The Most Dangerous Room in the House?

Matt Nager for The New York Times

One of the first things occupational therapist Lois Glover noticed while scrutinizing the bathroom in Irwin Berch’s airy house in Burlingame, Calif., was the gouged wall.

Mr. Berch lived on his own and managed fairly well at 91. But as Ms. Glover put it, “As we get older, toilet seats get lower.” Mr. Berch had been holding onto the doorknob for support as he stood up from the toilet; sometimes, the door swung away and struck the wall.

A towel rack was coming loose, Ms. Glover observed. Mr. Berch confessed he had been using it to steady himself as he stepped in and out of the shower.

When Ms. Glover finished her two-hour assessment of the home, a service of the nonprofit Center for Independence of the Disabled in Belmont, Calif., she left Mr. Berch and his son with a list of suggested modifications to his home and routines. Several of them concerned his bathroom.

Is the bathroom the most dangerous room in the house? The federal Centers for Disease Control and Prevention compiles statistics on falls, the leading cause of injury deaths among older adults, and it’s no secret they can be devastating — fracturing hips, producing traumatic brain injury and sending seniors to nursing homes. But the C.D.C. doesn’t track where falls occur.

We do know, though, that bathrooms greatly trouble the people charged with retrofitting homes for the disabled, young and old. Bathrooms abound in hard surfaces — tile, porcelain, cast iron, marble — that get wet and slick. People often use them at night, when they’re less alert. Everyday actions — closing your eyes to rinse off shampoo, say — can throw off your balance. “Bathroom falls are major bone-breakers, particularly for older women with osteoporosis,” said Kent Mickelson, director of the Center for Independence of the Disabled.

To make them safer for seniors, specialists suggest:

• A handheld shower and a bench to sit on. For those who only have a tub shower, an inexpensive transfer bench will fit across the tub’s side so a user can sit and then slide over the edge instead of climbing over.
• A higher toilet seat that makes it easier to sit and to rise. Various configurations exist — raised plastic seats, for instance, or platforms that lift the entire toilet. For Mr. Berch, Ms. Glover recommended a safety frame that bolts to the wall, with armrests that will let him use both his arms and his legs to stand.
• Grab bars, installed at the right place and proper height for the individual.
• Adequate lighting, including a nightlight that automatically turns on when natural light dims.
• Floors free of scatter rugs.

“I was thrilled,” said Michael C. Berch, whose father has rejected a move to assisted living though he walks with some difficulty. “I’d been thinking, if he really wants to stay in his house, he’s going to need some assistive devices.” Two grab bars, installed, will cost the family $250; the toilet frame can be ordered online for $48.95. If Irwin Berch had met the center’s low-income guidelines, the equipment and installation would have been free.

Almost 400 independent living centers across the country provide these assessments and home modifications, or refer to local companies that do. The National Association of Home Builders has also trained more than 2,500 certified aging-in-place specialists (called C.A.P.S.) who’ve completed a three-class course. Home health agencies and rehab facilities often employ occupational therapists trained to offer individualized solutions.

Of course, safe and adaptable bathrooms make sense not only for the elderly but for all of us, a principle known as “universal design.” Greg Miedema, a C.A.P.S. contractor in Tucson who chairs the National Association of Home Builders Remodelers, puts reinforced walls in every bathroom he renovates to hold the grab bars a bather may one day need. Every stall shower he installs is curbless, and he aims for doorways three feet wide, in order to accommodate wheelchairs.