In a senior living facility, the bathroom is arguably the most important space to providers and their residents. Studies show that most incidents and falls occur in the bathroom. The independence, hygiene, dignity, and safety that occurs in the bathroom is all pivotal. That is why it’s so important to create an environment that supports aging over time and promotes independence for seniors.
Here are 10 key elements to making a safe, comfortable, and pleasant bathroom environment.
1. LIGHTING. The amount of lighting the elderly need increases due to changes in aging eyes. Often, mature adults are most disoriented in the middle of the night. The ability to see clearly, and do so seamlessly, is vital for seniors. Automatic lights and night lighting can aid the sense of security and reduce risks throughout the bathroom. During the day, adequate lighting in the shower and tub increases the ability to see faucets and toiletries, reducing the likelihood of slips and falls. Also, it is important to provide proper lighting around the toilet and within the shower area in the event that staff assistance is necessary.
2. FLOORING and FINISHES. Non-slip flooring and textured finishes reduce the risk of falls. Flooring, especially in wet areas, is critical to meet requirements for slipping as the introduction of rugs or mats can be a tripping hazard. Providing flooring that is glare-free and provides for some level of altering color and contrast improves vision clarity. Be very mindful of transitions from carpet to tile or vinyl to ensure that there is little to no elevation change that may increase the likelihood of a fall.
3. SHOWERS/TUBS. When it comes to showers, low-threshold showers and collapsible vinyl shower dams are preferred in resident rooms compared to tubs. Weighted shower curtains are key to keeping water where it needs to be along with vinyl collapsible dams that not only assist in keeping water inside the shower but allow for feet and assistive devices to “crush” the dam versus a non-zero entry shower with a fixed 4” lip. Ideally, barrier free entry is the best option. Adequate floor pitch to drains also prevents “ponding” of water, especially if a barrier-free shower area is provided. Moveable shower seating is appropriate for the majority of those in an independent living situation. For all, we must ensure non-slip flooring, and placing grip strips is an optional additional safety measure. However, mats placed on the floor should be avoided in the tub/shower area. Adjustable shower heads and handheld showers, with fixed and multiple docking locations for flexibility allow for staff assisted bathing and ease in resident use. When tubs are desired, specifically designed step-in models with fixed seating are ideal for independent and assisted living and even some skilled care situations.
4. NURSE CALL SYSTEMS. Be sure to provide emergency pull cords or buttons, strategically placed near the shower/tub and toilet, with no clutter around them. Be certain the location of the call buttons is paired with proper automatic lighting to ensure they can be found in the most difficult of times.
5. TOILETS. There are several factors related to toilets that we need to be aware of to provide safety and comfort. The American with Disabilities Act (ADA) requirement is that toilets are between 17” and 19” from the floor to the top of the seat. The high end is often too high for older women. We suggest setting the height at the mid-end of the ADA range. We must decide about the type of seat. A closed front establishes a more residential sense, but for toileting assistance an open front is better for staff. Another feature that is helpful to aging vision is to provide contrast of the toilet to the wall and flooring. Most toilets are white, and providing a darker wall helps with visibility.
6. GRAB BARS. There are many types of grab bars, and their function and placement are crucial. Inside the shower, along the bathtub, and beside the toilet area are all important. In the area of the toilet, those that pivot up when not in use are usually preferred by both staff and residents. With the swing-up types, toilets are placed 24” away from the wall versus 18” for a side wall-mounted grab bar. This allows for more area for staff assistance with double transfers. Another advantage of the swing-up type is that those affected by a stroke, where strength is impacted on one side of their body, can use one side or the other. When non-flexible rear bars or just one grab bar is the only type available, it might not serve them adequately. Additionally, properly placed and enforced towel bars (with textured surfaces) that double as grab bars can provide an additional source of security at sink areas and between the shower and toilet.
7. FAUCETS. Easy-to-use faucet handles, being mindful of those with arthritic hands, are important. Single-lever faucets are recommended as they are easier to use for arthritic hands with the benefit that residents don’t have to try to blend the two faucets for just the right temperature. Also, the height and distance off the sink ledge is important for infection control. Providing plenty of clearance to properly wash hands is key. Sharper contrast of fixtures, such as contrasting sinks to countertops, provides greater visual clarity to our aging population.
8. VANITY AREA. Tilt mirrors allow for shorter persons and those in wheelchairs better coverage and visibility. Mirrors should be lower to the sink/backsplash if not the tilt type. Adequate lighting at the mirror reduces leaning in or to one side to gain a clearer view, providing better lighting at the face. The height of the sink should be no greater than 34”, and under the counter should include 27” of clearance to allow for knee space when operating a wheelchair.
9. ACCESSORIES. In real estate, it is all about location. That is true for the placement of accessories too. Medicine cabinets should be placed on the side wall and lower for better access. Outlets should be placed closer to the edge of the counter so that cords can hang instead of creating a hazard on the counter and closer to the water source. Towel and soap dispensers may differ depending on if they are used by staff or residents. Staff will use single-use paper towel dispensers, where residents may have their fabric hand towels hanging on the front edge of the sink for easy access. Toilet paper dispensers, soap shelves in the shower, and staff care accessories such as glove box holders, are all part of the overall layout. Maintaining the residential feel of the bathroom can be difficult, but it is possible to place these more institutional accessories in spaces not readily visible.
10. STORAGE. Be sure to provide adequate storage for both residents’ personal belongings and for staff. Staff often need to have access to such items as incontinence products and personal protective equipment). Also, consider the need for secure storage for such items as medicines or cleaning supplies. Proper storage reduces clutter, keeping the floor space clear for walkers, assistance, and more.
Be sure to create a senior-friendly design. As we all age, our vision, mobility, strength, range of motion, and cognitive abilities decline. Increasingly, we’re impacted by glare, less contrast, and eye disease. We have a greater need for assistive devices such as canes, walkers, wheelchairs, and grab bars. Our ability to reach heights or step over barriers changes. We might experience greater weakness on one side of our body. Cognitively, we may have greater confusion, forgetfulness, and less desire for social activities. Being mindful of these 10 elements will provide our residents with the ability to safely age in place, maintaining independence to do their daily tasks.
Julie Heiberger is a senior project architect and the Senior Living Market Leader for Hoffman Planning, Design & Construction, Inc. With more than 25 years of experience, she is a member of the American Institute of Architects and the National Council of Architectural Review Boards. She received her Master of Architecture from the University of Wisconsin–Milwaukee. Email Heiberger at jheiberger@hoffman.net.
Jon Rynish is a senior project architect with Hoffman and a Leadership in Energy and Environmental Design (LEED) accredited professional. A graduate of the University of Wisconsin-Milwaukee with a Bachelor of Science in Architectural Studies, he has more than 15 years of experience in the design profession. Email Rynish at jrynish@hoffman.net.