Strategies for using the bathroom on the job
The prospect of spending eight to 10 hours a day at work can be terrifying when you need assistance to use the bathroom. Here’s a look at some strategies and products that can make life a little more comfortable outside your comfort zone.
Popping the question
It all starts with a request by the employee for specific bathroom accommodations.
In that case, employers still must consider other options, such as providing longer breaks so the employee can travel to an accessible restroom or allowing him or her to work from home.
Employers must do more to accommodate employees than they would in making modifications for the general public, says Linda Batiste, principal consultant for the Job Accommodation Network (JAN). But at the same time, they have more flexibility to find something that works for that employee’s unique needs.
|When Aimee Wehmeier worked for State Farm Insurance, the company moved a wall to make the restroom larger to suit her needs. The investment was a good one — Wehmeier remained on the job almost 10 years.|
When Aimee Wehmeier, who has type 2 spinal muscular atrophy (SMA2), worked as an auto claims representative for State Farm Insurance in the late 1990s, her employer modified its already ADA-compliant restroom to meet her specific needs.
“I waited until after I got the job [to discuss the needed modifications] — I didn’t know what they would say,” says Wehmeier, 37. “I figured all I could do is ask, and they could either say ‘yes’ or ‘no.’”
Wehmeier needed a larger restroom that would fit a cot so she could lie down to remove her back brace and clothing. State Farm moved a wall to make the restroom larger and provided a cot.
State Farm’s investment paid off for them — Wehmeier devoted nine-and-a-half years to the corporation, and employees with similar needs also could use the new facility.
|Rasa Szepelak and her Voc Rehab case manager explored many different options for her Plantation, Fla., workplace bathroom accommodations.|
Sometimes renovations just aren’t feasible. Customs broker Rasa Szepelak of Plantation, Fla., found herself in that situation.
Szepelak, 56, who has ALS (amyotrophic lateral sclerosis), was able to fit into the small employee bathroom until she got a power wheelchair in 2006.
Her local office of the Florida Department of Vocational Rehabilitation (Voc Rehab) determined the bathroom couldn’t be made accessible without remodeling the whole office. Some other solution was required.
“My Voc Rehab case manager and I looked at everything, including going to the restaurant and gas station down the street to use the bathroom,” says Szepelak, who works full time. “My problem is, once my ride leaves in the morning, I don’t have anybody to take me down to these facilities.
Using a Port-a-Potty or commode won’t work because there’s nowhere to put it, says Szepelak. The company offered her the option of working from home, but she prefers working in the office for now.
“I like interacting with my fellow co-workers, and if I stayed home all day long, I’d be going nuts all by myself,” she says.
Szepelak’s solution, for now, is to wear pull-up incontinence underwear to work, mostly as a precaution.
“For the most part, I don’t need them,” she says. “For that time that you actually do need it — when you’re stuck in traffic and you know you’re not going to make it home — it’s been a godsend.”
Anything that attaches to the toilet or restroom wall, ceiling or floor is considered a “structural need” and is the financial responsibility of the employer.
|The GoOnTheGo portable urinal from Excretec minimizes the risk of spills even when turned up-side-down.|
This includes such things as grab bars, which can go a long way toward providing accessibility. They usually attach to the wall next to the toilet, but if no wall is handy or more bars are needed, bars can be mounted on the wall behind the toilet and either flipped down or bolted in place next to the stool. Other grab bar options are poles that attach to the ceiling and floor, and removable grab bars.
Low-set toilets can be raised with toilet seat risers, which are available with handles, legs or a wider base for additional support. There also are toilet elevators that mount under the toilet and raise the entire unit.
Lifts provide another option. Toilet lifts attach to, or are used over, the toilet, slowly lowering and raising users. More expensive models are electric or water-powered and operate with the touch of a button. Self-powered lifts are less expensive, but require some upper body strength to use.
Patient lifts, which lift the user out of the wheelchair and onto the toilet, may or may not be considered the financial responsibility of the employer, says Batiste. This is an area that should be negotiated with the employer.
Lifts can be free-standing mobile units or ceiling- or wall-mounted to conserve space. Some installed lifts, such as the SureHands, are designed for independent use, but mobile lifts require a helper to move them from the wheelchair to the toilet. Help also may be needed to get into the lift sling or to adjust clothing.
Accommodations you provide
Top: Driving Systems’ WAVEGRIP grab bars offer an ergonomic grip pattern.
Below: The Foot Flush by Foot Flush International enables hands-free flushing.
Many useful bathroom accommodations don’t attach to the building and so are considered “personal needs” items that are the financial responsibility of the employee.
One example is a transfer board or transfer bench, made of plastic or wood, that allows users to easily and safely slide from wheelchair to the toilet. Costs vary from under $20 to almost $200.
For some people, urinals are the solution. These require some mobility and upper body strength to use without assistance. Urinals are available for both men and women and can be used while sitting or standing.
|Ag Apparel’s Susan Long Pants have zippers on each side seam for easy removal.|
Urinals for men, costing from $10 to $50, usually have lids to prevent spills. Urinals for women aren’t as easy to use, for obvious anatomical reasons. Although there aren’t as many on the market for women, there are models that look like troughs, funnels or toilet seats. Costs can run from $16 to $70.
Joyce Klein, Anchorage, Alaska, has myotonic muscular dystrophy (MMD, also called DM). Her weakening muscles make it hard to get up from a seated position without assistance. Klein, 62, who is now retired, swears by her “pee like a man,” which is the nickname she gave her Freshette by International Sani-Fem because it allowed her to urinate while standing.
Adapted clothing makes bathroom trips easier and quicker. Available in a variety of styles, including professional attire, adapted clothing may feature Velcro, elastic, or side zippers and snaps for easy opening and removal.
Open-back slacks, available online from Silverts (www.silverts.com) run from $15 to $60. They look like regular slacks when the wearer is sitting in a wheelchair, but the backside actually is an open flap that provides access to the toilet without removing them. Similarly, cotton skirts and dresses worn without underwear can make life easier in the bathroom for women.
Think outside the bathroom
Like Rasa Szepelak, some people prefer the peace of mind that comes from wearing incontinence pads and liners, adult diapers and disposable or reusable pull-up protective underwear.
|Maddak’s Bolt-On Elevated Toilet Seat with Arms combines a toilet seat riser with safety handles for added security and help getting on and off the seat.|
Available in a variety of absorbencies, incontinence products draw moisture away from the body to prevent rashes or skin breakdown, while controlling odor and protecting clothing.
Disposable adult diapers generally come in bags of 14 to 22 for $16 to $35 or cases of 62 to 75 for $50 to $75. Reusable protective underwear costs from $12 to $40.
Another option is a urine collection systems which generally consists of an internal or external catheter, tubing and a collection device such as a leg bag.
|BioDerm’s Liberty external male catheter attaches differently than condom catheters.|
External catheters fit over the male anatomy like a condom and should be changed once a day. Connected to a tube that’s attached to a collection device, the disposable sheaths are held in place with adhesive.
Companies have been working on an effective female external catheter, but at present the technology still has its share of glitches.
Opinions differ on internal catheters, such as Foley catheters that are inserted into the urethra, or suprapubic catheters that are surgically inserted into the bladder through the abdomen.
|Toilet lifters raise and lower users in a safe, controlled manner. (Shown: Power Toilet aid by Stand Aid)|
Most medical experts warn against indwelling catheters, due to the danger of infection. They note that the risk of infection from introducing anything foreign into the body far outweighs any convenience.
The key to safely using internal catheters, say those who use and like them, is to strictly follow protocols, including proper hygiene and drinking enough water to prevent clogs and infections. Some people seem to have better luck than others. A urologist can provide more information.
“I personally would never give it up,” read a listserv entry from a woman with ALS who has used an indwelling Foley catheter for six years. The catheter is changed every three to four weeks. “I live on my own, go with girlfriends for unlimited coffee and never have to worry about bathrooms.”
|Getting bathroom assistance from a co-worker can be made safer by using a patient lift.|
Some employers are willing to pay personal care attendants to help employees with disabilities use the restroom, but it’s not required by law. However, the Equal Employment Opportunity Commission’s informal guidelines do require employers to consider letting employees self-pay a personal attendant to help them at work, if there’s no undue hardship, such as a security issue.
Besides paid attendants, some people ask friends or family members to meet them at their workplace a few times a day for restroom breaks.
Another approach is to get permission to ask other employees for assistance. Employers may refuse of course, perhaps due to fears of lost work time or liability if someone gets hurt, and co-workers may refuse for a wide variety of reasons.
But some people are fine with it. That’s the system I use in my work at MDA National Headquarters. I posted fliers on the bathroom doors and bulletin boards asking for volunteers to help me transfer in the bathroom using a portable lift — no heavy lifting or personal care required. (I monitor my liquid intake so usually I only go twice a day.)
Eight people volunteered, meaning I don’t monopolize any one person’s time.
Don’t give up
Every situation is different, but if you need help using the restroom, one of these methods — or some combination — may work for you and your employer.
Be creative and keep looking, advises Batiste, adding, “I’m hoping something in the future is done to make a better system, so [using the bathroom] is not a hangup for people getting work or keeping work."
It may seem like a solution to the bathroom problem, but going all day without fluids and not using the bathroom can be dangerous, says Lora Clawson, nurse practitioner at the MDA/ALS Center at Johns Hopkins University in Baltimore.
Signs of dehydration include a dry, sticky mouth and darker-colored urine. Mental fuzziness, dizziness and light-headedness also warn of the need for more fluids.
Clawson recommends drinking six to eight 8-ounce glasses a day of water and other nonalcoholic, noncaffeinated fluids. It sounds like a lot, but taking small sips throughout the day may make it easier to handle.
She also recommends urinating several times a day to avoid a urinary tract infection, which is the main risk of “holding it.” There is some evidence that infrequent urination also may be linked to bladder cancer.
Workplaces built after January 1992 that offer restrooms to employees must include an accessible restroom. In workplaces built before January 1992, employers must consider each employee’s need on a case-bycase basis, meaning they can wait until there’s an employee with a disability to make the restroom accessible.
Whenever the workplace was built, employers must consider whatever changes would allow employees to use the restroom, such as adding another grab bar or installing a toilet lift.
“It’s supposed to be a process where the employer and the employee work together to come up with options, and that’s where JAN comes into play,” Batiste says. “They can call us and we can brainstorm with them and try to come up with different ways to keep the person working and also be able to use the restroom.”
For more information, call JAN at (800) 526-7234 or visit www.jan.wvu.edu.