Life on Wheels (93 page)

The bathroom is often the space that is the greatest challenge to make accessible. In a 1993 US Census Bureau report, 4.5 million people with disabilities reported having difficulty bathing, and 2.1 million had trouble using the toilet. Millions of people are inconvenienced—even endangered—by inaccessible bathrooms. Any impediment to easy access to the bathroom can lead someone to delay their bowel or bladder program—which can have secondary health consequences. A bathroom that is easy to use protects your health (see Figure 7-7).

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:

The bathroom is a site of many household accidents. The US 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 are often 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. You could also replace the toilet with a wall-mounted unit. A wall-mounted unit not only lets you install 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 feet.

Individual chair users have their own unique needs and preferences for how they position themselves relative to the toilet. Some people get onto the toilet only occasionally; possibly only for their bowel program. 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 that 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 that nothing, such as towel rack or decorative artwork, 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. This requires you to do a full 180° transfer—a treacherous feat for many chair users with no ability to stand at best. For safe transfers, it is generally necessary to be able to achieve a 90° angle to the toilet. Some people being assisted are best transferred from a position next to and parallel to the bowl.

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 that lets you down into the tub is a sort of balloon that 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 that 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 handheld shower head gives you or your personal assistant the ability to hold the shower head to rinse easily.

Antiscald controls allow you to set a maximum possible water temperature. Your inability to quickly move out of the path of the stream or your inability to sense dangerous temperature makes this a valuable device. These devices also control water pressure, which can affect water temperature when it fluctuates. You’ll find these in some hotels.

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 with 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 during the plan review and permit-approval process.

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 7-8). You can transfer onto the seat at normal height, raise the wall, and fill it with water for your bath. 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 that 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 that the cushion would not slip and that you are very stable. Also note where the grab bar is located—sitting back against it might be uncomfortable, especially if it is cold metal. Be sure your need for upper-body balance and stability are being met. 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 is common to most stall showers. These units can be used in new construction or replace an existing bathtub.

Another 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 are essential, particularly around the shower, toilet, and bidet. A grab bar needs to be secured 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 and should never be used as one, even momentarily. It is not able to carry your body weight.

A mobile home might have some walls that 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 onto 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.

Although there are standards that offer advice on 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. In your own home, you are not bound by code standards that apply in public settings, and you may set grab bars at the position and height that are optimal for you.

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 that they 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 more generically 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 might indeed be grab bars but 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.”
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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 that both enhance safety and are aesthetically pleasing.