Toilets, Lavatories, and Faucets for the Accessible Home

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Toilets
The design of the toilet, the height of the installation, and the approach must all be considered for use with mobility aids. The toilet can be approached in several different ways. In a residence or health care facility, the user may first transfer into a shower wheelchair, which can roll over the toilet. Alternately, the individual may choose to transfer directly from their wheelchair to the front or side of the toilet.

Elongated toilets are easier to use when transferring or aligning with the shower wheelchair. Choose a toilet seat adjustable to wheelchair height for adults and children (11 to 19 in a.f.f.). The lower height range may also be necessary to allow clearance when using a shower wheelchair. An existing toilet seat can always be replaced by an elevated seat if necessary.

For bowel and bladder care, specify a lower toilet with a higher seat, leaving a gap between the two. It may be necessary to reach into this gap for digital manipulation or to empty a leg bag. Specify a seat with an opening in the front. The seat must be firmly attached for stability when transferring. The seat must not be sprung to return to a lifted position, but it should remain up independently when raised. Men with hemiplegia or one hand do not have a free hand to hold up the toilet seat while using the toilet. A flat or padded lid is more comfortable to lean against than one that is crowned or dished.

Most toilets are too high to easily empty a leg bag. The lip of the toilet needs to be below the level of the drainage tube and the leg may have to be elevated to this level to empty the bag. Wall-mounted toilets can be installed at the proper height and are easier to clean since they have no base. The clearance below also provides extra floor space for wheelchair footrests.

For ease of maintenance, the toilet could be installed in the shower and used as a shower seat in some installations. The toilet seat must be padded or non-slip, and a bench-type seat eases transfer. A toilet in the shower will also simplify clean-up after a bowel and bladder program. Plan the lavatory and mirror outside this area to keep the mirror from fogging.

One toilet model uses warm water for washing and warm air for drying rather than toilet tissue. This type is especially helpful for people who find it difficult to manipulate tissue. A portable bidet is also available.

A wall-mounted toilet can be installed as high as necessary for people who have trouble sitting and rising. With a high toilet, a low stool may be required for the bowel program, elevating the feet to facilitate elimination.

Make sure the stop valve (or cutoff valve) on the toilet is easy to use and within reach. The flushing lever must also be on the approach side.1 A flush valve in the center of the tank is harder to reach but more neutrally handed.

Flush valves in back of the toilet can be uncomfortable for people who lean back for balance unless a toilet seat lid is provided. All controls must require less than 5 lbf. for operation; a toilet flush lever extension may be needed. A more universal design is a sensor for automatic flushing.

For a quieter water flow, specify pipes with as large a cross section as possible, and install low-pressure cisterns instead of high-pressure heads. Quieter toilet rooms serve people with a wide range of hearing abilities. People with speech differences who need to be clearly heard and people with reduced vision who depend more on their sense of hearing also appreciate lower ambient noise levels.

Toilet accessories
A transfer board may help in sliding from a wheelchair onto a toilet. Select a toilet seat with a wide bench that is easier to grasp when transferring.

If a seat with arms is needed for support, make sure the arms are adjustable to the most comfortable height. Arms that extend to the floor are more stable than arms that rest on the toilet bowl.

A tissue dispenser must be at least 19 in a.f.f. and yet low enough so that grab bars do not interfere with its use. It must be installed 7 to 9 in in front of the toilet. The toilet tissue holder must permit continuous paper flow and be usable with one hand. Dispensers must be avoided that might require users to reach into a hole to initiate paper flow, and no dispenser should have a sharp or serrated edge. The dispenser should be recessed, if possible, so it will not interfere with use of a mobility aid. Consider two tissue dispensers for a constant supply, with one at a lower height for children (2 to 6 in above the toilet seat).

Lavatories
The type of lavatory, the location, and the accessories are all important factors in access. Lavatories with pedestals to the floor can be used, in some cases, with wheelchair footrests spread apart, but clearance for wheelchair footrests is required by most standards to extend the full depth of the lavatory.

Lavatories with legs limit access. Wall-mounted lavatories are easy to wheel under if properly installed. In the past, accessible lavatories have been cantilevered up to a depth of 27 in without additional bracing. If the lavatory was ever needed for support or if an electric hospital bed caught under the edge, the cantilever could break loose. A better solution is a countertop installation with a slight cantilever.

Water supply and drain pipes can be plumbed in a horizontally offset position to free knee space. Sharp or abrasive surfaces below the lavatory may injure a seated user. Insulate pipes under approachable lavatories or add a removable cover to prevent burns. Plastic pipe may not require insulation if the maximum hot water temperature does not exceed 120 degrees,2 but people with circulation limits can be burned by metal pipes at this temperature. Because of reduced blood flow, the heat cannot be carried away from the skin as rapidly and these people are burned at lower temperatures. The burn also takes a longer time to heal because of the limited blood supply. Thermostatic controls limit maximum temperature and prevent sudden changes.

The height of the lavatory is critical in accommodating the needs of people with varying ranges of motion. To be used from a standing position, the top of the lavatory should be from 32 to 36 in a.f.f., depending on user height. Adults in wheelchairs need a lavatory no higher than 34 in a.f.f. with knee clearance of 29 in at the front edge.3

Children in wheelchairs require a lavatory that is no higher than 30 in with a knee space of at least 24 in.4 To meet all of these needs, one option is to specify an adjustable-height lavatory. A clear floor space of at least 30 x 48 in must be provided, extending under the lavatory a maximum of 19 in. For children in wheelchairs the clear floor space should be at least 36 x 48 in extending under the lavatory a maximum of 14 in. Mount controls within 14 in of the front of the lavatory. Clear floor space for adults or children must never be obstructed by the doors swing, however the required turning space may overlap both the clear floor space and the door swing in most states.5

To improve visual acuity, identify the edge of the lavatory area by contrasting with a color. Color-coded hot and cold water controls are also helpful. Avoid glass lavatories, which may be visually confusing.

Faucets and Controls
A single-lever faucet can be easily controlled with one hand; spring-loaded faucets often take too much strength to operate. To improve reach, mount faucets and controls on the front apron of the counter or to the side of the lavatory. If the lavatory is used to wash hair, use a goose-neck design, which is easier to control than a hand-held spray.

The most universal faucet controls are operated without use of the hands. These controls sense any object underneath and set flow at a safe, preset temperature. These valves can also be set to open and close the flow at preset intervals, without the use of external controls. If a self-closing valve is used, the faucet must remain open for at least 10 seconds.6 A temperature control will prevent burns. Set the mix valve at a temperature of 115 degrees to start, and do not exceed 120 degrees.7

The noise created by water flow should be minimized to serve people with a wide range of hearing abilities. Specify quiet ball cocks designed to give a smooth flow and aerating nozzles on taps. Also reduce the water pressure to further quiet the flow.

Note: a.f.f. = above finished floor

References
1. Americans with Disabilities Act Accessibility Standards, 1991.
2. North Carolina State Building Code Council, North Carolina State Building Code, vol. 1 C (Raleigh: NCSBCC, 1989).
3. ADA Accessibility Standards, 1991.
4. NCSBCC, 1989.
5. ADA Accessibility Standards 4.23.3
6. ADA Accessibility Standards, 1991.
7. NCSBCC, 1989.

Excerpted from Beautiful Universal Design: A Visual Guide, Cynthia Leibrock and James Evan Terry, John Wiley & Sons, 1999; Used With Permission. © Cynthia Leibrock and James Evan Terry.