Bathroom adaptive equipment is often overlooked as a potential need for a family until it is almost too late. Whether the child has gotten too heavy to lift and manage for bathing or the caregiver has a hurt back. The best time to secure adaptive equipment for the bathroom is before it gets to that point. Generally, it is recommended to start using a bath chair when a child no longer fits into an infant tub and is unable to sit independently. It is also highly recommended to use a bath seat with any child that is prone to seizures to assist with decreasing risk of injury. Toileting equipment is recommended when it is age appropriate to begin toilet training, a child shows interest or intent towards toileting, or when a child is not able to sit on the toilet safely or independently in order to complete toileting activities.
While bathing equipment is vital for increased safety while bathing, it is not deemed a medical necessity. Unfortunately, the legislative powers that be have determined that a person can be cleaned just as effectively with a sponge bath; therefore it is not covered by insurance. Occasionally waiver services will provide the funds to purchase a bath seat. The only way to encourage change is for those most affected, parents, caregivers, and children, to contact their congressional representatives and ask them to reconsider coverage for adaptive bathing equipment. The average cost of an adult bath seat is 25-150 dollars versus 300 dollars plus. Bathing is not just about getting clean. The water, especially if warm helps to relax tight muscles. This helps to make dressing and range of motion easier while potentially decreasing the pain level of the child. Bathing helps to really clean any residual urine and fecal matter that might be left on the skin better than a cloth. This promotes increased skin integrity. One of the number one causes of bedsores and skin ulcers is prolonged exposure to bodily fluids/waste without being properly cleaned. The acid and prolonged moisture begins to break down the skin composition and integrity. Bathing also just makes a person feel good. Adaptive equipment for the bathtub just makes sense from a safety perspective. A child can drown in as little as 1 inch of water. This is a frightening statistic, especially if a child is unable to sit on their own or lift their head up. A fall or slip in the tub could lead to serious injury and possibly death if not immediately noticed. It is imperative that a child who has a seizure disorder or is unable to independently maintain their balance be properly supported and secured in the bathtub.
Now that the importance of bathing has been discussed, let’s discuss toileting and then all equipment can be discussed. Toileting is a very important component in overall health. Many children take medication which causes constipation and then medication to reduce these side effects. It is difficult to complete everything that needs to be done on the toilet if a child is not properly supported. There are many ways to introduce toileting. First, develop some type of communication with the child, whether a sign, approximation, word, gesture, etc. to let the caregiver know when the toilet is needed. Second, if a child is showing irritation after soiling a brief or is showing interest in toileting, it is a good time to start. Third, adaptive toileting seats are appropriate with a time-void or bowel program. Fourth, if needed, place the child on the toilet every hour at first and 20 minutes after each meal. Lastly, make a big deal about successes, not accidents. They will happen. A reward chart is a good reinforce. Have the child receive a sticker or check mark in a box on a grid each time they are successful. Once the grid is full, there is a larger reward, like a toy or book.
Toileting is a very private and personal thing. Many children when learning to use the toilet want to be left alone while they use the restroom. This is a right of privacy that children with special needs do not always have. Using the restroom in private is not a luxury, it should be standard. This is where adaptive equipment aids the child and caregiver. It gives the child the support that is needed for toileting successfully and the confidence that they can do it. It also begins to give age appropriate independence and respect for privacy to the child. This privacy can also extend to showering by placing a small towel or washcloth over the child’s private parts to reassure them that their privacy and modesty is respected. After all, what adolescent or teenager wants to be naked in front of their parents or caregivers?
So, if adaptive bathing equipment is not covered by insurance, is a toileting device? Generally speaking, yes. An adaptive toileting system is an approved piece of equipment most of the time; but not always. For this reason, it is sometimes better to look for the system that will give you the most bang for your buck or the individual pieces that best meet the needs of the child. Adaptive bathroom equipment can be divided into 2 major categories, single purpose and multi-purpose. Single purpose equipment implies that it is strictly for toileting or bathing. Examples include the Columbia Wrap Around, Aquanaut, Leckey Advance Bath Seat, Shower Buddy TubDipper, and the Columbia Elite. Many of the shower/bath chairs have optional bases that will allow the seat to be used in either a tub or a roll in shower. Multi-purpose adaptive bathroom equipment can be used for more than one thing. It can be used for toileting and bathing. Examples include the Snug Seat Flamingo, Rifton Blue Wave Toileting system and the Columbia Omni.
How do I know what to pick? First, determine what is needed the most. Is it something for bathing, toileting, or both? If the need is isolated to one area, read the descriptions, look at the sizes and measurements for the equipment, and consider how it will need to be stored when not in use. This helps to narrow down the choices. Next, try to predict what a child might need 1-3 years down the road and 4-5 years down the road. Does the bathroom equipment need to serve more than one purpose or will the needs be the same. If the equipment will need to be used for bathing and toileting, one will have to consider if one piece of equipment will meet all future needs or if 2 separate pieces are better. Finally, consider all upcoming surgeries and their potential impact (i.e. growth spurts and weight gain with feeding tube) and any planned or anticipated home remodeling projects. In addition, there are many options to secure the additional funding to offset the cost of the desired bathroom equipment. Many times the United Way can direct a family to organizations to help, local Kiwanis, Knights of Columbus and Lions Clubs also tend to donate money. There are available grants from United Health Care of up to $5000 for adaptive equipment (you don't even have to have UHC insurance to qualify), and organizations that assist with funding special needs equipment (i.e. Children's Charity Fund).
If at any time, it becomes too confusing or difficult to navigate through the world of bathroom equipment or any other piece of equipment, please do not hesitate to contact us here at Tadpole Adaptive. We are always willing to provide unbiased and informed guidance.