Author: Liz.Lepley

Over the last six months, Faizal has been experiencing issues with his continence. Before this, Faizal was well-regulated and hoisted onto a T40 commode/shower chair to open his bowels and pass urine; however, more frequently, Faizal can’t wait. This has become a concern for Faizal, Nadia and the district nursing service, who are increasingly concerned about pressure damage. Nadia’s primary concern is that overnight, she struggles to move Faizal, which means he is lying in his soiled pad all evening.

Faizal and Nadia were visited the following week by an OT from social services, and they discussed the potential for Nadia to be able to support her husband overnight. It is agreed that hoisting is unrealistic as Faizal states he isn’t always aware when he has opened his bowels or passed urine. The OT discusses a strategy of making it possible for Nadia to turn her husband, clean him and change his pad on her own overnight.

Nadia discusses with the carers the possibility of hoisting Faizal onto the commode overnight on her own. The carers advise her that it is illegal to hoist single-handedly, and they will have to report this to social services if they think this is what she is doing. Nadia discusses this with the district nurse when she visits, who advises that the carers’ advice doesn’t sound quite right and refers her to the local social services team for an urgent Occupational Therapy (OT) assessment to see how Nadia can support her husband overnight.

The OT arranges for a Ceiling Track Hoist (CTH) to replace the current mobile hoist, and a bed management system is provided. The OT looks at Grace’s wish to continue to use the toilet and sit out in a chair. When assessing Grace’s postural needs, the OT establishes that a well-fitted shower chair that can fit over the toilet and support Grace at the hips and the lower thoracic area would help her maintain a good upright position. The OT chooses a T40 shower chair which he builds in his local stores to Grace’s measurements. The T40 height is adjusted so it moves easily over the toilet, allowing Grace to use the toilet as usual and making it easy for one handler.

The OT picks a Dartex seat that is more comfortable than standard material coverings and side support that help hold the hips and the lower thoracic area comfortably, preventing Grace from leaning – making toileting and showering a more pleasant experience. The OT also provides a lap strap to stop Grace from sliding forward over time and holding the hips in an optimal position.