The Accessible Bathroom
Part 3 – The Toilet

Note: The "Accessible Bathroom" series originally appeared on a blog page and was never completed. Several elements of design have not been discussed such as fixtures, electrical and cabinetry. It is not known if the series will ever be completed. However, if you have a specific question relating to the topic here, feel free to contact us with your question.

The Toilet

Covered are:

  • Toilet Height
  • Toilet Location in Room
  • Bidets
  • Bidet Control Location
  • Toilet Paper Dispenser
  • Sources Links

Most toilets come in to heights of either 14 or 17 inches tall and come with round or oblong bowl shapes. Being 6'-3", I've always hated the 14" tall toilets since it made me feel like sitting on the floor. At least the 17" toilet was the same height as typical table chair. Having so few choices to meet your needs doesn't mean you'll have to settle for less than optimal accessibility.

An accessible toilet is actually an approach to a usable design that addresses your abilities and preferences in its actual usage. You've probably been to various places that had "accessible" rest rooms. You've probably have thought that most were lacking in some way by placement of the grab bars and location of the toilet relative to the immediate area. You probably asked yourself, "accessible to who?" At home, you've likely become quite adept in using your current water closet but would really like to make it easier. Your abilities will drive the design. Some people are quadriplegic or paraplegic and may have some abilities such as being able to transfer via "stand and pivot" or may have a progressive condition as mine where abilities are in constant change.

My ability to stand is severely limited. The closer I am to already standing, the easier actually standing becomes. For example, standing from a tall stool is much easier than trying to stand from a desk chair. The closer I am to actually standing, the less effort it takes for me to stand. Ideally, I want it like it was when I was still ambulatory.

toilet height

For the toilet, the solution was either to raise me from the toilet or, have the toilet placed higher than typically found. Lift seats designed for the toilet are ideal for existing applications but, don't allow for one element that I wanted – a bidet toilet seat to attach to my existing toilet. Seat lifts would not allow for the use of the add-on bidets seats since they have their own toilet seat as part of the lift. So, that left me with the decision to raise the toilet to the height I needed. For me, I needed to raise it 6 inches and that is what I did. A small platform was created out of concrete with the plumbing extended accordingly. It could have been just as easily made out of pressure treated wood – pressure treated to be more resistant to moisture and as better surface to tile. It is extremely important to note the location of the toilet water supply line relative to the base such that there is sufficient space surrounding the shut-off valve for operation. In my case, there was not room to install the wall trim piece and barely enough to operate the valve. In the end, I tiled the platform as I did the walls and floor.

Location of the toilet within the room can be an issue in the case of those who "transfer" to the toilet. Depending upon the disability and the need for assistance or not can suggest an ideal location when budget allows such a choice. Some may require a left side (or right) transfer ability and may need space for an assistant to help with transfers. In my case, the toilet location provided the free area needed for side and front transfers.

Of course, there were other options such as purchasing an all-in-one toilet/bidet and then, purchase a toilet seat lift but the cost of this approach started around $2000 for what I needed versus $1000 for the add-on seat and the cost of creating the platform. If a higher toilet is needed but, not as high (only 3.5 inches), you could use a toilet platform kit.

This may sound of the obvious for the bidet option but, location of the controls is an important design consideration. Most after market bidet seats such as the one I purchased have a wall mounted control unit. Depending upon toilet location within the room, this can be something of a challenge to locate based upon disability. The toilet paper dispenser location was a problem because of this. The only practical solution was to purchase a free-standing toilet paper dispenser. These are manufactured by several companies, inexpensive and can be purchased locally and online in various finishes and styles.

A note about the after market bidet seats: Though well made, they weren't designed to withstand the rigors of slide transfers and eventually parts began to fail after about a year or so. For my case, the only option remaining is to do without or go with a combination toilet bidet which can be expensive.

Some may suggest an inexpensive elevated seat that can be purchased for under $20. These are simple elevated-seats made of plastic that fit atop a toilet. I found them OK for temporary situations such as away from home but, very undesirable for the long term. This is because you are raised further above the water in the bowl. Any deposits into the bowl come from a greater distance and subsequently make a splash. The seat and bowl need constant cleaning from the splashing after every use. Also, since the seat is loosely fitted atop the bowl, there is some movement which may pose a problem for some especially if transfer requiring a board in needed.

Sources Links opens in a new window
(I do not endorse any of the below and provided only as general reference)

Pre-Made Toilet Platform Kit Raises Toilet 3.5 Inches
http://www.awalifts.com/bathroom_accessories.html

Power Lift Seat for the Toilet
http://www.toiletliftchair.com/

Aftermarket Bidet Seats
http://www.biobidet.com/
http://www.totousa.com/ (look under washlets)

Toilet Grab Bars

Grab bars — Placement of these should be exactly where you want and need them. They are an added cost for each one but, having all you ever need can make using the toilet one less thing that is a struggle to perform. Take notice of how you use the toilet now in where the bars help and where they don't. Are they too low or too high? Do you wish they could move out of the way? In my case, I wanted bars on either side of the toilet at 36" and 30" from the floor. I wanted two heights because I would use the higher for transfers to and the lower for transfers from the toilet. However, there wasn't a wall close enough to mount bars and either side. I also wanted to be able to do a side transfer with a transfer board when I was no longer able to perform a stand and pivot. The solution was swing-down bars that mount on the wall behind the toilet. The bars come in different lengths so be sure to purchase them long enough. I found that the shorter ones didn't meet my needs and ended up installing one that, when down, extended out equal to the front of the toilet bowl. Though there are couple of manufacturers of these, I used this brand for its esthetics. In the USA, they are normally stocked in white but are available in various colors by special order. To me, all of the other brands looked had a definite institutional look. If you're like me, you don't need any reminders that you have a disability!

The swing-down style has a couple of advantages in that grab bar is actually a loop. The result was that I got grab bars at two different heights as I wanted. It is important that the wall have some sort of reinforcement because the style of grab bar can allow much more twisting forces than those that run along the wall. I had scrap 2×6 inch lumber placed behind the drywall to mount the grab bars. In over a year of daily use and the occasional collision with my chair, they show no signs of weakness. In addition, there are accessories such as toilet paper holders that attach to the grab bars.

A note about esthetics. Hospitals and other public places purchase items based on lowest cost that meet requirements. Typically, for these places, esthetics only come into play when costs are trivial. Designing an accessible bath for the home must consider esthetics with more emphasis. My approach was to minimize the appearance of a bathroom being for a disabled person. The bathroom design philosophy was accessibility without being a patronizing reminder of needing it. Home should always be the escape from reality where one can live life without struggles and humiliation. Mental health is just as important as physical health.