www.patientcenters.com -- Life on Wheels Center -- The Accessible Bathroom
An existing home might have several bathrooms. They don't all have to be accessible. Ideally, there should be an accessible bathroom on each accessible floor of the home.
Creating a larger bathroom for access does not have to rob the rest of the home of space. Ron Mace explained:
Builders of new apartments benefit from providing access.All we need to do in bathrooms is increase the size by about a foot to get enough maneuvering space for a wheelchair. If you plan it carefully, you're only adding about five square feet, and you can get that by just taking a few inches out of adjacent rooms. You hardly notice the difference, except that the bathroom is a bit more luxurious.
People who move into an apartment with a large bathroom don't even know it's for access. They just love it. It turns out to be a marketing plus.
Safety
The bathroom is a site of many household accidents. The U.S. Consumer Product Safety Commission reports that more than 110,000 accidents occur in bathtubs and showers each year. Some chair users make several transfers each day from their chair to a toilet or bath. More than for any room in the house, you need to think of safety as much as simple access to the space.For a chair user who is able to stand to use the shower or bath, a slippery surface can be extremely treacherous. Various floor materials respond differently to being wet. Some new ceramic tiles or rubber-based linoleum surfaces have better slip resistance. Keep the bathroom floor clear of small objects on which you could slip, and use cleaning products that do not leave a slippery film.
Toilets
Toilets are often installed too low for people with disabilities. This can be solved with a riser to elevate the seat, available in various heights. Some riser products lift out of the way to allow others to use the lower seat. A company called Med/West makes a power elevating toilet seat which you can set to a preferred height. You could also replace the toilet with a wall-mounted unit. A wall-mounted unit not only lets you put it at exactly the height you need, but also frees up floor space underneath which increases the turning radius available to you by allowing additional clearance for your footrests.Chair users have their own needs and preferences for how they position themselves relative to the toilet. Some people don't get onto the toilet or only get on occasionally. Those who use catheters empty their bladder into a plastic container which is then dumped into the toilet. Others wear a leg drainage bag and need to be able to get the drainage tube into the toilet to empty the bag.
The side of the toilet or bidet needs to be placed at the right distance from the wall. If the side of the toilet is too close, you risk bumping the wall during transfers. If it is too far away, you could fall between the wall and the toilet while reaching for the tissue dispenser or a grab bar.
Toilet paper holders or items which might extend from the surface of the wall need to be placed for easy reach from the toilet. They should not be too far away or behind the plane of the shoulder, making it necessary to reach behind oneself. Many people lean forward and drop their head as they transfer from the toilet to the wheelchair; make sure nothing is in the way of your head.
There needs to be sufficient clear space in front of and next to the toilet or bidet to get your chair in the optimal position for transfer. In public, far too many so-called accessible bathroom stalls are wide enough to enter, but leave you sitting directly facing the bowl. If you are facing the bowl, you need to do a full 180-degree transfer--a treacherous feat at best. For safe transfers, it is generally necessary to be able to achieve a 90-degree angle to the toilet. Some people being assisted are best transferred from a position next to and parallel to the bowl.
Tubs and showers
Getting into a bathtub is difficult for many people with disabilities. They cannot step or lift themselves over the edge of a tub or, once in, cannot lift themselves back out. Yet they yearn for the luxury of a good long soak, after having to typically settle for showers or, worse, sponge baths in bed.One design which lets you down into the tub is a sort of balloon which is "inflated" with water. The balloon lowers you down into the bath when you release the water from inside it. You refill it from the tub tap to raise yourself back up. Some people also use sling lifts in the bathroom to make transfers onto a shower chair or down into the tub. A portable lift can do double duty in the bedroom and bathroom.
Sitting on the floor of a tub is a problem for people with posterior muscle atrophy. There are a few tubs designed with a foam base under a heavy, vinyl-like covering. Some people have found success with the proper density of foam which provides support but does not float. An air floatation cushion could be used if it can be partially filled with water to keep it from being buoyant, which would make you unstable in the tub.
A tub becomes usable as a shower with a shower chair or tub seat. Some designs allow you to get into the chair outside of the tub, and then pivot or slide into place. A hand-held shower head gives you or your personal assistant the ability to hold the shower head to rinse easily.
Anti-scald controls are now commonly available. They control water pressure, which can affect water temperature when it fluctuates.
Shower and tub controls are typically placed in the center of the wall over the spigot, which can be difficult to reach from a chair when you are outside the tub. Controls would ideally be located closer to the outside wall and lower down for easy access. Many people who prefer to sit in the tub would benefit from having controls on the side wall where they can be reached from inside the tub. In either case, a single, lever control is easiest, compared to knobs or handles that require a strong grip. Make certain that the contractor understands the reason for the location of controls, because they--and building inspectors--are accustomed to seeing controls in the center and could unwittingly override this valuable access detail.
A range of bath and shower units are being developed for the convenience and comfort of those with disabilities. For example, the Freedom Bath is a bathtub with a side wall that raises and lowers, and includes a seat formed inside the tub (see Figure 2 (click here)). You can transfer onto the seat at normal height, raise the wall, and fill it with water for your bath. After emptying the bath water when you are done, bring the wall back down for an easy transfer out. There is no need to deal with the dramatic change in level to get to the bottom of a bathtub, but you can still be immersed for a good soak. It is the size of a normal bathtub.
Some stall showers have a molded seat built in; others use a fold-down platform which lifts out of the way for use by people who stand. You might need to add a cushion to such a platform, in which case you need to be careful it would not slip and that you are very stable. Prefabricated shower units are designed to roll into, accommodating rolling shower chairs designed for the purpose. Prefab units have only a small lip at the edge, rather than the three-inch or larger lip that are common to most stall showers. These units can be used in new construction or replace an existing bathtub.
A more advanced solution is to build a wet room--a space, sometimes just the open corner of a large bathroom, that is tiled with a drain on the floor. Faucets, shower heads, and handholds are installed on the walls, also tiled. You wheel into the area in a rolling shower chair to wash.
Grab bars in the bathroom
Grab bars are essential, particularly around the shower, toilet, and bidet. A grab bar needs to be attached to a solid structure in the wall, typically horizontal reinforcement between vertical studs that can be drilled into. Builders are now encouraged to provide support structure in bathroom walls for the eventual addition of grab bars, but it is not yet a standard construction measure. When sufficient structure is not already present, it is sometimes necessary to break into the wall to add the structural backing.Sometimes a brace can be added across studs on the surface of the wall which can then carry a grab bar. But a brace near the bath or shower becomes a trap for water which will eventually cause damage. Another approach is to sheathe the wall with 3/4 inch plywood, which creates a strong structural base for grab bars. The plywood sheathing is more costly than adding one or more studs, but allows installation of support at any location you choose. Grab bars need to be able to carry as much as 300 pounds. A towel rack is not a grab bar. It is not able to carry your body weight.I moved into a newly built apartment complex that used the handicapped-adaptable approach. In my smaller, second bathroom they couldn't put a grab bar in the bathtub because they hadn't reinforced the wall. There was nothing to attach it to, so they just put the grab bar vertically at the front of the tub. It's totally useless and just a waste of money.
A mobile home might have some walls which are only made of particle board, fiberglass, or sheet metal. These materials are incapable of supporting a grab bar, but it might be possible to add reinforcement behind these surfaces. There are grab bars available that clip on to the side of a bathtub or toilet, and don't require structural support from a wall. Be very certain they are firmly installed, check the attachments regularly to keep them tight, and then test carefully in advance by applying force in several directions before relying on them for support.
While there are standards which advise specific grab bar heights, optimal height and position for grab bars depend on your exact capabilities and size. A grab bar that is standard height might be too high for some people because of their height or because the muscles they would need to use are weak or unavailable.
Some people benefit from supports immediately next to the toilet, functioning as armrests. For others, these can be obstructions during transfer from a wheelchair. Some products are hinged from the wall, so can be raised out of the way during a transfer, and brought down for safety and stability while using the toilet.
In Building for a Lifetime, the authors suggest thinking in terms of handholds--places in the room where people might require support as they bend or lean in the course of their business. Handholds can include a shelf, countertop, or a ledge around the bathtub. This kind of thinking might mean you reinforce the support of the sink, for instance. The authors recommend using "a generous supply of handholds." 1
The selection of access products for the bathroom has expanded. Major bathroom appliance manufacturers have been applying their skill to the design and appearance of accessible fixtures. Grab bars, for instance, are available in options beyond the once-standard stainless steel. They can now be found in a variety of colors and designs. An accessible bathroom is an enhancement to your home, and you should have no reservations about proceeding with such changes.
The bathroom sink
Many bathroom sinks are set in a cabinet top. The cabinet can be removed from under the sink to allow room to get close to the sink, after making certain that the cabinet is not supporting the weight of the sink. Remember to cover the water pipes under the sink with insulation to ensure that you don't burn your legs.The best sink faucets are single lever types. Anti-scald devices are useful here. Use a spout that extends far enough out so it is easy to get your hands fully underneath the water, unobstructed by the back of the sink.
Choose a faucet with an easy-to-use control for closing the drain. The old style rubber plug with a chain is easy to use.
Regulating air temperature
There are unique temperature management issues in the bathroom. Warm water in the bath or shower generates heat and humidity. On the other hand, you tend to feel chilled when you open the shower curtain and let in the cooler air from the rest of the room or house. For people with temperature sensitivity, heat and cold can be managed with:- A dedicated air conditioner
- An infrared heat lamp
- A wall-mounted heater
- An exhaust fan
- An operable window
Notes:
- Margaret Wylde, Adrian Baron-Robbins, and Sam Clark, Building for a Lifetime: The Design and Construction of Fully Accessible Homes (Newtown, Connecticut: Taunton Press, 1994), 268.
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