(Excerpt from Design Details for Health by Cynthia A. Leibrock)

The Kohler Design Center, offering "hands on" universal design training to 150,000 participants each year. The universal bathroom addresses a lifetime of needs, the future of each visitor to the Kohler Design Center as well as the future of interior design and architecture. It responds to the diversity of our population, and our changing needs in each season of life.

When we design for the average user, we accommodate only a few people well. Universal design acknowledges that one size does not fit all, and that a bathroom must meet the needs of children, tall people, wheelchairs users, and adults of shorter stature. It accommodates a person who uses an assistant, a walker, a scooter or a stroller. It addresses changes in hearing and vision and offers older people increased lighting levels, lower ambient noise levels, ergonomically designed products and safety features accommodating reduced reaction times. Most importantly, it prevents institutionalization by facilitating home health care and "aging in place."

Universal design is also invisible, never stigmatizing the user or pointing out their physical differences. Listed below are some of the features that have been visually integrated into the design:

1. Turn-around Space: (shown by a graphic in the floor). A 60-in by 60-in turn-around space provides enough room to maneuver with strollers, scooters, crutches, canes, walkers and guide dogs.

2. Transfer Space: Clear floor space adjacent to the water closet allows parents room to help children. Attendants use the space to help older family members, and people in wheelchairs use the space to transfer to the water closet.

3. Lavatory Area: The lavatory and mirror are installed outside of the shower area to keep the mirror from fogging or being sprayed by the hand-held shower. For children in wheelchairs a 36 by 48-in clear floor space extends under the lavatory. Children actually need more room to maneuver than adults who only need a 30 by 48-in clear floor space. A vanity stool can be used in this space by ambulatory family members who prefer to sit while using the lavatory. A lightweight stool on legs with glides is more stable than a stool on casters.

4. Adjustable Height Lavatory: With this installation, the counter can be adjusted between 25-in and 42-in a.f.f. to meet the needs of tall users, adults of shorter stature, children, and seated users. The flexible waste and supply are positioned to prevent burns. There are no sharp or abrasive surfaces below the lavatory which could injure a seated user. Clearance for wheelchair footrests extends the full depth of the lavatory. For people with allergies or chemical sensitivities, solid surface vanity tops are preferable to laminates adhered to press board or particle board since both may offgas formaldehyde. The horizontal finishes were chosen in lighter colors to increase the ambient light levels to improve visual acuity. For people with vision differences, the edge of the lavatory area is identified by a contrasting chrome bar. The bar also provides support for standing users, a grip to reposition a wheelchair, and a place to hang towels.

5. Lavatory Controls: The levers can be easily controlled with one hand. They are cued with large markings in red and blue to identify water temperature. Aerating nozzles on taps reduce ambient noise levels, and the water pressure can also be reduced to further quiet the flow. Quieter faucets 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.

6. Mirrors: The mirror at 40-in a.f.f. can be used by a seated user or an adult of shorter stature. A tilted mirror should not be specified because it distorts the image of the user.

7. Removable Cabinets: Each cabinet under the counter is designed as a freestanding unit that is totally removable. Removable cabinets will also make the home easier to sell by offering access to a wider market, including people who use mobility aids. A movable cabinet under the sink can serve as a cart between the counter and tub or toilet, perhaps to store equipment for the bowel and bladder program. When the cabinet is moved out, the space under the counter is clear for seated users and the top of the cart can serve as extra counter space. The cabinet has locking casters and a top rail to prevent items from sliding off. Dividers have been added to the cabinet for people who are blind who need a small place for everything. Each storage area is labeled so sighted people will put things back correctly. Medications are stored in a locked drawer, within reach of wheelchair users but not accessible to children. On all drawers, C grip handles are horizontal and centered.

8. Toilet and Shower Grab Bars: Grab bars are installed at a height of 33-36-in a.f.f. on all sides of the roll-in shower. For the easiest approach to the toilet, grab bars are located behind the toilet and on one side. Grab bars should not chip, and they cannot have sharp or abrasive edges. They must not rotate within their fittings. A textured finish is applied for a sure grip.

9. Bathtub Grab Bars: A grab bar is often used by bracing the forearm between the bar and the wall for support. For this reason, install the grab bar exactly 1 1/2-in from the wall or the entire arm could slip through the opening. One horizontal grab bar should be installed at the foot of the tub when a tub seat is used at the head. Two horizontal grab bars are placed on the long wall: one 9-in above the tub and the other 34-in a.f.f.

10. Shelving: Upper shelves should be of tempered glass or clear plastic to make the contents more visible by children, wheelchair users, or adults of shorter stature. Adjacent to the shelves, four heights of hooks should be offered.

11. Accessible Shower: A shower is quicker, easier, and safer to use than a bathtub. (See Tables 12-4 and 8-2) This shower can be used from a shower wheelchair or by a standing user. A corner shower open on two sides allows access from more than one direction. The wheel-in shower floor must be sloped rather than curbed, since a curb may block wheels or become a tripping hazard. A 2% slope to the drain is sufficient; a steeper slope makes it too difficult to maneuver a shower wheelchair or gurney. The many joints on the ceramic mosaic floor tile reduce slippage.

12. Shower Control: The system provides temperature and surge controls to provide a safe flow of water which can be set to a temperature which will not burn a child if accidentally bumped. The pressure-balancing feature prevents a surge of hot water which could burn a person with sensation limitations.

13. Hand-held Shower Adjacent to the Toilet: The fixture is ideal for use from a shower wheelchair or for cleanup after using the toilet. It can also be clipped to an adjustable-height bracket for use as a conventional shower by a tall standing user, person of shorter stature, or a child. The vertical adjustment does not obstruct the grab bars. The valve will not catch the shower hose and requires only one hand to regulate water flow and set the desired temperature.

14. Towel Bars: are offered in four heights and should be reinforced to withstand emergency use as grab bars. Bathroom walls should be reinforced floor-to-ceiling with 3/4-in plywood or with wood blocking installed between the studs.

15. Shower Wheelchair: After one transfer to a shower wheelchair, the user can roll into the shower, under the lavatory, or over a toilet. Multiple transfers to a seat in the shower or to the water closet are not required. With the wheels locked over the toilet, the chair can also be used by a standing person with strength limitations who needs an elevated toilet seat with arms. There is a gap between the two seats and an opening in the front for digital manipulation or to empty a leg bag. Shower wheelchair storage is also discreetly provided.

16. Shower Curtain: Plan showers with curtains, not doors which take up floor space. Ceiling-mounted shower curtains have a clean appearance, especially when they curve around two sides of the shower.

17. Shower Caddie: To prevent soap, shampoos, and accessories from slipping out of reach, choose a caddie which drains easily and will not rust. A second caddie should be installed at a height for children or people of shorter stature.

18. Bathtub: The bathtub should have a gently sloping flat (not rounded) bottom for stability. The floor of the tub must be slip-resistant. The handles can be grasped for entry or exit. The color contrasts from the surroundings to improve visual acuity, and the vertical stripe visually "bends" at the water depth for people with vision limitations.

19. Bathtub controls: Choose a lever-type faucet and drain control for easy operation. Controls must be installed toward the approach side.

20. Bathtub Seat: A soak in the bathtub relieves pain for many people, but standard bathtub design can make it difficult to get in and out. The seat is installed at wheelchair height, but a standing user can also transfer from it. Install the edge of the seat flush with the top of the tub to make it easy to slide slowly into the tub from the seat, using the adjacent grab bars.

21. Hand-held Shower Adjacent to the Tub: This shower can be used from the seat for a quick clean-up, to shave legs, wash hair, or by people who do not have the strength to lower themselves into the tub. It helps others with washing and rinsing while bathing, and it can also be used to bathe a child in a child seat or on a bathing table.

22. Toilet: An elongated toilet installed at a 17-in height is easier to use when transferring or aligning with the shower wheelchair. A wheelchair user can also transfer directly at this height, and the flush lever is on approach side. The quiet toilet serves 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. For a quieter water flow, specify pipes with as large a cross section as possible.

23. Toilet Seat: The flat lid is more comfortable to lean against than one that is crowned or dished. The toilet seat is securely installed, but it can always be replaced by an elevated seat if necessary. 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.

24. Toilet Tissue Dispenser: One 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 is 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. A second tissue dispenser should be provided for a constant supply, and it has been lowered use by for children (2 to 6-in above the toilet seat). The cover protects the tissue from the hand-held shower.

Ask about consulting universal design services: Cynthia@AgingBeautifully.org