British Geriatrics Society
Behind Closed Doors
Delivering dignity in toilet access and use
(April 2007)

A new campaign to ensure vulnerable people get to use the toilet in private has been launched on18 April 2007 by a group of organisations led by the British Geriatrics Society (BGS). A best practice toolkit has been designed to ensure older people in care homes and hospitals use the toilet in private.

Toilet access and use behind closed doors is also being used by the campaigners as an important marker of the implementation of dignity and human rights to the most vulnerable.

Current hospital practice often falls short of respecting the dignity and privacy of older patients, some of whom are the most vulnerable in society. Staff sometimes ignore requests to use the toilet, tell people to wait or use incontinence pads, or leave people who are incontinent wet or soiled.

The new toolkit includes guidelines to give older people the freedom to use the toilet in private when they want in hospital or a care home – and advises how that can be successfully implemented. Organisations are being asked to encourage lay people to undertake environmental audits to assess toilet facilities, using a checklist produced alongside the standards.

Dr Jackie Morris, BGS Policy Committee Chair, said “Providing services that put the dignity of older people at the centre is fundamental. It is an essential part of their human rights and is supported by the Department of Health. Individual trusts must ensure that resources are allocated to provide and maintain buildings and facilities that are sensitively designed to enable people to use the toilet in private.”

Dr Win Tadd, from the Department of Geriatric Medicine,  Cardiff University , said “Giving people back control over this most private of functions will enhance their independence and rehabilitation, reduce lengths of stay in hospital and promote continence. Protecting the human rights and dignity of older people should be of paramount importance to all health and social care staff.”

“Behind Closed Doors” is part of a wider BGS ‘Dignity’ campaign, which aims to empower and inform older people about their human rights in this area, while educating and influencing care providers and policy makers. By focusing on a taboo older people should have a better experience in hospitals and care homes.

The Dignity campaign has been led by the BGS collaborating with a number of organisations, including Age Concern England; Department of Geriatric Medicine, Cardiff University; Carers UK, Continence Foundation; Help the Aged; In contact; and the Royal College of Nursing.

‘Behind Closed Doors’ is being launched at a parliamentary reception on 18 th April.

For further information and interviews, please contact Linda Cuthbertson on 020 7935 1174 ext.254 or Lucy Widenka on 020 7935 1174 ext.468.

Notes to Editors

Behind Closed Doors Standards:

Access
All people, whatever their age and physical ability, should be able to choose and use the toilet in private. There must be sufficient toilets and equipment available to achieve this.

Timeliness
People who need assistance to use the toilet should be able to request and receive timely and prompt help. People should not be left on the commode or bed pan for longer than necessary.

Equipment for Transfers and Transit
Essential equipment to assist people to gain access to a toilet should be

• readily available
• used for transfer onto a transit chair and on / off the toilet.
• used in a way that respects the persons dignity
• used in a way that avoids unwanted exposure.

Safety
People who are unable to use a toilet alone safely should normally be offered use of a toilet with appropriate safety equipment in place and with supervision if required.

Choice
People’s choice is paramount. Their views should be sought and respected.

Privacy
Privacy and dignity must be preserved. People who are bed bound require special attention.

Cleanliness
All toilets, commodes and bed pans must be clean.

Hygiene
All people in all settings must be enabled to leave the toilet with a clean bottom and washed hands.

Respectful Language
Discussions with people must be respectful and courteous especially in regards to episodes of incontinence.

Environmental Audit
All organisations should encourage a lay person to undertake an environmental audit to assess the toilet facilities.

Download the full campaign document in MS Word

Download pdf leaflet

or download:

Standards (pdf)
Action plan (pdf)
Decision Aid (pdf)
Environmental audit

This campaign has been endorsed by:

Age Concern England

British Geriatrics Society

Department of Geriatric Medicine, Cardiff University

Carers UK

Continence
Foundation

Help the Aged

In contact

Royal College of Nursing