Best Practices in the Design of Toileting and Bathing Facilities for Assisted Transfers

Meeting User Needs

The primary goals of the alternative designs were to accommodate independent transfer and use of a toilet, tub, or shower as well as assistance by as many as two care providers. Moreover, the designs were intended to prevent and/or reduce injuries to all users, both elders and care providers and to permit ease of access by individuals with many types of impairments.

Despite the expected variations in types of impairments as well as differences in severity of disability among the different levels of care, designers presumed that most older people in these facilities had the capability of supporting their own weight and pivoting on their feet during transfers. As a result, grab bars on both sides of a toilet that would support a standing transfer were provided rather than alongside and behind the toilet as would be used for a sliding transfer. Moreover, the same grab bar placement could be used to accommodate people with both right and left hemiplegia (often associated with stroke in older individuals). In fact, this alternative added sufficient flexibility to accommodate independent and assisted transfers that it also was used in non age-segregated healthcare facilities, such as Beechwood Home in Cincinnati, OH, (Dorsky Hodgson and Partners) to accommodate both younger and older adults with Multiple Sclerosis, Cerebral Palsy, and spinal cord injuries.

In facilities where people with cognitive impairments are prone to incontinence, the location, frequency, and visibility of toilet facilities were considered as important as their physical design. Toilets were often located to enable older individuals to easily see them. For example, layout of the bathroom in many of OWP&P’s projects was designed to maximize visibility of the water closet from within the sleeping room as a cueing device to encourage frequent toileting. Bathing fixtures that were familiar, non-threatening, and comfortable were selected to reduce agitation. Faucet controls were placed out of reach of the cognitively impaired individual or designed to prevent accidental injury. Finally, bathing fixtures were designed to provide ready access to all areas of the bather’s body without excess strain on the caregiver.