A soak in the bathtub relieves pain for many people, but standard bathtub design can make it difficult to get in and out. It can be especially difficult to transfer from a wheelchair into a poorly sized tub or a tub with a track. For a combination of a tub and shower, specify a trackless installation. For seated users, the height of the tub should match the height of the chair seat. The most universal height to serve both adults and children is 17 in a.f.f., but the needs may vary from 11 in for children to 19 in for an adult (1).

Bathtub Seats 
A seat installed on the end of bathtub is most helpful when transferring from a mobility assistance device. A platform on the approachable end of the tub allows the user to enter the tub. The extra length of the tub and seat may extend the space in the bathroom to allow a 5-ft turnaround space for wheelchair users.

Bevel the edge of the seat so that it can be used as a headrest, and slant the end of the tub to make it easy to slide slowly into the tub from the seat, using the adjacent grab bars. For additional comfort, the slant may be contoured for extra back support. A fold-down utility tray is another convenience.

Install a hand-held shower to use from the seat. This is useful to people who do not have the strength to lower themselves into the tub. It also helps others with washing and rinsing in the bathtub. The controls should be lowered and installed on the long wall of the tub.

If a platform cannot be added to the end of the tub, consider a movable seat that fits over the tub. The seat is used with a hand-held shower, not for transfer into the tub. The shower curtain should have a slit to fit over the seat. Seats are available without backs if this support is not necessary. If a back is needed, make sure it is textured. Some seats have adjustable legs with nonskid rubber tips. Others can be fastened to the edge of the tub.

Children can be bathed in a child seat or on a bathing table that fits in the tub. One innovative bathtub design incorporates a stationary tray and a rotating tub to ease entry and exit.

Types of Bathtubs
Generally, a bathtub should have a flat (not round) bottom for stability. The floor of the tub must be slip-resistant. If not, add a non-slip bath mat that runs the full length of the tub. Look for tubs with narrow rims or handles that can be grasped when getting in and out. Soft tubs provide a non-slip surface that may prevent falls and will certainly cushion the blow if a fall does occur.

Use a contrasting stripe to identify the bathtub rim and base perimeter. Vertical stripes in the tub will help to identify the amount of water through refraction or "bending" of the stripes at the level of the water.

Some doors on tubs swing up or open out for easy access. These doors are tightly sealed and can be used with a whirlpool bath. Make sure that drain controls are within reach and that it drains rapidly. A tub with a swing-up door can be ordered for a left or right approach, allowing full use by a person with hemiplegia. The strong side of the body can be used while transferring and accessing tub controls. A high-volume drain allows the tub to be quickly emptied before exiting.

A spa can be made accessible to many people through the addition of a lift or a series of steps, the highest of which should be at the height of a wheelchair seat (17 to 19 in a.f.f.) (2). The user can slide from one step to the next, employing natural buoyancy to help with transfer.

Bathtub Controls 
Choose a lever-type faucet and drain control for easy operation. Controls must be installed toward the approach side. To eliminate controls, specify an automatic fill system which programs use and presets the temperature and water level. This is especially helpful if sensitivity to temperature is a factor.

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

References
1. Americans with Disabilities Act Accessibility Standards, 1991.
2. ADA Accessibility Standards, 1991.

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.