Appendix: Redesign suggestions for the bathroom— Most dangerous room in the house

. This e-architect exclusive is a hitherto unpublished section from my book “Renovating Existing Housing to Make It Wheel Chair Accessible.”

Overview

Cautionary note: The intent of this analysis is to pour cold water on the sense of accomplishment one achieves from renovating a residence to make it wheel chair accessible. A residence in the wrong place is no residence at all. After all the elderly and disabled are best served by a public transit system also offering dependable para transit.

It is directly relevant to note the disabled and elderly are a group discriminated against considerably [9]. Let us first focus on the matter at hand; viz. renovating. While focusing remember there is a leitmotif here (the community where the renovation takes place) which will emerge as the goal of this analysis. The goal is integration of the house renovated for the disabled and the community without. Without complete integration access is incomplete and resources are wasted.

The bathroom and bedroom are clearly the areas in the residence where accommodations are required for safety and other purposes. One example of an issue worthy of attention concerns the use of mobility devices  useful for getting from room to room and whose function may affect the ability to make individual rooms accessible.

The issue of a sling an individual can use without assistance to lift oneself up from wheelchair to toilet seat or from bed to wheelchair has a significant effect on the process of home renovation.

Figure BR 1. Sensor warning of fall hazard

For individuals with mobility problems, the bathroom is the most dangerous room in the house. It can be wet leading to falls. Clients may be impatient to get in and out quickly thus lending to its danger. There may be inadequate rails. Depending upon when the residence was built, the entrance and exit may be uncomfortably narrow. This might be a good place to consider removing walls and widening the hallway.

Entrance and exit

In many older residences, the path leading to the bathroom is a narrow one. Figure BR2 shows the client using a mobility device to come from the bedroom [behind] in the direction of the refrigerator [ahead].

Figure BR2. Narrow bathroom entrance

The width of the hallway with the bathroom door closed is 41 inches. ADA standards call for a width of 48 inches. The reader may not help but notice that because of a shortage of electrical outlets, the toaster is on the floor.

Figure BR3. The hazards of a narrow bathroom door.

With the bathroom door open the width is only 38 ½ inches. Figure BR3 shows what happens when a powerful power chair, driven by a client impatient to get to the bathroom, collides with the door. A door in a narrow hallway causes difficulties for an individual riding a mobility device including the problem of being able to close the door.

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One solution is a pocket-door once fashionable in the late 19^th Century which is making a comeback especially for those modifying homes for greater mobility.

Figure BR4. Sliding pocket doors

Clients using the bathroom sink below must go elsewhere, to the kitchen sink for example (or bring along their own mirror) to comb hair, apply makeup, shave, and perform other daily rituals.

A lower sink and mirror set are the most immediate solution. Two grab bars at the base of the sink would make it easier for the individual with a mobility disability to stand or maintain balance. A specially designed sink located elsewhere in the residence could save on remodeling costs. Below is a sink installed at an appropriate height in a residence bedroom which can be modified for individual requirements.

Figure BR5. Bathroom sink

Insertion of an additional sink (either in the bathroom or elsewhere in the residence) also is useful to minimize bathroom accidents can be cleaned up without becoming a major issue)

Other bathroom considerations include:

• Where to put one’s cane, crutches, or park one’s mobility device
• Storage of toiletries so they are accessible

Bathroom sink

Clients using the bathroom sink must go elsewhere, to the kitchen sink for example (or bring along their own mirror) to comb hair, apply makeup, shave, and perform other daily rituals.

Figure BR6. Kitchen sink (provides options not available at bathroom sink)

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Toilet

Going to the toilet requires more prudence than adults without disabilities require. A mobility disability, by its nature, means it takes more time to get from one place to another. Individuals used to going to the toilet on a schedule comfortable to them before they became disabled may be surprised at how much extra time they must factor in.

Figure BR7. Toilet

The toilet shown above should be reassuring. The two grab bars are sturdy and well-positioned. However, it is always helpful to make sure the toilet seat itself is securely fashioned and to check each time before using.

For individuals with transference issues, there are transfer boards for going from wheel chair to toilet:

Figure BR8. Toilet transfer board

This is a convenient way of transferring from a mobility device to the toilet. Less elaborate transfer boards are available. For those with more serious mobility problems, a sling attached to the ceiling is recommended or one might consider installing tracks on the ceiling so a device the individual can use by oneself can easily be moved from the bedroom where it lifted the individual from bed to wheelchair.

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Use of a sling

Figure BR9. One of a wide variety of slings

Within the past five years, two developments have made it practical for individuals with severe mobility disabilities to live independently. The first is the development of a sling an individual can use oneself for transference. The above is not a good photograph and should be replaced with a better one. The second development is the use of the ceiling as a method for locomotion; namely, one puts oneself in a sling attached to the ceiling; tracks along the ceiling make it possible to move across the residence, and one can lower oneself to, for example, a bed or a wheelchair in the kitchen. Notice the ceiling tracks:

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Ceiling

Last year, I saw a trailer developed by Blueroof Technologies in McKeesport, PA for the use of veterans whose lower limbs had been amputated. The veteran was able to go by sling and ceiling device from bed to bathroom to kitchen for breakfast and then out into the world on a mobility device. Not all this information is relevant to the bathroom.]

Figure BR10. Ceiling tracks

Toilet

If the individual does not allow enough time to position oneself at or on the toilet, accidents can occur just when they seemed most avoidable. Individuals who have not experienced an accident since childhood and who assumed such problems would not occur for decades find themselves discouraged when an accident occurs. For individuals who suddenly experience mobility problem, incontinence may be a temporary consequence and it is useful for the individual to understand that temporary means temporary.

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Bathroom fixtures

Figure BR11. A convenient dispenser

Figure BR12. Shower head for roll-in shower

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Figure BR13. Shower head ready for use

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Figure BR14. Shower head ready to be put back in place

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Figure BR15. Standard shower chair

Bathtubs

Conventional bathtubs, such as the one below, provide problems involved with getting in and out. The market place, using slings and transfer boards, does make it possible for individuals with mobility difficulties to take baths. However, a roll-in shower, unless other considerations are involved (e.g. skin disorders, the requirement to soak limbs, and the like), the roll-in shower is probably the most cost effective.

Figure BR16. Think twice about getting into this bathtub

Off the shelf technology gives residents an added level of protection. Figure BR1  shows a motion detector in the bathroom. Motion detection makes it possible to alert caregivers (by a voice simulator automatically calling 911 or another number) if someone slips in the shower, for example, and does not get up according to a pre-programmed time schedule. The cost of this technology is relatively modest and has been falling steadily.

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Imagine using this imaging technology displayed for design and working out such issues as how to get from scooter to bath chair? One might:

• Turn the scooter around so water does not fall on the controls
• Back up to the shower chair
• Swivel the scooter chair locking it into place.
• A hand rail would be useful to go from scooter chair to shower chair.

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Figure BR17. Virtual reality is helpful when going to the shower

References

Footnotes

1. I am sad to say that Nadya Ludwig is dead. Nadya and Lilian H. served as greeters at Addison Court’s hug a firewoman and man on Valentine’s Day. The event was held at the bingo parlor across from my apartment. Each left the low-income disabled and elderly housing complex in which I live in an ambulance.

Books

Doidge, Norman (2007). The Brain That Changes Itself, Stories of Personal Triumph from the Frontiers of Brain Science. New York, NY. Penguin Books.

Durkheim, Émile (1897; 2006 translation). On Suicide. Trans. Robin Buss. London, England. Penguin Books.

Gratz, Roberta Brandes (2010). The Battle for Gotham, New York in the Shadow of Robert Moses and Jane Jacobs. New York, N.Y. Nation Books.

Hamilton, D. Kirk & Watkins, David H. Watkins (2009). Evidence-Based Design for Multiple Building Types. Hobokin, NJ: John Wiley & Sons.

Jacobs, Jane (1961). The Death and Life of Great American Cities. New York, N.Y. Vintage Books.

Keesing, Roger M. (1976). Cultural Anthropology, A Contemporary Perspective. New York, N.Y. Holt, Rinehart, and Winston.

Kottak, Conrad Phillip (20080. Cultural Anthropology, Twelfth Edition. New York, N.Y. McGraw-Hill.