Using the PHAATE Model to Understand Changing Needs

As service providers, we are often gathering information and assessing people’s current or immediate needs for assistive products. But how often do we consider a person’s longer-term needs? Do we also consider how and why the person’s needs might change over time?

There are many reasons why a person’s needs for bathing, showering, and personal hygiene/toileting may change. In this article, we explore a framework for gathering information and assessing a person’s assistive technology needs and how those may change over time.

PHAATE diagram

The PHAATE Model

The Policy, Human, Activity, Assistance and Technology, and Environment (PHAATE) model was developed by the University of Pittsburgh in 2006.

It represents factors that can be considered in designing a technology solution and providing services. The Human is at the center of the PHAATE model. The Human is sometimes described as the “end user” of the assistive technology. The World Health Organization (WHO) describes this as the person who uses, or who would benefit from, assistive technology.

The model includes Activity (usually multiple activities) and the Environment in which the activity or activities occur. The model includes both Assistance and Technology, recognizing that we may use assistive technologies in conjunction with Assistance from others, such as paid attendant carers or caregivers, or unpaid care. The WHO describes this assistance component as a person’s circle of support.

By combining the factors of Assistance and Technology, the PHAATE model acknowledges that the Human’s (person’s) needs and personal preferences for Assistance may change, and this may affect the type and features of any assistive technologies they use. Finally, the PHAATE model acknowledges the impact of Policy on design and service provision for assistive technologies, as well as the assessment, selection and specification, funding, maintenance, and disposal of the assistive technologies themselves.

The PHAATE Model & Mobile Shower Commode Chairs

The PHAATE model is useful for assessing mobile shower commode chairs (MSCC) to meet a person’s needs, both now and in the future. We can define MSCCs as a chair on wheels that can be used for toileting and showering.

The Human (person or end user) of MSCCs could be at any age or stage of life. The person’s needs will change over time:

— A child experiencing expected childhood development and growth.

— A young person/emerging adult/adolescent in transition to adulthood.

— An older person experiencing changes in ability to safely bathe, shower, or toilet independently.

A person’s needs may also change through:

— Progressing or changing of health and/or functional status (for example, the person regaining functioning through rehabilitation and healing).

— Natural processes of aging.

— Changes in the environment (such as moving home or going into respite care).

— And changes in personal preferences in how they complete activities of daily living.

In assessments, it’s useful to explore the person’s understandings of their own bathing, showering, and toileting practices. The person, and their circle of support, has often spent time gathering information, resources, and opinions on their situation. They may already have an idea of their likely health journey (also called “patient journey”). They may have already considered how this journey might impact their daily lives and activities.

As service providers, we explore the insights people have into their lives, and their lives as their conditions change. We can explore their expectations for their lives, and their lives as these changes occur. These insights and expectations can help us to understand the person’s needs, preferences, and decisions around their seating goals, including function, posture and positioning, pressure and skin integrity management, and comfort or discomfort.

Activities involving MSCCs (or equipment for toileting/showering/bathing) can include transferring on and off; propelling and maneuvering; dressing, undressing and drying; showering; toileting, bowel care and intimate hygiene; positioning and repositioning. Each activity incorporates a series of tasks. Some activities, such as toileting or taking a shower, include tasks that demand physical and/or cognitive skills. For example, the activity of going to the toilet requires us to know that we need to go, and then to get to the toilet, remove some clothing, position ourselves over the toilet, reach for supplies like toilet paper or tissue, intimate hygiene care, flush the toilet, move away from the toilet, restore our clothing, wash hands, exit the toilet room, and return to what we were doing.

People may require different types of Assistance for bathing, showering, or toileting. People also have personal preferences in terms of assistance they need or want. Bathing, showering, and toileting are highly personal and intimate activities. They require us to be in various states of undress, and expose our bodies to others in ways that may be uncomfortable, upsetting, or even distressing. Having a spouse or family member provide personal assistance and care can cause changes to important relationships. It’s vital to explore and understand these, and be sensitive to the needs and personal preferences of both the person and those in their circle of support.

The Technology in this case is the MSCC. Different brands and models of MSCCs have different options, accessories, and adjustments. Some options can be added later, while others may only be included when the MSCC is initially ordered. Tilt-in-space and postural supports are examples of this. Some MSCCs are adjustable and allow changes to the back support angle, seat-to-floor height, arm support height, foot support height, or seat position. Some also have replaceable or changeable components, such as the seat or back support, to address postural changes and skin integrity concerns.

The physical Environment where MSCCs are used can include toilet rooms or cubicles, water closets, bathrooms, and showering areas. These areas can be hazardous due to hard and slippery surfaces, and may have obstacles, such as piping, cisterns, and amenities. The areas can be complex sensory environments due to noise, steam, and lighting.

MSCCs may also be used in other areas of a person’s living environment. The MSCC may need to fit in and around a bed and fit through doors and hallways. It’s therefore important to assess things like turning circles and space for the MSCC (and an assistant), different flooring surfaces (which impact propelling and maneuvering), and the presence of thresholds or lips between flooring surfaces. If the person plans to travel, the characteristics of rental or temporary accommodation may also need to be considered.

Finally, Policy impacts MSCCs choices. As the person’s needs change, they may need new assessments. People and their circle of support need to know when they should seek out new assessments, and also how to access the needed services. Flags indicating the need for a new assessment could include:

— Changes to health and function, safety, independence, comfort, skin integrity, or posture.

— Changes to the environment – perhaps moving into a new home or renovating the existing home.

— Getting new or additional assistive technology, such as a transfer aid.

— Changes to the MSCC itself, e.g., signs of wear or indications the MSCC is becoming unsafe or dysfunctional.

As service providers, it’s also important to provide information on what people need to do to access services. This could include providing a Web site or phone number to call for advice and help.

Editor’s Note: This story is sponsored by Raz Design.

About the Author

Emma Friesen, Ph.D., is the Clinical Director for Raz Design Inc., a rehab shower commode manufacturer in Toronto, Canada. Emma is a Chartered Biomedical Engineer with expertise in complex rehab equipment, product usability and measuring outcomes of seating and positioning interventions.