This is a multi-part series to help caregivers learn how to help older adults with their personal care. Activities of Daily Living, or ADLs, are basic self-care tasks. In Part IV, we will focus on how to help adults use the bathroom.
Assist Toileting Elders or Using a Commode
First, assist the older adult to safely get to the bathroom toilet or commode, using any necessary gait devices and proper transferring techniques. Check that there is enough toilet paper and provide privacy. Finally, wash your hands.
Assisting with Bedpan and Urinal
First, get the things you will need (gloves, clean & dry bedpan with cover, bed protector, laundry bag, toilet paper, towel and washcloth, double trash bag). Wash your hands and provide privacy. Put on gloves, then slide bed protector and bedpan under hips, and position the bedpan so it is firmly against the buttocks. Finally, take off your gloves and wash your hands again.
Assisting with Perineal Care
Perineal care refers to the cleaning of external genitalia, surrounding skin, and buttock areas. It is important to protect the older adult’s privacy as much as possible when providing perineal care by covering as much of them as possible. This also helps to keep them warm. It's an important part when you help adults use the bathroom.
Follow standard precautions whenever you provide perineal care, because your hands will be coming into contact with body fluids. This protects both you and the older adult. Perineal care is generally performed during bathing, but for older adults who are incontinent or have a urinary catheter, you will have to do it more often to keep the skin healthy and free of infection.
Before beginning perineal care, raise or lower the bed at a comfortable working height. Position the older adult with their knees bent and legs slightly apart, unless there is some reason not to. Drape the area with a towel.
For men, place a towel over his abdomen and cover his legs with a sheet or towel. Once you have organized all supplies and you are ready to begin providing care, fold the blanket or towel back to expose the perineal area. Wash the patient’s upper thighs and inguinal area. Clean the tip of the penis at the urethral meatus in a circular motion from the center outward. Wash the shaft of the penis from the tip to the base in a downward motion.
Wash the scrotum including the underlying skin folds. If the male is not circumcised, retract the foreskin and clean the tip of the penis at the urethral meatus in a circular motion from the center outward. Then return the foreskin to its original position. Lastly, wash the outer buttocks then inner buttocks.
For women, place a towel over her abdomen so that one corner is pointing in the direction of her head and the other corner is covering the perineal area. Secure the lateral corner of the blanket loosely around her legs. When you are ready to begin, fold the corner covering the perineal area back onto the patient’s abdomen to expose the area you will bathe. Clean the perineal area from front to back, to prevent contamination from the rectal area to the urethra. It is also important to use a separate area of the washcloth for each area or a new washcloth if the one you are using becomes soiled. After you wash and thoroughly rinse each area, pat them dry to prevent skin irritation.
If the older adult is continent, once you have completed perineal cleaning and drying, apply a barrier cream (such as Desitin) to the perineum to help protect the skin.
When you help adults use the bathroom, or help him or her clean up afterward, remember to provide them with privacy and respect. Be sure to wear gloves for the safety of yourself and the elder you’re working with.