Healthcare Plumbing And Piping 2007: Healthcare At Home
As the public ages, the need for designing plumbing fixtures for the elderly becomes more important. The approach for the elderly includes nursing homes, hospitals and healthcare facilities, as well as housing for the elderly. Another area, often ignored, is the individual homes owned by the elderly. Some of these homes had been purchased when the owners were in their 30s, and now they find themselves approaching their 80s. Many elderly people prefer to continue living in their own homes. This may require an adjustment in the plumbing fixtures.
While the ANSI A117.1 standard on building accessibility has made strides in addressing the elderly, it has not had the progress in some areas that Europeans have enjoyed. Whether it is politics, lack of understanding or difference of opinion, the North American approach to accessibility for the elderly lags behind Europe.
European concepts are entering the North American market as a result of the interest in accessible elderly fixtures where ANSI A117.1 would not be mandated. The European concepts include in-place showers, more graspable grab bars, toilet seats that make it easier to get on and off, and fold-down shower seats with legs that rest on the floor.
In-Place ShowersThe in-place shower concept is designed to allow a shower to be added to any room. The shower is placed on an existing floor, allowing for a wheelchair to readily enter the shower area. The in-place shower also allows an existing bathtub to be removed with a shower base added.
The shower is completed by the addition of vinyl or ceramic tile walls, and glass sides and fronts. The glass sides often are only 4 feet high, based on the splash factor for someone showering in a wheelchair.
When a drain is present, the piping is added under the floor to accommodate the new shower. When a drain is not readily accessible, pumped wastes are provided. The pump waste includes a small individual sewage pump that pumps the shower waste to an available drain.
Water piping for the add-on showers typically is provided by flexible piping such as PEX tubing. The shower valve is placed at a lower height to allow use by someone confined to a wheelchair. Of course, the showerhead is on a hose connection.
Some of these shower bases sit on existing floors, while others require the subfloor to be removed. When the subfloor is removed, the shower base provides the structural integrity for the installation.
In-place showers were originally envisioned for those confined to a wheelchair; however, they have also proved to be popular for the elderly who no longer have the strength to climb the stairs or step over a tub to use a shower. While the in-place shower was a European concept, many U.S. manufacturers are now providing these types of shower bases.
Grab BarsAsk the elderly their biggest complaint regarding grab bars and it would be, “Why are they so large and smooth? Wouldn’t it be better to have them of a size that is graspable and maybe ribbed?”
The development of the modern-day grab bar is based on the physically challenged who still have upper-body strength. In other words, an individual who can maneuver to lift his or her body onto a water closet or into a bathtub. The size is based on studies of these individuals’ hands and grasping strength. The shape was a consistent diameter and smooth to allow an individual’s hand to slide along the grab bar.
The elderly have different needs. They want to reach for a grab bar and hold it in one location. They don’t want to slide along the bar. Furthermore, their grasping ability is much different than an individual with reasonable upper-body strength.
My own 80-year-old mother complained after a recent cruise, saying, “Why can’t you come up with grab bars that aren’t so slippery and smooth? Did you see that elderly person grab it and slide and fall? If your hands are wet like his or sweaty, the grab bars are useless.”
Well, yes, I did see the elderly person fall. And, yes, we can make a better grab bar to prevent falling.
Falling is one of the biggest concerns for the elderly. It is often difficult or impossible for an elderly person to get up after falling. Hence, a grab bar needs to prevent an elderly person from falling or sliding on the bar.
The European response to this has been a graspable grab bar that has varying diameters. The coating is vinyl rather than a stainless-steel bar. These types of grab bars do not allow for the easy sliding of one’s hand, but they provide a very firm grip.
When you look at these grab bars, you can see that the graspability is much greater than a smooth grab bar. Some manufacturers have resorted to calling these bars “grip bars” rather than grab bars. That is to distinguish that they can be used for gripping in many areas of a building, but they do not qualify as a grab bar.
There is a proposal before the ANSI A117.1 Committee (which regulates the accessibility standard) to allow these newer European-style grab bars for plumbing fixtures. If the committee votes favorably, it will still take another two years before any state agency could adopt the standard.
Some installers are seeking approval of the European grab bars as an alternative, especially for medical and housing facilities for the elderly.
Fold-Down Shower SeatsThe other European concept for healthcare facilities and the elderly at home is the fold-down shower seat with legs that sit on the floor. Since the advent of accessible showers, there have been fold-down seats; however, the European fold-down seats have a unique design. The previous seats have always attached to the wall.
The accessibility standard has been written in such a way that the fold-down seat cannot have legs that sit on the floor. All of the armature for the seat must resist a 250-pound force. If legs sit on the ground and are not permanently attached, the legs cannot resist the 250-pound force. They will always move when there is no load on the seat.
To avoid a problem, the legs for the European showers are placed back from the side and front of the seat. This is designed to prevent the individual using the seat from hitting into the legs. Of course, this is one of the reasons for the 250-pound force requirement in the standard.
The seats also are more comfortably shaped. The current ANSI standard specifies seats of a given shape that allow for the transition from a wheelchair to the seat. The individual would then slide on the seat to completely enter the shower compartment.
Certain European seats are equipped with arms that swing up and down. They also are designed for comfort when sitting in the seat. The chairs still allow for a smooth transition from a wheelchair.
When a seat is not required by code, as often is the case for elderly housing and certain medical facilities, these more comfortable fold-down seats can be used. The ANSI seat requirements only apply when required by code.
It should be noted that the fold-down seats were one of the first European concepts adopted by U.S. manufacturers. You will find these seats in nursing homes, homes for the elderly and hospitals. Many of the elderly prefer the conformity of the formed seats compared to the straight seats.
There currently is no proposal to the ANSI standard to allow the European fold-down seats and comfort seats. Without a change to the standard, the seats may only be used as an alternative, requiring individual approval, or for showers that are not required to be accessible by the code. Most of the housing for the elderly, nursing homes and hospitals contain fixtures that do have to be accessible. Hence, this style of seat may be installed.
The European concepts provide a different approach for addressing plumbing fixtures for the elderly. All of the European fixtures, grab bars and seats can be installed for elderly use. While not all of the components meet the accessibility standard, for most installations, the accessibility standard does not apply.