Designing an accessible bathroom that still looks like a bathroom

The questions that come before any product

1. How does the person transfer? Standing and pivoting, sliding sideways from a wheelchair, or being assisted. Each implies a different layout and different clear space.
2. Which side is stronger? Rail and seat positions are not symmetrical in practice. A rail on the wrong side is a rail that cannot be used.
3. Seated or standing to shower? A seated shower needs a seat at the right height, a rail reachable from it, and controls operable while sitting.
4. Does a carer assist? If so, they need room to stand alongside and that space has to be designed in rather than found.
5. Is this for now or for the next fifteen years? A progressing condition changes what should be built today.
6. What can the person actually operate? Hand strength and dexterity determine tap type, door handles and shower controls far more than aesthetics do.
7. How do they get into the room? Door width, threshold, and which way it opens.

Level access showering

For most people this is the heart of it, because the step into a tray or over a bath edge is the most common point of failure and the biggest fall risk in the room.

• A wet room floor or a low-profile level-access tray. Both work. A tray is simpler to install and easier to replace; a wet room gives a genuinely flush, seamless floor. See wet rooms.
• Slip-resistant flooring with a rated coefficient. This is a real specification, not marketing language, and it matters more here than anywhere.
• A fold-down seat fixed into solid blocking – not into plasterboard and not into tile alone. The wall must be reinforced at first fix, which means deciding before boarding.
• Thermostatic shower valve with a maximum temperature limit. Essential where someone may have reduced temperature sensation or slow reactions.
• Controls reachable from outside the spray, so the water can be started and adjusted before getting under it.
• A shower head on a riser rail so it works both seated and standing, plus a fixed head if wanted.
• A screen rather than a curtain where possible – easier to manage, and it stays where you put it.

Grab rails

A grab rail is a structural fixing that will be trusted absolutely, suddenly, by somebody who cannot catch themselves if it fails.

Blocking the walls costs almost nothing at first fix. Even if rails are not needed yet, timber noggins at likely positions mean a rail can be fitted properly later without opening the wall. If there is any prospect of needing them, do it now.

WC, basin and door

• WC height should suit the person’s leg length and transfer method. A raised height suits many people and not everyone – too high is as bad as too low. Raised seats and height-adjustable frames both exist.
• Clear transfer space beside the WC on the stronger side, and room for a carer if needed.
• Drop-down rails fixed into blocking, on the correct side, operable with one hand.
• Basin wall-hung with clear space beneath for a wheelchair, or set at a height suiting a seated user. A pedestal blocks access completely and should not be used.
• Lever or single-lever taps, operable with a closed fist, thermostatic or blended to prevent scalding.
• Mirror positioned for both seated and standing use, or tilted.
• The door must open outwards, or slide. This is the detail most often missed and the one most likely to matter – if somebody falls against an inward-opening door, they cannot be reached.

Making it look like a bathroom

There is no reason an accessible bathroom should look clinical, and a great deal of what makes one accessible simply makes it a better bathroom.

• Level access showers are what people specify by choice in new bathrooms anyway.
• Good lighting – bright, even, no glare and no shadows. Accessible bathrooms are frequently under-lit, and good lighting benefits everybody.
• Lever taps are contemporary, not medical.
• Contemporary grab rails are available in finishes that read as design rather than as equipment – and colour contrast can be achieved with a matt black or coloured rail against a light tile rather than with hospital white.
• Wall-hung sanitaryware gives the clear floor space accessibility needs and the clean look people want.
• Underfloor heating frees the wall the radiator was on, warms a floor that will get wet, and is genuinely better for someone who is cold-sensitive.
• Fold-down seats in good finishes disappear when not in use.

The things that read as institutional are usually white plastic fittings, chrome rails against white tile, and a fluorescent light. None of those are required.

Funding and assessment

Worth starting early, because the process takes time.

1. An occupational therapist assessment through the local authority. Genuinely valuable in its own right – an OT will identify things about how the person moves that are easy to miss – and usually a requirement for funding.
2. A Disabled Facilities Grant may be available where work is needed to make a home suitable for a disabled person. Means-tested in most cases and administered by the district council. In Norfolk each district council runs its own scheme.
3. VAT relief may apply to qualifying work for a disabled person. The rules are specific about what qualifies and about the declaration required, and your supplier should be able to explain how it applies.
4. Charitable and local sources exist for some situations and are worth asking an OT or a social worker about.

Start with the council’s housing or adaptations team. Assessment and approval take time and it is far better to begin before it is urgent.