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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

Data Collection
Best practices design solutions were identified from several sources including expert informants who were involved in the design or implementation of innovative solutions and archival data that documented innovations.

Expert Informants
Selection of Participants.
A comprehensive search of design and or provider organizations in the forefront of the design of residential and institutional environments for individuals who may require assistance with toileting and bathing was conducted. The search included traditional bibliographic databases to identify sources within the design and gerontological literature; online searches of designs and innovative products for people requiring assistance with transfers; interviews with major providers of eldercare facilities, including Manor Care and Sunrise Corporation; attendance at major aging conferences (i.e., AAHSA, ASA, and GSA) to solicit participation from exhibitors; recommendations from nationally-known design for aging experts (Maggie Calkins, IDEAS, Chardon, Ohio; Marc Warner, Ageless Designs, Jupiter, FL; and David Hoglund, AIA, Perkins Eastman & Partners, Pittsburgh) as well as staff at relevant organizations such as the Center on Aging, University of Wisconsin, Milwaukee; AAHASA; and the Center for Universal Design, NC State University; and recommendations for residential construction from members of the home modifications listserv sponsored by SUNY Buffalo.

Selecting potential participants was difficult. Although a large number of health and care providers as well as architectural and interior design firms specialize in Assisted Living and other Long Term Care options, most hadn’t really addressed toileting and bathing beyond the requirements in ADAAG. Nonetheless there were a few firms that were very interested and knowledgeable about the problem; and had actually done some things to accommodate assisted transfers. In addition, designs used by the major development corporations like Manor Care and Sunrise, didn’t really offer any alternatives to ADAAG either.

Individuals/firms that agreed to participate in the project included:

Senior Living (Independent, Assisted Living, & Extended Care)

  • Gregory Scott - Reese, Lower, Patrick & Scott (RLPS) Architects, Lancaster, PA
  • Gaius Nelson - Nelson Tremain Partnership, Minneapolis, MN
  • Peter Wilson - Cochran, Stephenson, & Donkervoet Inc., Baltimore, MD (architects and interior designers)
  • John Capelli - Ewing Cole Cherry Brott (ECCB), Philadelphia PA
  • Robert Pfauth - O’Donnell, Wicklund, Pigozzi & Peterson (OWP&P)Inc., Chicago, IL
  • Cornelia C. Hodgson - Dorsky Hodgson + Partners, Inc., Cleveland,OH

Residential (single- and multi-family)

  • Alan Browne - Extended Home Living Services, Wheeling, IL
  • Dick Duncan - Center for Universal Design, NCSU, Raleigh, NC
  • Louis Tenenbaum - Baltimore, MD

Healthcare Facilities

  • Roland Binker - Ellerbe Becket, Washington, DC

Participant Interview.
Each of the participants selected was contacted to inquire about their willingness to participate. All of those contacted agreed to participate, although not all ultimately responded. Design architects were asked to respond to a short interview to obtain detailed text and graphic information about the design solutions that each was using to accommodate assisted toileting and bathing and for whom (see Attachment A).

The information collected included the location of and approach to water closets, transfer and roll-in showers, and bathtubs; space requirements at fixtures; support and transfer devices and methods, including grab bars, lifts, shower chairs, and other hardware and devices that facilitate fixture use; assistance methods, usability with and without assistance, and such other information as may be necessary to fully describe the layout, use and rationale for the design approaches identified.

Archival Data
A comprehensive search of information sources believed to be relevant to assisted toileting and bathing was also undertaken to identify innovative architectural designs and products (e.g., tubs, showers, toilets). The search included three types of information sources: 1) electronic databases and bibliographical indices of periodicals [e.g., Avery Index of Architectural Periodicals, e-architect, Educational Resources Information Center (ERIC), and REHABDATA operated by the National Rehabilitation Information Center (NARIC)]; 2) published materials (journals, books, conference proceedings); and 3) online keyword searches of Yahoo, Netscape, Lycos, and Hotbot. These searches focused primarily on identifying featured and award-winning designs. The presumption was that these designs were considered to be exemplary according to some criteria.

Keywords used in information searches included the following:

access accessibility products arthritis
architecture assistive device bath
bathing bathroom bathtub
bathtub accessibility commode design
disabled disabilities environment
grab bars handicapped bathtub transfer
impairment mobility nursing homes
design for aging frail elderly caregiver assistance
bathroom accessibility showers shower accessibility
toilet toileting toilet design
toilet transfer wheelchair transfer wheelchair accessibility

Sources that were considered useful were those that contained information on bathroom designs and products that were not typical ADA designs. In addition, information was gathered regarding the: characteristics of those subpopulations for whom the designs were intended, how the designs were intended to be used, and the types of facilities in which they were used.


Archival and interview data were analyzed to determine trends and differences in design approaches. In addition, supporting documentation of architectural and product design solutions were evaluated to determine appropriate applications for each solution and the advantages and disadvantages of each.