The plumber had just installed low-flow toilets at our home, subsidized by our drought-conscious city.
The new commodes had the added benefit of being quieter with higher seats, as well, so after our first "test drive," my husband and I both chuckled at how the humble upgrade could have such a positive impact on our quality of life.
Most healthy individuals visit the bathroom between four and ten times a day.  For seniors who might be struggling with bathroom independence, that can be a daunting task physically, mentally, emotionally, socially.
Bathroom Use Impacts Quality of Life
Giving older adults the tools and support they need to successfully manage this most basic function can have a tremendous impact on their quality of life.
The first step is to address the elephant in the (bath)room. Toileting is a universal function and one of our earliest accomplishments as a child. But it is also an intensely private matter. So, when a grown man or woman is having trouble making it in time, they may be understandably ashamed and reluctant to discuss the problem. Family members, in particular, may feel uncomfortable bringing the topic up with the parent who potty trained them once upon a time.
"Family caregivers may be reluctant to help their parent because they want to protect their dignity. They may feel extreme sadness that this is just another sign their loved one is failing," says aging parent coach Judy Burkle.
Help with Toileting Improves Health and Outlook on Life
However, research shows that when seniors have appropriate care for such tasks as going to the bathroom, their overall health and outlook on life improve. The ability to care for themselves with as little intervention as possible gives them an increased sense of dignity and accomplishment, validating their identity. The greater the sense of dignity, the greater the quality of life, and that is more important to many aging seniors than how long they live. 
The causes for toileting troubles are myriad, ranging from confusion to mobility issues to visual impairment or illness. The family must discuss the matter with the primary care physician to determine the specific problem to determine the best solution.
- Cognitive: they may forget they need to use the bathroom, forget where it is, or not recognize the toilet (for example, the gentleman with dementia who used the sofa instead, raising and then carefully lowering the seat cushion when he was finished)
- Mobility: trouble walking quickly enough resulting in accidents
- Visual: depth perception
- Verbal: difficulty communicating their need to go
- Emotional: discouragement, embarrassment, fear of falling, or failure
- Physical: difficulty managing clothing or the toilet paper, muscle weakness
- Illness: temporary incontinence due to a urinary tract infection (UTI) or other ailments
- Medical: side effects from medications
Family Caregivers Should Remain Calm
Solutions will depend on the cause, but a caring, respectful, and patient attitude will go far in ensuring their success.
Your role is to provide just the amount of support your aging loved one needs, but no more. And to approach the job of going to the bathroom in a calm, professional manner. Use their name, not your relationship (Mom, Grandma), or—worse—treat them like children with condescending terms such as "honey" or "dear."
Avoid using pads or briefs unless truly necessary. If they're embarrassed, a light sense of humor may be welcome; let them know you understand it's and it's okay.
Minimize their understandable distress by cleaning up accidents discreetly and promptly.
A good start towards understanding and compassion is for the non-disabled caregiver to pause and think through all the mini tasks required to succeed at something we might personally take for granted. Dementia expert Teepa Snow breaks down the process of toileting into about twenty or more specific steps.
Tips for Assisting Loved One in the Bathroom
The video How to Assist Someone in Going to the Bathroom walks through the various steps with helpful tips such as:
- Use clear communication and short sentences to explain the next step, for example, "I'm going to help you stand up now" and "Lean forward when you're ready." Match your visual, verbal, and physical cues (e.g., point, say where you're going, and guide them gently).
- Allow them to walk at their own pace but stay nearby to prevent a fall. Move away from their field of view but close enough to assist once they are safely seated
- Guide them carefully to the seat, perhaps with an arm around them. Backward motion can be physically challenging, so sitting down abruptly can frighten or startle them, inhibiting their ability to go.
- Help them to the bathroom at regular intervals.
- Offer matter-of-fact encouragement. "Now turn slowly; that's good."
- Elastic pants are much easier to adjust than those with buttons, zippers
Other ideas to consider include:
- Make signs to hang on the bathroom
- Paint the seat a bright color so it's easier to see
- Keep a urine bottle handy and/or provide a bedside commode
- Use a bidet, toilet tissue aid, or wet wipes for clean-up
- Dab Vapor-Rub under your nose for handling those messy jobs
Bathrooms Can Be Dangerous
Be sure to keep safety in mind. Bathrooms can be dangerous, with their hard surfaces and tight quarters. Sitting down and standing up can cause blood pressure changes, leading to dizziness and a possible fall.
Ensure the bathroom path is kept clear; remove any rugs or floor mats; use automatic night lights, and install grab bars. A raised toilet with handles can be a godsend.
Professional Caregivers Help but Be Appreciative
If you are blessed to have professional caregivers helping your loved one, be sure to tell them how much you appreciate their providing this less-than-desirable but very important service. A little gratitude—maybe even a handwritten note or Starbucks gift card—can go a long way to making sure your parent receives cheerful and compassionate care.
For family caregivers, Buerkle suggests easing the stress and burden of the caregiving role by setting aside time for yourself.
"Ensure that you are setting some time aside for yourself, so you have the patience and the empathy that you need to be kind to your aging parent. Remind yourself often that they would not choose this situation. Find a support group with like-minded people who can share their experiences and tips with you. Make sure to take care of yourself so you can help your aging parent in this challenging area."
As you consider your aging parent's condition, taking care of your physical well-being is a vital investment in your own future.
In the video Why Fitness Matters, fitness coach Mark Vacanti says, "One of the top reasons why a person checks into assisted living is because they can't get off the toilet. They can't do a half rep of a bodyweight squat, so they have to have someone taking care of them."
He encourages baby boomers, "You have a huge advantage. You have grit. You've had hardships in your life, and that creates strength. Diamonds are built under pressure. You can dig into that piece of your body and of your soul and put out the effort to make this change."
 "What Your Bladder Is Trying to Tell You About Your Health," Cleveland Clinic HealthEssentials, July 17, 2019
 Bell, S. P., Patel, N., Patel, N., Sonani, R., Badheka, A., Forman, D. E. (January 2016). Care of Older Adults. Journal of Geriatric Cardiology, 13(1):1-7. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753005/
Bathing and Toileting are normal living activities most of us take for granted; however, as we get older, we generally need help and assistance with these basic functions.
Long-Term Care Insurance policies get trigger by the policyholder needing help with at least two of the six primary activities of daily living (ADL) OR supervision due to cognitive decline.
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The job of being a family caregiver is tough and emotionally demanding. Most family caregivers are unprepared for the role, and they are untrained as well.
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