Dignity - supporting toilet access and use in frail older people

Good practice guide
Good practices guides focus on providing information on a clinical topic.
Jackie Morris
Date Published:
Last updated: 
10 May 2018

The aim of the "Behind Closed Doors" campaign is to raise awareness that people, whatever their age and physical ability, should be able to choose to use the toilet in private in all care settings.

“Toilet Access and Use” has been chosen as a marker of Human Rights and Dignity. Wide dissemination of our educational leaflets, decision aides, standards and check lists to voluntary groups, patient and carer groups as well as to care staff, will make patients aware of what they should expect. Giving people back control over their most private of functions will enhance their independence and rehabilitation, reduce lengths of stay and promote continence.

The campaign emphasises the importance of the environment, as well as care practices and will help in the future commissioning of facilities. It provides commissioners, chief executives and inspectors a measure of good practice and clinical governance.

The Department of Health publication, A New Ambition for Old Age described how some healthcare staff  demonstrate deep-rooted negative attitudes and negative behaviour towards older people. They recommend that each NHS Setting providing care for older people nominate a member of staff to take responsibility for protecting and promoting the dignity of older people.

It is recognised that the dignity of older people is infringed every day in many different ways. These infringements include:

  • visiting at ward rounds
  • split back night dresses
  • inappropriate hoists
  • mixed sex wards on Medical Admissions Units
  • patients wearing pads without underwear
  • ward curtains or night dresses or smocks which do not fit properly exposing patients or allowing mooning
  • hoisting patients without covers.
  • patients being referred to as bed blockers, social problems

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.


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.

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.


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


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


All toilets, commodes and bed pans must be clean.


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.