Good bathroom design can support more independence with washing, toileting and personal hygiene. Good design can also help with identification of the toilet and bathroom, especially during the night.
What do the ticks mean?
helps or is of benefit to most people
helps or is of benefit to some people
helps or is of benefit in specific circumstances
means that this aspect of design needs to be considered carefully before being adopted
Having additional lighting in the shower cubicle supports people to carry out personal care tasks independently.
Bathroom lighting should be independent from any extractor fan. People can find it helpful to leave the door ajar and the bathroom lights on at night both for background night lighting and to help them to find and recognise the bathroom during the night. However, they may be disturbed by the noise made by a constantly operating extractor fan.
People find grab rails helpful in bathrooms
Separate hot and cold water taps can be easier for people to operate and are less confusing than mixer taps.
Low-profile shower trays make it easier for people to get into and out of shower cubicles and present less risk of people tripping. Some people may also find wet rooms a helpful alternative.
Toilet seats which contrast with the toilet and bathroom surfaces help people to find the toilet.
Bathrooms should incorporate at least one mirror to help people carry out personal care and grooming. However, it is useful to incorporate a way of covering up mirrors into the bathroom design, as they may cause confusion and upset people with dementia who no longer recognise their own reflection.
Doors of a different colour to that used for other rooms help people identify the location of the bathroom. Supplementing this with appropriate signage or pictures is helpful as some people may not always be able to remember the significance of door colours.
Signifiers and/or signs can also be used on bathroom doors to allow people to identify the bathroom.
Some people may find sliding bathroom doors helpful as these reduce the risk of accidentally walking into doors and door handles, but others may find them unfamiliar and confusing so people’s views should always be sought when contemplating changes.
Points for reflection and further consideration
Bathrooms can be hazardous places. Limited space, hard surfaces and fixture and fittings, and the potential for slipping on water, soap, shampoo, etc. all increase the risk of injury. When considering the most helpful design for a bathroom, it is important to balance the reduction of potential risk on one hand and protecting people’s rights to privacy, maintaining their dignity, and fostering and promoting their independence on the other.
We conducted a structured literature review which involved systematic searches of a wide range of electronic databases, complemented by consultation with expert informants who were asked to recommend materials (such as reports) that the searches might not have identified. The searches yielded 14,616 ‘hits’. 14,043 were discarded as either duplicates or not relevant, and the remaining 573 were scored for relevance on the basis of title and abstract. In total 33 publications were included for full text review: 28 based on relevance scores, and 5 items recommended by expert informants.
These were systematically evaluated using a proforma which enabled assessment of the quality of the research reported, and assembled key information regarding the subject matter, results and conclusions of each item. The quality criteria used to assess different types of research were drawn from standard protocols including Centre for Research and Development (CRD) Report No 4, Cochrane Effective Practice and Organisation of Care (EPOC) checklists and, as appropriate, Critical Appraisal Skills Programme (CASP) assessment criteria (NHS CRD 2001; Cochrane EPOC 2002; CASP undated). Each publication was rated as being of High, Medium or Low quality, based the extent to which the research as reported in the publication meets the relevant quality criteria, and an overall rating was provided for each of the sections within the guidelines. Publications rated as being of lower quality are still of evidential value, but should be regarded as providing suggestive rather than definitively evidenced findings.
We assessed the overall quality of published evidence for guidelines in this section as Low. We based the guidelines on evidence contained in the following publications:
- Cooper, B. A. (1999) ‘The utility of functional colour cues: seniors' views’, Scandinavian Journal of Caring Sciences, 13(3), 186-192.
- Kelly, F., Innes, A. and Dincarslan, O. (2011) ‘Improving care home design for people with dementia’, Journal of Care Services Management, 5(3), 147- 155.
- La Grow, S., Robertson, M.C., Campbell, A.J., Clarke, G.A. and Kerse, N.M. (2006) ‘Reducing hazard related falls in people 75 years and older with significant visual impairment: how did a successful program work?’, Injury Prevention, 12(5), 296-301.
- Long, R.G. (1995) ‘Housing design and persons with visual impairment: Report of focus-group discussions’, Journal of Visual Impairment & Blindness, 89(1), 59-69.
- Unwin, B.K., Andrews, C.M., Andrews, P.M., & Hanson, J.L. (2009) ‘Therapeutic home adaptations for older adults with disabilities’, American Family Physician, 80(9), 963.
Our expert interviewees said
- Our expert interviewees did not comment on bathrooms
People with dementia and with sight loss and their carers
taking part in interviews and focus groups told us
- It is useful to have grab rails in the bathroom in case you need them
- In care homes, the light switch for the bathroom often also activates a fan. Staff cannot leave a light on in the bathroom at night so people can find their way there if they need to in case the noise from the fan disturbs the resident
- Although mirrors were not an issue for those taking part, some professional carers indicated in the past they had known care home residents with dementia who had became distressed by mirrors
- It is helpful if shower trays are low enough that people do not have to make an effort to step in and out them
- Yellow bathroom and toilet doors are easier to spot and help people to find their way to the toilet
The survey found
- Out of 82 people who answered questions on this section, 74% thought that guidelines on lighting would be ‘very helpful’ and a further 25% thought they would be ‘helpful’
- When people were asked to either agree, disagree or say that they were unsure about a series of statements, the highest levels of agreement were in relation to: installing grab rails in the bathroom (99%); having bathroom lighting independent from extractor fans (98% agreed); using signs or items that people associate with bathrooms on the bathroom door (94% agreed); using low-level shower trays (92% agreed); using toilet seats that contrast with the toilet (92% agreed)
- The highest levels of disagreement or uncertainty were in relation to: using of a sliding door in preference to a conventional door (31% disagreed, 40% not sure); importance of including a mirror in the bathroom (21% disagreed, 28% not sure); providing a means of disguising mirrors (11% disagreed, 28% not sure)
Selected quotes from people completing the survey
- ‘As long as mirrors can be disguised or removed if required that is fine. Sliding doors can be awkward for people with dementia if not a conventional type of door but appreciate maybe necessary if small bathroom to maximise space. From a sight loss point of view sliding doors are beneficial as can't be left open and reduce the risk of people banging into. Other advise could be to add contrasting colour on the inside strip of the door to highlight.’
- ‘My mother's room has a sliding bathroom door. It is difficult to close properly, although that may be beneficial if she needs to be "rescued" by a staff member. Taps: it needs to be easy to see how to use the tap - complex lifting/twisting actions might be confusing. The water temperature needs to be controlled so that it can't get too hot. Signage: if the person no longer remembers that a picture of a toilet = the place to go to the toilet, then it doesn't matter how many signs there are, they will simply not make the connection.’
- ‘I am answering generally, because of reflection in the bathroom a reduced eye sight may impact on visual hallucinations. Contrasting toilet seats are useful but colour is important, a lot of homes are choosing red which is causing additional problems. Red can mean stop, hazard etc.’
- ‘Some things like sliding doors sound like a good idea but if this is a change from existing doors it could create as many problems as it solves also same with taps and flushes.’
- ‘While most of the statements above seem to make good sense, it may be worth qualifying them to encourage people to consider them in the context of their own particular circumstances. What is relevant and appropriate in a small, homely setting might not be the case in a larger institution - and vice versa.’