Optimizing Toilet Location for Assisted Toileting

Objective: By comparing an Americans with Disabilities Act Accessibility Guidelines (ADAAG) compliant design with alternative designs, this pilot study resulted in recommendations for designing patient bathrooms to facilitate assisted toileting.
Background: The ADA Accessibility Guidelines were developed primarily to address the needs of a disabled population, such as returning Vietnam veterans, with sufficient upper body strength to transfer independently directly from a wheelchair to the toilet. However, the majority of older persons with disabilities (90%) stand to transfer to the toilet, rather than laterally moving from the wheelchair to the toilet.
Methods: The research used a repeated measures research design to evaluate caregiver responses during assisted toileting for various toilet configurations. The study included 20 patients who were transferred onto and off of a toilet for each of four different configurations by one or two caregivers. Toileting trials were videotaped and analyzed by and occupational therapist. Additionally, caregivers completed 5-question, self-report surveys after each toileting trial.
Results: Survey data indicate that staff members prefer the largest of the tested configurations, where the centerline of the toilet is 30" from the sidewall, rather than the 18" required by the ADAAG and where there are 2 fold-down grab bars provided. Care givers perceived the grab bar locations as better for helping them safely transfer subjects in a modified (non-ADAAG) configuration, and also that the grab bar style in a modified configuration (non-ADAAG) improved safety when transferring subjects.
Conclusions: Although care givers were observed to safely transfer residents to and from the toilet for all configurations tested, regulations regarding accessibility of patient bathrooms should acknowledge the perceived benefits of increasing the distance from the side wall to the centerline of the toilet to as much as 30" and allowing 2 fold-down grab bars instead of the required side-wall and back wall grab bars.

This study, funded in part by The Academy of Architecture for Health Foundation (AAHF), is to be published in the Health Environments Research and Design Journal.
Citation: Sanford, J. and Bosch, S.J. (in press). Non-compliant toilet room design for assisting persons on to and off of the toilet. Health Environments Research and Design.