ground. When you go to a higher height, it’s 3 inches higher, closer to 17 inches. When you have someone that’s bariatric, it’s hard for them to get up and down with all of that weight on their knees and joints. If they have to go sitdown to 14-inch low levels, they can’t get up,” he says.

He says that raised toilet seats also can make a difference, but they can come with safety concerns as well. Because the hinges or bolts that go through the porcelain in the back are tightenedby vinyl or plastic nuts, that creates a weak point for a toilet seat.

“The difficultly with raised toilet seats is they’re not an integral part of the toilet, so if you have a large person and you have a raised toilet that maybe has a little looseness to it, that can be adangerous situation,” he says.

O’Callaghan recommends a product with rubber stoppers on the bottom side, so when the toilet seat is set down the rubber stoppers are curved to match the exact curvature of the top of the bowl. If a person put a little pressure on the seat and tries to move it left or right, it won’tmove. The stoppers grip the top of the porcelain to prevent the toilet seat from moving.

Ultimately, simple, straightforward bath safety tools and techniques such as these don’t just keep bariatric patients safe and sound, it restores their confidence in a critical, every day part of life that, when otherwise taken away from them, leaves them feeling demeaned and marginalized. No one should be afraid to use their bathroom for fear of injury. It’s often the little things make bathing uncomfortable, make people scared or just not bathe or make it so that they can’t do it independently. That’s where thoughtful HME providers can make a difference in patients’ lives.“Until you do this a lot, you don’t spend a lot of time thinking about it,” O’Callaghan says.

This article originally appeared in the December 2012 issue of HME Business.

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