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The Public Right-of-Way Accessibility Guidelines (PROWAG) rulemaking has concluded. The PROWAG final rule has been published in the Federal Register. Please visit the Access Board’s PROWAG page for the guidelines.

Toileting and Bathing Facilities for Assisted Transfers

August 1, 2001

Jon A. Sanford, Project Director Atlanta Research and Education Foundation

Although the Americans with Disabilities Act Accessibility Guidelines (ADAAG) were initially issued in 1991, many of the guidelines were based on design standards for people with disabilities that were developed almost two decades ago. In the time since the development of these early requirements, the demographics of the population of people with disabilities have changed dramatically. People are growing older and a larger number of individuals are living longer with disabilities (Bureau of the Census, 1992; Chirikos, 1986; Colvez & Blanchet, 1981, Jones & Sanford, 1996; Kunkel & Applebaum, 1992; LaPlante, Hendershot, & Moss; 1992; Zola, 1993). As a result, individuals’ functional abilities may not be served by existing design guidelines. A number of researchers, including Czaja (1984), Faletti (1984), Sanford, Echt, & Malassigné (1999), and Steinfeld & Shea (1993), have argued that accessibility standards, based primarily on the capabilities of young people, may not compensate adequately for range of comorbidities and secondary conditions that are common among older people with disabilities. In fact, adhering to accessibility codes may do more to promote excess disability among older people than to ameliorate it (Sanford, Echt & Malassigné, 1999; Sanford & Megrew, 1995). This suggests that alternative guidelines based on the needs and capabilities of elderly individuals should be established, particularly in buildings used primarily by older people (e.g., residential care facilities, senior centers and independent living facilities).

Access to toilet and bathing facilities is clearly an area in which research data suggest that a review of ADAAG specifications is needed. For example, Sanford, et al. have previously reported (1995, 1999) that the preferred ADA toilet configuration does not work as well as it should for the majority of older adults, including both those who stand to transfer, as well as those who transfer directly from wheelchair to toilet. In these studies, subjects who stood to transfer consistently reported that the preferred ADA configuration was the most difficult to use, whereas grab bars on both sides of the toilet, such as the alternative ADA configuration were easiest to use. In contrast, older respondents who were nonambulatory reported that all of the configurations (including the preferred and alternative ADA configurations) were equally difficult.

However, previous studies focused only on independent transfer, which is the underlying presumption in ADAAG. Unfortunately, many older people lack the upper body strength to pull themselves out of a wheelchair or have problems raising and lowering themselves onto a toilet even with the assistance of grab bars. Therefore, many individuals may require person-assisted transfers, regardless of the grab bar configuration.

Prior research suggests that some toilet and grab bar configurations that were the most radical departures from ADAAG (e.g., swing-away grab bars) were not only associated with greater safety and ease of independent transfer, but also potentially offered greater flexibility in facilitating assisted transfers. This suggests that alternative designs that can accommodate both individuals with disabilities as well as those who provide assistance to them need to be identified, particularly in the design of facilities that will be used mainly by older adults.


ADAAG was developed with the intention of providing greater access for individuals with disabilities. These guidelines, as most other accessibility codes, standards, and guidelines, are generally based upon the stature, strength, and abilities of younger adults. Little consideration has been given to the needs of frail individuals and those requiring assistance from caregivers. This is particularly true of the majority of users in health care and long term care facilities. Therefore, the specific objective of this project was to identify and analyze best practice exemplars of design solutions that accommodate assisted use of toilet and bathing fixtures. This information is intended to assist the Access Board to identify, understand, and evaluate key issues and features.