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Design Considerations for Bathrooms

Worksite Redesign Technical Advisory Project

A prototype bathroom plan and its blueprint are included with this book for use in future medical homes. Model bathrooms should accommodate all levels of disability. Intense onsite evaluation is required because of the varied and extensive exposure to injury possible to residents and staff. The main areas addressed call for provisions for:

  • Pocket doors that provide for the widest openings in homes. Doorways thus equipped allow for easy entrance and exit without exposure to swinging doors and pinch/trap points. Standard doors reduce entry space (even when open) by several inches smaller than their stated width.
  • Natural light and ventilation in all bathrooms. Light should be adequate to provide safe care for residents without overstimulation, or visual discomfort to the resident.
  • A second heat source for bathrooms, such as a high efficiency fan with infrared lamps, to aid in floor drying, prevent slips, produce additional ambient warmth, and inhibit microbial growth. Extra warmth for the resident will encourage relaxation and cooperation.
  • Walk-off mats or other shoe drying surfaces at bath and laundry exits. Mats must have beveled or low profile edges to prevent tripping. Wet shoe surfaces expose residents and staff to falls, slips and injuries in general. Non-skid wax should always be used on vinyl surfaces.
  • Grab bars with a 250 pound holding capacity. Bars used as towel racks or as clothing hooks must have the capacity to withstand the weight of the resident or employee when grasped for support in an emergency. Using high capacity bars will reduce the risks to both resident and staff during care situations where support is required. Bars should not protrude where they will present a hazard in movement/flow areas.
  • Wall backing (for ease of future bar installation) in all bathrooms, from 30" to 36" above the floor. The backing should be done at the time of redesign/retrofit.
  • Use of full coating of mastic, applied edge-to-edge on mirrors to prevent glass shards produced from breakage. Common nonbreakable mirrors, such as stainless steel or plastic, reflect poorly and have been found to be unacceptable. Non-shatter safety glass mirrors are available, but the image is distorted.
  • Elimination of all latches, handles, hooks, toilet paper holders, or any other hardware extending into the movement/flow area.
  • As much work space on both sides of the toilet as possible and/or practical, with 24" being the minimal allowance. If this space allowance is not achievable, as much space as possible must be made available to provide staff with unconstrained work space when assisting residents with toilet activities. This allowance enables the use of good body mechanics by staff.
  • Elimination of conventional tubs and shower units. If a tub is required for medical treatment, adequate work and toe space allowance is necessary. A minimum 4" toe space and 24" clear working area surrounding the perimeter of the tub should be available. If the space requirements given above are NOT met, this should be the deciding factor AGAINST installing a conventional tub in the home. The reason for this recommendation is to protect employees and residents alike from the dangers of performing a human lift.

    Human lifts are inherently dangerous because:
    • Lift is not compact
    • Lift can shift and move
    • Person being lifted could be wet and slippery, no good handholds
    • Lift is occurring at close to floor level. Floor level lifts present extremely high potential for injury
  • Adequate space for lifting equipment. This must include door and hallway space to provide adequate turning radius for lifting equipment. If doors and hallways are not designed with adequate space, staff will attempt to lift the equipment fully loaded with the resident, or move the equipment in confined spaces which will transfer force loads to staff by the process of muscular contraction. This presents extremely high potential for injury.
  • Lifting, pushing and pulling in constrained spaces increases the force the body uses to perform the action. Force is a major risk factor for soft tissue injury. Space requirements must be evaluated for all equipment that is to be used for residents. Most importantly, space requirements must be evaluated for the use of this equipment to travel through a home and position it properly at its destination. Providing design solutions to eliminate risk factors for soft tissue injury to the employees also supports safety for the residents.
  • Room to store necessary shower equipment.
  • Floor drains, using non-skid tile to prevent slips and falls. Glazed tile surfaces are easily cleaned and disinfected.

The prototype bathroom design is part of a larger effort to reduce workplace injuries among providers in residential care facilities. Common sources of injuries in bathrooms are the confined or awkward access to bathroom fixtures, the inadequate space around fixtures to allow proper positioning of an assistant, and the hazard of wet walking surfaces. The introduction of the elevated tub and accessory lift was a significant improvement in bathroom safety and function. This prototype bathroom design improves bathroom access and internal maneuvering space. It simplifies the movement and storage of the lift, and it allows for the safe and effective use of each bathroom fixture.

These guidelines are the result of a design session using a full-scale mock-up of the bathroom space. The technical advisory team included an ergonomics specialist, nurse, safety coordinator, state housing coordinator, a contractor and an architect. The design was developed by Rowell Architecture and first implemented at a care facility at 44th Ave. in Salem, Oregon. The bathroom guidelines will be applied to future projects.

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Reflected Ceiling Plan



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  •  Shower/toilet area is small, increasing risk to staff when assisting a resident
  • Window provides light but cannot be opened for ventilation
  • A zero-threshold shower would be an improvement
  • Damaged surfaces on walls indicate need for greater surface protection
    -FRP (Fiberglass Reinforced Plastic) is recommended


  •  Threshold makes transfer to shower dangerous
  • Bars help reduce risk. All bars must have 250 pound holding capacity (factory-installed bars meet or exceed this standard)
  • Rug is a hazard
  • Single-handle, scald-prevention valve prevents scalding and allows for one-handed operation

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  • Wide, roll-in shower installation
  • Flexible hose aids user, providing more options for grooming and care giving
  • Built-in shelf provides storage for shampoos, soaps, etc.

                       15th Avenue


  • Zero-threshold shower makes transfers safer and simpler
  • Shower of sufficient size to permit assistance
  • Eliminate rugs and provide hamper for wet towels
  • Epoxy floor coating provides good traction and easy maintenance

Santa Clara Avenue


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15th Avenue
  • Large, roll-in, zero-threshold shower eliminates step and provides staff plenty of working room
  • Wall-hung toilet improves ease of floor maintenance and cleaning
  • Overhead cabinet is an obstruction
  • Heat vent in floor is a sanitation problem
  • Single-handle faucet permits one-handed assistance
Wall-hung, flush valve toilet allows for ease of cleaning
  •  Floor-mounted registers are unsuitable in wet environments, and unsanitary in any location

  • Counter height and single-handle faucet and sink support seated resident independence
  • Open space also accommodates staff assistance
  • Pocket door allows for maximum use of doorway space
  • User-friendly hardware


Oak Street
  • Lack of projections in area protects resident and staff
  • Plumbing and drain assembly fully enclosed
  • Tempered mirror affixed with mastick

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  • Medical tub and lift system assists in physical lifting of resident from bed to tub and back
  • Operable windows provide natural light and ventilation
  • Humidistat-controlled fan runs automatically until room is dry
  • Ample room at both sides of the tub for staff
  • Room allows easy maneuvering and access
  • Non-skid tile floor with floor drain
  • Adequate room for storage of medical equipment


48th Avenue

  • Path used for transport is straight, wide and unobstructed for easy access
  • Pay particular attention to transition areas from vinyl surface to tile as a slipping hazard
  • Room width accommodates equipment lift storage
  • Room must be large enough if lift is to be stored, as shown here

48th Avenue


  • Provide as much work space on both sides of toilet at possible, 24" plus
  • Space is quite small, making assistance difficult
  • Shelving located where it is accessible, within easy reach and not an obstruction
  • Sink plumbing nicely protected

  • Bars that fold out of the way improve access
  • Sink plumbing is well protected
  • Recessed dispensers prevent bruising
  • Remove towel bar behind toilet to prevent its use as a grab bar in an emergency
  • Cove vinyl makes floor easier to maintain and sanitize

Grab bars require backing and should be designed to take 250 pounds.

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  • 24" access to both sides of toilet provides room for staff assistance
  • Bar folds out of the way when desirable
  • Dispensers recessed
  • Counter edges rounded
  • Good storage provided for bath needs
  • Non-skid floor with floor drain
  • Ample room for movement and turning


Pioneer Pike

  • Accessibility to tub is limited
  • Use fold-up bar on chair side for access to tub
  • Epoxy floor and wainscot system provides easily-cleaned wet space
  • Floor drain helps keep floor dry
  • Drain from tub is a tripping hazard

Provide 24" clearance on both sides of a toilet.


15th Street
  • Wall-hung toilet makes floor cleaning easier, and also eliminates tripping hazard
  • Ample room around toilet to assist
  • No bars
  • Excellent room access

  • Half bath with excellent access
  • Sink recessed into alcove to eliminate corner obstructions
  • Ample room provided around toilet for staff assistance


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  • Open shower room has good access and grab bars
  • Good artificial and natural light, ventilation, and a humidistat sensitive fan
  • Non-skid tile floor with a center drain
  • Ample room for movement and turning


  • Generous roll-in shower
  • Interlocking "dry-deck" system creates non-skid surface, that must be regularly removed and cleaned
  • Storage provided for shower needs
  • Shower chair may be stored in bathroom




48th Street
  • Large open room-tile walls and floor create a fully waterproof space
  • Non-skid tile floors allow wheeled equipment to move easily
  • Stippled tile surface helps to prevent slips and falls for caregivers and ambulating residents
  • Adequate lighting and bright surfaces
  • Wheeled bin reduces carrying
  • Dispensers recessed
  • Shower curtain encloses space, helps hold in heat and splashes
  • Residents in this home are bed bound and never use the toilet. Bin placement reflects function based on resident and employee need. Providing adequate space allows for this functional design.

48th Street

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  • Overhead lift allows patient to be lifted and lowered, reducing caregiver need for lifting
  • Track position allows it be used to assist at toilet
  • Storage receptacles on either side of the tub indicates the need for adequate storage and shelving in this bathroom
  • Storage shelf above toilet should be recessed and better organized
  • Inadequate room on both sides of the tub for transfer equipment and caregiver assistance
  • Toilet does not have adequate space on both sides to allow a caregiver to assist
  • Pass-through to laundry room allows for easy disposal of soiled laundry
  • Window is just a mirror, no outside light or ventilation provided

  • Pictures show different views of the same room
  • Client specific, supportive adaptation
  • The transfer board and shower arrangements support independence for specific resident needs
  • Open shelving over the commode encourages spills
  • Floor space reduced by buckets
  • Grab bar used for storage and not available for intended use
  • Sink plumbing well protected

High Street

High Street

  • Both photos are of the same bathroom
  • Large window provides good natural light and ventilation
  • Easy movement from toilet to shower
  • Space around toilet is not adequate for a caregiver to assist from both sides. At least 24" on each side of toilet is recommended
  • Insure that all grab bars are adequately reinforced to hold 250 pounds
  • Swing bars allow caregiver to assume better lifting position when assistance is needed
  • Good example of shower space developed in an area where conventional tub/shower previously existed


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