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Activities of daily living (ADLs) are fundamental skills that are necessary for independent self-care, such as eating, walking, using the toilet, dressing, bathing/showering, and mobility. ADLs are used to indicate an individual’s functional status and to determine qualifications for medical care, therapy, nursing care, and insurance eligibility. When loved ones need assistance with ADLs, this may require family caregivers to learn how to appropriately support and provide care in a manner that allows their loved one to maintain some independence while living at home.

This document will address understanding resistance to toileting, considerations for assisting with toileting, and maintaining a safe and healthy environment when toileting through tips and tools to support your caregiving responsibilities. Additionally, this factsheet will refer to incontinence, which is the loss of bladder control.

Understanding Resistance to Toileting

Having difficulty with or resistance to toileting, whether due to incontinence or not, can cause frustration for both the caregiver and the care recipient. Since toileting is such an intimate activity, the care recipient may feel shame for losing their independence and autonomy and refuse to accept help. Due to the private nature of toileting, they may not want to communicate or admit the challenges they are experiencing and refuse help due to not wanting to be a burden.

Here are some points that your care recipient may not be communicating:

  • Need for privacy: Toileting can be perceived as one of the most private and personal activities and can lead to the care recipient feeling hazukashii or embarrassed. Factors such as the relation to the care recipient, gender, and age can make it even more difficult for them to accept help.
  • Loss of independence: The care recipient may not want to be a burden to their adult children, spouses, and/or loved ones, and they may wish to do things by themselves without admitting reliance on support. This can lead to accidents and communication difficulties.
  • Mobility challenges: The care recipient may be dealing withloss of mobility/balance or limited strength that affects their ability to toilet. This can include sitting on and standing from the toilet, having difficulty getting clothes on and off before and after using the toilet, or difficulty cleaning oneself appropriately after using the toilet (VA, 2024).
toilet with hand bars

Considerations for Assisting with Toileting

The care recipient may experience accidents due to not wanting assistance with toileting or due to incontinence, which is the loss of bladder control.

person sitting on toilet holding hand bar

Here are some tips and tools to consider to help with toileting:

  • Use a consistent frequency/routine – Since your care recipient may not tell you when they need to use the toilet, ensure that they use the toilet regularly by asking if they need to use the restroom or offering verbal reminders every 1.5 to 2 hours and experiment to find the timing that works best (Family Caregivers Online, 2022).
  • Be mindful of diet – Consult with your doctor about your care recipient’s diet including fiber-rich foods that will help to improve continence.
    • Avoid dietary irritants such as coffee, tea, soda, chocolate, wine, and artificial sweeteners, and keep a diary to determine any patterns (Goad, 2023).
  • Consider products to assist with the following
    • Toileting
      • Commode (simplified toilet with supports) and bedside commode
      • Bedpan or urinal
    • Accidents
      • Incontinence briefs
      • Incontinence pads (disposable or washable)
      • Plastic bed or mattress cover
    • To help maintain independence
      • Sink knobs that are easier to hold, with extended length levers, tap turners
      • Seat raiser on the toilet to help sit down and get up from the toilet
      • Adaptive clothing to make dressing and undressing easier
  • Be prepared for accidents – Having an incontinence care kit in the form of a packed bag with the products above, a change of clothes, and clean up essentials prepared can be helpful (Daily Caring, 2021).

Maintaining Safety and Hygiene when Toileting

Adhering to some best practices when assisting with toileting and finding the right tools can help contribute to completing the task with more ease while also helping the caregiver and recipient to maintain safety.

cleaning toilet with sponge
  • Reduce risks to ensure a safe environment – Help to minimize fear-based objections such as low vision and falls by considering home modifications if needed for safer and easier toileting (Clark, 2023):
    • Falls
      • Grab rails in the toilet area
      • Toilet paper roll holder with grab bar or safety support
      • Raised toilet seat with safety frame
      • Transfer bench
    • Vision
      • Toilet bowl with LED nightlight
      • Lighting and motion detection lights for nighttime use
    • Accessibility
      • Removed door locks
      • Doorways wide enough to fit a wheelchair or walker, swing clear offset hinge
      • Mechanical lift and toileting sling with harness for transferring
  • Be aware of appropriate hygiene
    • Always wash your hands
    • Consider products if needed to assist with hygiene
      • Medical gloves
      • Toilet bidet seat attachment
      • Toilet aid tool to assist with reaching and cleaning the perineal area
      • Adult personal cleansing wipes

Additional Assistance

If you need additional assistance in assisting with toileting due to discomfort by you or the care recipient or due to greater than physical capability, in-home care may be an option. Additionally, consulting with a physician or dietician may help to understand the right diet for incontinence.

Conclusion

With knowledge of why your care recipient may be resisting toileting, tips for toileting, and the right tools that work best for both you and your care recipient, toileting can be a more efficient, safer, and easier process to navigate with confidence and meeting them where they are at.

Sources

Clark, A. (2023). How to: Toilet an elderly person (+ tips from an expert). Retrieved from https://agingtoday.com/caregiver/toilet/  

Daily Caring. (2021). Incontinence care: 9 tips for caregivers. Retrieved from https://dailycaring.com/incontinence-care-9-tips-for-caregivers/  

Family Caregivers Online (2022). Dementia care: Toileting and bathing. Retrieved from https://familycaregiversonline.net/dementia-care-toileting-and-bathing/   

Goad, K. (2023). How family caregivers can help loved ones manage incontinence. Retrieved from https://www.aarp.org/caregiving/health/info-2023/incontinence-care-guide.html

Goldenhart, A. L., & Nagy, H. (2022). Assisting patients with personal hygiene. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK563155/  

National Institute on Aging. (2024). Urinary incontinence in older adults. (n.d.). Retrieved from https://www.nia.nih.gov/health/bladder-health-and-incontinence/urinary-incontinence-older-adults  

Open Resources for Nursing (Open RN). (2021). Table 13.2b, [common types of assistance required[]]. – nursing fundamentals – NCBI bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK591828/table/ch13mobility.T.common_types_of_assistanc/VA (2024) TSGLI ADL Standard for Toileting. (n.d.). Retrieved from https://www.benefits.va.gov/INSURANCE/docs/TSGLI_ADL_Standard_for_Toileting.pdf  

Wayne, G. (2023). Self-care deficit & activities of Daily Living (adls) nursing care plan and Management. Retrieved from https://nurseslabs.com/self-care-deficit/