Toilet Training is a Disaster

Rebecca Dutton

OTs evaluate how clients get on and off the toilet.  However, aides are the ones who deal with dressing and undressing during toileting.  Aides have large caseloads so they speed up toilet time by doing everything for their clients.  This assistance masks safety issues.

Small weight shifts while pulling my pants up threw me off balance.  I had to repeatedly twist my trunk so my sound could reach across the front of my body to get my underpants over the paralyzed hip and reach behind me to get my underpants over the affected hip in back.  Continue to twist when I pull my pants up over my affected hip.  It took 2 weeks for my standing balance to improve enough for me to feel safe when I pulled my pants up without an aide in the bathroom.
Toileting also requires repeated turning.  After I walk into the bathroom I have to turn 180 degrees to close the door at home or a doctor’s office.  I am facing the door I just closed so I have to turn 180 degrees to walk to the toilet.  When I get to the toilet I have to turn 180 degrees so I can sit down.  I have to turn 180 degrees after I stand up so I can flush the toilet.
OTs do not evaluate gait in the bathroom because ambulation is PT’s domain.  PTs do not evaluate standing balance while twisting the trunk and repeatedly turning 180 degrees because toileting is OT’s domain.  Yet needing 24 hour assistance for toileting can lead to a nursing home.  This is a severe consequence so OTs and PTs need to stop worrying about stepping on each others toes.