What level of physical support does the individual need to have a shower or to have a bath? If they are able to be safe, are they able to remain in the bath whilst you leave the room or do you always need to be in there? If so, is there enough room for you to stand in the bathroom and to maintain your physical distance so that there is some personal privacy or are you required for safety perspective to keep your eyes on someone the entire time? With toileting, some environments policies require two people to assist with the toileting, to be in the same room with the individual. Some students refuse to do this and may have greater toileting difficulties or school attendance difficulties because they are protecting themselves from anyone other than a parent or trusted carer assisting them with intimate personal care.
In certain situations there is no privacy. Disabled bathrooms in public settings do not contain privacy curtains to allow the carer to maintain a personal visually blocked distance from the person that they are supporting. They might need to be in the room but they might not need to be standing looking at the person. Do they stand and turn their backs? How comfortable is it to be watched whilst you are on the toilet? Teaching individuals to ask their carers to turn their heads if and when appropriate supervision wise can be helpful if they need to remain in the room during bathing, showering or toileting. Risk assessments to determine how many people need to be in the room at one time for toileting is essential to ensure that there is no other impact e.g. non school attendance from this environmental demand being placed on the student.
Hospital settings can also be an issue when individuals are used to only having a parent manage their bathing or showering. The forced entry into the bathroom of a group of people may be overwhelming when they are unknown to the individual regardless of the appropriate intent of those assisting. This may contribute to aggressive challenging behaviours out of feelings of invasion of privacy and anger at people trying to move their bodies in certain ways regardless of the need to keep them safe or to help them finish showering etc. Medical and nursing procedures that are also associated with bathing, showering and toileting need to be slowed down and looked at as to who is the most appropriate person to be in the room and as to whether a parent can be talked through completing the touch so that the individual does not feel forced into doing something that is overwhelming for them. This might prevent further escalation of distress associated with being in a hospital setting in the first place.