Key considerations: door width, shower enclosure, access to sink and toilet, your ability to transfer
Typical modifications and cost ranges:
- Replace bathtub with shower enclosure, $7,500
- Create wet room, $15,000-$20,000
- Widen interior doorway, $2,000
Ensuring available space within a bathroom is a key consideration when planning modifications. And given many modern homes have more than one bathroom, it is important you consider all bathroom spaces for modifications. In some cases, a main floor half-bath can be expanded to create an accessible bathroom (consider borrowing square footage from an adjoining closet or laundry room). A main floor laundry room, if big enough, can often be converted into a roll-in shower/bathroom for a relatively low cost, since the plumbing is already in place.
Shower Back to Top
The most challenging accessibility feature of a bathroom is usually the threshold to the tub and/or shower. There are a number of solutions to this challenge that typically depend on the user’s ability to transfer (independently or with the help of a caregiver). An occupational therapist is the professional best able to determine what equipment or modifications are required for your safe transfer.
You have the choice of two typical arrangements for your shower – a roll-in shower space that is separate from the rest of the bathroom, or a wet room.
Creating a Roll-in or Transfer Shower Space
A separate accessible shower space is critical for safe bathing. The size of shower space will differ depending on your ability to transfer. The optimal size for a roll-in shower space is 60”x60”. It should also have a 5x5 turning space outside the shower threshold (though this turning circle can include shower space as well).
Where such space is not available, a standard tub 30”x60” in size can be enough if you have a caregiver to assist you, as long as there is another 6” of adjacent space (for a total of 36” in width). This extra space can be enough to accommodate a rolling shower commode on casters. If you are independently transferring, a 36”x36” minimum enclosure can be feasible, with the use of a permanent shower seat (to and from which you transfer) and grab bars placed at the appropriate height.
A roll-in shower space can be created using several methods, depending upon the room and shower layout:
- Replace a traditional shower or tub insert with a barrier-free shower insert
- Use a shower element like the Wedi Fundo Ligno, a tile-ready floor unit that can be integrated into a wooden floor covering
- Use collapsible water dams or collapsible thresholds at the shower entrance
- Use trench drains, which are troughs that run along the open side of a curbless shower
Creating a Wet Room
In our experience, a wet room is usually the most universal solution to the challenge of creating an accessible shower space. A wet room is a room with no thresholds in which everything can get safely wet.
A wet room has two main advantages: a wheelchair user can move freely throughout the space, and a fully accessible shower space can be created using a much smaller square footage (e.g. a converted main floor bathroom).
Suggested features and considerations:
- Wet room floors are sloped downwards towards a floor drain, at a ratio of 1/8” slope per foot of floor space. Using a product like the Wedi Fundo Ligno means no sloping will be required, as the product already features a slope.
- Continuous ¾” plywood backing behind all gypsum (including the ceiling) is a worthwhile investment because it enables the future installation of supports, such as grab bars, anywhere in the space. At the very minimum, plywood sheeting should be used on the walls surrounding the toilet and shower areas to a height and width that support recommended grab bar locations.
- When creating a wet room, HVAC (including all heat registers and vents) must be moved off the floor and have water-resistant covers.
- Switches and receptacles must be placed beyond a 3’11” spray zone from the water source, and coverings for switches should be exterior grade, as these are water resistant.
- You can use a shower curtain in a wet room to help delineate the shower space and minimize the shower spray area.
- Squeegees are a helpful tool for wet room clean up. Also, mopping the floor after each use is recommended to speed drying for safe non-showering use. Considering who will clean the wet room and how are important considerations (individuals with hand- or upper-body weakness may have more difficulty holding and manipulating long-handled tools).
Other Shower Details
A telescoping showerhead attached to a vertical slide bar and featuring single lever temperature and flow control is optimal. Hardware that has the option of being handheld tends to simplify bathing. A handheld showerhead with a minimum 59” hose is recommended for both the independent bather and a caregiver-assisted person. An on/off switch on the showerhead itself is suggested.
Both the choice and placement of hardware should take into account caregiver needs, including making shower controls reachable from outside the shower. Shower controls should be a maximum of 47” from the floor and may be offset toward the opening to ease operation by a caregiver.
Other helpful equipment for shower use includes shower seats (built-in or portable), transfer benches and grab bars. The appropriateness of certain types of equipment and the proper location and installation of this type of equipment is all very specific to the user. An occupational therapist is best qualified to recommend appropriate equipment to you.
Grab bars are perhaps the most commonly recommended modifications for individuals of all ages and disability levels. An occupational therapist can determine the most appropriate size, location and position for the specific user.
Shower stall generally include a 36”-48” vertical grab bar just inside the shower entrance and a horizontal grab bar within at the user’s optimal location. A grab bar along the long wall of a tub can vary significantly in height, position and location and should be placed specifically to your needs.
Reinforcement with blocking (2x4’s or plywood as described above) is required to ensure secure grab bar installation. Grab bars come in varying lengths; find one that will reach two studs. Alternatively, an industrial-strength wall fastener can be used where blocking is not available at the right location.
Doorways Back to Top
As with all interior doors, 36” of clearance for the door into the bathroom is optimal.
Note: Because bathroom doorways frequently open into hallways, pocket doors or barn doors can make excellent alternatives to traditional swing doors.
Sinks Back to Top
An accessible sink should be about 6” deep and mounted 34” high (unless a different height is preferred by the user). Roll under clearance for the sink should be at least 29” high and 36” wide, although these dimensions may vary depending on the user.
Carefully consider the shape of the sink, looking for shallow ones. See Product Recommendations for sinks that increase accessibility
Also, consider how the sink is mounted and how the plumbing is attached to the sink, to ensure there is open knee space for you. A drain offset to the rear is recommended to keep pipes beneath the sink as clear of knee space as possible. Ensure the pipes under the sink are covered to prevent burns on your legs if you are a wheelchair user with limited or absent sense of feel. Boxing the pipes in or wrapping them in insulation can accomplish this.
If there is room for two sinks, place one lower than the other for accessibility and the second sink at standard height. This will make them suitable for both wheelchair users and non-wheelchair users.
Consider turning down the water temperature at the water heater to lower the risk of scalding; 49 degrees Celsius is the maximum recommended.
Choose sink hardware that uses levers or paddle handles.
Toilets Back to Top
It is important to consider your needs when determining the height of a toilet and the space needed between the toilet and adjacent walls. Generally, toilets can be made more accessible by increasing the height of the seat, or by using a commode chair.
When choosing a toilet, ensure it is compatible with a commode chair if you will use one (and vice versa when choosing a commode chair). Some rolling commodes cannot fit over taller or elongated toilet seats, so be sure to evaluate this prior to replacing a toilet. Bowl shape (elongated versus round), seat height, and clearance behind the seat will all affect compatibility. An occupational therapist can be consulted. Trialing the toilet in place (but prior to installation) with the commode chair is recommended.
Toilet seats that are 18”-19” (higher than standard height) are beneficial for those transferring from a wheelchair or from a standing position.
Depending on the type of transfer, toilets can be installed to feature transfer space that is 36”-39” to the side of the toilet. In front of the toilet, there should be a minimum of 30” clearance and an adjacent 5’x5’ turning circle for positioning. If you are using a commode chair, you will need to ensure there is 18” of clearance between the toilet and the wall to accommodate movement of the chair.
The centreline of the toilet must be 18” from any adjacent wall to allow for grab bar-mounting.
In general, horizontal grab bars by a toilet should be 33”-36” from the finished floor and located on a sidewall and the back wall. The side-wall grab bar should extend at least 18” in front of the toilet.
Wall-hung toilets can be beneficial because they free up more space (the water-tank is in the wall). This type of toilet is beneficial when you are trying to configure a small space (potentially saving you 10”). Wall-mounted toilets are more expensive, but there are some affordable options on the market. Wall-mounted toilets are also easier to keep clean and provide more space for a caregiver’s feet. They are compatible with commode chairs.
See Product Recommendations for toilets that are often used to increase accessibility.
Other Bathroom Details Back to Top
The best bathroom mirrors are those that pivot, so all users can adjust them to the proper angle.
Locate all electrical receptacles 30”-48” above the floor and at locations near the front of the vanity if possible, not along the rear wall of the vanity.
Front-loading washers and dryers are the most accessible options. Use a plinth or pedestal to lift the unit off the floor, so the opening is 36”-47” off the floor. A wall-mounted clothesline or drying rack can help save floor space.