Are you Comfort-Able on your toilet?

I have a strange habit of always going into the ADA stall in community bathrooms to do a quick visual check of the space, as I have yet to find one that does not have something ‘wrong’

On this last occasion I was checking out a bathroom and noticing the typical errors—flush control not mounted on the wide side of the toilet area, door hook installed too high—and I noticed a woman near the sink area with an inquisitive look.  We engaged in conversation about the ADA stall and she proceeded to tell me that her husband was a remodeler and ‘everyone wants a comfort height toilet’ so he recommends them to all of his clients.  Hoping that I did not have a look of horror on my face, I politely let her know about my passion for space planning  and that not all people benefit from comfort height toilets. She quickly interrupted me and said, “now I am talking about comfort height toilets, not ADA height”.  I assured her that I knew the difference, and gave credit where credit was due regarding having the knowledge that there are different height toilets on the market, but continued our conversation with regard to feature-matching fixtures to meet the needs of the client.

A standard toilet measures 14 ½” above the finished floor to the top of the porcelain bowl.  This does not include the toilet seat, which can be different thicknesses and change the overall total height.  Federal law dictates that an ADA height toilet is to fall between 17”-19” above the finished floor.  This leaves the comfort height toilet.  A comfort height toilet is approximately 2” taller than a standard height toilet, measuring ~16.5” above the finished floor to the rim (not including toilet seat).  At 16.5” above the finished floor, this toilet height is not ADA-compliant as it is ½” lower (however, there are toilets on the market that are called ‘comfort height’ and do fall within the 17”-19” ADA height range).

I discussed that not all persons benefit from a comfort height toilet, as this is due to each person having different ergonomic needs based on their own body measurements.  It is also about the physiological position that one’s body must be in to maximize the ability to evacuate the bowels (yes, I am an Occupational Therapist by background, so I went there).  Look at the toilet systems of some other cultures; you will frequently find a bathroom stall with nothing else but a hole in the floor that requires one to squat to get the job done.  Obviously this scenario does not work for someone who has difficulty with sit-to-stand from a surface that puts their hips at a level below their knees, but these are the variables that need to be considered when choosing a toilet; especially since this is something that we as humans need to use multiple times a day.

I am 5’3” and have a longer torso and shorter legs; a comfort height toilet is currently too high for me.  At this time, a comfort height toilet is also too high for my husband, who happens to have a spinal C5-C6 incomplete spinal cord injury.  Most people would have a knee-jerk reaction and say, he should have an ADA height toilet, or at least a comfort height toilet, when in fact, that is too high……for him.  Will we benefit from a higher toilet in the future?  Perhaps, but it is not the right choice for us right now.

There are many variables when choosing a toilet, height being one of them.  Determining height also has many factors to consider including anthropometrics, transfer status (how one gets on/off the toilet), as well as how many different users will have access to this toilet.  A comfort height toilet is a great option; operative word here being ‘option’.  We have choices because we all have different needs.  Feature-matching fixtures to meet a person’s (or household’s) needs is key.

Hotel accessibility is like a box of chocolates……

Even with the ADA in place, providing a minimum requirement for accessibility, it still never ceases to amaze me that each ‘ADA’ hotel room we encounter, is so very different.  My husband Bill, who uses a manual wheelchair due to a spinal cord injury, is a travel agent and knows this issue all to well.  Our last three hotel stays truly exemplify the fact that you just never know what you are going to get.  Thus, the inspiration for this blog post.

We stayed in Washington, DC for a quick get-away over Thanksgiving and had the opportunity to stay in two separate hotels.  The first accessible hotel room boasted large amounts of space, both in the room and the bathroom.  The room we received had a tub with tub seat and plethora of grab bars.  Bill, who could access the controls to turn on the water, and could transfer onto the flip-down tub seat, had difficulty with reaching across the tub to pull the tub seat down and, our favorite, could not reach the hand-held shower on the opposite short shower wall.  We find that this is a typical scenario in many ‘ADA’ hotel rooms.  Even though it is on a slide, Bill is at the mercy of someone placing the handheld closer to him in the shower, and then hoping that housekeeping won’t put it back on the slide at the top after cleaning the room.

In this second hotel room, we encountered a roll-in shower with flip-down seat and once again, a plethora of grab bars.  Bill was once again able to easily transfer from his wheelchair to the bench, but this required that he roll his manual wheelchair into the shower area, and then try to push his chair outside of the shower area once he was seated on the shower bench.  Bill sustained a C5-C6 incomplete spinal cord injury, which resulted in quadriplegia.  Pushing his chair outside of the shower area and then attempting to retrieve it was challenging for his balance, as it required that he hold the front grab bar with his left hand (which only has tenodesis grasp) and rotate his trunk to the right while reaching to the side and behind him with his right arm, which is challenging for his sitting balance, and almost caused him to fall off the shower seat.   Even if he were to be able to do this independently, he now has his front wheelchair wheels within the wet shower area.  Adding another layer of challenge is the handheld shower unthinkingly placed at the top of the slide bar.

For our recent trip to the International Builders Show in Las Vegas, we once again encountered an ‘ADA’ room with a tub.  We were given the option of a tub with a stand-alone shower seat, or a roll-in shower with a stand-alone shower seat.   Things that make you go hmmm……    Bill made the choice of a tub with stand-alone tub seat, as this was the lesser of two evils.  A roll-in shower sounds great, but using a roll-in shower with a stand alone shower seat is dangerous for Bill as the seat may slide when he is attempting to transfer to/from his wheelchair and it may tip over in the shower if he were to have a muscle spasm.  His thoughts—less area for the stand-alone shower seat to move in a tub than in a large roll-in shower.  Neither was ideal, but we are used to ‘making-do’ in hotels.  Upon making this decision, the hotel changed their mind on the choices and stated that by law we are supposed to be in the room with the roll-in shower.  As I educated the staff about ADA, and the areas of concern with both of their ‘ADA’ rooms, miraculously the ‘hotel engineers’ located a tub bench that can be fastened to the tub!  Ok, so this is a bit better, still no chocolate covered cherry, but better.  As they arrive to the room and we all convene in the bathroom, the first engineer says to the second engineer, “where does it go?”  I politely take over and educate the engineers about the placement of the tub bench to best meet Bill’s needs.  Even though the tub bench allows for increased ease of transfer and increased safety versus a stand along shower seat, the tub seat is very hard and uncomfortable to transfer onto (Bill has sensation below the level of his injury) and he still is at the mercy of the handheld shower being lowered from the top of the slide bar.

Please note:  tub bench was height adjusted and was positioned to accommodate Bill’s long legs swinging over the tub.   The picture actually makes the tub look longer than it is; Handheld in picture is 20” in front of tub seat, which allows Bill to access it when it is in a lowered position.  Also note in the picture that the plumbing under the lav is not covered/insulated.

This blog is a look at how these specific ‘ADA’ hotel bathrooms did not meet Bill’s needs; but what about the many other patrons that will use these spaces?  These bathrooms will be utilized by a number of people of different ages and different ability levels.  A universal design approach would allow for meeting the needs of the majority of patrons that stay within these hotels.  This would not only create a better user experience, it would provide for an added layer of safety and potentially less liability overall for the hotel.

Perhaps we can be very forward thinking and progressive and say, why shouldn’t all guest rooms in a hotel be universally designed? This way it won’t be a matter of saying “we need an accessible room” and hope to get one that we can ‘make-do’ in.  Perhaps…….

Imagine what it would be like to have your first mammogram…while seated in a wheelchair (2012 update)

Almost two years ago I wrote a blog regarding the Access Board planning to set standards for medical diagnostic equipment.  As of February 9, 2012, these proposed accessibility standards were published for comment in the Federal Register.

I am dedicating the re-posting of this blog in an effort to provoke thought about the importance of this issue.

From May 11, 2010:

For women around the world it is almost like a rite of passage: the baseline mammogram. It is advised to get it done prior to age 40 and I crossed that bridge this year. It is an interesting process that I felt more like a mannequin than a person, being positioned in such a way that the mammography machine can take the best picture. As I was standing there, being the compliant patient, I could not help but wonder, how would this process work if I were seated in a wheelchair? If I did not have control over my arms or my torso? Could the machine get a good picture???

In my case I actually needed to return as there was an inconclusive spot on one of my pictures. After a second round with the machine, it was determined that it was a positioning issue that folded the skin in such a way that obscured the picture. Now, if this can happen with an able-bodied person that can twist and contort in any way requested, how can one be sure an accurate picture can be taken for someone with a mobility impairment?

I frequently wonder how my husband manages, with a C5-C6 incomplete spinal cord injury, when he has a medical appointment.  I think about this as I sit in the dentist chair, as I am seated on the family doctor’s exam table, as I am getting up on the x-ray table sitting just so to get the best picture.  Currently, it may take him some extra time, but he is able to complete these functional transfers. What will happen five, ten or twenty years from now when he has less mobility? Less ability to complete functional transfers? How do others with mobility limitations manage this task when the equipment is built for use with able-bodied persons?

According to the Access Board, standards are to be set for medical diagnostic equipment under the new health care reform law. “The ‘Patient Protection and Affordable Care Act’ authorizes the Access Board to develop new access standards for medical diagnostic equipment including examination tables and chairs, weight scales, x-ray machines and other radiological equipment, and mammography equipment.” It is hard to believe that this is actually not addressed under the current ADA.

This is yet another area of accessibility that has been overlooked. I am thankful that there will be regulations for medical diagnostic equipment, but am realistic in knowing that seeing this actually take effect in the doctor offices may take a while.

What are your thoughts/experiences with this issue?

Take me out to the ballgame!

Buying tickets to go to the theatre, see a concert or catch a sporting event has always been a bit of a challenge.  The first obstacle we have run into is that when you need to buy accessible seating tickets, you cannot purchase them from TicketMaster or any other third-party source.  Accessible seating must be purchased from the venue itself.  In some instances, they must also be picked up at the Will-Call window, versus sent to you in the mail.

With the Department of Justice adopting the revisions to ADA Title II and Title III, the amended regulations provide guidance on the sale of tickets for accessible seating, the sale of season tickets, the hold and release of accessible seating to persons other that those who need accessible seating, ticket pricing, prevention of the fraudulent purchase of accessible seating, and the ability to purchase multiple tickets when buying accessible seating. It also requires a venue operator to accommodate an individual with a disability who acquired inaccessible seating on the secondary ticket market only when there is unsold accessible seating for that event.

Part of the regulation that I am excited about, is the ability to “Permit individuals who use wheelchairs to sit with family members or other companions.”  This is opposed to ” a companion seat must be provided next to each wheelchair seating location.  The companion seat is a conventional seat that accommodates a friend or companion”.  This was a good start, but what happens to a family of four?  What about when we go to events with friends or other family?  Previously, we would always try to arrange to sit near our friends or other family.  Now, we will actually be able to sit together!

Although this is a positive change to some, it is being viewed as a negative to others.  One question that has been asked is, does this decrease the amount of accessible seating?  No.  There is still the same amount of accessible seating, but it now becomes a design issue.  How can the layout of the venue be setup to allow for the seating of multiple family members next to a person with a disability, but still provide a reasonable amount of accessible seating dispersed throughout the venue, while still maintaining lines of sight?

Perhaps all of the areas that are designated as accessible seating can allot for either a wheelchair and/or a conventional seat to be placed.  This scenario would increase the number of areas that would need to be available as possible accessible seating within the venue, but would meet the need for dispersion of seats.   This scenario will also allow for the change to have family sit next to the person with a disability while still allowing for the reasonable amount of accessible seats overall.

What are your thoughts on this change?  How do you anticipate this will be implemented?

In celebration of the 20th anniversary of the ADA

History

The Americans with Disabilities Act (ADA) is turning 20 this year.  Signed into law by President George H.W. Bush on July 26, 1990, it is “An Act to establish a clear and comprehensive prohibition of discrimination on the basis of disability.”  Eighteen years later, on September 25, 2008, the ADA Amendments Act of 2008 (ADAAA) was signed into law by President George W. Bush.  The intent of this amendment was to give a larger scope of protection to workers with disabilities.

ADA Basics

There are 5 titles of the ADA.  They include:

1. Title I—Employment
2. Title II—Public Entitites (and public transportation)
3. Title III—Public Accommodations (and Commercial facilities)
4. Title IV—Telecommunications
5. Title V—Miscellaneous Provisions (including technical provisions)

For more detailed information regarding the ADA, you can contact The ADA National Network.  Their role is “to provide information, guidance and training on the ADA, tailored to meet the needs of business, government and individuals at local, regional and national levels.”  There are ten regional ADA National Network Centers throughout the country.  Mine is the Mid-Atlantic Center.  Do you know yours?

What will you be doing on July 26^th?

Many cities are having local ADA anniversary celebrations.  My home state, Delaware, is having the “Delaware does ADA 2010” celebration on July 26^th at Rehoboth Beach.  My former city, Philadelphia, is having their ADA Celebration, hosted by Liberty Resources, at Independence Park.  Where’s your local ADA Awareness celebration? To find out where a celebration is near you, go to this link.

It is only two weeks away, what will you be doing on this anniversary?

What does the ADA mean to you???

Imagine what it would be like to have your first mammogram…while seated in a wheelchair

For women around the world it is almost like a rite of passage: the baseline mammogram. It is advised to get it done prior to age 40 and I crossed that bridge this year. It is an interesting process that I felt more like a mannequin than a person, being positioned in such a way that the mammography machine can take the best picture. As I was standing there, being the compliant patient, I could not help but wonder, how would this process work if I were seated in a wheelchair? If I did not have control over my arms or my torso? Could the machine get a good picture???

In my case I actually needed to return as there was an inconclusive spot on one of my pictures. After a second round with the machine, it was determined that it was a positioning issue that folded the skin in such a way that obscured the picture. Now, if this can happen with an able-bodied person that can twist and contort in any way requested, how can one be sure an accurate picture can be taken for someone with a mobility impairment?

 I frequently wonder how my husband manages, with a C5-C6 incomplete spinal cord injury, when he has a medical appointment.  I think about this as I sit in the dentist chair, as I am seated on the family doctor’s exam table, as I am getting up on the x-ray table sitting just so to get the best picture.  Currently, it may take him some extra time, but he is able to complete these functional transfers. What will happen five, ten or twenty years from now when he has less mobility? Less ability to complete functional transfers? How do others with mobility limitations manage this task when the equipment is built for use with able-bodied persons?

 According to the Access Board, standards are to be set for medical diagnostic equipment under the new health care reform law. “The ‘Patient Protection and Affordable Care Act’ authorizes the Access Board to develop new access standards for medical diagnostic equipment including examination tables and chairs, weight scales, x-ray machines and other radiological equipment, and mammography equipment.” It is hard to believe that this is actually not addressed under the current ADA.

This is yet another area of accessibility that has been overlooked. I am thankful that there will be regulations for medical diagnostic equipment, but am realistic in knowing that seeing this actually take effect in the doctor offices may take a while.

What are your thoughts/experiences with this issue?