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Toilet Rooms & Bathrooms

The creation of an accessible toilet room and, ideally, a full bath is a priority for DV/SA providers when considering an investment of capital dollars. It is important to take the same care with the design of an accessible restroom or bathroom as any other. Too often the accessible restroom looks like an institutional space even if nothing else in the environment does. Bathrooms should communicate a message of welcome and healing. The design of this most intimate space deserves care and attention to safety, comfort and independence.

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Noise

When remodeling, evaluate and reduce the noise that travels from the bathroom with sound insulation. Use solid core doors. Plywood backing in the walls that permits a wide range of locations to secure grab bars and other fixtures also provides sound insulation. Exhaust fans can create a haven of white noise.

Color

The bathroom should communicate comfort, safety and healing. It’s important to steer clear of institutional choices of color or materials. Healing environments should avoid institutional associations. The role of color and mood, however, has been understudied. “While several studies show that a color-mood association exists, it appears that different colors awaken different moods for various people.” ¹ Choose warm but subtle color.

Lighting

Balance lighting for general illumination every time that the room is used with task lighting for times when a survivor is doing personal grooming. How one feels about oneself is influenced for many people by a look in the bathroom mirror and it is worth making sure that the lighting is not overly harsh.

Showers

Consider how important the survivor’s first shower is at a shelter. This may be her first moment of relief - the first sense that there are opportunities to share a new future.

Showerhead

• For tight shower/bath spaces, install a curved shower rod so that the survivor feels unencumbered when using a handheld showerhead. Install a pull-down/flip-up shower chair for all showers even if they are not fully accessible so that the survivor can be supported if she feels weak.
• Thermostatic mixing valves automatically regulate water flow and temperature. The survivor will not need to be disrupted by sudden temperature changes or feel that she has to continuously adjust the temperature. It is a simple way of increasing a person’s sense of personal control. This also helps people with tactile sensitivity, imprecise hand control, or limited cognitive awareness.

  courtesy of Adaptive Environments

• Look for a showerhead that mounts on a vertical bar to create a hands-free adjustable height showerhead that also gives the option of picking it up to direct flow wherever you like. This is recommended to enhance flexibility for a range of users and a survivor’s sense of personal control.
• When looking for these models, make sure that the showerhead can be positioned well at different angles when hanging so that you can get a reliable shower both hands-free and handheld. Test the knob or lever for tightening and loosening the unit to be certain that it can be operating with a closed fist.
• Some advice from the AARP: “Your hand-held shower will be easier to use if you can turn on and off by pushing a switch on the handle. Pick the largest switch you can find. Then you can shut off the water by pressing the switch against your body. Look for a unit that shuts off when you drop it. This keeps water from squirting all over the bathroom - and all over you.”
• Being able to adjust to different heights and at different angles for different users is ideal.
• Other showerhead features to consider are push-button pause controls and ergonomic handles.
• Handheld showers should have at least 60” of flexible tubing.

Shower stalls

courtesy of Brad Walker, R.A., designer

• Pre-fabricated bath/shower units come in an array of styles, including roll-in shower versions and extra-wide entries. You can replace an existing bathtub with a shower without major expense.
• Most bath stores sell showers that come in one ready-to-install unit molded from a single piece of fiberglass. Sometimes a shower model will fit in the space of an existing bathtub with drain lines that carry away water to the same location as the bathtub.
• Some large models require space remodeling.
• Look for models with low or no sill. This will reduce the likelihood of tripping.  No sill models can be used by wheelchair users who can transfer to a shower seat.
• There are very few grab bars that will secure successfully to a fiberglass shower. Some have built-in grab bars but you will want to add plywood of solid wood blocking during installation in order to retain the opportunity to add a bar horizontally or vertically in the future.
• Adjustable shower seats or fold-down seats can be purchased to add to an existing shower. Always attach a wall seat to wall studs, so that it doesn’t fall out of the wall.
• If you are doing a complete renovation, you should plan on a roll-in shower with a fold-down seat, grab bars and a floor drain. A departure from the usual central floor drain, in which the floor slopes slightly into the drain, is a ‘trench’ drain which creates a trench at the rear and the floor slopes slightly toward the rear. It tends to minimize standing water.

Shower controls

• Choose a pressure valve marked with visible and clear temperature options. Knobs with high color contrast and large words are easier to read.
• Pressure-balancing valves (Most new home construction has this)
• Ask your plumber about anti-scald devices. One option is to turn down the water heater to 120 degrees but you may want hotter water elsewhere in the building. Anti-scald controls can also attach directly to showers, tubs or sinks and kick in when the water goes above a certain pre-set temperature. This is for everyone’s comfort, but it also is essential for people with low tactile sensitivity. Devices range from simple to complex.

Bathtubs

• Towel racks or a towel table should be accessible from the seated position of the tub in order that a person can dry her face and hands before climbing out of the tub. This is a general safety and comfort issue.
• There are standard placements for grab bars recommended in ADAAG (see diagrams below). You may wish to supplement this configuration with vertical bars that many people, especially people who can stand but may have difficulty, find helpful in getting in and out of tubs or showers.

Grab Bar Placement drawings by ADAAG

• Portable grab bars can help avoid reconstruction if there is no plywood backing on your bathroom walls. The WingIt is like an oversized molly bolt. With 5/8" sheet rock (common in commercial facilities) no blocking is needed, which means there is no need to tear open and reconstruct existing walls, saving time and money. In residential installations, it is still preferable to have blocking if you are installing over 1/2" dry wall. (WingIts alone with 1/2" drywall will only hold up to 250 pounds). However, installation over ceramic tile, tub surrounds, marble do not require blocking and can handle up to 800 pounds.
• If you don't want to change your bath fixtures, attach a spray unit that fits right on a tub faucet.
• For people with limited mobility and coordination, faucets mounted toward the front edge of the tub instead of centered on the front tub wall save having to stretch over to check the temperature of the water.
• For people with limited agility or coordination, a fold-down built-in bench or a light weight insertable bench can be used in combination with a handheld shower to feel safer sitting while washing.

Floor Approach with Bath Seat, Drawings by ADAAG

Sink and Vanity

• Placing lights around a mirror instead of above works best for reducing shadows on the face. Tiltable mirrors on extension arms are ideal for people of different heights, children, and for switching between sitting and standing.
• Create clear space under the sink and counter. It creates kneespace when sitting and increases access for someone who uses a walker or a wheelchair. Consider retractable, removable, or swiveling doors for under sink. Drains should be located at the back to prevent burns from hot pipes. Pipe protectors are available from Truebro, Inc.
• Faucet design is important to functionality. Faucet costs widely vary and cost tends to be reflected in how well it works and for how long. Use a single lever because they are easy to operate. An extra long lever handle enables a person to turn on a tap with an elbow when hands are dirty. This reduces the spread of germs. Choose a spout that allows survivors to easily wash their face and hands without banging into the spout.
• Just like for showers, ask your plumber about installing anti-scald devices and thermostatic mixing valves. For those with limited tactile sensitivity, this helps regulate water temperature. It also protects someone who may not be alert.
• Choose wall-hung lavatory over pedestal models in order to eliminate the potential barrier of the pedestal for people who use the sink while seated.  Mount it no higher than 34” above a finished floor.  Take advantage of the wall-hung design to include a surface on which someone can set toiletries without them sliding into the basin.

Toilets

• For small spaces, consider a wall attached toilet that can be brushed clean underneath. This increases the sense of spaciousness in the bathroom and makes it easier to clean around the toilet.
• Choosing a toilet for the comfort of diverse users involves selecting a height that will be safe and easy for people transferring from a wheelchair or who may have difficulty lowering themselves or rising. A reasonable height is 16 ½” from the finished floor.

Other Bathroom Features to Consider

• People with mobility limitations, strength issues, arthritis or anyone who feels unsteady, may benefit from a toilet support bar that can be rotated out of the way but which snaps easily in place if needed. HEWI makes very strong and attractive models.
• Install a fan-delay timer switch or an automatic humidistat control that automatically turns the fan on and off. These controls increase control of moisture and mold content in the air which is important for people who have asthma and allergies. For someone who is absent-minded and having trouble paying attention, a humidistat control is ideal.
• Consider radiant ceiling lamps, a feature found in many hotels.They can supplement an old or inadequate heating system and keep survivors comfortable who may have trouble regulating their internal temperatures.

¹R.B. Tofle, B. Schwarz, S. Yoon, A. Max-Royale (2004) Color in Healthcare Environments, Coalition for Health Environments Research, p.16.

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