When you start a building design project, “How will my bathrooms be designed?” is probably not the first design consideration that enters your mind. 

A vaulted-ceiling great room or niche corner café always steals the show (both in design meetings and magazine cover photos), but the importance of safe and efficient bathroom design in senior living and long-term care facilities cannot be overstated.

Creating a safe and comfortable bathroom environment is crucial due to the high incidence rate of falls and accidents in these spaces. Good bathroom design is essential for maintaining hygiene, dignity, and independence among residents. 

Therefore, creating a space that promotes safety and supports physical decline over time is vital. Here are key elements to consider for achieving this goal:

  • The vanity area: Tiltable mirrors and mirrors positioned lower to the sink/backsplash provide better visibility for shorter individuals and those in wheelchairs. Ample lighting at the mirror reduces the need to lean in, offering a clearer view and better facial lighting. The sink height should not exceed 34,” with 27” of clearance under the counter for wheelchair accessibility.
  • Proper lighting: Sufficient lighting is essential as aging eyes require more light to see clearly. Seniors often experience disorientation at night, so automatic and night lighting can enhance their sense of security and reduce risks. During the day, sufficient lighting in the shower and tub areas helps prevent slips and falls by improving the visibility of faucets and toiletries. Proper lighting around the toilet and in the shower area is also important for staff providing assistance.
  • Storage and accessories: The placement of accessories is vital. Medicine cabinets should be accessible on the side wall and at a lower height. Outlets should be positioned closer to the counter’s edge to prevent cord hazards. Towel and soap dispensers may differ based on whether staff or residents use them. Staff typically use single-use paper towel dispensers, while residents may prefer fabric hand towels easily accessible on the sink’s front edge. Toilet paper dispensers and soap shelves in the shower should be part of the overall layout. 
  • Storage for staff needs: Suitable storage is essential for efficient staff operations. Staff often require access to items like incontinence products and PPE (personal protective equipment). Consider discreet built-in glove box holders to blend staff efficiency while maintaining a residential feel. Secure storage for such items as cleaning supplies is also an important consideration. Proper storage reduces clutter, keeping floor space clear for walkers, assistance, and more.
  • Appropriate finishes and flooring: Non-slip flooring and textured finishes significantly reduce the risk of falls. It is important to choose flooring materials that meet slip resistance requirements, especially in wet areas. Avoid rugs or mats, which can become trip hazards. Flooring with glare-free surfaces and contrasting colors improves visual clarity. Ensuring minimal elevation changes between different flooring types, like carpet to tile or vinyl, further reduces fall risks.
  • Systems for nurse call: Emergency pull cords or buttons should be strategically placed near the shower, tub, and toilet, with no clutter around them. Pairing call buttons with automatic lighting ensures they are easily found in emergencies.
  • Fixtures and faucets: Easy-to-use faucet handles are important, especially for those with arthritis. Single-lever faucets are recommended as they are easier to operate and eliminate the need to blend two faucets for the right temperature. The height and distance from the sink ledge are important for infection control, providing enough clearance for proper handwashing. 
  • Safe showers: Low-threshold showers and collapsible vinyl shower dams are preferable in resident rooms. Weighted shower curtains and vinyl collapsible dams keep water contained and allow easy access for people with mobility issues and/or assistive devices. Barrier-free entry is the ideal option. Proper floor pitch to the drain prevents water pooling, especially in barrier-free shower areas.

Moveable shower seating is suitable for most independent living residents. Non-slip flooring and optional grip strips enhance safety, but mats should be avoided in the shower area. Adjustable shower heads and handheld showers with multiple docking locations provide flexibility for staff-assisted bathing and resident use. 

  • Positioning toilets: And yes, the toilet. Nobody ever wants to talk about the toilet! Toilets must meet ADA requirements, with heights between 17” and 19” from the floor to the seat’s top. The higher end is often too high for older women, so a mid-range height is recommended. Choosing between closed and open front seats depends on whether the toilet is for independent use or staff assistance. Providing color and texture contrast between the toilet, wall, and flooring helps with visibility, especially since most toilets are white.
  • Secure grab bars: Proper placement and type of grab bars are crucial. They should be installed inside the shower, alongside the bathtub, and beside the toilet. Pivot-up grab bars are preferred in the toilet area as they allow for more space when not in use. These bars are beneficial for residents who have had strokes and need support on one side. Non-flexible rear bars or single grab bars may not provide satisfactory support. Towel bars with textured surfaces that double as grab bars can offer additional security near sink areas and between the shower and toilet.

Designing a senior-friendly bathroom involves considering the decline in vision, mobility, strength, range of motion, and cognitive abilities that come naturally with aging. Seniors are more affected by glare, experience reduction in the ability to see visual contrast, and often face the impacts of eye diseases. 

They require assistive devices like canes, walkers, wheelchairs, and grab bars. Their ability to reach heights or step over barriers changes, and they may experience greater weakness on one side of their body. Cognitively, they might face increased confusion or forgetfulness. 

By addressing these elements, we can design a bathroom that ensures senior residents can age in place safely, maintaining their independence, dignity, and ability to perform daily tasks.

Julie Heiberger is a senior project architect and the Senior Living Market Leader for Hoffman Planning, Design & Construction Inc. A member of the American Institute of Architects and the National Council of Architectural Review Boards, she received her Master of Architecture from the University of Wisconsin-Milwaukee. She can be reached at [email protected].

Jon Rynish is a senior project architect with Hoffman and a Leadership in Energy and Environmental Design (LEED) accredited professional. A graduate of the University of Wisconsin-Milwaukee with a Bachelor of Science in Architectural Studies, he has collaborated on numerous senior care facility projects, specifically for nonprofit senior living providers, religious congregations and county providers. He can be reached at [email protected].

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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