Reprinted with permission from the American Association of Retired Persons.
Sinks and Lavatories
Three elements are critical in lavatory design:
- the clearance underneath the sink (for those who use wheelchairs)
- the height of the sink (for those who may have difficulty bending from the waist or for others who are seated in chairs)
- the faucet hardware (for those who have hand dexterity problems)
People in wheelchairs need approximately 27" to 30" of height underneath the front of the sink so they can get as close as possible to the basin. Removing the doors or the entire cabinet below the sink can eliminate access problems. A decorative curtain below the sink will allow access while providing a concealed undersink storage area. If you remove your sink cabinet, cover or shield any sharp edges or hot water supply and waste pipes (if the hot water temperature is set above 115-degrees Fahrenheit). To cover the pipes, use pipe insulation or build a box around the pipes to protect you from burns.
Your sink should be located at a height where you can use it comfortably whether you're seated in a wheelchair or standing. Generally, a 30" high lavatory top provides easy access if you're seated; 34" is the maximum height allowed by barrier-free design standards. If you are very tall and have difficulty bending, raise the top to 36" or even 40". If there are others in your household who are short, a compromise height of approximately 30-34" should be acceptable to everyone.
If you have limited hand dexterity, adapt your faucets so you can operate them easily with a single hand. Single lever faucets are best because they provide a visual indication of water temperature, and don't require fine hand dexterity to operate. They also provide a mixed water temperature from a single tap. You can replace existing knob-type hardware by removing the handles and installing double levers or cross knobs (available at most hardware stores) that fit the faucet stems. When handles are hard to turn, their washers probably should be replaced.
The optimal toilet seat height varies from one individual to another. It's easy for most people to sit down or get up from an 18" high seat. However, this seat height often creates problems with bowel movement. Many older people need to assume a squat position, with their knees above the level of their buttocks. Toilets mounted at a low height would resolve this problem, but they create problems for persons who have difficulty getting up and sitting. A design which raises the feet slightly helps to resolve the problem.
Rehabilitation hospitals now teach people how to transfer themselves without assistance from wheelchair to toilet or tub as illustrated here.
Stable support such as grab bars or tub edges is critical to allow individuals to safely complete this independent transfer. If independent transfer isn't possible, lifts are available to help people from one place to another, but they usually require assistance from another person.
Grab bars surrounding toilets must be located so they are convenient and strong. Most building codes require that they be capable of withstanding a 250 pound load. To support this weight, the bars should be screwed directly into wall studs, or installed using a blocking technique. Molly bolts, nails, or screws into sheetrock are not adequate. There are three basic types of grab bars:
- sheltering arms
Consider the needs and capabilities of users in your home before you select a particular type. Pivoting grab bars can be moved out of the way and yet be close when they're needed to provide support. Wall-mounted grab bars are the most stable, and sheltering arms provide the best support for getting up and sitting down on a toilet from a standing position. Grab bars designed for wheelchair users aren't always satisfactory for people who use crutches, canes, or walkers to get around. Many elderly people find getting up from or sitting down on a toilet difficult because they've lost muscle strength in their legs and knees. For this reason, sheltering arm grab bars are superior to wall-mounted grab bars.
The sheltering arm grab bar surrounds you, providing support similar to the arm rest of a standard chair. It allows you to use your arm and leg muscles to lower yourself onto the toilet and return to a standing position. Sheltering arms also provide better balance support while you are seated on the toilet. Make sure that these bars are firmly secured to the toilet to prevent instability or shifting. Tightly attach the bolts to the toilet and check them every few weeks. Sheltering arm grab bars which have legs that extend to the floor (see illustration) are more stable than bars which rest only on the toilet bowl. You can make perfectly useable wooden or plastic grab bars from common construction materials. If you make rectangular wooden grab bars, allow closure between the thumb and fingers of your hand. This provides the best grip when you close your hand around the bar. The optimum diameter for grab bars is 1 1/4 to 1 1/2" for adults. For a child or person with a very small hand, the ideal diameter is 1 to 1 1/4". The distance between the wall and the grab bar should be 1 1/2". A wider space can be dangerous if you slip and your elbow lodges between the wall and the bar. A narrower space is not adequate for fingers and knuckles.
Tubs and Showers
Transferring someone from a wheelchair to the tub is one of the most hazardous activities you may ever have to attempt at home. Getting into the tub is also hazardous for semiambulatory persons. To accommodate these individuals, your tub area must be carefully designed to provide maximum safety for a minimum effort. Grab bars should be securely mounted on the walls or on the tub side to provide support during the transition.
Tub seats allow persons in wheelchairs or others who have poor strength in their legs to sit in the tub and take a bath or shower without having to lower themselves to the floor of the tub. A tub seat also works well for those who tire easily and need to sit while bathing.
Several types of tub seats are available. You can also install a built-in tub seat, which will be more stable and safer than a removable seat. Be sure to carefully design this seat for drainage, so that water runs back into the tub and not out the side when you bathe.
Since many people prefer a bath to a shower, think about your preference before deciding which is the most appropriate unit to install. If you have poor circulation in your extremities, you may find that soaking in a warm tub at the end of the day is an excellent way to relax and get more comfortable.
Shower and Tub Controls and Accessories
As with lavatory faucets, single lever shower and tub controls are the best. Antiscald temperature controls are available that prevent the water temperature from exceeding an established limit. If the water temperature in your house is above 115- degrees Fahrenheit, you should consider installing this feature. Shower curtains and doors are the two primary means of containing water within showers or tubs. But sliding doors with tracks can present a formidable barrier if you are transferring from a wheelchair to a tub seat. The lower tracks often have sharp edges which can injure persons who try to slide over them. For this reason, you should try to provide a shower curtain in a tub to be used by a person transferring from a wheelchair.
Accessibility standards call for two types of showers in accessible facilities:
- roll-in showers
- transfer showers
Roll-in showers provide a gentle, easily crossed threshold that keeps water in the shower area. A person in a wheelchair can easily roll from the shower area to the rest of the bathroom. In most cases, people who will roll into the shower will use a special commode chair. Because its small wheels can catch on ridges, thresholds, and cracks, it's important to have smooth thresholds between the bathroom and the shower. Roll-in showers normally require a larger space than standard showers, but they should be equipped with the same hardware and controls as standard showers.
Transfer showers require that you transfer from your wheelchair to a seat in the shower compartment. The dimensions of a transfer shower are critical. When you're seated in the cubicle you should be able to easily reach the surrounding grab bars and controls. You can probably transform your existing shower into a transfer shower by simply installing a seat and the appropriate controls. Make sure that a clear floor area is available for a wheelchair to approach the shower area and allow an easy transfer to the shower seat. Hand-held shower heads are a necessity for many people, particularly those who are seated in a shower or tub. These fixtures often come with adjustable height rods and/or fixed hooks to allow the shower head to become a fixed level unit.
It's imperative to have at least 5' of hose attached to the shower head so that it can reach the end of the tub or shower. Many manufacturers provide special adapters that replace the existing shower head or tub spigot with a nipple for attaching the shower hose.
You're more likely to have an accident in your bathroom than in any other room in your home. Therefore, your bathroom should be designed and equipped to help you avoid slipping or injury when you use the facility.
Non-skid adhesive strips, flowers, or dots are a low-cost solution to the problem of slippery walking surfaces, both inside and outside of the bathing unit. Replacing the existing floor surface with a slip-resistant surface, such as a non-skid ceramic tile or indoor/outdoor carpeting, is another solution that is more costly, but may be more aesthetically acceptable.
Securely mounted grab bars or strong towel bars are necessary at places where a person may be off balance. They must be capable of supporting at least 250 pounds of force (more if anyone who is a frequent user of the facility weighs more than 200 pounds). To make sure they are capable of supporting this weight, ask the dealer or manufacturer, and screw the bars directly into the studs in the walls or a secure form or blocking that has been applied to the studs. Screws fastened into tile or sheetrock are not adequate anchoring.
Make sure you have adequate lighting in your bathroom so you won't trip, slip, or hurt yourself. It's especially important to light the area around the lavatory or sink for convenience, personal grooming, and easy reading of medicine containers and directions. It's also important that your lights shine on the object being viewed, rather than directly into your eyes. Direct light sources create special problems for people who wear glasses that refract light, causing glare problems. Cover bulbs with some kind of shade to create indirect, soft illumination.
If you use any electrical appliances in the bathroom (hair dryers, electric shavers, electric hair curlers, etc.) their circuits should be Ground Fault Interrupted (GFI). This type of equipment virtually eliminates the possibility of electrical shock and is part of the bathroom building code in many states. Hire a professional electrician to install GFI outlets to make sure they are properly grounded, and test the circuits regularly to make sure that they are operational, using the button on the outlet.
Many older homes don't have adequate storage space for medicine, equipment, and linens in or near the bathroom. If your space is limited, you may want to install medicine cabinets or shelves to hold these items. If you or others in your home have equipment ordered by your doctor or rehabilitation therapist to assist you with personal hygiene, make sure the items you use frequently are stored within easy reach.