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Bathroom Safety Design:
Part II - Remodeling Suggestions

Improvements Make Sink,
Tub and Shower Safer
By: Mary Lou D'Auray, BA, CID, and Stacey Matzkevich, MSG, MSW, LCSW

Falls in the home account for 80 percent of all deaths in the elderly. Most such falls occur in the bathroom. In her book "Elderdesign," Rosemary Bakker cites U.S. Public Health Service figures confirming that two-thirds of fall-related deaths are preventable. This is the second of two articles designed to guide caregivers in the process of redesigning a bathroom to create increased ease of use for seniors.

General bathroom design
  • If possible, build a complete bathroom on the first floor to avoid having to go up and down stairs.

  • Ideally, the bathroom should have a five-foot turning radius for wheelchair accomodation, with a roll-in, no threshold shower. This design will allow accessibility for wheelchairs, walkers, and will also prevent seniors from tripping.

  • Adapt counters to make knee space that allows seating at the counter.

  • The bathroom doorway should be 32 inches wide, without a sill - again, to allow accessibility for wheelchairs and walkers. The door should swing outward into the hallway, rather than opening into the room, in case anyone falls inside the bathroom, in front of the door.

  • Arrange all doors and cabinet doors so that, when they open, they do not block or cover light fixtures. Diminished light may disorient someone who is vision-impaired.

  • Install a large medicine cabinet at an easy-to-reach height, to avoid stretching and reaching.

  • Use a slip-resistant floor, such as vinyl.

  • Round all edges of cabinetry, to eliminate the possiblity of injury on sharp corners

  • Create adjustable shelving for the cabinets and storage units, so that frequently used items can be placed exactly where needed.

  • Incorporate use of levers on doors and drawers. These are easier to manipulate than twist doorknobs or latches, particularly for seniors with arthritis who have difficulty with grasping or hand dexterity.

  • Use tempered glass or apply shatterproof plastic glazing on all glass. These precautions make it less likely that large sharp shards of glass will result if glass does break.

  • Install a ceiling vent and fan to increase air circulation and reduce humidity.

Grab bars
  • Properly install non-slippery, color contrasting grab bars near the toilet, in the bathtub, and in the shower area. Make sure you have grab bars properly installed to sustain loads from a few pounds to 300 pounds without failure. Bars should have no movement or play. Movement can cause a senior to react or panic and get hurt, even if the bar holds.

  • Consider having an occupational therapist come into your home to position the bars and provide instructions for using them.

  • Ensure you use a qualified installer who provides the following:

    • Guarantee that installation meets or exceeds building codes and government guidelines for safety rails in hazardous locations.

    • Guarantee that installation is waterproof.

    • Manufacturer's guarantee that product is recommended for your particular application.

    • Certificate of insurance from the installer.

  • Install a toilet that is adjustable or has a seat that is at 18 inches from the floor. The elderly sometimes have trouble getting up and down; a higher seat eases this problem.

  • Place the toilet paper holder and grab bars within easy reach of the person seated on the toilet.

  • Install a height adjustable mirror unit to accommodate a sitting or standing viewer, and a shallow sink to eliminate having to bend over to reach the bottom of the sink.

  • Install counter tops, sinks, and cabinets low enough to accommodate someone in a wheelchair.

  • Consider mounting a magnifying mirror to aid with grooming.

  • Install a single-lever, touchless, or push button faucet with temperature and volume control. This allows you to preset temperature and volume so the senior can't get burnt.

  • Insulate any exposed pipes under the sink to avoid burning the knees of wheelchair users.

Shower and tub
  • Remove shower sill for easier access and to prevent tripping.

  • The shower door should swing into the bathroom or be a sliding door. Roberta Null, author of "Universal Design," points out that triple panel sliders or accordian doors, rather than a door that opens into the room, allow maximum access to bathroom space.

  • If a curtain is used, make sure it is attached to a solid rod, firmly screwed into the wall. Seniors may grab the curtain if they fall. A solid rod may hold where a tension rod certainly will not.

  • Install a wall mounted soap and shampoo dispenser in the shower. This can keep a senior from fumbling with slippery bottles and soap that contribute to falls if dropped.

  • Install anti-scalding, pressure balance water temperature and regulator controls for shower and bathtub. These keep the water from suddenly getting too hot when someone turns on cold water elsewhere in the house, for example by flushing a toilet. Or, ensure that the water heater is set to 120 degrees Fahrenheit (49 degrees Celsius).

  • Use a waterproof, non-slip chair in the shower to allow the senior to sit while taking a shower. If needed, use a securely fastened bathtub transfer bench. This will help the caregiver in the bathing procedure.

  • Install a hand-held shower unit that may be used while seated.

  • Place shower controls near the entry point of the shower and bathtub faucets at an easily accessible location, possibly outside the tub. Careful location of the faucets will mean that a caregiver will not have to overly extend, or get wet, while turning on the water.

  • Eliminate steps to the bathtub. If this is not possible, no more than one step should be used, and a grab bar should be placed next to this step.

  • Non-slip, adhesive safety pieces should be stuck onto the bathtub floor surface.

  • Use a clamp-on hand support on the bathtub, to help support the person entering the tub.

Lighting and electrical
  • Provide adequate general and task lighting that is non-glare, and easily switched. For example, install glare-free lighting over the mirror and a waterproof light in the shower. Glare or dark spots make tub edges difficult to see.

  • Have all outlets ground-fault interrupted, in order to prevent electrocution.

  • Make sure electrical appliances such as hairdryers, electric rollers or razors are a safe distance from any water source.

Safety-oriented design is corrective and preventative, said Null. It promotes a psychological sense of health and well being, of belonging, of self-esteem, and self-worth. This means that the effect caregivers put into designing a safe bathroom can make a senior feel better today and prevent problems later.