When a pee costs tens of thousands of pounds.

People used to call going to the toilet “Spending a penny” because that’s the coin you had to put in the slot in a public toilet. These days not being able to spend a penny in the right place at the right time can end up costing your family a fortune.

Incontinence is one of the major reasons why people with dementia have to move to a care home when they have dementia. Family carers find it harder to manage toilet problems than any other behavioural symptom.

But incontinence is not inevitable in dementia. If it happens in the early stages, the reason is probably difficulty in getting to the toilet in time. The person might forget to go, or they might not leave enough time to get there and get out of their clothes before they start to void urine or faeces. It’s potentially embarrassing and very inconvenient and increases the cost for the carers. Having a routine of reminding them helps, but it can give rise to arguments.

Design of the home

In some cases, design of the home or care home causes difficulty for the person to find and use the toilet. Few people have an ensuite toilet in their bedroom at home. In addition, the person needs a toilet for convenience near where they spend most of the day. That would probably be in the living room and if they live in a house with an upstairs bathroom, that’s a problem.

Lighting can be an issue at night. Too much light will prevent sleep. A movement sensor that switches on the light when the person gets out of bed at night is very useful.

In a newly designed care home or specifically designed housing it’s essential to make dementia friendly toilets. Apart from location and layout, you need to consider the necessity to have enough room for someone to help the person if they have a stroke or other physical problem which means they can’t go to the bathroom on their own. I’ve seen many care home toilets where a person of my build (substantial) would not be able to get into the space to help a resident in need. Architects, please have a rugby playing, chunky, care assistant in mind when designing these, rather than a willowy angel.  Why do you keep putting the loo up against a wall? If the person has a stroke on that side they can’t push themselves up into a standing position when finished and I can’t get in beside them to help wipe or to help them to stand. You only had one job to do, which was to make the WC accessible to frail elderly residents and without that space it’s no better than any other cubicle.

Mirrors can be a problem

You need them for grooming, but if the person with dementia doesn’t recognise their own face anymore, they will logically conclude that they are being stared at by a stranger through a hole in the wall. There are many practical ways of covering up a mirror, including a roller blind. Keep the light bright but try to avoid glare. Grab bars, toilet seats and hand towels which have a contrasting colour to the background will help. Shiny floors might seem to be wet and so should be avoided because they reduce the confidence of the person to walk over them. On the ASK Sara website, you will see many bits of kit that will help to avoid flooding accidents. It’s easy to control water temperature to avoid scalding risk.

Even at home. You can have a lock on the toilet door that allows opening from the outside if help is needed. Only recently, I met an older woman whose husband with dementia managed to kick and badly bruise her while she tried to retrieve him from behind the inward opening toilet door in their house where he had fallen on the floor. It’s time for them to have an outward opening bathroom door. Think about this early for yourself. He also often used the wall mounted toilet paper holder as a grab bar when getting on and off the toilet which meant it ripped off the wall. That caused his fall in the first place.

With care homes being so expensive and waiting times for social work assessment to get into one so long, it’s a shame to have to go there earlier than needed, and managing continence is one important part of that.

There’s much more on this and other tips on my blog