Dementia-friendly environments: Toilets and bathrooms

The bathroom

The bathroom can present a number of challenges for a person with dementia, given they are likely to have problems with their memory or working out what things are. A number of design features can help. For example, contrasting colours will assist a person with dementia to use bathroom facilities. Toilet seats, handrails and towels should all be easy to identify. This means that they should be easy to see and look like the item they are supposed to be. Even something as simple as providing a bar of soap (which should be a different colour from the sink it sits on) can prompt a person to wash their hands when they might forget otherwise.

There are general design suggestions that are worth implementing to make bathrooms and toilets safer.

General improvements

While it’s vital to consider an individual's needs, there are general design suggestions that are worth implementing to make bathrooms and toilets safer.

Always provide handrails, bath seats and non-slip bath mats. Make sure that these are in contrasting colours so that people can see them, even if their eyesight is poor. Make sure that the thermostat for hot water is not set too high, in order to help prevent scalding. The person with dementia may forget to check that water is at a safe temperature.

Use a special bath plug that allows the water to drain away if the bath gets too full. Although flood detectors are available, by the time there is a flood, this situation is already dangerous, with a risk of slipping.

Promoting a pleasant experience

Bathrooms should be furnished and decorated to promote a pleasant experience. Avoid a sterile hospital-like appearance that is pale and where it is hard to see things. People with dementia must be able to see what they need to use, because they may not remember easily (see the Lighting feature in this section). Use open shelving to display toothpaste, brushes, shampoo and so on.

A person could find mirrors disturbing in this and other settings as they may not recognise the person in the mirror as themselves. Cover or remove mirrors if necessary (see the Bedrooms feature in this section).

Baths

Bathing should be a comfortable experience and design can help facilitate this. The water must not be too hot or too deep. A person may prefer to use bubble bath or to have soap in clear water.

Taps should be of traditional appearance (separate hot and cold taps), simple to operate, with clear indications of hot and cold water. This allows the person with dementia to control the situation themselves.

Assistive technology can help avoid the bath being too hot (see the Assistive technology feature in this section), although you have to be careful not to create a noisy alarm that is hard to understand. People can trip over bath mats and some may be anxious about approaching the bath if they are not sure what it is they are about to step on. Non-slip mats, preferably blending with the bath colour, will reduce the risk of slipping in a wet area. However, if you can replace the whole floor with a non-slip surface, you may reduce the need for mats.

Showers

Showers should be level to access and have controls that are easy to use. If the shower door and panels are made of glass, any reflections could cause distress or confusion to a person with dementia. You could overcome this by placing a towel or towels over the shower door. If you have a shower curtain, make it a contrasting colour with everything else in the bathroom. Avoid a jazzy pattern as this could be confusing and distracting.

Wash basins

Soap holders and toothbrush holders could be of contrasting colours to the wash basin. If not, use different-coloured soaps or face flannels to provide the contrast. Some care settings don’t allow the use of sink plugs, in order to prevent flooding. This is unnecessary because you can now buy an inexpensive sink plug which will automatically empty the sink if it gets too full.

Toilets

Toilets must be easy to find. Hang door signs at the right height for an older person and make them visible from as many viewpoints as possible. Seats should be of a contrasting colour to the pan. Some people think that colouring the toilet water can also aid recognition, which might help if the person is peering into the pan before using it. Of course, bright light in the toilet would help people see what is what, but make sure your lighting does not create glare (see the Lighting feature in this section).

Cisterns should be traditional in appearance: push-button designs are relatively new in the UK and an older person with dementia may search around for a lever flush. You can put simple 'push to flush' signs on concealed cisterns. Toilet roll holders, or toilet paper, should be a different colour from the walls and easy to reach. Some toilet paper dispensers are easier to use than others, so pick a simple one.

En-suite bathrooms

These should have low-level lighting overnight to improve visibility without disturbing sleep or a mechanism such as a movement sensor which automatically switches the light on when the person gets out of bed (see the Assistive technology feature in this section). The toilet should be visible from the bedhead position. The reason for this is that you want the person to be able to move between the bed and the toilet as they wish during the night without having to ask for help or being distracted, for as long as they are able to do this. It is more dignified to be able to look after your own needs and this can be made as safe as possible with the right design.

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