Guest Author Teresa Boynton, MS, OTR, CSPHP a safe patient handling and mobility (SPHM) expert best known for her work on the Bedside Mobility Assessment Tool (BMAT) and providing a safe environment for patients and caregivers. More detail can be found at the end of this article.
Takeaway:
Safely addressing someone’s need for assistance with toileting and elimination is essential – and adaptive equipment plays a key role. Effective equipment has been found to protect dignity and autonomy while reducing risk, especially at the bedside. Support tools like the BMAT can help each person understand how their abilities can be matched to the safest approach for their unique situation and setting.
BMAT: Four Simple Checkpoints That Help Toileters and Aides Know What They Can Do Right Now.
Needing toileting assistance is deeply personal. For toileters, what matters is not just getting safely to the toilet or commode — it’s also about preserving privacy, control, and participating in their own care as much as they are able. For aides, dignity of care means bringing a steady, respectful presence to one of the most vulnerable, and potentially embarrassing, moments of daily life; peeing and pooing.
For some toileters, the ability to move, transfer or walk may change from day to day, even hour to hour. This variability is real. It is also manageable — when toileters and aides share a simple, repeatable way to understand mobility and choose the right level of support based on current needs.
That is what the Bedside Mobility Assessment Tool (BMAT) provides.
BMAT gives toileters and aides a shared language for balance, strength, and safety so every transfer is grounded in dignity, current needs, capabilities and recognized limitations, not guesswork.
BMAT: Four Simple Checkpoints (Tests) That Help Toileters Know What They Can Do Right Now.
BMAT presents four quick actions a toileter can perform while the aide observes. They are not tests of worth or independence — they help to create a “safety conversation.”
The toileter asks aloud, and the aide observes:
Checkpoint 1 — Sit & Shake
Can I sit upright at the edge of the bed or chair and keep my balance while reaching across my body?
Checkpoint 2 — Stretch & Point
Can I straighten each knee and move each ankle up and down?
Checkpoint 3 — Stand
Can I rise to standing and stay steady?
Checkpoint 4 — Step
Can I march-in-place, shift weight, and take a small step forward and back?
These checkpoints help answer:
- How is my balance today?
- Is standing safe or risky?
- Is stepping and then walking possible or am I too unstable?
When a toileter cannot confidently perform a checkpoint, the temptation is to “just do it” — either the toileter pushes ahead or the aide risks their own body and provides all or most of the effort. Sometimes this works BUT just as often, it doesn’t.
This is the root of many toileting-related falls.
The safer alternative: match the toileter’s ability to the right equipment — the right dose of assistance.
Five Levels of Toileting Equipment Based on BMAT Principles
BMAT helps identify which of five broad categories of equipment will keep the toileter safest while maximizing participation.
Checkpoint 1 Equipment — When sitting balance is limited and more assistance is needed, equipment options may include:
- Bedpan
- Total-lift device with seated sling
Checkpoint 2 Equipment — When sitting is safe but leg or ankle control is limited
- Sit-to-stand lift
- Transfer board
- Height-adjustable commode
Checkpoint 3 Equipment — When standing is possible but not reliable
- Stand-assist device
- Height-adjustable commode positioned close to the bed
Checkpoint 4 Equipment — When stepping is possible but walking may not be safe
- Walker
- Gait belt (with training and clinical justification)
Short-distance assisted walking Equipment when all four checkpoints are possible but urgency or fatigue still create risk
- Standard walker
- Grab bars
- Nighttime commode
- Height-adjustable commode for independence
BMAT helps to ensure the toileter receives the least intrusive, safest option each time – based on current needs.
Why Toileting Is a High-Risk Moment
Even strong, independent toileters can experience:
- Lightheadedness
- Weak legs
- Unsteady turning
- Urgency that outpaces balance
- Fatigue that wasn’t there an hour ago
Using BMAT, toileters and aides set safety guidelines to determine “What Kind of Day is This?”
- “Today is a Sit-and-Shake-only day — let’s use more support.”
- “I can stand but not step — let’s pivot with equipment.”
- “I’m steady right now — let’s use the walker.”
Importantly, the use of BMAT is Age-Friendly care in action: honoring what matters, protecting dignity, providing safe mobility while decreasing anxiety and the risk of falling.
About the Author
Teresa Boynton, MS, OTR, CSPHP
PPAL Toileter welcomes Teresa Boynton, a safe patient handling and mobility (SPHM) expert best known for her work on the Bedside Mobility Assessment Tool (BMAT) and providing a safe environment for patients and caregivers. Teresa is a member of the PPAL NIH Study NR019516 research study.
Teresa, an occupational therapist and ergonomics specialist, began developing the BMAT in 2003 to help hospital staff use the right SPHM equipment, thereby avoiding risky manual lifting. Grounded in the 2007 revised NIOSH guidelines — which cap ideal-condition manual lifting at 35 pounds — the BMAT was piloted by a large hospital’s medical-unit nursing team who found it improved communication, reduced staff injuries, and decreased patient falls.
Early on, the BMAT was also used to teach patients and family members about ongoing mobility needs that might carry over as their loved one was discharged to home or to a long-term care setting.
Personal Statement
In helping to care for my mother (who lived to 95), mother-in-law (who lived to 92), and my father-in-law (who lived to 105 and was incredibly independent through his 104th year), I became increasingly aware of how toileting needs and anxiety around toileting impacts quality of life and what matters to older people. Easy access to toileting and concerns around remaining in control of bladder and bowels and avoiding falls became increasingly critical.
Connect
Microsoft Copilot assisted in generating preliminary text based on references identified by the authors, then prompted to suggest advocacy-oriented language to use when communicating with toileters and aides. That draft was subsequently reviewed, edited, and finalized by the authors for accuracy, completeness, and fit before being uploaded to this site.