title: An investigation of noncompliant toilet room designs for assisted toileting.
abstract: OBJECTIVE
  By comparing an Americans with Disabilities Act Accessibility Guidelines (ADAAG) compliant design with alternative designs, this pilot study resulted in recommendations for designing patient bathrooms to facilitate assisted toileting.
  
  
  BACKGROUND
  The ADA Accessibility Guidelines were developed primarily to address the needs of disabled populations, such as returning Vietnam veterans, with sufficient upper body strength to transfer independently directly from a wheelchair to the toilet. However, the majority of older persons with disabilities (90%) stand to transfer to the toilet, rather than laterally moving from the wheelchair to the toilet.
  
  
  METHODS
  The research used a repeated measures research design to evaluate caregiver responses during assisted toileting for various toilet configurations. The study included 20 patients who were transferred onto and off of a toilet for each of four different configurations by one or two caregivers. Toileting trials were videotaped and analyzed by an occupational therapist. Additionally, caregivers completed five-question, self-report surveys after each toileting trial.
  
  
  RESULTS
  Survey data indicate that staff members prefer the largest of the tested configurations, where the centerline of the toilet is 30 inches from the sidewall, rather than the 18 inches required by the ADAAG, and where there are two fold-down grab bars provided. Caregivers perceived the grab bar locations as better for helping them safely transfer subjects in a modified (non-ADAAG) configuration, and also that the grab bar style in a modified configuration (non-ADAAG) improved safety when transferring subjects.
  
  
  CONCLUSIONS
  Although caregivers were observed to safely transfer residents to and from the toilet for all configurations tested, regulations regarding accessibility of patient bathrooms should acknowledge the perceived benefits of increasing the distance from the sidewall to the centerline of the toilet to as much as 30 inches and allowing two fold-down grab bars instead of the required sidewall and back-wall grab bars.
  
  
  BACKGROUND
  ADA, toilet room design, healthcare design, evidence-based design, human factors, safety, staffPreferred Citation: Sanford, J., & Bosch, S. (2013). An investigation of noncompliant toilet room designs for assisted toileting. Health Environments Research & Design Journal 6(2), pp 43-57.
authors.affiliation: Corresponding Author: Sheila J. Bosch, PhD, Gresham, Smith and Partners, Sheila_bosch@gspnet.com; (813) 417-9387.
authors.forename: Jon
authors.initials: J
authors.lastname: Sanford
authors.forename: Sheila J
authors.initials: SJ
authors.lastname: Bosch
mesh_terms: D006801:Humans; D010865:Pilot Projects