Begin with the bathroom!

Talk to anyone who is a caregiver and they will invariably say that the bathroom is the first room in the house that needs modifying in order to make everyday living easier. In a standard bathroom there is bending, sitting, rising, stepping over, stepping into, leaning over, reaching, pulling, turning and the list could go on! As individuals' needs are different, so are the solutions that will enable varying levels of independent living or assisted care.

In Peter and Rosetta's home in Barrie, Ontario, the time had come for some modifications to their washroom. Peter had a stroke six years ago and through therapy, hard work and family support was able to perform many daily activities unaided from a wheelchair. Their biggest physical barriers were in the washroom where the narrow door, the high curb on an otherwise roomy shower, the sink with lower cabinet and low toilet were making it difficult for Peter to manage on his own.

With a budget of $2,500, some basic changes were drawn up and a local contractor hired. The door into the washroom was widened, the shower stall curb was lowered and grab bars were installed to enable Peter to lift himself into the shower where there is a seat and hand-held shower controls. The old sink and lower cabinet were replaced with a wall-hung sink and, with a carefully positioned mirror, Peter can look after all his personal grooming. An 18-inch toilet replaced the original lower one and a securely fastened vertical grip pole was positioned to enable Peter to perform the transfer unaided.

The following is a typical list (and by no means complete) of areas to consider when looking at modifications to the bathroom area.

Toilets
Standard toilet heights are 14 inches high and for people who have the ability to rise from a sitting position, this is no problem. Portable commode seats that sit on top of the toilet are one solution if the standard seat is too low. However, some individuals feel unsteady on a portable seat. Most bathroom fixture manufactures now make 18-inch high toilets that can be installed in the same space and on the same flange that a lower toilet was removed from.

Tubs
For our aging population's bathing needs, the bathroom tub is literally a dinosaur dying a slow death. Whether it is used as a tub or as a tub/shower combination, the narrow design, high sides, slippery surfaces and lack of sitting area all work together to make an object that for many individuals can be virtually impossible to climb in or out of. Accessories like adjustable tub seats or bathboards are one solution for some with the ability to lift their legs over the front edge of the tub. One innovative bathtub product can be installed in the same space as a standard tub; its side widens to form a seat and it has continuous grab bars at the back and side to make it easier to lower into the tub. However, often the area of limitation is exiting the tub and for those with reduced upper body strength, this can be a dangerous manoeuvre.

Showers
Showering is the option of choice for many. Standard shower stalls are often too small to accommodate a seat and in many cases have a 5-inch curb at the door. In modifying existing space, there are two routes to take. One is a custom shower, designed to suit the available space, with a "walk-in" (low curb) floor and built-in seat. Care must be taken in the choice of surfaces; floor tile should be slightly textured to prevent slipping. The location of grab bars (and their structural support) and placement of shower controls must be considered. Another solution is a retrofit moulded fiberglass shower unit. Available in varying sizes, the larger units are designed to fit into the space that a 5-foot tub would occupy and their sectional design allows the units to be moved in through existing doorways. They have a minimum 1 1/2-inch curb for ease of entry and exit, one or two seats moulded into the corners, grab bars and hand-held shower controls.

Sinks and taps
Of prime importance is not the sink, but the space under it. For wheelchairs, wall-hung models are the best, to allow for ease of movement under the sink. The top edge should be no more than 33 inches from the finished floor, and supply pipes and drains must be insulated to prevent scalding. Lever taps are easiest to control, avoiding the twist and turn movements that can be difficult for many with arthritic and related conditions.

Accessories and surfaces
Along with the installation of grab bars at the tub, shower and toilet areas, consider their dual use as towel bars. Locate electrical plugs with safety in mind, and toilet paper dispensers and mirrors for ease of use. Replace glass or china items with plastic or acrylic. Surfaces should be non-slip but easily cleanable. Remove area rugs.

Lighting
Often overlooked, proper intensity and placement of lighting can help reduce injuries from falls and help individuals be independent. An overhead light should be augmented with lighting above the shower or tub and accent lighting at the mirror. If a wheelchair is used, lower the height of lights around the mirror to reduce shadows.

Jane Cameron is owner of ElderHOME Design Group located in rural Tottenham, Ontario.

Tel: 905.939.8025