Designing for Aging in Place and Disability Enabled Bathrooms

This is a complex topic with a lot of variables.  Please excuse any lapses, I’m trying to be as PC as possible so no offense is ever intended.  The variables depend upon the extent of disability whether it be physically disabled, some degree of paralysis from heart or stroke issues, impairment from a disease like Parkinsons or the result of an accident that now limits physical activity in one form or another.

By qualification, I am not a doctor, physical therapist or any type of medical professional.  I am a professional remodeling contractor whose job it is in these situations to develop solutions to whatever problems are at hand and making sure they are to code and can accommodate whatever level of disability is present either now or in the future.  I try my best to be a solution oriented thinker that can help my client with a successful design that allows them greater freedom.  People in this situation are vulnerable and need a trusted advisor in the process.  A trusted advisor with the client’s best interests at heart is the role you must play.

Obviously, there are code issues present for every situation from doorknobs, levers at the sink, width of doors etc….  It’s not my intention to review all of those as there are plenty of publications on those topics as well as ADA books, and code regulations.  You may or may not have to deal with all those issues but the contractor you choose for the job should know their way through all the regulations and code issues so they can properly guide you in your design.  My point in this article is to discuss the items of primary importance in reaching your final design.  The number one step in the process is information gathering and assessment of the situation.

Why are you doing this?

The answer to this question ranges from a sudden catastrophic event which severely impacts mobility to the effects of a disease or medical condition or simply trying to prepare for a future in which you fear your mobility may be impacted.  I have been contacted by clients who, considering their present situation, felt it advisable to prepare ahead of time should they be wheelchair bound at some time in the future.  Others were concerned about the impact of trips and falls, balance issues, instability, slippery flooring, or muscle weakness either now or in the future.

Information Gathering and Assessment:

The most critical element in this process is the ability to listen to the client, learn what their needs are, where they hope to be in the design process, ie. What will make them happy.  Gather all the possible input regarding their specific situation.  You have to ask questions! Be thoughtful and thorough in the questions you pose and listen to the answers provided and you must learn to hear the words and intent not spoken but implied so body language and facial expressions are paramount.  Once you are sure you’ve heard all their information, repeat it back to them and walk them through the design choices.  You’ll find a lot of times they might have had a different picture in their mind than what you pictured so arriving at the same destination is critical in understanding the issues they’re dealing with.

Some examples of previous issues for comparison:

The most demanding bathroom we remodeled was back in Massachusetts.  A woman was stopped behind an oil delivery truck who suddenly began to back up on the road and could not see her behind him.  Never mind the fact that it’s illegal for a truck to back up on a road without assistance.  He pushed her car into a ditch and crushed it.  She ended up severely paralyzed.  Their bathroom was designed by an architect who specialized in these types of cases.  We created an entire wet room where the client was wheeled into the room and helped into a special chair which was suspended from the ceiling with a track.  The seat (with restraints and straps for safety and to hold her in the chair without slipping) was then navigated by a remote control unit which would move across the ceiling and position her for showering or bathing.

In Las Vegas I was asked to come and look at a bathroom that was done by someone who had no idea what they were doing and had no licenses.  The client was a woman who had suffered a stroke during a surgical procedure.  She had been in a wheelchair for several years.  Although she was able to stand, after about 30 seconds she would be hit with tremors and body shakes which would get progressively more intense the longer she tried to stand.  The bathroom was a hall bath and those are typically no larger than 35-40sf.  The door opens in and you’re facing a vanity with a toilet next to it and the tub beyond the toilet.  There was not enough room to get the wheelchair into the room and certainly no way to turn it.  A wheelchair needs a minimum 60” turning radius.  What the person had done was remodel the shower with acrylic slabs.  He constructed a seat right at the entrance on the left shower wall which gave her little or no entry.  To compound matters, the seat area was slanted in the wrong direction so the water would accumulate at the rear of the seat instead of running off into the shower.  To visualize, you have a toilet projecting from the right side of the wall as you face the shower.  Fifteen inches from the center line of the toilet is the shower.  The width of the room is 58.5”.  The seat in shower extends out 12” and an elongated toilet bowl projects out 29-30” from the wall.  Put those numbers together and this poor lady had about 16” to squeeze her body through into the shower.  This particular client had been in this declined physical state for approximately 10 years.  During that period of time, as you might expect with little or no exercise or physical activity, she had gained a significant amount of weight which further exacerbated the difficulties she was facing getting into the shower.


For my purpose this means surveying the site and the existing conditions and then trying to bring the design together based on the combination of what their desires are, what the site conditions dictate as well as the potential budget concerns.  After I have examined the site and understood what their goals are, I begin to ask additional questions to help me understand what their needs are.  In the situation I just described I had a long conversation with the client.  What is the extent of the disability, how much movement do they have, what do they feel they need in order to reach their goals and a host of other questions that are prompted or directed by the answers I receive.   This person had already exhausted their funds with the first person who gave them the bad design and poor workmanship.  We were not going to be able to widen the doorway, move the vanity or toilet and essentially there was no option to re-design or reconfigure the space so the challenge was to make it work for them somehow.  Once I reached an understanding of the limitations to her mobility I was able to at least give a temporary solution so she could reach her goals.  During this period of time they would have access to the shower and it would buy them some time to gather more money to effect a permanent solution or change the location altogether.


Based on our conversations we started our solution in the bedroom.  When she woke she had extreme difficulty turning over in the bed as she prepared to exit.  She still had very good hand and grip strength so I installed a bar on the wall behind the bed that allowed her to reach over her head while still prone and rotate to the outside of the bed.  Next we secured the night stand to the wall and installed another bar on the nightstand so she could reach over and pull herself into a sitting position.  As you can see the questions took us right back to the beginning of her day by examining how she was able to get out of bed and get mobile through the home.  If I hadn’t asked all the questions I would never have realized how much difficulty she had getting out of bed.  For the first time in at least five years, she was able to turn herself over in the bed and sit up without her husband having to help roll her over and pull her up to a sitting position.

The client was able to stand for short periods of time and had good arm and grip strength.  She was also able to walk with support for short distances and that was critical to reaching our goal since additional construction expense was not an option.  We wheeled her into the bathroom and walked through her movements and routine to devise a procedure and placement of support bars that would allow her to gain access to the shower.  As a result, she was finally able to shower.  Now, was this a by the book solution with ADA approved construction at every point? No, but it was a real world situation that allowed her access to the shower under existing conditions that she had no option or money to change. 

I recently went to a home where a gentlemen was suffering from Parkinsons and after looking at the existing bathroom we developed a design so he could enter the shower and not have to step over a threshold.  We will remove the existing flooring and replace it with an R11 tile that gives extreme slip resistance.  We will widen the shower entrance to accept a wheelchair for a time in the future when his mobility.  We will also install grab bars and eliminate the glass as much as possible to lessen the risk of balance loss and falling into a glass wall.  To accomplish this we’ll construct pony walls with glass on top for visibility, relocate the shower head and extend the shower pan out further at an elevation that will drain properly and give enough distance by code to turn the wheelchair.  The owner looks to this as a temporary five year solution because the master bedroom/bathroom suite is on the second floor.  Unfortunately, with the progression of this disease there may come a time in the future when access to the second floor is no longer possible and the client will need a stair lift, elevator or design a new area to accommodate being confined to the first floor of the home. 

In conclusion, we are not always able to create a “picture perfect” design in line with all ADA guidelines but we are trying to deal with the specific problems faced by clients in many different situations and then try to help them to achieve their goals.  The main point behind this article is that we can’t walk in with a cookie cutter, one stop approach.  Every situation is different and each client will have a specific set of needs so the best place to start is by asking questions, listening to the answers and attempting to find a solution that will help and benefit them.  Once we have that, we use our knowledge and skills to develop a solution to whatever the problem may be.  You may also come into a situation where the clients’ needs, and present living conditions are beyond a solution that you can provide.  In that case I think the best you can do is to give them your evaluation of the situation, perhaps provide whatever advice you can and refer them to a person or an agency that may be of further assistance.