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Design guidance and considerations for a domestic accessible toilet

 (incorporating the relevance of Building Regulations Approved Document M 2013, Lifetime Homes criteria, BS9266 Design of Accessible & Adaptable General needs Housing)

Using functional rooms – including the bathroom/going to the toilet – is the second biggest problem faced by families with a severely disabled child.

Some 1/4million people either cannot move around their home, or rely on being carried (English House Condition Survey)

Local authorities are required to address housing needs that arise from old age or disability

Accessible homes

Some 1.8million people need accessible housing. Only 7% of homes in England meet current minimum accessibility features. Under current Regulations, homes need only be ‘visitable’ i.e. level access, flush threshold, toilet on entrance level, door width compliant with Document M; accessible, adaptable, wheelchair-accessible are all optional requirements.

There is growing pressure for an accessible housing default to be included under National Housing Policy.

Home adaptations

Statistics show 25% of households with a disabled person need a home adaptation. Bathrooms are the most common form of home adaptation, with 20% of disabled people in private households using them.

Some 500,000 households with no adaptations say they needed eitherSome 500,000 households with no adaptations say they needed eithera special toilet seat or other aid to use the toilet; a further 200,000+ that already had some adaptations specified provision of an additional toilet, relocation of an existing WC or aids to use a toilet as a requirement they now deemed necessary (English Housing Survey 2012).

Yet only 12% of properties meet the four key features of visitability/acces- sibility – level access,flush threshold, wide doors and circulation areas and use of a toilet on the ground or entry floor (English Housing Survey Homes Report 2011).

New build – Lifetime Homes/ Part M (4)Category 2

Under the Lifetime Homes/ Category 2 criteria, bathrooms should be acces- sible, and, in dwellings of more than one storey, there should at least be an accessible WC on the entry level, with the flush on the cistern side furthest away from the wall. The WC should have a clear space in front of 750mm to enable oblique or frontal transfer.Walls should be strong enough to support adaptations such as grab rails.

Lifetime homes should also deliver potential to future- t a hoist to provide a transfer route from bedroom to bathroom, by which ceilings should be strong enough to support the hoist with a 200kg weight loading.

Regulations do not specify a minimum ceiling height in domestic environ- ments; experience shows, to enable adequate lifting, a minimum 2.4m floor to ceiling is an appropriate dimension.

It is additional, good practice, that the main bedroom and bathroom are adjacent, with a connecting, full height panel that may be knocked out to form a direct doorway or link of at least 900mm width.

BS9266 recommends a level access shower be provided from the outset; if not, space and drainage provision should be made within an accessible bath- room to simplify future retro-fitting.

Design Principles

There can be a tendency to reduce disability to a singular form of mobility impairment, that of a wheelchair user.

We can often become fixated with the physical environment and forget about other aspects that contribute to making a bathroom inclusive. Indeed, many ‘wheelchair-accessible’ spaces are still not accessible for other disabilities.

Research shows that most adaptations ‘pay’ for themselves within a year. Domestic bathrooms are often small, making them difficult to adapt to the ideal. Before any adaptation is undertaken due consideration should be given to disruption and practicality, now – and in the future, for the primary user and any other members of the household.There is the need to balance what the Occupational Therapist judges is ‘necessary and appropriate’ and what the housing provider deems ‘reasonable and practical’. For example, a first floor or above  at having a bath replaced by a shower will need the shower tray to be raised to provide adequate drainage. If the user later needs a frame or wheelchair, that tray will become inaccessible, as it is not level access.

Further, although there is no minimum requirement for turning circles in domestic bathrooms, sufficient space should be provided so that a wheel- chair user can conveniently use the bathroom and gain side access to the WC.Whilst a ceiling track hoist is the preferred option, if a mobile hoist is specified, there needs to be adequate space to manoeuvre it.

Individual Considerations: toilet

  • The long-term suitability of the person’s property in regards to access and/or other adaptations that may be required at a later date
  • The long-term suitability of the person’s property in regards to access and/or other adaptations that may be required at a later date
  • The types of controls required for the individual/carer to use independently Should the WC be conventional, have a bolt-on wash unit or an automaticshower (wash and dry) toilet
  • The user’s ability to independently get on and off the toilet

Individual Considerations: wetroom
Note: the considerations relevant to a separate toilet also apply to a wetroom with WC within

  • Replacement of a bath with a shower delivers more useable space within the bathroom, facilitating manoeuvrability if the primary user is in a wheelchair
  • Replacement of a bath with a shower delivers more useable space within the bathroom, facilitating manoeuvrability if the primary user is in a wheelchair
  • Whether the individual has tried a shower before and can tolerate the spray Is the shower to be used independently or with support from a carer?
  • What other equipment may be required ie a changing or shower stretcher? 
  • Users with limited mobility and/or sensitive skin may benefit from a bodydryer
  • In the shower, what type of seating is required and whether it should beIn the shower, what type of seating is required and whether it should bewall-mounted, static or height-adjustable, or a wheeled shower chair  
  • Consider the overall size and design of the shower area to facilitateindependent use and to accommodate any further equipment or carers. In some instances, where an existing bathroom is being altered, additional space may be acquired by the reconfiguration of door openings etc.

Environmental Design Considerations

  • Consider the layout primarily in relation to:
  • Ease of access to existing plumbing services
  • Location of window to ensure privacy
  • Away from doors to avoid any overspill of water
  • Location of wash hand basin and toilet facilities
  • Check the height requirement of the seat/shower chair. Shower chairs vary dramatically from being freestanding to wall mounted, padded or not padded
  • Check the height requirement of the seat/shower chair. Shower chairs vary dramatically from being freestanding to wall mounted, padded or not paddedConsider the compatibility of the shower chair with the toilet: it needs to  fit over the WC, and, if a bolt-on unit or automatic shower toilet, care needs to be taken to ensure the douche is still in the correct position to effectively clean
  • Consider the location of the shower controls and showerhead. In most cases people often find having these located to the side of them easiest to access from a seated position
  • Think about other features such as a shower curtain or shower screen, particularly if a carer needs to assist.
  • Consider the location of the toilet to enable easy access, especially if transferring from a wheelchair. If an automatic shower (wash & dry) toilet is included, it is recommended that it be fitted with an appropriate RCD but can be located within zone 1 of the bathroom (ie adjacent to the shower or bath), with the provision of a suitable curtain or shower screen to prevent direct line of spray. It is NOT recommended that the user showers whilst sat on the automatic shower toilet

Sensory Design Considerations

Sensory features can often be overlooked or misinterpreted further down the line at the installation stage. It is important to specify these features and give some justification rather than simply ‘it looks nice’.

Colour and texture play an important role in design. Not only does it make things more aesthetic it also can offer visual and tactile guidance for those with impaired vision.

Ergonomics eases use

Grab rails that are ergonomically designed enable the individual to grasp comfortably, assisting with transfers

Avoid Glare

Shiny/glossy tiles can reflect light and often cause glare,it is worth considering whether matt effect tiles are more appropriate

Contrasting Colour

The use of contrasting colour on the floor and walls can help to distinguish the shower area and promote independence. With some types of flooring, different colours can be bonded together to define different areas

Touch and Feel

Products with tactile features such as raised bumps,dimples or touch sensitive controls are also available to assist with the use of equipment such as shower controls, wash hand basins and or toiletsProducts with tactile features such as raised bumps,dimples or touch sensitive controls are also available to assist with the use of equipment such as shower controls, wash hand basins and or toiletsThere are more products on the market now that are also offering auditory guidance.

Every Detail Counts – additional features that require thought!

Wash Hand Basins

  • Should the washbasin be fixed, swing or laterally – or height-adjustable, depending on whether other members of the household will be using the room, and whether the disabled user is in a wheelchair
  • Consider the person’s abilities when selecting a wash hand basin. Do they use a wheelchair? How far they can reach?
  • Wall mounted wash hand basins offer more flexibility in regard to height and keep the floor space clear. These can be set at the appropriate height for a person or fitted onto adjustable wall brackets to be raised in height, swung to the side or slid along to optimise access to other fixtures. If this is the case then ensure that there is a flexible supply and waste system
  • Make sure that there is enough space around the basin; it may be that additional arm support is required which can be achieved through a worktop or specialist basin with extended sides
  • Ensure the wall is strong enough to support the basin and someone weight- bearing on it: many users will use the basin in place of a support rail
  • Careful consideration should be given to taps. Lever taps tend to be the most user friendly however there are other wash hand-basins on the market that offer infra-red operations for those individuals with limited dexterity.

Toileting

  • Toilet height affects a person’s ability to easily get on and off, alone or aided. Height varies, although the standard is accepted as 410mm from floor to top of seat. People with limited knee bend require a higher seat, and may require plinths to be added
  • Existing drainage may restrict the options of re-siting the position ofa toilet. If it is essential to relocate the toilet it is worth getting a surveyor to check whether this is feasibleNB some toilets – including wash & dry toilets – can be fitted witha macerator, which may help obviate such issues
  • Consider the amount of space required to undertake transfers and whether these are carried out in front or beside of the toilet
  • Consider the proximity of fixtures that may assist or inhibit transfer to/from the toilet
  • Consider the potential to add fixtures (grab rails etc) to facilitate transfer
  • Close coupled suites may inhibit the use of an over pan chair
  • Levers for flushing should be large and on the appropriate side of theWC. Some individuals find the use of a push button easier than levers.Alternatively remote- flushing operation may be an option
  • Consider the compatibility of the toilet with other accessible accessories,such as shower seats.
  • A toilet lift raises and lowers the user over the toilet whilst ensuring they are suitably supported
  • Can the user easily reach toilet tissue if required?
  • Conventional WC,bolt-on unit or automatic shower toilet? The choicedepends on the user’s physical ability to wipe clean after toileting. Bear in mind a bolt-on unit is just that, so significant strain will be put on  fixings, especially if the user is side-transferring onto the unit from a wheelchair. The white paper Guide to Specification of an Automatic Shower Toilet (www.clos-o-mat.com/downloads) covers toilet specification and considerations in greater detail

Showers

  • Specification of a long flex is always useful, enabling the user to easily reach all parts of their body
  • Shower screens can be considered safer and more hygienic than shower curtains
  • If a wetroom environment, the tray needs to be properly recessed/flush to achieve the level access, and drainage needs to be adequate.

Hoists

  • Bathroom ceilings should be capable of supporting a ceiling track hoist. Under Building Regulations (Approved Document M) the ceiling specification is to accommodate a hoist with a loading of 200kg. Ideally,at build stage, joists should be positioned to accommodate subsequent installation of a track hoist. In an adaptation, if the ceiling is not strong enough, floor supports (gantry legs) and/or wall brackets may be required
  • The hoist needs to enable manoeuvring of the user to points around the room – over/by the WC, basin, into a bath, to a shower
  • Doorways need to be wide enough to enable the hoist system to transfer across the thresholds, and move across corridors, landings into an adjacent bedroom
  • The hoist system should enable transfer/moving of the user within the room, and potentially into other spaces within the dwelling
  • With ceiling track hoists, there needs to be adequate clearance floor to ceiling to enable adequate lifting (minimum 2.4m).

Closomat

The UK’s first, and still biggest-selling, supplier of wash and dry (automatic shower) toilets, the Closomat wash and dry toilet has sold over 55,000 units since it was introduced some 55 years ago, many of which are still in daily use at least 30 years after first being installed.

Today the Closomat Palma Vita floor-standing automatic toilet is the industry benchmark, being the only one of its kind developed specifically for disabled people. The Palma Vita is the only unit of its kind to achieve Medical Device Class 1 certification.

Closomat has extended its expertise to now offer a range of accessible toilet, bathroom and wetroom equipment, including shower chairs, Apres Shower body driers, and the Aerolet range of toilet lifters.

As a result, the company is unique in delivering in house design advice, supply, installation, commissioning and aftercare service & maintenance through its own dedicated team of engineers.

Download our White Paper