Aging-in-Place Bathrooms: Planning and Design for Older Adults

Let’s face it: housing isn’t usually built to best-serve specific residents, but to be acceptable to a wide swath of people. However, there are many among us who have more-specific needs for our homes to accommodate. Especially in a bathroom, where hard finishes and water make things treacherous, good design can be the difference between injury and safety. Ultimately, the bathroom needs to work for its owner to meet their health needs. “Universal Design” strives to make buildings work for all people, both young and old. The term “aging-in-place” refers to designing spaces to overcome challenges specific to older adults.

Estimated reading time: 12 minutes

Introduction

Designing for the physical needs of a variety of occupants is known in the industry as “universal design.” When design is tailored to age-related needs, it’s known more specifically as “aging-in-place.”

Certified Aging-In-Place Specialists (CAPS) are design professionals who are specifically trained in this field. They, along with an Occupational Therapist may be a good resource as one considers age-related home modifications

With professional help and a little forethought, you can anticipate many potential problems and incorporate their solutions into a design plan. That will improve your confidence about staying at home, as well as keeping you safe and independent.

What is ADA-compliance? ADA compliance requirements for residences

Many homeowners begin their research for a disability-friendly remodel with building guidelines set forth by the American for Disabilities Act (ADA). While ADA-compliance seems like the natural target, it is worthwhile to consider the situations the regulations were written for. The typical ADA-compliant bathroom is in a commercial property meant to serve the needs of all sorts of people. The writers of the guidelines did not tailor them to any particular disability, although people who use wheelchairs will find those bathrooms better suited to their needs. While ADA-compliance in *your* home may be nice to have, it’s not required and perhaps not even the best way forward. During the design phase of your project, consider every aspect of how you approach and move through the space in your home. You’ll want to tailor the entire experience so that you are best able to use the space and minimize difficulties.

While we typically don’t strictly adhere to ADA guidelines per se, we can use ADA regulations as a guidebook for thinking through and making choices to improve your every day comfort and safety.

Remodeling concerns:

When you consider the changes that could be made to improve your comfort and safety, it can begin to look like the project is getting large and overwhelming. How much will it cost? How long will it take? Will everything be a mess? Is it worth risking the comfort and safety you have now to acquire more comfort and safety later?

Designing an accessible bathroom layout for a home

When remodeling for aging-in-place, the layout of your bathroom will likely be one of the largest changes. A standard sized bathroom normally has  too little open space to accommodate turning around as needed for wheelchair or walker accessibility . The 2010 ADA guidelines have specific requirements for each area of the bathroom, but we can generalize those  for simplicity’s sake: 1. There must be an open area to fully accommodate turning around. If designing for a wheelchair, that space will need to be 60 inches in diameter. 2. Each fixture must have clear floor space in front and to the side to accommodate using those fixtures (adding grab bars is often very useful). 3. The door to the bathroom shouldn’t swing into these areas unless the occupant can occupy floor space that is out of the way.

Because  a standard 5×7 or 6×8 foot bathroom is usually too small to accommodate these needs, oftentimes a contractor needs to remove/rebuild walls to make the layout work.

Flooring and Transitions

The Flow and Flooring Transitions Between Rooms

We begin with the door:- most codes  specify a minimum 24- 28-inch wide door for the bathroom. This can be too narrow for a person using walking aids; it is much too narrow to accommodate a wheelchair. It’s a good idea to plan for a door that is 36-inches wide for wheelchair accessibility. Another option is to install the door to swing outwards rather than inwards depending on the surrounding space. The bathroom and hallway layouts determine whether this is a better choice over the standard inswing.

Let’s also consider the flooring transition into the bathroom.  Is there a bumpy transition piece that would be a tripping hazard or cause difficulty in a wheelchair? How flat is the floor? We need to address these potential problems to facilitate safe movement through and around the bathroom.

Flooring Type

While we’re always partial to tile for a bathroom floor, it is also the most expensive option, and isn’t right for every customer. The only real stipulations for the  a flooring in your aging-in-place bathroom are that the material is water resistant, that it maximizes friction for traction, and its durability.

Luxury Vinyl Plank is quickly taking the flooring world by a storm as a cost-effective and durable option. Its water resistance makes it a good choice for the bathroom. While its life expectancy isn’t as long as tile, it still retains good friction under foot and remains the best budget option for a disability-friendly or aging-in-place remodel.

Another option is rubber flooring. When friction is the most important consideration for your flooring, rubber is the best choice. Rubber is limited in style options, but that trade-off may be worth it for the safety-conscious homeowner. Tile is the gold standard for bathroom flooring. When installed properly, its life expectancy is essentially forever (at least as long as the home itself). While some large-format polished tile can be slippery, this problem can be mitigated by using certified porcelain products. See below for an explanation.

Flooring Friction

To prevent falls and injury in the bathroom, avoiding slippery floors  is a must.  While all flooring materials are more slippery when wet, some are more suitable for use in the bathroom. Tile’s slip factor seems to be the most worrisome to customers, so we’ll address that here.

The Tile Council of North America helped develop a testing standard (ANSI A326.3) for measuring the slipperiness of flooring when wet. This is measured as the Dynamic Coefficient of Friction (DCOF), and everything over 0.42 on the scale is considered “safe”. C  “Certified porcelain”  exhibits a DCOF over 0.42. While it’s best to do some real world testing before purchase, starting your search with certified porcelain may be a wise choice.

Another way to increase the friction in a tile floor is to use small tiles or a mosaic. A larger number of grout joints increase your foot or shoe’s purchase on the floor. Reproductions of art deco and other historic styles of tile often utilize small tiles and create patterns on the floor. This option may be another appropriate one for your needs.

Walk-in Tubs

The last consideration for creating safety in an aging-in-place bathroom is how to move into and out of the tub/shower. The options vary in costs and benefits.

A walk-in tub has a gasketed door that allows one to step with no need to lift the foot over a barrier. Usually there is a seat molded into the tub. When the door is closed, it allows the tub to hold water. Once the occupant drains the tub, they can open door and exit. This style retains the benefits of using a tub, including soaking or hydrotherapy for sore joints. The potential downsides are the wait times for fill and drain:  The user must enter before filling and exit after draining.  The occupant may become chilled while waiting for the tub to drain. More on walk-in tubs here.

Curbless Showers

A curbless or zero-threshold shower is basically a shower built into the floor. There is no barrier or curb to step over. This eliminates a potential tripping hazard, as well as allowing a wheelchair to roll all the way into the shower. Customers often opt to install a bench in the shower, so they can avoid standing or transfer from a wheelchair. There are a number of ways the bench can be configured:  as a built- in tiled bench, or as an installed foldable/swivel unit.   With the building products on the market today, your imagination is the limit. While the cost for a curbless shower is higher due to the technical complexity, many homeowners find the safety factor and myriad of customization options worth the extra investment.

For either option, there are some usability details to consider:

1. Will the shower controls be accessible while seated on the bench?
2. What fixtures emit water and in which direction? Will the choices meet  your changing needs?
3. Is there enough space to maneuver within the footprint of the shower, whether with a wheelchair, or when using  surrounding grab bars?
4. Consider the finish materials for your shower. Is there enough friction on the floor to make the occupant feel secure while maneuvering?

Choosing ADA-compliant Plumbing Fixtures

Toilets and Bidets

While layout and barriers take up much of the design energy in an aging-in-place bathroom, there are also specific fixtures to consider. ADA-compliant toilets have heights between 17-19 inches to allow for ease of transfer from a wheelchair (There is an exception for residences to install shorter toilets). Even if the design goal does not include wheelchair accessibility, the greater height makes a world of difference for those suffering with joint or back pain. Among the  toilets that we recommend, most brands will offer ADA-specific toilets.

Several of our customers have chosen a bidet or a bidet-seat to make clean up easier. The bidet provides clean up with the touch of a button, avoiding  the difficult movements associated with toilet paper clean up.  Several companies have entered the bidet market in recent years. Toto and BioBidet in particular offer good reliability as well as options for every customer.

Vanities and Sinks

The right choice of vanity or sink will make a big difference in your bathroom. The correct sink height is important for ease of reach. A bulky cabinet below the sink often prevents wheelchair users from getting close  enough to use the sink efficiently. Often, a wall-hung vanity is the best choice. Extra storage can be installed to the side as needed.

To accommodate everyone who might need to wash up, one solution would be to build two sinks at differing heights. Each person can choose the sink most suited to them.

Choosing the details fixtures and flooring/walls

Even the small details can really improve the experience and usability of your universal bathroom.

HVAC registers

Have you ever considered your floor registers? Often, they are made of a simple white metal, or brass with a design punched into the sheet metal. Most floor registers sit on top of the finished floor and create a bump and potential tripping hazard. There are several registers available that take a different approach to their grates. Ventiques brand floor vents are flush mounted with your flooring (They must be installed when new floors are put in). The makers designed these vents with safety and accessibility in mind. Not only are they flush- mounted, they are designed with high-pressure point load in mind (i.e. for a wheelchair). Chameleon and Aria brands also make flush-mount vents, albeit without the high weight ratings.

Lighting

To set up bathroom lighting for poor eyesight involves more than making the room brighter.  We must also consider ways to reduce glare. This  takes into account the light angles and how the light reflects off of objects.  Avoiding overly reflective finishes on fixtures and flooring can improve one’s “mental map” of the room as well. Also, proper management of  contrast in the colors and finishes of the room will helps certain objects stand out.

Spreading out light sources is an additional way to support poor eyesight. This could involve creating a diffusive light source near the top of the room for general lighting, and then  managing additional light sources for particular areas, like near the vanity. LED lights now come in all shapes and sizes, so we can tailor customized lighting to fit almost any application. A good lighting designer will be a useful partner in this design challenge.

The correct placement and type of switches make a big difference in safely and comfort. Lighting should be easy to reach and turn on/off. Solutions for arthritic hands include devices that are triggered by waving or that detect movement. A smart-home system also will control lighting.

Mirrors

How a mirror sits in the room makes a difference.  Is the mirror set at  the right height so that anyone can see themselves? Is the angle appropriate, not only for seeing oneself, but to reduce glare from light sources? One option is to incorporate several mirrors, including one on a scissor mount that can be moved into any position.

Grab bars, Faucets, and Hardware

ADA-compliant bathrooms in a commercial or public environment have very specific standards for the placement and size of grab bars. In the home environment, we can be more flexible to meet individual needs.

Placement of grab bars is determined by usage needs.. They may be needed around the toilet, at the shower entrance, within a shower, and at a vanity. Grab bars not only  provide support as one uses individual fixtures, but they also allow for safe movement through the space.

Homeowners are often wary of installing too many grab bars, as traditional grab bars tend to look institutional and uninviting. Several companies have stepped up to not only develop better-looking grab bars, but also to design fixtures that double as support points. The Invisia Collection incorporates grab bars into shower fixtures and bathroom hardware, doubling their usability. Delta’s Decor Assist Collection, as well as hardware from Speakman, hide the grabbar capabilities a little more, but similarly make it easy to hold on to their fixtures for support.

A consideration for arthritic hands: it is easier to use levers than knobs on moving parts. Try out the fixtures whenchoosing faucets and shower hardware. Fixtures should operate easily without needing too much “grab” force. Or consider  touch-operated faucets.

Shower Seat

If you have plenty of room, a permanent bench may be appropriate. You just need to ensure access to all the shower fixtures from the bench. If you don’t have a lot of extra room,  several fold-down shower seats are available.  A large number of designer options come in teak so don’t have the antiseptic look of hospital furniture.

Another option is a sliding transfer seat. This works best l for those who have caregivers. The transition happens outside the shower and lessens the risk of caregiver back injury or slippage.

Do you like it?

Many customers worry that designing their bathroom for aging in place will result in an institutional look – their bathroom will look like it belongs at the gas station or the grocery store. Don’t worry! There are many colors, fixtures, and patterns to choose from which will look like they belong in your home while meeting your needs. Many, many people have taken these steps and are happy with the result.

Other Resources

Aginginplace.org provides a large variety of information to those interested in learning more about the ins-and-outs of planning an Aging-in-Place bathroom.