Commode bowl used for bedbath

Charlie Barker 28/11/17 Dignity Champions forum

I am a domicliary carer. One of the gents that I look after had a rapid decline and is now pretty much bed bound. I’ve been off for a few days and went in yesterday.
I asked him what are we using for a wash bowl and where is it, he pointed me to the commode bowl. Initially I thought that he was joking. But no, apparently this is what is being used! The commode was only ever used twice, and I bleached it after both uses. And I managed to find something more suitable to use.
I called the office to tell them about someone being washed out of a commode bowl and I was shocked that they barely saw an issue with it.
Is this in my head, or is this totally undignified?

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mike stone 28/11/17

I'm no expert - but it seems undignified, and unsatisfactory, to me. I'll ask on my Twitter feed for views on this.

lindsey swarbrick 28/11/17

I feel this is totally undignified as there is no reason that a suitable wash bowl should not be used. They are readily available and can be purchased at minimum cost. I would not like, or not like anyone I know, to need to use a commode bowl to wash in. This is not in your head and I agree, In my view this does not respect a person’s dignity.

Lindsey Swarbrick
Service Manager, Greenhill House
Leonard Cheshire Disability

Emma Houghton 28/11/17

I'm sorry to say but I can see what you are trying to express but what we must remember is Choice - and some people are happy with making choices that are not always what we would think is the best or even safe sometimes (people can take risks) - therefore before saying that using the commode bowl (clean) is undignified, you should check whether this is the mans choice, - since he said that this is what you were to use, if nothing else at least you have a bowl! Some people would actually get upset if you used something else that they had told you to use too!

Kind regards

mike stone 28/11/17

I asked on Twitter at:

First reply was:

Totally undignified.
Would those in the office use the toilet bowl to wash in however clean it was? Using a commode bowl is no different to using the toilet to wash someone

And, for Emma - I didn't see it, when I read post, as 'the patient chose to have the commode used': I took it that he indicated 'the carers have been using the commode' ? It is also a little more complicated, I think, if there is a safety concern around it: yes, if he is capacitous and he were washing himself 'in an unsafe way' then I think 'that is his choice' - but I suspect that isn't true if another person does the actual washing?

Suzie Lloyd 28/11/17

Not only is this practice undignified, negligent and disrespectful, the
more pertinent objection is on the grounds of infection control.

Suzie Lloyd 28/11/17

On the grounds of COSHH the worker should not be using bleach. A sterilizing agent should be used and in the initial assessment that was carried out any such requirements should have been risk assessed.

The risks to the worker and the Client are as great from using bleach as they are from those of lack of infection control.

lindsey swarbrick 28/11/17

I do agree that choice is always the first port of call. If that is so then I would expect that to be identified.

Lindsey Swarbrick
Service Manager, Greenhill House
Leonard Cheshire Disability

lindsey swarbrick 28/11/17

I believe this post identifies that this is wrong in so many levels. As I stated earlier, the individuals choice should be considered however, as also mentioned this was not made clear and this then opens up to vulnerability, background, understanding etc. It is difficult to fully understand through posts however, the general understanding is to that to wash in a commode is not the right thing to do an many levels.

Lindsey Swarbrick
Service Manager, Greenhill House
Leonard Cheshire Disability

Suzie Lloyd 28/11/17

The person's 'choice' becomes irrelevant in circumstances which might compromise the health and safety of others. There are many misunderstandings around 'Choice/Capacity' and this can be firmly laid at the feet of incompetent trainers and inadequate care providers.

Suzie Lloyd

Emma Houghton 28/11/17

Also Domicillary is different to Homes. Have recently read about Risk and Intermediate care, NICE too

Ayshea Hutchison 28/11/17

Such poor practice I find it totally undignified and degrading.

Brendan Whyte 28/11/17

This appears to be a breach of The PUWER 1998 Regulations Section 4(3). The equipment is being used for purposes for which it was not suitable. There is also the issue of whether there is a case of neglect as it appears someone is failing to provide for the needs of the client i.e not assessing new needs and providing a washing bowl when it is clear they are unable to leave their bed.

James Foad 28/11/17

I agree with the above. Firstly does the have Dementia? Does he have any family? If the gentleman has dementia I would be explaining to him what the commode bowl is used for and that perhaps it might be better to find something else to use as a wash bowl usually by just explaining can change the mind of a person with dementia and still giving that choice but your steering the person away from a bad choice. If the gentleman has family depending on your companies policies you could phone the family member and find out if the man would normally make that sort of choice or if he would be horrified if it was a normal situation.

The question i would be asking myself would be was the gentleman given the choice in the first place? or was the commode bowl used for convenience instead of trying to find something else. As for your company i would be having serious words with the manager or owner. If you still got the same response i would be taking the matter further.

If my Dads carers had done this and my dad had made that choice and my Mum or i hadn't been told or asked about this choice then i would be throwing the carers out and reporting the matter to their office.

Neil Purcell 28/11/17

Can't believe what I'm reading here this is totally unacceptable on every level and bad practice it's not a matter of choice in this situation but control of infection.
27 years working in adult care in the community I'm totally dumbfounded on this never came across anything like it SHAMEFUL .

Vicky Ebanks 28/11/17

Undignified...would you allow yours to be washed in a commode bowl? Management so wrong on so many levels, forget choice... its about doing what's right. Personally I would purchase a wash tub for the individual it's obvious they are not in the right frame of mind. It's all about having a clear conscience!

Emma Houghton 28/11/17

Charlie you said 'The commode was only ever used twice, and I bleached it after both uses'

I can understand if the bowl was mistaken for a wash bowl if not in the commode itself. There would be no infection control issue if it was CLEAN

People can prefer bleach - especially elderly ex health professionals! Disagreeing with these can get you in 'hot' water and be disrespectful

Every situation in the community requires person centred consideration and on its own merits before jumping to conclusions and making judgement

Craig Davies 28/11/17

I find this so hard to read. A commode bowl used?! Even a new member of staff would know not to use this even upon a request. My worry would be the level of support and supervision the staff are receiving. As a dom care provider my self bleach should not be used as this is an irritant to both service users and staff. Reminisce of bleach will remain in the commode bowl and this person has washed his face with it. I would inform then family so they are aware and pass my recommendations to them. Your office seems to not see an issue with this I would leave a note for the family to inform and them and request a wash basin.

Emma Houghton 29/11/17

What is ‘right’ to one person may not be ‘right’ for another. This is The Dignity Council - we shouldn’t impose our own values against anothers wishes. I’ve never had complaints, work safely but also respect individual and family uniqueness otherwise you are out of touch I’ve been told with ‘real’ life and how people live. Many people oppose conforming to care home like rules and prefer their own homes where you can live how you want

Caroline Fennell 06/03/18

I feel like I might have missed something here.
Charlie didn't say that the client requested they used the commode bowl, just that it was being used. I wonder if anyone had asked the client if there was a suitable bowl in the house for washing. Or offered to source a suitable bowl. You wouldn't use the toilet to wash someone so why would this be acceptable?

mike stone 06/03/18

Very good point Caroline - we were told he pointed to it in response to 'what are we using', in the original post. Although I've just looked back - I did make the same point in my own post on 28/11/17. But I think the post did want to explore the question 'is it ever acceptable [to use]?' more generally - and most of us think it shouldn't happen.

Samantha Stone 06/03/18

I find this a very tricky situation. Being involved in dom care for a lot of years, you do come across some practices that aren't in keeping with our own standards.
I'm afraid I would have asked a little more, was he using the bowl as nothing else was available, was it being used for ease, was he oblivious to the fact a bowl can be purchased for as little as a £1, also maybe the gent didn't use the commode with being bed bound and needing support to wash on the bed so therefore the bowl was sterile and safe to use. So many times vulnerable people, and indeed not so vulnerable, do not realise there are other options available or they worry about costs (so many times have I been told off for running a tap to get hot water). As a manager I would have expected this to have been picked up during needs and risk assessments, I then would have gone out of my way to ensure a more suitable bowl was available if it was found the practise would compromise health .

Registered manager