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

Users and Needs

Facility Types and User Profiles.  
Many of the facilities reviewed were healthcare and residential facilities specifically designed for older adults. This approach was purposeful as users of these facilities often require the assistance of caregivers and therefore may have accessibility requirements that are different from those specified in ADAAG. The potential need for alternative designs is outlined in the draft AIA Guidelines (2001) that were approved in a final committee vote. The guidelines state:

It shall be recognized, however, that the users of hospitals and health care facilities often have very different accessibility needs from the typical adult individual with disabilities addressed by the model standards and guidelines... Hospital patients, and especially nursing facility residents, due to their stature, reach, and strength characteristics, typically require the assistance of caregivers during transfer maneuvers. Many prescriptive requirements of model accessibility standards place both older persons and caregivers at greater risk of injury than do facilities that would be considered noncompliant. Flexibility may be permitted for the use of assistive configurations that provide considerations for transfer assistance.

Users of healthcare and eldercare facilities often have mobility problems, use wheelchairs and walking aids, and suffer from incontinence. Therefore, toilet and bathing fixtures in these facilities were intended to accommodate older people who had many different types of impairments and comorbidities, including limitations in reach, difficulty lifting legs, and difficulty with sit-to-stand; who used devices for assistance with ambulation; and who could transfer either independently or with assistance.

Generally, the severity of disability was expected to increase as a higher level of care was provided. For example, independent and congregate living facilities designed by OWP&P, were expected to accommodate people with mobility disabilities due to physical frailty, stroke, and arthritis. In contrast, skilled nursing facilities, such as those designed by ECCB, were expected to accommodate people who were generally frail due to arthritis and other age-related conditions, people with later stages of dementia, people aging with a disability, and subacute patients.