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September 08 2011 - Update

ARCHIVED Wet Area Showers – Enable New Zealand Region

Enable New Zealand would like to stimulate some debate within the EMS Housing Assessor community regarding Wet Area Showers.

A recent Enable New Zealand update on disabilityfunding.co.nz noted a review of EMS expenditure across District Health Board areas demonstrated a wide variance in volumes of housing modifications, specifically bathroom/toilet modifications. After taking into account differences in District Health Board population and demographic information, the varying volumes of bathroom modifications appear to reflect a difference in practice and paradigm that EMS Housing Assessors might apply to the notion of ‘need’ for modifying a bathroom or for finding other solution.

It is understandable that EMS Housing Assessors would identify a variety of factors that would influence clinical decision making processes and perhaps have a different individual set of expectations and weighting for each of the factors identified during an assessment. It is recognised that for bathroom modifications there has never been any set standards or indicators as to what circumstances warrant the various solutions possible for a disabled person having difficulty bathing.

The EMS Criteria - which relates to housing modifications for bathrooms is:


Return to, or remain in his/her own home
Modifications to enable a person to return to, or remain in his/her own home must establish that without the modification, the person would be unable to manage and/or be physically safe at home and would have to be admitted to a hospital or residential service.

Primary Care
Housing modifications may be purchased to enable:

  • A person to carry out their role as the primary carer of dependent children.
  • A child with a disability to receive disability related care.
It might appear that there is a greater focus from assessment services on safety and potential ‘risks’ rather than the ability to manage and achieve the activity successfully. Extensive bathroom modifications (i.e. Wet Area Showers) are often justified in reports to minimise risk of falls or caregiver injury. Evaluation of the reality of that risk, or whether that risk is eliminated with the installation of a Wet Area Shower is difficult to measure with no validated tool in place to assist in assessment.

Enable New Zealand would like to develop set indicators for the recommendation of Wet area Showers funded by the Ministry of Health. We are aware some Assessment Services may have undertaken previous work in this area and would encourage a sharing of knowledge and standards from Assessment Services.

The draft indicators for Wet Area Showers below have been developed by Enable New Zealand. These are a starting point, to raise and stimulate debate. We look forward to, and appreciate, your feedback and discussions.

Wet Area Shower Indicators


Indicators for the recommendation of a Wet Area Shower:
  • The person is a wheelchair user who has minimal sitting balance/trunk support and is unable to use a shower bench, bathboard, bath transfer bench etc.
  • The person has fixed skeletal deformities or high muscle tone preventing them from using the existing bathroom facilities.
  • The person has the need for regular and thorough bathing during each day due to continence and skin integrity issues which cannot be achieved using the existing facilities. The person will have the ability to gain benefit from the Wet Area Shower for at least two years.
  • There is evidence that independence will be achieved following the installation of a Wet Area Shower and the current care package will be significantly reduced on an ongoing basis.
  • Where a Wet Area Shower is identified to manage bathing for people with challenging behaviour the Ministry protocol regarding challenging behaviour needs to be followed.
Indicators for solutions other than a Wet Area Shower for the bathroom:
  • The person is able to sit, balance, transfer but is unable to lift legs over the bath edge. The need to wash lower limbs may be met through other methods.
  • The person can sit on a showerchair/stool in their shower cubicle but the shower cubicle is small providing some aspect of difficulty for caregivers.
  • The existing bathroom facilities are unsafe and difficult to use for anyone.
  • The person is able to stripwash independently or with assistance of support people.
  • There is a large step into the shower cubicle which the person finds difficult to manage. Options to reduce the step and assist with access and egress from the shower cubicle are to be explored first.
  • The person is able to walk independently or with the assistance of a walking aid and transferring in and out of the bath is a perceived risk. Other options exist to manage this risk.
  • Water pooling on the floor during the showering process or care givers get wet.
  • There are other ways to manage these issues.

Your feedback will be useful in ongoing development of policy development and best practise guidelines for environmental modifications for disabled people. We aim to add such guidelines to the resources available to EMS Housing Assessor information on the HIIRC website. Engagement and feedback from the EMS Assessor community is vital to ensure future policy development is grounded in the real world and answers the issues you would see on a regular basis.

Thank you for your time and consideration, we look forward to your feedback, please send this to David.Guest@enable.co.nz.

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