Residential, Nursing & Care Spring 2019 Newsletter
THE OT GURU Dysphagia Diet Standardisation Initiative Framework
NEVER WRESTLE A PIG What does this have to do with training?
URINALS ON PRESCRIPTION A handy resource
DO YOU WORK WITH CHILDREN & YOUNG PEOPLE? Now available - 2nd edition of Kidz to Adultz Magazine
Charity number: 224742
Explore Our Key Features
Dysphagia Diet Standardisation Initiative Framework...........................................................4 Moving & Handling training courses......................................................................................8 Never wrestle a pig.............................................................................................................11 Practical guide to the use of incontinence pads..................................................................14 A handy resource about urinals on prescription..................................................................18 2nd edition of the Kidz to Adultz Magazine.........................................................................25
Disabled Living Helpline Numbers Occupational Therapy, Equipment and Moving & Handling Advice 0161 607 8200
Bladder & Bowel Nurse Specialists and Continence Product Advice 0161 607 8219
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The OT Guru Highlights the International
As an Occupational Therapist working with older people in Residential and Nursing Care; some of the most valued joint working was along side the Speech & Language Therapists. Learning about the risk factors associated with meal times and particularly when to recognise if a resident required a swallowing assessment by the Speech & Language Therapist. My interest was further enthused when recently informed about the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework, which enables dissemination of the Framework for Managers and Care Staff working with older residents. This article gives a brief overview of Dysphagia and the IDDSI. Along with some guidance, to ensure all residents with potential risks can to be referred on appropriately. Each year, individuals of all ages all around the world are diagnosed with feeding or swallowing difficulties (known as Dysphagia). Dysphagia can be described as difficulty moving food, liquid, saliva or medication from the mouth to the stomach. 4 8
Cichero (2013) states Dysphagia is associated with malnutrition, dehydration, chest infection and potentially death. While promising treatments are being developed to improve function, the modification of food texture and liquid thickness has become a basis of dysphagia management. Foods are chopped, mashed or purĂŠed to compensate for chewing difficulties or fatigue, improve swallowing safety and avoid asphyxiation. Liquids are typically thickened to slow their speed of transit through the oral and pharyngeal phases of swallowing, to avoid aspiration of material into the airway and improve transit to the oesophagus. Food texture and liquid modification for dysphagia management occurs throughout the world. However, the names, the number of levels of modification and characteristics vary within and across countries.
Dysphagia Diet Standardisation Initiative Framework Multiple labels increase the risk to patient safety. National standardization of terminology and definitions has been promoted as a means to improve patient safety and interprofessional communication. Two primary reasons for pursuing international standardized terminology are: (1) improved patient safety and (2) evolution of the field of dysphagia to deliver better treatment outcomes. With regard to patient safety, texture-modified foods are generally provided to reduce risks associated with choking, while thickened liquids are provided to reduce risks associated with aspiration.
Consequently, the ingestion of texturemodified foods and thickened fluids is rarely the diet of choice, but rather a diet of necessity for the person with dysphagia if they wish to maintain safe oral intake of nutrients. Julie A. Y. Cichero,Catriona Steel, Janice Duivestein et al (December 2013) The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative; Current Physical Medicine and Rehabilitation Reports, Volume 1, Issue 4, pp 280–291|
The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/. Attribution is NOT PERMITTED for derivative works incorporating any alterations to the IDDSI Framework that extend beyond language translation. Supplementary Notice: Modification of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to elements of the IDDSI framework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such errors have previously been associated with adverse events including choking and death.
Source for poster http://ftp.iddsi.org/Documents/IDDSI_Framework_creative_commons_2018.pdf
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cont... The OT Guru Highlights the International Risk Factors to Consider Guidance on the Management of Dysphagia in Care Homes (Royal College of Speech and Language Therapy) Ensure the mouth is clean and free from residue at the end of the meal. Encourage a ‘clearing swallow’ or ‘saliva swallow’ to assist in clearing residue from the mouth. Cleaning teeth and the mouth at intervals during the day is advocated.
Feeding Safely Routines Conscious Level no one should be given food or drink if unconscious or semiconscious. Alternative nutritional and hydration options should be discussed with the responsible clinician. Distraction - reduce distractions at mealtimes to facilitate concentration and awareness. This should include reducing chat and the patient/client should not be encouraged to talk/respond when eating or drinking. The reason for this should be explained to the client. Time - allow adequate time to support the individual to eat and drink. Consider the use of insulated containers to maintain the temperature of food for those people whose mealtimes may be prolonged. Positioning - people should sit upright for all snacks, meals and drinks. People should remain sitting upright for at least 30 minutes after a meal to avoid reflux. Oral Hygiene - it is of key importance to note that people with eating and drinking difficulty often have poor oral hygiene which can lead to a greater incidence of chest infections. 6
Position Yourself - at eye level so that you may observe signs of aspiration as well as being able to provide verbal prompts and encouragement. Positioning yourself above eye level or sitting at the side of individuals to assist with eating and drinking may have a negative impact on the individual’s ability to swallow safely as they may change their posture. Utensils - ensure you have the correct utensils identified for the individual to facilitate a safer swallow and to improve sensory awareness. Glasses and Hearing Aids - swallowing requires multi-sensory stimulation. Food should be visually appetising in its presentation and smell appealing in order to stimulate the appetite (and thus salivary flow) as well as increasing the amount taken. Ensuring that the individual can hear the guidance and advice being given e.g. when prompted to slow down. Similarly an individual’s swallowing will be affected by hearing the crackle and crunch of different food consistencies. Therefore, hearing aids and glasses need to be available and fit comfortably. Dentition - dentures, if worn, should fit well. Be aware that some individuals prefer to eat without their dentures and softening the diet may help.
Dysphagia Diet Standardisation Initiative Framework These small portions of food or drink should be given at more frequent intervals in the day. Oral intake charts should be completed to ensure the person receives adequate nutrition and hydration. The Dietician should be asked to advise if a patient/client is losing weight.
Modifying Diet - ensure the correct consistencies of food and drink are prescribed for the individual with dysphagia. The International Dysphagia Diet Standardisation Initiative (IDDSI) (Cichero et al., 2012) has been adopted by the Royal College of Speech and Language Therapists. See previous information. Snacks as well as meals should be available in the appropriate consistency to assist in the provision of nutrition and hydration outside of mealtimes. Resources and information on the implementation of IDDSI are available from the RCSLT website and the IDDSI website. Independence - individuals should be encouraged to feed and drink themselves to encourage and maintain functional independence. Vary the amount of assistance according to individual need (e.g. verbal prompts, loading spoon, hand over hand feeding etc).
Size of mouthful - experimenting with the preferred size of mouthful is important. It should be sufficient to stimulate chewing and swallowing but it is important to avoid overlarge mouthfuls. Documentation - the amount of food and drink that has been consumed should be noted in order to monitor adequate nutrition and hydration. Advice on adequate nutrition and hydration can be sought from the dietician. Other professionals - the roles of the physiotherapist in managing any associated respiratory condition, the dietician in managing nutritional and hydration support, the occupational therapist in postural and feeding equipment, the nurse in overseeing safe feeding practice, the dentist in denture fitting, and the medical staff in monitoring and managing general health all need to be stipulated and agreed in local care plans for dysphagia management. https://www.rcslt.org/
Portion size - people who are frail or lack stamina should be given small portions which require less energy to eat (e.g. softer and/or more moist foods).
Angela Christian Occupational Therapist
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Moving and Handling - Train the Trainer (5 day) Are you responsible for training others safe Moving and Handling in your role? Are you responsible for carrying out Risk Assessments and Handling plans? Do you need to plan training courses and deliver your training to a variety of different people? The Trainers and Assessors course will give you the knowledge and confidence to perform your role as a Moving and Handling trainer and assessor. Content Relevant legislation and guidance Factors to be considered when carrying out a Manual Handling Risk Assessment How to carry out a Risk Assessment Techniques and equipment that can be used to reduce risk when Moving and Handling Correct techniques used to assist those with mobility needs and how to teach this to others Controversial techniques in order to teach people the safest way to move someone How to identify individual learning needs plus aims and objectives of a training session How to prepare a lesson plan How to deliver a session and evaluate a training session. How to feedback and support when learning safe techniques. Dates 7th, 10th, 13th, 14th, 22nd May 2019 8th, 9th, 15th, 25th, 26th July 2019 13th, 17th, 18th, 24th, 25th September 2019 Presenter: Elizabeth Hallows Chartered Physiotherapist MCSP LPC (Back Care Management). Target Group: Nurses, Physiotherapists, Occupational Therapists and others who have responsibility for carrying out Manual Handling Risk Assessments and training. Cost: £650 plus VAT - includes light lunch and refreshments, Open Awards registration, verification and certification. Venue: Disabled Living, Burrows House, Priestley Road, Worsley, M28 2LY How to book Booking forms can be completed on the Training Section of our website at: www.disabledliving.co.uk/training/
Did you know? We also have the following courses available for booking:
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Moving and Handling - Update for Trainers - only £95 + VAT Moving and Handling Risk Assessment (3 day) - only £450 + VAT
Moving and Handling - Bespoke Training Courses In Your Workplace or at Disabled Living's Training Facilities Moving and Handling Children at Home and in School Working with children who need assistance to move, needs holistic and bespoke training particular to the person being moved. We can offer a tailor made course based on the persons current handling plan which will involve the person for part of the session. If no assessment has been done we can offer a full moving and handling assessment which can then be used to facilitate training and practice. Aim: to enable delegates to handle children more effectively, in their work areas, use safer moving methods in ways which maximise the skills of the child and maintain the safety of the handler. For further information contact the training team on 0161 607 8200 or email training@disabledliving.co.uk
Moving and Handling for Personal Assistants The training takes place in the home of the person being cared for so it can be tailored specifically to that person’s environment, needs and equipment. Delivered at a time to suit you we can usually be flexible with times and dates of training. Aimed at: professional healthcare workers who have knowledge of moving and handling or novices who have never had any formal training at all. We encourage the person being cared for to be involved in the training if they wish to be. This encourages inclusion and a person centred approach. For further information contact the training team on 0161 607 8200 or email: training@disabledliving.co.uk
This is a bespoke course only for your organisation, no individual bookings taken.
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Watch Our New Promotional Film for 'In the Dock' with an Expert Witness
Click here to watch the video via our website
A Workshop for Healthcare Professionals Including Those Who Work in Residential, Nursing & Community Care There are different scenarios which could end up with someone being summonsed as a witness. Whether it is a coroner's court or a civil negligence case this workshop will help you to understand what will be required and how to improve your practice so that a court appearance will be less intimidating. Using real life scenarios, expert witnesses and solicitors will lead you through the process and highlight areas you can improve and share good practice in. On this interactive day you will work on a project which culminates in you appearing in the dock in front of a Judge and Jury. Find out how to protect yourself in your reporting and recording at work, what your responsibilities are and how to be confident in your work and not be afraid of being taken to court. Our next workshop Date: Thursday 25th April 2019 Venue: Manchester Cost: ÂŁ65 + VAT (includes light lunch and refreshments) Please visit our website to book your place and for more information: www.disabledliving.co.uk/training/our-workshops/in-the-dock-with-an-expert-witness/
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Never Wrestle a Pig!
George Bernard Shaw: “I learned long ago, never to wrestle with a pig. You get dirty, and besides, the pig likes it.” This quote makes me chuckle but it’s so true. I used to feel like I was wrestling with a pig when I was trying to get my team to learn how to do their job. Deborah Bell, Enablement Team Manger at Disabled Living explains what she means... Before working at Disabled Living I was nursing with a team of staff who cared for a young chap (let’s call him M) in his own home. I did this both part-time and full-time for around six years. M had been in an accident in his late teens and had spent a long time in hospital in various parts of the country. He had close family and friends who would appear at all times of the day and night to keep him company. M was ventilated and as a quadriplegic could only move his head. Whilst he made great effort to remain positive, he did at times have bouts of grumpiness and understandably could be quite sharp tongued.
His voice was the only way he could control things and sometimes the team members would get spoken to in a way that could upset them. This would lead to times when there was a high turnover of staff which in turn led to some difficult days when there wasn’t enough staff to care for M. On these days he couldn’t go out as two people were needed for this. We spent one year in particular where this had become a vicious circle. Members of staff were not staying, which in turn made M less confident in the staff that were new. He would become critical and point out mistakes and they would leave. It was a very difficult situation to work in and I am sure it was a very difficult situation to live in.
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I couldn’t get the staff to training on their days off and if they were working nights it wasn’t reasonable for them to attend training either before or after a night shift.
When well staffed, M was active despite his very complex needs and he had an active social life which involved members of my team. As I said, he always had two people with him at all times and regular trips to the pub were the norm. Team members varied in age and experience, originally all employed via an agency. Eventually they were all employed directly by M who was their employee. Some had been there a few years and knew how to perform the everyday tasks whilst others had no experience in care and had come from very different walks of life.
It was at a point when we were trying to organise a series of mandatory training around food hygiene that I felt like I was really trying to wrestle a pig. I felt like I was always nagging staff about their time and effort. It made me feel more stressed than I should have been. Something needed to change. As a nurse I had undertaken some online training and I decided it was time to see if this method would be more attractive to the team and to M who was adamant that the training was high quality and relevant to him. We chose some courses initially and began to implement the new process where staff could log on in the afternoon of their shift when M had visitors so they could do their training during work time.
There were different personalities, some loud and some quiet which was evident with the volume in the house sometimes. As with many care situations the common issue of staff leaving and new staff coming on board was just part of the job. When I first started I found it challenging to keep up with organising the inductions and mandatory courses needed alongside all the specialist knowledge the carers needed in order to look after our employer. At the time I started, all the training was done on a face to face basis. There needed to be 10 regular staff working a 24 hour rota 7 days a week. You can imagine how difficult it was to ensure everyone was available to attend the training. There were regular occasions when training would be booked and paid for and the number of staff who actually attended made it financially unfeasible. 12
The first course we chose was Food Safety. It went down a treat. Within two weeks all the staff had completed the course and were up to date with their skills. The next course we chose was Equality and Diversity followed by Communication which I felt was important for the team to become highly skilled in.
The transition to training online for this team was smooth and effortless. I cannot say whether it was the support the team felt from being offered the training or whether it was this particular group of people. But the same team stayed for the next three years (I know! Almost unheard of). M calmed down quite a lot in this period, he even went on holiday abroad which took a lot of organising but was so worth it in the end. I’m sure that not all the improvements were down to online training. However, the staff were definitely more motivated. They could ask for training on specific subjects knowing they would be listened to. I wouldn’t have been able to arrange all the training they received on a face to face basis. It wasn’t financially possible.
However, e-learning gave us a much wider opportunity to include subjects relevant to M and his condition. For some subjects such as Moving and Handling, face to face training is necessary and invaluable. But I wouldn’t hesitate to recommend online training for many other subjects. Disabled Living have partnered with Innovue to deliver these very popular courses; the majority are £15 each per person. It is so easy to do and it makes investment in your staff a no brainer. I highly recommend it if you want to stop wrestling with pigs. Have a look at the wide range of courses we have available on: www.disabledliving.co.uk/training/elearning/ Deborah Bell, Enablement Team Manager
HERE'S THE EASY WAY TO FIND WHAT YOU ARE LOOKING FOR... The Disabled Living Supplier Directory provides information about companies and organisations that provide equipment, products and services to support disabled children, adults and older people. You'll find the Supplier Directory on our website. www.disabledliving.co.uk 13
Continence Corner - Practical Guide to the Use of Incontinence Pads
The consensus document regarding the provision of continence containment products for adults was published in 2017. This document was produced, to ensure all adults who suffer with urinary or faecal incontinence, undergo a comprehensive assessment and have equitable access to a service. The consensus document was exposed to wide consultation and is part of the NHSE work on Excellence in Continence care. It has received endorsement from the following organisations: Association for Continence Advice (ACA) NHS England Excellence in Continence Care (EICC) Programme Board RCN Continence Forum United Kingdom Continence Society (UKCS) It is important for those individuals, presenting with continence problems, that they are offered a full continence assessment, including treatment and management options. Unfortunately for some individuals, continence is not achievable; therefore the aim is to offer individual improved management, which may include product provision.
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Effective containment of leakage is fundamental. There is an extensive range of incontinence pads available. The following principles can be applied to use of all pads and if followed optimum performance from the pads will be achieved. Pad selection – all bladder and bowel problems are individual, incontinence pads should be selected based upon individual symptoms, specifically to meet those needs. You need to consider how often leakage occurs, volume of urine lost, toilet access etc, level of independence or dependence of care. Bowel Incontinence – no pad absorbs faeces / stool / faecal matter, but can help to contain faeces.
Continence Corner - Practical Guide to the Use of Incontinence Pads Storage – store in a dry place such as a chest of drawers or wardrobe. Do not store pads in a bathroom or cellar as the dampness will affect the overall absorbency of the product leading to potential leakage, loss of dignity and skin related problems. Pads can be removed from the packaging into a drawer, for example, up to 24 hours prior to use to aid activation of the fibres responsible for absorbing urine. Most pads are vacuum packed so it is good to let them breathe prior to application to aid comfort. Fitting – the pads should be fitted as per manufacturer’s instructions, here are further hints and tips to aid fitting: If the pad has an adhesive strip these should be worn in close fitting underwear, e.g. Sloggi pants, with the strip removed and the pad attached to the gusset area of the pants. If the pad does not have an adhesive strip these should be worn with close fitting underwear, as described above, or with fixation pants that can be sourced from all pad companies. Underwear is important if pads are worn as a two piece system. If the pad is not held in place effectively there will be leakage and the pad will not hold the amount of urine it should. For all in one products that fasten with side tabs, these must be selected based upon hip and waist measurements as they should fit like a pair of pants. These are suitable if a two piece system has failed. For example, if an individual removes pads.
If the product fits at the waist but appears to leak from the leg area due to thin legs, for example, then fixation pants can be worn over the product to aid a better fit closer to the body to reduce leakage. If more absorbency is needed it is worth considering looking for an alternative style of pad as going up a size to gain absorbency does not work. Leakage and poor fitting will occur. Most pads, with the exception of bed sheets, are body worn and therefore should be worn with close fitting underwear. Pads should not be placed under an individual a bed or chair as this will result in leakage and will not provide effective protection. Before fitting any pad fold it length ways as this aids close fitting to the body promoting better absorption of urine and containment of faeces whilst activating anti leak cuffs, if present. Wetness indicator – if present this will be visible on the outside of the pad, it should be used as a guide to assist with changing a pad when it is near to its absorbency capacity. Refer to the individual manufacturer guidelines to assist with this.
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Continence Corner - Practical Guide to the Use of Incontinence Pads Water based creams should be used, not oil based as these can greatly interfere with the absorbency of the pads by clogging the pores that assist absorption of urine. Do not use talc as this clogs the pad.
Bowel incontinence - if a pad is soiled or contains faecal matter the pad should be removed as soon as possible and skin hygiene attended to immediately. Creams should be avoided when pads are worn as much as possible. Only prescribed creams should be used in the affected area and applied in a very thin layer.
If all of the above good practice has been followed and the pad is leaking or you observe any skin related issue please consult with your local Continence Service to request an assessment of needs. If you would like further information please contact the Bladder & Bowel UK National Helpline on 0161 607 8219 for a confidential and discreet discussion or email bladderandboweluk@disabledliving.co.uk Karen Irwin Service Manager / Specialist Nurse
Visit Bladder & Bowel UK's Online Shop
We are delighted to be working in partnership with Complete Care Shop to provide you with a comprehensive online shopping facility for equipment and products to make life easier. Complete Care Shop has over 250,000 in stock items at competitive prices offering you choice from a wide range of manufacturers including disposable pads, pants, urinals, bedding protection, disposal and reusable bed and chair pads, wipes, gloves and a whole lot more. The main advantage of purchasing via the Bladder & Bowel UK website, is the opportunity for you or your clients to speak to Continence Specialists for free impartial help and advice, ensuring unnecessary purchases are not made.
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Visit: www.bbuk.org.uk/online-shop/ or call: 0161 607 8219
talkhealth - Online Clinic for Bowel Issues & IBS From 8th – 19th April 2019 talkhealth will team up with The Allergy & Free from Shows, Action Against Allergy, Bladder & Bowel UK, Bowel & Cancer Research and ERIC to present an Online Clinic on Bowel Issues & IBS. This is part of a series of online clinics, run throughout the year, with a panel of leading medical and charity experts available during the period to help answer your concerns.
Clinical experts will be available to answer questions on issues surrounding bowel incontinence, bowel cancer, constipation, IBS and any other bowel issues.
During the clinics, there is an “Ask the Expert Day” with talkhealth organising a Q&A session, which is hosted by leading charities and NHS Trusts, offering the opportunity to speak directly to experts online.
For more information please visit: www.talkhealthpartnership.com/online_clinic s/online_clinic_on_bowel_issues_and_ibs_2 019.php
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Urinals On Prescription For further information contact: Bladder & Bowel UK Helpline: 0161 607 8219 Email: bladderandboweluk@disabledliving.co.uk The following urinals may be obtained on medical or nursing prescription Male Urinals Product
* Beambridge Funnel (range of sizes available)
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Prescription Order Number (left to right in the photo) Mini 6 – 35 M Youth 6 – 38 Adult short 6 –37 Adult 6 – 35 (Adult & Mini are pale blue in colour)
Male Draining Jug
6-50
UriBag
URIbag
Urinals On Prescription Product
Image
Prescription Order Number
Payne’s male urinal bottle
1350
Beambridge Bottle Bag
6 – 80 (female adaptor available to purchase directly from Beambridge Medical Tel 01483 571928)
Female Urinals Product
* Bridge Urinal
Bridge Saddle Urinal
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Prescription Order Number
6 – 18 or 6 – 18 T (with connecting tap)
6 - 26 19
Urinals On Prescription Product
* Beambridge lady funnel
Uribag F
* Whiz
* Beambridge Lady Jug
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Prescription Order Number
6.40
Manfred Sauer URIbag F
ATD 2002.1 (PIP code: 304-5554) or ATD 2004.10 (with 10cm connecting tube for use with drainage bag) (PIP code: 314-5554)
6-45
Urinals On Prescription Product
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SheWee
Prescription Order Number
Pip Code 343-0394
Unisex Urinals Product
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Prescription Order Number
* Beambridge Pod
6 - 60 6 - 6T (with connecting tap)
Uriwell
80-3360934-134
Please note: All urinals marked with a * can be attached to a drainage bag Any type of catheter drainage bag is suitable, eg leg bag, night bag 21
Urinals On Prescription Accessories to use with urinals (available on prescription) Product
Payne’s non spill adaptor (for use in standard size male urinals)
SafetyGel (liquid absorbing powder)
Vernagel (super absorbent powder) 22
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Prescription Order Number
1351
PIP Codes: Sachet 7g : 3859816 Shaker Pot: 3715190 1.5 kg granules: 3715208 4.5 kg granules: 3715224
Available in boxes of 100 sachets PIP Code: 322 – 9184
Do Your Residents Need to Access the Toilet Urgently When Out and About?
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Bladder & Bowel UK (BBUK) have launched a new Just Can't Wait Card Recognised and supported by many retail and service organisations, giving you access to toilets not normally available to the general public. FREE pocket sized plastic card BBUK confidential helpline Available from BBUK - a charitable service
Get your card from: bladderandboweluk@disabledliving.co.uk www.bbuk.org.uk Registered Charity No: 224742
2nd Edition of Kidz to Adultz Magazine The 2nd edition of our Kidz to Adultz Magazine is now live online! The 44 pages are packed with interesting articles including: 10 Fantastic Years of Kidz to Adultz Middle Campaining Against Cuts My Autism Journey Low Cost Clothing Adaptations Self Care for Parent Carers A Parent's Guide to Moving & Handling Do Your Children Have the Right Play? The Sensurround Experience at Redbank House Jazz Up Your Wheelchair Disabled Living's Supplier Directory PLUS MUCH MORE!
Take a look at the new magazine via: https://issuu.com/disabledliving/docs/kidz_to_adultzmagazine _march_2019?e=26748259/68597590 You can also access the magazine via our Kidz Exhibitions website: www.kidzexhibitions.co.uk
You can also read...
Disabled Living's Information Leaflets www.disabledliving.co.uk/equipment/information-leaflets/
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Get in touch with us
For more information please visit: www.disabledliving.co.uk
Disabled Living Head Office - Disabled Living, Burrows House, 10 Priestley Road, Wardley Industrial Estate, Worsley, Manchester M28 2LY Tel: 0161 607 8200 Email: info@disabledliving.co.uk Website: www.disabledliving.co.uk