Remodeling for Wheelchair Access: (Part 3) Bathrooms
A few years after a car accident that left my brother Miguel paralyzed from the shoulders down, he had to be flown to a state-of-the-art facility in California in a last-ditch effort to treat an infection that was causing his lungs to collapse. Soon after arriving he was strapped onto a device called a Rotobed. This expensive piece of medical equipment, complete with all the bells and whistles, is simply a bed that slowly rotates from side to side, reaching rather steep angles. Aided by gravity, stagnant fluids are mobilized out of the lungs. With this bit of high-tech bedding and the expertise of his medical team, he was taking deep breaths within a matter of days.
The center's staff encouraged family involvement, so when it was time for a shower, I joined in. As a high-level quadriplegic, my brother had previously been limited to bed baths and an occasional shower in his tiny bathroom, involving perilous transfers and the skills of a contortionist. Here, his nurse, standing under five feet, placed a full-body plastic transfer board under him and slid him onto a gurney by herself for the trip across the hall. The shower room was exactly that: an 8-by-8-foot tiled room with a floor drain and a hand-held shower nozzle perched on a mount on the wall. Still comfortable on the gurney, my brother enjoyed his shower, while the nurse and I barely got our shoes wet.
On our way back to his room, he thanked the nurse for his first relaxing shower in two years and then described his bathroom back home.
"Ay, dios mio!" said the Colombian-born nurse, rolling her eyes. "Tell me, do you have a yard at your house?"
"Yeah," he replied, looking a little perplexed.
"Well, forget about all this accessible-shower stuff. All you do is sit out in your yard on a plastic chair and hook up your hose to the kitchen sink. You know, with one of those little adapters they sell? And there you are. You have yourself a shower."
Well, he hasn't tried her idea yet, though I have encouraged it more than once, pointing a hose at him. Nevertheless, that hospital visit did leave us pondering the difference between one's sense of what is necessary and the absolute minimum one needs to get along. If you are up for year-round outdoor bathing, you now have all the information you need. Otherwise, have a look at these ideas to help make your bathroom wheelchair accessible.
Because it is usually small in size, the bathroom is the room most likely to be remodeled to accommodate the wheelchair user. While it may be possible to redesign your current bathroom, increasing the size of the room is inevitable in most cases. You can convert adjoining closets or part of a bedroom to extra bathroom space.
Entering the bathroom through the typical 30-inch door is impossible for most wheelchair users. A 36-inch door that swings outward can make entry easier and increase the usable space inside the room. It also adds a measure of safety in case someone with limited mobility were to fall, blocking an in-swinging door. As an alternative, a pocket or sliding door is a good option.
Once inside, you'll need a clear floor space 60 inches in diameter for turning. Create an area 30 inches wide (or more, depending on the individual's transfer technique) adjacent to the toilet, along with grab bars for those with use of their hands. Access into a standard shower or tub involves similar requirements.
A standard toilet is too low to allow someone to transfer comfortably to it from a wheelchair. To match the level of the wheelchair's seat, choose a toilet with a seat that's 17 to 19 inches from the floor. Such toilets are now widely available and help not only wheelchair users but anyone who has trouble standing up from a low seating position.
If the wheelchair user has the use of his or her hands, install grab bars on the walls behind and next to the toilet. They should be 33 to 36 inches from the floor, with fasteners penetrating directly into solid wood or masonry (wallboard alone doesn't provide adequate support). When remodeling the bathroom, plan ahead by reinforcing with solid blocking areas of the wall where you'll install the grab bars, and then cover the blocking with wallboard.
Showers fit loosely into two categories, each with its own advantages. Seated showers or shower/tub combinations require the bather to transfer from the wheelchair onto a built-in seat or accessory bench secured onto the tub. Provided there is adjacent clear space to allow a safe transfer, many shower or shower/tub combinations can easily be adapted at minimal cost. Grab bars can help enormously.
The roll-in shower permits the user to bathe while seated in a waterproof wheelchair. The shower's floor, sloping toward a central drain, forms a continuous barrier-free surface with the rest of the bathroom floor, providing usable turning space even when the shower is not in use. (This type of shower is especially good for quadraplegics.) Typically built in place and surfaced with ceramic tile, it can be a complex construction requiring alterations to the existing floor structure. Major plumbing fixture manufacturers now offer ready-to-install fiberglass units sized to fit into the 60-inch space normally required for standard tubs. Some models are slightly raised from the floor to avoid the need for alterations and include a short ramp. I liked the clean, open qualities of the roll-in shower I built for my brother so much, I included a similar design in my own bathrooms.
Getting down to details, hand-held showerheads are a smart choice. Units mounted on a bar allowing vertical adjustment of the showerhead are the most versatile. Shower or tub controls should be easy to grasp and mounted at the appropriate level.
Most important, you need to install an anti-scalding valve. These temperature-sensing valves automatically adjust the water mixture to prevent potentially lethal burns caused by unexpected changes in water temperature. My local building code now requires them even for general use.
Wall-mounted sinks provide access and maximize floor space. The top of the sink should be no higher than 34 inches, and you should look for special models with shallow bowls extending 17 to 19 inches from the wall to allow adequate knee clearance. Be sure to allow enough turning space for a forward approach. Wall-mounted sinks, like grab bars, require solid wall areas for proper installation. As with kitchen sinks, be sure the user's legs are protected from hot or abrasive objects, such as pipes through which hot water is flowing.
Install mirrors and medicine chests at the appropriate levels. If you use storage cabinets, try wall-mounted units to preserve floor space or create a cabinet that is built into the wall by stealing closet space, if available, from an adjoining bedroom.
Recently, my brother moved to a new house not far from where I live. He still talks wistfully about the shower room we got to use during that hospital visit. Somehow, I get the feeling it's only a matter of time before we go to pick out the tile for a new state-of-the-art bathroom.
-- Gabriel Wolff is a former biology teaching lab director at UC Santa Cruz who specializes in home remodeling.
Martha F. Somers. Spinal Cord Injury: Functional Rehabilitation. Appleton &Lange. Norwalk, Conn: See Chapter 18: Architectural Adaptations.
Nondiscrimination on the Basis of Disability by Public Accommodations. Federal Register. Department of Justice, Office of the Attorney General. Part III. 28 CRF Part 36.
Adaptable Housing: A Technical Manual for Implementing Adaptable Dwelling Unit Specifications. Boston, Mace, &Long.