Personal and Intimate Care
Scope of this chapter
Put simply, personal and intimate care is care that is related to the things that we would normally do in private. It includes things like going to the toilet, having a shower, and getting dressed. We may decide to do these things in the company of a very close and trusted relative or friend or have them support us if we needed it, but we would certainly not normally choose to let anyone else see or support us.
Understandably, people can find it very difficult or embarrassing to receive personal care. They can also feel vulnerable, especially if they have limited mobility or are fully dependent on others.
We cannot avoid carrying out personal care, but it is important that we recognise how people may feel about receiving it and that we provide it in a dignified way, as well as a safe way.
Regulation 9: Person-centred care
Regulation 10: Dignity and Respect
Regulation 11: Need for Consent
Related Chapters and Guidance
Needs and preferences must be established before the service begins.
A formal review of needs, preferences and risks should take place annually, and whenever there are signs that needs, preferences or risks have changed.
At each provision of personal care, staff should observe the person’s reaction to it and ask appropriate questions to enable feedback.
- Was that OK?
- Did you enjoy that?
- Is that water warm enough?
- Do you like this soap?
- Is there anything I could do differently next time?
- Is there anything different you would like to try?
What can the person do independently and what do they need support with?
People often need support with only one or two elements of a task. Break tasks down and maximise opportunities for independence.
Level of support with different tasks
Aids used to promote independence and safety
Some people have emollients, creams or ointments prescribed that must be applied as part of a personal care routine.
Adverse skin reactions
It is important to know if the person has ever had an adverse reaction to a skincare ingredient, so that this can be avoided.
Cultural needs should always be regarded as needs to be met, not as preferences.
Known issues and risks
Carer preference - gender, age etc.
Preferred products - soap, shampoo, skin care, sanitary products
Preferred routines - shower vs bath, how often likes to wash hair
Preferred time of day - morning, evening, midday
Anything that is important to the person - depth of water, privacy wishes, communication during care etc.
All needs and preferences must be recorded in the individual care or support plan and communicated to staff.
When needs and preferences have been understood, an appropriate and proportionate assessment of any personal care related risks must be carried out.
- Infection risks;
- Moving and handling risks.
Risks should be assessed in a person-centred way, with participation of the person.
There is a chapter of this Handbook dedicated to risk assessment.
See: Risk Assessment (person-centred)
Depending on the nature of the risks, specialist support may need to be requested from a health professional.
Moving and handling equipment is equipment that staff use to support someone to transfer, move around at home or move around in the community.
Examples of moving and handling equipment used in personal or intimate care includes:
- Bath lifts or hoists;
- Slide sheets;
- Transfer boards;
- Electric profiling beds;
- Walking aids e.g., frames;
- Handling belts;
- Lifting cushions;
- Bed rails and levers;
- Any other equipment provided after assessment to support with mobility and transfers.
Before using equipment, check that it is clean and appears safe to use.
Moving and handling equipment must always be used safely in line with individual care or support plans, risk assessments and relevant regulations.
There is a full chapter of this Handbook dedicated to safe moving and handling. This includes maintenance of moving and handling equipment.
See: Moving and Handling
After using moving and handling equipment, clean it so that is safe for next time or another person to use.
It is important to make sure that the environment in which personal and intimate care is going to be carried out is safe.
This could include:
- Checking for slip and trip hazards;
- Making sure all necessary moving and handling equipment is to hand;
- Making sure all necessary PPE is to hand;
- Making sure water temperature is not too hot/cold;
- If relevant, making sure there is a way to call for assistance.
When providing personal and intimate care, all relevant infection prevention and control measures should be followed. For example, PPE.
There is a chapter of this Handbook dedicated to infection prevention and control.
Adverse reactions to products
It is important to make sure that any products being used during personal care are not likely to cause any irritation or adverse reactions when applied.
If the person has any known allergies to ingredients, product packaging must be checked to ensure that it does not contain those ingredients.
If a product indicates an 'do not use after’ date, staff should not use the product beyond that date. In a care home, it should be thrown away. In other settings, the person should be encouraged to dispose of it.
Prescribed emollients, creams or ointments
Any prescribed emollients, creams or ointments should be used in line with the prescribers' instructions. This could be during showering/bathing or afterwards. It may be necessary to allow them time to absorb before dressing.
Prescribed emollients, creams or ointments are medication, and their administration must be recorded.
For further information, see: Medication Support
If a person has dry skin patches, seek their consent to contact the GP or Pharmacy for advice about suitable products that can be used safely to alleviate this.
If a person has reduced mobility or is receiving continence care, staff must monitor their skin integrity for signs of pressure areas.
For further information and guidance, see:
Information and Guidance for Specific Safeguarding Issues
If a person already has a pressure area, this should be attended to in line with medical advice. Normal personal care routines may need to be adapted to incorporate this and promote recovery.
Always seek consent before doing anything to, or on behalf of a person.
Only provide personal or intimate care if it is needed.
Maximise opportunities for independence.
Maximise opportunities for privacy.
Minimise embarrassment and do everything possible to make the person feel at ease.
Flexibility: Be flexible around the time that personal and intimate care is carried out. We all follow different routines and like different things.
Communication: Talk to people about what is going to happen and in what order so they feel secure in this and can say if they want things to be done differently. For example, “I am going to run the water now for your shower, if I help you get undressed on the perching stool in the bathroom, then move into the shower chair - is that OK?”
Comfort: Make sure a room is warm before getting a person undressed. Make sure the water is at their preferred temperature. Dry them quickly after showering or bathing.
Time: Do not rush the person. Allow time for independence and enjoyment of a routine.
Privacy: If safe, leave the bathroom to allow people to use the toilet, shower, or bathe in private. Knock on doors before entering. If you are in a room, close the door so nobody else can see inside. Lock doors so nobody else can enter.
Continence care needs to be provided when a person is either incontinent with urine, faeces or both. Continence issues can also arise when someone has reduced mobility and cannot get to the toilet quickly enough.
Continence care can include:
- Support with the supply of continence aids;
- Support to use/change continence aids;
- Support to protect bedding;
- Support to empty urinals, bed pans or commodes;
- Support with catheter care.
People can feel embarrassed about needing continence care, especially when a pad needs to be changed or they have an accidental leak onto their clothing or bedding. It is important to manage this sensitively and offer reassurance. Do not act in any way that can make them feel worse. Remember, non-verbal communication is very powerful so be aware of any facial expressions or body language you use that could make someone feel bad about themselves.
Provide continence care regularly to reduce the risk of accidental leaks occurring.
Always check whether someone that is wearing continence wear is comfortable.
Always check for potential pressure areas and use effective strategies to reduce the risk of these occurring.
Always use continence aids in line with instruction and training given by a continence specialist. This is usually a Continence Nurse.
If someone’s continence care is a result of not being able to mobilise quickly, make sure that any requests for support to use the toilet are responded to quickly.
Most women have a menstrual cycle (period) every 3-5 weeks, although this can vary.
As their period approaches, make sure that the person has sufficient sanitary products of their choice available. Some people will want to use pads, and some will prefer tampons. If the person has no preference, pads are normally easier to use.
If someone needs direct support to change their sanitary wear, a pad should be used. Tampons are not appropriate as they would require you to have inappropriate contact with the person’s genitalia.
Ask the person regularly if they are comfortable or need their sanitary product changing. Be aware of anyone that has a heavy flow of blood and offer to change it more often. This will reduce the risk of an accidental leak.
If someone has an accidental leak into their underwear or bedding, this should be managed sensitively. Provide reassurance and do not draw unnecessary attention to what has happened - this can cause embarrassment.
If menstruation is heavy or painful, it may be beneficial for the person to seek medical advice about measures that can help. For example, some contraceptives can lighten the flow, improve mood, or prevent periods altogether.
Staff should always encourage a person to carry out personal care routines. However, everyone has days where they feel unwell, or just don’t feel like having a wash or getting dressed.
Everyone has the right to refuse personal care.
If a person has the capacity to make this decision it should always be respected. Where the person lacks the capacity to make decisions around personal care, they should be supported by prompts and encouragement.
Healthcare advice should be sought if there are symptoms and signs that the person’s refusal is linked to illness, or if a health condition is deteriorating (or could deteriorate) as a result of refusing personal care.
Depending on the circumstances, it may be necessary to raise a self-neglect safeguarding concern to the local authority.
Last Updated: March 22, 2022