When I was in school I studied the related concepts of “Universal Design” and “Visitability”.
Universal Design is about designing spaces for accessibility from the beginning, so that what we consider “accommodations” are simply a part of reality.
Visitability is about making all living spaces “visitable” by people with mobility challenges.
Visitability was pioneered by Eleanor Smith of the organization Concrete Change in Atlanta. She posited that a few simple changes in how we design and build houses would make a world of difference. If all homes had a zero-step entrance (this could mean a ground-level entrance or a ramp), 32 inch clear openings in first floor doorways, and a wheelchair-accessible bathroom on the main level, wheelchair users could visit their friends and family. If all of these are incorporated into design, the costs are minimal. She began with a local ordinance requiring visitability in all housing built with government funds.
Visitability is not the same as accessibility. To make a home fully wheelchair-accessible includes (among other things) raising outlets and lowering light switches to make them reachable from a wheelchair.
Opponents argue about interference with private property rights, but all housing requires permits and all permits require compliance with building codes. Codes change. Incorporating visitability into building codes means we don’t single out government-funded housing. If we add these to the UBC (the model Uniform Building Code), we don’t have islands of compliance in a sea of non-compliance.
Universal Design means (from the Disability Act of 2005):
- The design and composition of an environment so that it may be accessed, understood and used
- To the greatest possible extent
- In the most independent and natural manner possible
- In the widest possible range of situations
- Without the need for adaptation, modification, assistive devices or specialised solutions, by any persons of any age or size or having any particular physical, sensory, mental health or intellectual ability or disability, and
- Means, in relation to electronic systems, any electronics-based process of creating products, services or systems so that they may be used by any person.
It is based on seven principles (from UniversalDesign.org):
- Principle 1: Equitable Use
- Principle 2: Flexibility in Use
- Principle 3: Simple and Intuitive Use
- Principle 4: Perceptible Information
- Principle 5: Tolerance for Error
- Principle 6: Low Physical Effort
- Principle 7: Size and Space for Approach and Use
In my work I see a lot of people who fall. Many of them are averse to making changes in their homes because they see them as for “old people” and getting old is something they don’t want to do or admit to. I often reply that it beats the hell out of the alternative. This leads to the third related principle, that of “Aging in place“.
Aging in place refers to staying in your own home as you age. If we incorporated universal design into all homes built, that would be a pretty straightforward task. If you live in a 100+ year old home, as I do, that takes a little more thought.
Installing grab bars during new construction is simple and cheap. Installing blocking in the walls to prepare for the future installation of grab bars is cheaper yet. It can usually be done with scrap lumber that would otherwise end up in a dumpster.
Retrofitting with grab bars takes a bit more thought but is still pretty simple. Wall studs are generally built on 16 inch centers. Grab bars generally come in increments of 6 inches. Do you see a problem here? 6 and 16 only line up at 48 inches (and multiples thereof). Do you need a 48 inch bar? Probably not. But this brings an opportunity. (All of these numbers may change in countries that use the metric system.)
We are not all the same height. Standards that you read may show the “correct” height for a grab bar. Actually, the correct height is the one that works for the user. The same height won’t work for one person who is 6’2″ and another who is 4’11”. Our wrist works best when our hand is in line with our forearm, like (e), not (f) below.
If a horizontal bar is too high, your wrist will look like (f). If the bar is too low, you will either bend awkwardly to reach it or not use it at all. If you mount the bar at an angle as shown, you have a range of available heights to reach with the appropriate wrist position. The other alternative, of course, is to mount the bar vertically, along a stud. Generally, to get into a shower or built-in bathtub, I recommend one bar mounted vertically to hold as you step in, then a second bar mounted at an angle along the side wall to hold once you’re in. Due to the standard dimension of bathtubs, there should be a stud in an appropriate spot. Shower stalls have more variation, but you should still be able to find a stud in an acceptable spot, either inside or outside of the door.
Before you screw it in place, try it! Either have someone hold the bar while you try it (grasping it but not bearing weight on the hand as you step), or mark the proposed location with blue painter’s tape and fake it, checking the height and angle. If more than one person is in the home, have them all try it.
If you don’t know how to install it, find someone who does. Your life may depend on proper installation. If you’re drilling through tile, tape the spot where you will drill, and drill through the tape. This will help prevent the tile from chipping. Use a sharp masonry drill. If you are drilling through a plastic tub surround, tape it and apply pressure with your free hand to prevent the plastic from chattering in and out from the wall with the drill action. Don’t trust screw anchors to hold the bar. Drill into studs or blocking. Some bars have multiple choices for mounting holes so you can maximize the number of screws into studs.
Think before you place screws. In the pictures above, the solid blue are studs, the large blue circles are the grab bar mounting plates, and the small blue circles are the screw holes. This is a common design. (The ones I mounted today have five holes in each plate, with three screws, so you can pick the best combination.) On the left you note that two screws are solidly in the stud and the third misses. On the right, no screw is solidly in the stud. If your choice is two screws (on each end) solidly into framing and one anchor (or unused hole) or three screws, none of which are actually going to hold, I’d opt for two solid screws over zero. With a three hole plate and nominal 2 x 4 framing (which is actually 1½ x 3½), this is what you get.
When mounting in a wet area, caulk the side of the mounting plate that will be against the wall to keep water from getting behind it and running into the screw holes, ruining your wall over time. Leave an opening at the bottom so that, if any water gets in, it can drain out.
There are lots of choices for bars. Feel the bar in your hand. Is it slippery? Probably not a good choice. How is the diameter? Can you get a good grip? You can get them in stainless steel, chrome, or enameled finishes. You can get finishes that match your other hardware. You can get brushed or knurled finishes to make it grippier when wet.
If you use a suction-mounted bar, don’t have the suction cups cross a tile grout line. The suction will not hold. Don’t place it on a plastic tub surround that is not firmly adherent to the wall. Remount it every time you use it, to be sure it is firmly adherent. They work best on solid surface (e.g. Corian) tub surrounds.
A towel rack is not a grab bar, nor is a curtain rod nor the handle on a shower door!
The hand-held shower shown above is a nice addition, simple to install, and inexpensive – or you can spend a ton of money for the aesthetic you want.
If you tire or tend to lose balance in the shower, a shower chair comes in handy. If you can’t step over the tub edge, a tub transfer bench fills the bill for a lot less money than removing the tub to install a shower or modifying the tub to a step-in model. Note that you can buy them a lot cheaper from a hardware store or drug store than from a medical supply store or a home health agency. I do not recommend falling in the bathroom, as there are no soft places to land.
Why should you listen to anything I just said? As a plumber (and before that, as maintenance director of a housing cooperative), I installed grab bars for a living. As an occupational therapist, I work with people who have been injured from falls and I work with them to make their homes safer. As an old person, this is not merely academic to me. As a bicyclist, I plan to stay healthy and keep riding for a long time.