Taking your Client to the Toilet

This is an area you know about, and have been trained in, however, it is useful to look at the basics from time to time, to remind ourselves of how to handle toileting, when working with new clients.

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Considering emotions:

Helping a client use the toilet or a bedpan can be a difficult and sometimes embarrassing process. It is important to consider the client’s dignity and privacy at all times. Talk to and reassure the client as you assist them, asking for permission at each step before proceeding.

When making house visits, PrimeCarers advises carers to ask clients if they need to use the toilet. This can be done in the same manner you would remind them to take any medication. This is especially recommended for those suffering from dementia.

Helping someone use the toilet:

If the client is not bedridden, they may be able to use the toilet or a commode. However, they may still require your support to walk, sit and stand. If the client is bedridden or cannot stand easily, contact their district nurse or GP to discuss alternative toileting arrangements. Other options include:

• a bedpan or urinal container
• a removable raised toilet seat
• handrails near to the toilet
• bed or chair raisers
• a hoist, or
• a commode 

If the client needs help with undoing buttons or removing items of clothing before using the toilet, make sure they have something to hold on to, such as a support rail. If using a commode, ensure the breaks are on during use.

While the client is using the toilet or commode, make sure to give them as much privacy as possible. Make sure nobody can see inside by closing the curtains or pulling the door to. Ask the client to tell you when they are finished and ready for your help again.

The client may be able, or prefer to attempt, cleaning themselves. In these cases, they may still require some assistance, such as passing them the toilet paper. If the client is unable to clean themselves, you may need to help them more directly. Consider the following guidance:

• First, help them stand or lean into an accessible position.
• Clean the client with toilet paper, followed by wet wipes or dry wipes if necessary. The client may also wish to be washed with clean water. Be sure to dispose of wipes in a biodegradable nappy sack, as flushing them down the toilet can cause drain blockages.
• For female clients, wipe front-to-back to help prevent infections such as UTIs.
• Once finished, assist the client back to the chair or bed, remembering to wash the commode if used.
• After removing your gloves, wash your hands thoroughly with soap and water.

Making it easier to use the toilet:

• Clients with poor eyesight or dementia may struggle to make out objects. Having a brightly coloured toilet seat, or lights that go around the toilet itself, can make things much easier for the client.
• When going to the toilet, some people prefer a regular routine. To ensure the client does not feel rushed, always allow them plenty of time.
• If there’s a long hallway leading to the toilet, consider placing a chair halfway. This will allow the client to rest if necessary.
• Keep the route to the toilet free from clutter to prevent trips or falls.
• Keep a hallway light on at night so the client can safely reach the toilet.
• If there are communication difficulties, consider putting pictures or arrows on doors, indicating where to go and what to do.

Helping someone use a bedpan:

If the client struggles to get out of bed, they may need to use a bedpan. Be sure to talk them through the process as you go along, and ALWAYS ask their permission before proceeding. Ask the client to sit up in bed if possible. Support them with plenty of pillows to ensure their back is in an upright position. If their bed is adjustable, adjust it so that their head and back are raised.

• If the client is able to lift their back and bottom from the bed (sometimes called ‘making a bridge’), ask them to do so. Slide a waterproof pad underneath them to catch any spills.
• Supporting their lower back with one hand, place the curved edge of the bedpan underneath their buttocks. Then ask them to rest their weight on the pan. Cover them with a towel to maintain their dignity.
• If they cannot lift their back, you may need to roll them on to their side. With the bedpan and waterproof pad in place, roll them back onto the bedpan.
• Once they are finished, ask them to raise their buttocks again and slide the pan out gently while supporting their lower back. If they are not able to do so, you may need to roll the client onto their side.
• While cleaning the client, cover the bedpan with a paper towel and put it to one side (such as on a chair or table).

To clean:

• Wipe the client with toilet paper, then wet wipes if required. Dry the area gently.
• Roll the client to a comfortable position and cover them with a sheet so they are less exposed.
• Offer the client some wet wipes and antibacterial gel to wash their hands. Alternatively, use soap, water and a dry wipe.
• Replace the client’s clothing and duvet. Empty the bedpan in the toilet, and wash with hot water. Ensure the bedpan is dry before it is reused. If you are using a bedpan, make sure you dispose of it correctly.

For more information and guidance, visit:

• https://www.alzheimers.org.uk/get-support/daily-living/toilet-accidents-support-advice
• https://www.completecareshop.co.uk/toileting-aids/ 
• https://www.caregiver.org/toileting-dementia
• https://www.mariecurie.org.uk/help/support/being-there/caring/helping-someone-use-the-toilet
• http://dailycaring.com/safety-tips-elderly-toilet-use/
• http://www.agedcarehub.nz/caregivers/caregivers-how-to-s/toileting-continence-care