By Miriam Cowling, Final Year Occupational Therapy Student
When I arrived at Astor Bannerman for my final-year University of Gloucestershire occupational therapy placement, a discussion with a sales director about times in which disabled customers had been unable to access baths due to perceived risk caused me to reflect on the role the Occupational Therapist plays in ensuring the safety of the individual and their family, whilst working to problem-solve ways in which the individual’s wishes are supported. I considered the importance of taking a person-centred approach to care and balancing risk.
Over the past nine weeks, I have carried out research on physical conditions such as Cerebral Palsy, Muscular Dystrophy and Spinal Cord Injury. This involved interviewing people and families living with these conditions to gain a deeper insight into the impact of physical disability on bathing.
Site visits and conversations with families, experts by experience and the Astor Bannerman team have taught me the importance of treating each customer as an individual, considering the family unit they are part of, thinking long term, and listening to the voices of those who will be using personal hygiene equipment. Learning how varied the presentation and impact of these conditions can be, has demonstrated the importance of individualised care.
I have learned that bathing is uniquely complex, and that empowering people’s choices can coexist with safety when the right support and equipment are in place.
Bathing as a Meaningful Occupation
Bathing has been categorised by the American Occupational Therapy Association (AOTA, 2020) as an activity of daily living. It carries physical, sensory, cognitive and emotional demands. Many of these challenges were highlighted in the literature I explored during my research project, which shows how factors such as muscle tone, cognitive processing, sensory needs and fatigue can create barriers for people with a wide range of disabilities.
Bathing also carries significant personal meaning. Families described bath time as: a place to unwind after pain-filled days and a rare opportunity to feel free in water. Bathing is not only about hygiene – it is about dignity, identity and respite. This emotional significance came through strongly in the lived-experience narratives included in my project, where parents and young people discussed the difference a safe, accessible bath made to their wellbeing.
I was interested to learn from research by Hoekstra et al. (2020) that examines the body’s anti-inflammatory response to passive heating, which can be achieved through immersion in hot water. This research further points to health and wellbeing benefits of bathing, especially for people with complex physical disabilities who are unable to achieve an elevated body temperature through movement and exercise.
There are also clinical benefits to bathing. Cross-sectional studies by Goto et al. (2018) reported that people who bathe in hot water experience good subjective health, strengthened immune function, improved sleep, pain relief and lower stress levels. These findings support the physical and psychological benefits of bathing.
Embracing Risk, Enabling Choice
Guidance from the Royal College of Occupational Therapists (RCOT, 2018) states that to help people access services, achieve their chosen goals and participate fully in life, occupational therapists must embrace and engage with risk. This guidance can be used as a reference point when balancing the risks of bathing with its therapeutic benefits and individual preferences.
Bathing can be viewed as both an activity of daily living and a deeply meaningful occupation, particularly for families with young children. It is not just about keeping clean; the experience itself – and the involvement of carers and family members – is equally important. Pain relief, alongside physical and psychological benefits, should also be considered when weighing up risk.
Service Users at the Centre of Practice
Occupational therapists have a duty to place service users at the centre of practice, working in partnership with them and upholding their autonomy. Practice is shaped by the occupational needs, aspirations, values and choices of those who access occupational therapy (RCOT, 2021, 3.4).
The risk enablement process provides a structured framework within which occupational therapists can assess and support risk-taking. Risk assessments and enablement plans should be shared with all professionals involved in the individual’s care.
Environmental Design
During a site visit to a respite home with one of Astor Bannerman’s team members, we observed how bathroom layouts, wheelchair turning spaces, hoisting requirements and transfer points varied significantly between settings. The occupational therapist and surveyor carefully discussed:
- proximity of basin, toilet and bath,
- sliding doors to increase wheelchair access,
- lighting, safety and sensory needs,
- postural support,
- how best to accommodate multiple service users within the space
Observing these discussions and the level of detail involved in planning a bath installation deepened my understanding of the importance of environmental design in supporting bathing and personal hygiene.
Collaborative Decision-Making
Families interviewed during this research project emphasised the importance of collaborative decision-making when supporting personal care, with a strong focus on respecting the dignity and preferences of the individual using the equipment.
One parent explained how bath time was essential for her daughter’s respiratory health and emotional wellbeing and how important it was to work with the occupational therapist to achieve this. The bath was not simply a hygiene tool; it was a way to support respiratory needs, relieve pain and connect. The first thing this parent did when her daughter returned home after a long hospital stay was give her a bath.
The Meaning of Bathing
Listening to participants describe their experiences highlighted how meaning elevates bathing from a “nice to have” to an occupation that shapes quality of life. One participant described his bath as a place to listen to music, relax and unwind. Another parent described it as a space where her daughter feels free and weightless.
Equipment Can Overcome Barriers to Bathing
Working alongside the Astor Bannerman team has helped me see equipment through a much wider lens.
From height-adjustable baths to supportive postural seating and hoisting solutions, I have seen how the right equipment can promote independence. It enables:
- children to enjoy water safely for longer,
- carers to protect their backs and reduce fatigue,
- young adults to maintain independence,
- safe bathing for people with sensory differences, pain or reduced strength.
Identifying with Astor Bannerman’s Values
During my induction in the first week of placement, I learned about Astor Bannerman’s values of Passion, Integrity and Vision, which shape conversations and inform practice. Employees are encouraged to share ideas freely and demonstrate passion for the people they support.
Conversations with the team reinforced the importance of integrity across the organisation. I reflected on how these values align with my own personal and professional values – particularly in advocating for service users, delivering person-centred care, treating others with dignity and respect, and enabling individuals to achieve what matters most to them.
What I Have Learned
This placement at Astor Bannerman has given me a deeper understanding of the challenges that physical disability can present in relation to bathing. I have witnessed the resilience of the people I interviewed, and I feel strongly about the importance of listening to their voices and ensuring they are heard.
I have seen the life-changing difference that supporting families to access appropriate bathing solutions can make – not only for the individual, but for the entire family unit. I have reflected on my personal and professional values and developed a greater appreciation for the role of environmental design in removing barriers to independence.
References
Goto, Y., Hayasaka, S., Kurihara, S. and Nakamura, Y. (2018) ‘Physical and mental effects of bathing: A randomized intervention study’, Evidence-Based Complementary and Alternative Medicine, 2018, pp. 1–7 Physical and Mental Effects of Bathing: A Randomized Intervention Study – PubMed
Occupational Therapy Practice Framework: Domain and Process-Fourth Edition (2020) The American journal of occupational therapy: official publication of the American Occupational Therapy Association, 74(Supplement_2), pp. 7412410010p1–7412410010p87. Available at: https://doi.org/10.5014/ajot.2020.74S2001.
Royal College of Occupational Therapists (2018) Embracing risk; enabling choice: guidance for occupational therapists. London: Royal College of Occupational Therapists. Available at: https://www.rcot.co.uk/explore-resources/rcot-publications/embracing-risk
Royal College of Occupational Therapists (2021) Professional standards for occupational therapy practice, conduct and ethics. London: Royal College of Occupational Therapists. Available at: https://www.rcot.co.uk/explore-resources/standards-guidelines/professional-standards-conduct-ethics
