Below is a handout that I created for the Senior Care staff as an inservice that I provided to them. It covers a variety of scenarios that can be more easily absorbed in a written format than the time it could take to review this info verbally. If you had a caregiver that needed a handout/training like this, it should be modified/individualized for their specific family member.
Toileting training for Senior Care staff
·
Assisting
patients with toileting is about balancing safety needs and the importance of
privacy
o Provide your patients with as much privacy to go to
the bathroom as possible, but yours and their safety always comes first
·
Reduce a
patient’s likelihood of rushing to prevent an accident by encouraging
individuals to go to the bathroom more regularly
·
Explain what you’re doing before
you start moving so your older adult knows what to expect – “I’m going to help
you stand up now.” “I am going to
pull your pants up now.”
·
Your safety
o Always
protect your back by bending your knees instead of from your waist.
o Ask
the individual to use the wheelchair arms or toilet seat arms for support
rather than holding on to your shoulders.
§
Once they have released their grasp
of the wheelchair/toilet arms they should hold onto your forearms
·
Patient safety
when sitting down and standing up from toilet
o When performing transfers from a wheelchair to the
toilet
§
Place wheelchair
at a 90 degree angle to the toilet
§
Always lock wheels
once in position
§
Do not hold onto
a patient’s belt loops on their waist as a means of holding onto the patient as
they can easily tear and result in a patient falling
§
Use a gait belt when necessary
·
Such as when certain individual’s
clothing may be too loose for you to hold onto to provide extra leverage
·
Gait belt goes snuggly above the
hips
§
If their legs are not strong,
place your knees in front of theirs (called blocking) while they stand to
prevent their feet from slipping out in front of them.
§
Undo belt and button/zipper on
pants before having individual stand up to decrease their standing time (as
long as their pants are not too loose that they will immediately fall down)
§
Tell the patient to start sitting
down only when they feel the chair on the back on their legs and/or when you
say it is time
o Hold
on to their trunk and hips to keep them stable. Don’t pull their arms or legs, it
could injure fragile extremities or throw them off-balance.
o If
one side is weaker than the other, stand on the patient’s weaker side for extra
steadiness and support
o If
you see that a patient uses the arm rests in a regular chair to help themselves
stand up/sit down safely then they also rely on arm rests for safely sitting on
a toilet
§
Individuals who “plop” into a
seat quickly typically would be safer using a toilet with arm rests
·
In a bathroom with only a grab
bar on the wall be cautious as certain patients may not be strong enough on
their one side to fully support their weight when sitting down.
o In
these cases have them only use toilets with two arms or allow them to hold your
forearm with their 2nd hand for assistance
o Don’t
let them hold on to the walker as they sit and stand because it could tip over
and cause a fall.
· Patient safety when patient is removing/putting on clothing
& providing hygiene assistance after toileting
o Consider how much physical assistance the individual
needs to put on/remove their clothing when toileting
§
Some individuals
might surprise you and can do more than you expect without your physical assistance
·
Consider giving
someone just a little bit of extra time to do it themselves
·
Consider giving
verbal instructions on what steps they need to take next
·
For example,
when safe, if a person cannot bend over safely to pull their pants up, consider
pulling it up part of their leg, but then letting them finish the rest
o Have the clothing pulled up their legs as high as
possible before standing to decrease the need for them or you to bend over
o Encourage the patient to hold onto the grab bar or
walker with one hand while pulling up their clothing with the other
o If
the person can support their own weight standing still, have them hold onto the
grab bar or walker while you provide physical assistance to clean or clothe
them
o If
the person cannot stand without you holding him/her up then the patient should
have a gait belt on, hold the gait belt with one hand and provide physical
assistance to clean or clothe them with the other
o If
the patient needs your assistance for wiping, be aware of how long the person
has been standing. Some patients
may need a sitting rest break on the toilet before you can finish cleaning them
and putting their clothes back on.
§ Wiping
can be done sitting or standing depending on the patient’s needs/abilities, but
having them sit during hygiene tasks is always safer
