Modify the Bathroom to Match your Abilities

With its hard surfaces and slippery floors, the bathroom can be an unforgiving place for stroke survivors. But modifications can help a great deal. Many require an investment of only a few hundred dollars and the skills of a handyperson. What works depends on your abilities and your preferences, plus the existing features in your home and your budget.

First, think about access

Standard bathroom doorways are 24 inches wide, with as much as two inches unavailable due to the width of the open door hanging from the hinge. In contrast, walkers are typically 18–25 inches wide and manual wheelchairs are 24–30 inches wide.

To obtain the full width, the door hinges can be replaced by offset or “swing-clear” hinges. Replacing the hinges and reinstalling the door requires two people and only a screwdriver and a rubber mallet or hammer.

For this solution to work, there must be adequate room for the door to open to at least 90°. If there isn’t enough room, an alternative is to mount the offset hinges on the outside of the doorframe so the door swings out.

In homes built before 1960, bathrooms are very small, and fixtures may be placed so they’re not accessible with a walker. In some cases, this can be solved by installing a railing or long grab bar for support to move through the narrow area to the toilet. This solution requires some handyperson skills.

If you use a wheelchair, there is seldom room in a home bathroom to maneuver between fixtures. To access the sink, toilet and tub/shower, it’s sometimes necessary to enlarge the bathroom or half-bath. Often, this can be accomplished by expanding into a closet, either in the bathroom or in an adjacent room. Consider relocating or adding a doorway to enlarge a bathroom to significantly improve access and reduce effort.

When there is no adjacent closet, expansion may involve expanding into an existing room or “bumping out” an exterior wall. In almost all cases, a bathroom expansion will require permits and skilled tradespeople.

You need an appropriate workspace in the bathroom for grooming

Install a single-lever faucet for the sink so you can easily control water temperature and pressure with one hand. Replace a pedestal sink or vanity with a shallow, wall-mounted sink so you can sit with your legs (and wheelchair leg rests) under the sink. Have the mirror lowered or install a retractable (accordion style) wall-mounted mirror. Be sure to have a “pipe sleeve” installed on the drain pipe below the sink to protect your legs from the pipe. A sink-mounted or wall-mounted soap dispenser makes washing easier if you must use one hand. Installing a new sink may require a plumber, especially if it’s being located to a new spot.

The toilet is usually the lowest “seat” in the house, making transfers to and from challenging. The seat can be raised three ways:

1. A seat elevator that attaches to the bowl and raises the seat several inches is the least expensive solution.
2. A toilet elevator that mounts between the floor and the toilet.
3. A standard toilet can be replaced by a higher toilet. These come in two heights. “Comfort height” toilets are 14.5 inches at the bowl rim (versus 13 for a standard toilet) and “ADA-compliant” toilets which are 16.5 to 18 inches at the rim.

If increasing the toilet height isn’t enough, toilet rails or grab bars may be necessary.

Toilet tissue dispensers can also be relocated to be more accessible. If toilet hygiene is difficult, replace a toilet with a bidet or install a bidet attachment to an existing toilet.

If there is no bathroom on an accessible level, or expanding isn’t feasible, the alternative is to add a bath. Although costly, it’s an opportunity to incorporate fixtures and features that make the bath most useful:

1. Install offset tub/shower faucet controls so they can be reached easily from outside the enclosure.
2. Install a “wet area” instead of a shower stall. If it’s hard to stand or walk, and you need help to transfer and to bathe, this makes a shower safer.
3. Install laundry facilities in the bathroom (if your washer and dryer are hard to access). This doesn’t add significantly to the cost of the remodel and makes laundry more convenient