Ken, a 77-year-old Vietnam veteran and retired counselor, had always lived a life of service and hard work. In June 2003, Ken's health began to decline and by December 2023, Ken became a full-time wheelchair user.
Living at home in San Jose with his wife Paula, Ken faced the daily challenges that came with his diagnoses of severe arthritis, spinal stenosis, and overall muscle weakness. Once independent and mobile, he now required assistance for most ADL tasks, such as transfers, bathing, and dressing. As his condition progressed, even basic tasks like showering and toileting became not only difficult, but dangerous.
Once Ken and his wife realized that the tasks around bathing and toileting were getting to be too much for them to manage on their own, they reached out to the therapist that provided Ken's wheelchair for guidance. She set them up with an evaluation in her clinic to discuss the situation.
Evaluation
During the interview at the evaluation, it was uncovered that as Ken's mobility declined, so did his ability to perform basic hygiene and toileting activities safely. The following main issues were identified:
Transfers
Ken was unable to safely transfer into or stand in a traditional tub or shower, which was what they had at home. There were no funds or the ability to remodel. Without the ability to bear weight or maintain balance, showering became impossible. For months, he received only sponge baths from his wife Paula, who had to perform these in his bed. Ken expressed the emotional toll of this shift, noting: "For a guy who used to take showers daily, it's been a great displeasure not being able to do that."
Unsafe Toileting Setup
Ken used a standard bedside commode that lacked stability and comfort. During one attempt to transfer to the seat, he experienced a fall serious enough to require intervention from the fire department.
Increased Physical and Emotional Strain
Paula, as Ken's primary caregiver, was placed under immense physical and emotional stress. The lack of appropriate equipment led to unsafe manual transfers, increased fall risk, and growing caregiver fatigue. The couple's daily routing was defined by fear of injury and ongoing discomfort, rather than dignity or independence.
Clinical and Functional Justification for Equipment
Considering Ken's medical condition and the escalating risks within the home environment, showering and toileting equipment became not just a convenience, but a necessity. The introduction of assistive hygiene and mobility equipment was clinically justified on multiple fronts:
Clinical Justifications
- Fall Prevention: Given Ken's history of falls and inability to recover without assistance, reducing the risk of injury was a critical priority.
- Preserving Skin Integrity: Prolonged immobility and infrequent bathing increased Ken's risk of skin breakdown, infections, and pressure injuries.
- Enabling Safe Hygiene and Toileting at Home: Equipment is essential for maintaining Ken's cleanliness and preventing infections or hospital readmission due to hygiene-related complications.
- Severely Reduced Endurance and Strength: Even short efforts to maneuver caused pain and fatigue, requiring seated, stable, and efficient equipment.
- Pain Avoidance: Without proper positioning and support, transfers and hygiene caused intense spinal and joint pain, further limiting his participation.
- Supporting Dignity and Mental Health: Restoring Ken's independent ability to participate in basic self-care helped address the emotional toll of dependency and loss of privacy.
Functional Justifications
- Minimizing Strain on Caregivers: Paula could no longer safely support Ken's transfers or assist in hygiene without risking serious musculoskeletal strain of her own.
- Least Costly Alternative: Ken and Paula did not have funds to remodel their home, and instead needed a solution that would work in their current setup.
Equipment Trials
A tub slider system was discussed with Ken. With this type of system, the transfer can be safely completed in the bedroom, eliminating the need for separate transfers onto toilets and into tubs in the dangerous bathroom environment. Tub slider chairs slide easily over and across tub walls without a manual transfer. After the chair slides into the tub, the connector bridge can be removed, and the shower curtain can be closed for privacy. The therapist suggested a Nuprodx MC6000 Mobile Tub Slider. As she knew Ken's bathroom was unique and the system would require some customization, she reached out to her provider for assistance completing the evaluation.
The provider met Ken at his home and was able to take the necessary body measurements as well as the measurements within Ken's bathroom. While measuring the bathroom, it was realized that Ken's bathroom had a different configuration than most, with the vanity next to the tub rather than the toilet next to the tub. This was further compounded by the back slope of the tub being further out than typical, leaving a very small space for the slider unit to fit. The account manager was able to be creative, and after contact Nuprodx directly via a video chat, was able to modify the base to sit on the longer back edge of the tub – a solution only Nuprodx can provide. This allowed the proper room for the slider unit and Ken's legs to fit safely within his tub.
During this visit, Ken and his wife were able to trial a demonstration unit and saw the great benefit it would being to them within their own home. They immediately agreed. Ken often had difficulty with hygiene due to his limited shoulder range of motion. The account manager suggested a side opening instead of a rear open hole, to allow Ken to lead to the side to more safely and comfortably manage hygiene and care. This was a great solution.
Delivery
After the account manager reviewed the order with the therapist, and the order was approved, a time was set up for delivery. Upon arrival, the chair was properly adjusted to meet Ken's body measurements and within 15 minutes, the entire system was installed in the bathroom. Assisted by his wife Paula, Ken transferred into the Nuprodx chair and completed a dry run. During this process, both Paula and Ken were guided and educated on how to safely operate the system.
Since the delivery the therapist has followed up with Ken and Paula to see how using the Nuprodx system has been. Paula shared, "It's incredibly simple and easy to use. This used to be a stressful process, so it's really nice that I don't have to worry about any more falls." Ken shared, "For me, one of the great joys in life is getting a shower. I couldn't do it without your chair. It's been indispensable for using it both in the shower and over the toilet."
Summary
Ken's story is a powerful and moving example of how the right equipment can truly restore dignity, safety, and independence in daily life. The use of specialized hygiene and mobility equipment in home care is clinically justified by the need to ensure safety, preserve skin integrity, and support functional independence for people with mobility impairments.
Equipment such as the mobile tub slider system addresses critical risks including fall prevention, pain management, and caregiver strain by enabling safe, seated transfers and reducing the need for manual lifting. These devices help maintain hygiene standards, prevent pressure injuries, and reduce hospital readmissions due to infection or injury.
From a therapeutic standpoint, they support patient dignity, mental health, and participation in activities of daily living (ADLs) while also serving as a cost-effective alternative to home remodeling or institutional care. Proper documentation of medical necessity – including the patient's physical limitations, environmental barriers, and caregiver capacity – is essential to support the clinical rationale for such equipment.
If you are a clinician, supplier, caregiver/family member, or individual seeking solutions to support safe and effective hygiene and mobility at home, Sunrise Medical's Nuprodx segment offers innovative, customizable options designed to meet a variety of needs. Reach out today to explore how these solutions can help restore dignity and reduce risk in everyday care.
Lindsey Veety
PT, DPT, ATP/SMS - Clinical Education Manager, US Northeast