Bathrooms are spaces we all use frequently, and we have well-established standards for their design. But when it comes to laying out bathrooms for older adults, the design considerations become much more complicated. In working with different senior living providers, competing priorities come into play based on each provider’s unique philosophies and resident populations – are we designing for full independence or assistance? How can the bathroom look as residential as possible while accommodating resident safety? How will the bathrooms be cleaned and maintained by employees?
Accessibility is an undercurrent of many of these questions, though numerous accessibility guidelines, standards, and codes overlay on the design of buildings depending on their type, location, and funding source. As designers, we can create any number of layouts that comply with these guidelines, but we should also seek to understand the functionality of these designs for older adults – especially when accessibility and functionality may be at odds. For the discussion that follows, we will reference the ANSI A117.1 Standard for Accessible and Usable Buildings and Facilities, which has been incorporated into the International Building Code (IBC) that many states and localities use to develop their building codes.
Designing bathrooms with older adults in mind
After identifying the applicable accessibility guidelines for a project, the design team should engage the client early in the design process to evaluate whether bathroom layouts complying with those standards provide the best experience for their prospective residents. Many of our accessibility guidelines grew out of an era that witnessed an influx of WWII veterans returning home with mobility-related injuries, and they typically assume independent use of bathroom facilities. This is not always the reality in communities for older adults, especially for skilled nursing or high acuity assisted living populations. Therefore, designers must leverage the collective knowledge of both community leadership and frontline caregivers on the client’s team to decide what level of resident independence should be assumed for their specific project.
In some situations, our teams conclude that accessibility guidelines might actually pose a barrier to dignified, comfortable use of resident bathrooms. Examples of common issues our teams flag from the ANSI A117.1 regulations as potential barriers to functionality include:
- Accessible roll-in shower regulations dictate shower controls be located on the back wall, but this means caregivers reach over a resident to access them to assist in showering.
- Accessible roll-in shower regulations mandate use of a fixed, fold-down seat on the short wall near the controls, which limits access to a resident’s back and poses multiple maintenance and safety concerns.
- Fixed grab bars next to toilets are inherently “handed” – so that if the side grab bar is on the left and that is a resident’s weak side, it is difficult for her to use the toilet independently.
These barriers can all be easily addressed with alternate configurations of fixtures and accessories, but those designs would be rejected by the authority having jurisdiction (AHJ) when they review the building design for compliance with ANSI A117.1. However, teams can seek approval of these alternate designs under the concept of equivalent facilitation if they can prove their solutions result in “substantially equivalent or greater accessibility and usability.” While the burden of proof in demonstrating equivalent facilitation rests with the design team, we often engage environmental gerontologists, code consultants, and other professionals to provide expert testimony as to the validity of the proposed solutions. This requires a little more work during the design process, but it can significantly improve the lives of residents for years to come.
For the Saint John’s on the Lake project, the team sought approval for seven variances relating to the toilet and shower in the typical SNF + assisted living resident bathrooms. Pictured is the conceptual plan along with full-scale mock-ups of the design.
Mocking it up: Going beyond the drawing board
Reviewing drawings alone might not be enough to determine if typical or alternate accessibility solutions function for a client, so we often suggest creating full-scale mock-ups to test bathroom designs. The first step in this process might be simply taping out the space and fixture locations on the floor of a conference room and having employees take turns demonstrating independent and assisted use of the space. Ideally, once the team has done this and reached agreement on a proposed layout, we can engage a contractor to fully build a model room for further testing and review. These full-scale mock-ups can then be thoroughly documented with photos and videos as exhibits for submitting an alternate design for approval by the AHJ.
Creating a game plan within your jurisdiction
When a team decides to submit a variance for alternate bathroom layouts, we try to engage AHJs early and often in the process. The client, design team, and AHJ all have a shared goal of providing for the health and safety of building occupants. Even though we’re all working together in this sense, AHJs need to understand the full picture of why a client is seeking a variance and how equivalent facilitation is provided in the proposed design. Having these discussions early will help build trust and avoid any unnecessary time and money spent on developing solutions AHJs would not accept.
Ultimately, accessibility guidelines are important to set a baseline for how people of all abilities can access and use spaces, but they don’t always address the complex, changing needs of communities for older adults. Rather than “recycling” bathroom designs from project to project, let’s challenge ourselves as an industry to talk more about bathroom configurations, thinking outside the box to improve functionality.