Sarah: You’re listening to Good Fit Poor Fit. A podcast that explores the interaction between people, design, and activity. Good Fit Poor Fit is part of The Universal Design Project, a nonprofit organization with a vision for every community across the USA to have a surplus of homes and opportunities for social participation that are universally and financially accessible.
[00:00:27] Learn more at universaldesign.org.
[00:00:31] Hello and welcome to another episode of our podcast. Today, Rebecca and I are going to discuss another listener question, which I think will be a great conversation for a lot of people to consider. So the listener question was about grab bars. She asked, “Can you review grab bars? There are traditional ones and some really pretty new ones. Does polished chrome work as well as textured? Should I consider a vertical bar for a neutral grip?
[00:01:01] Now, Rebecca, this could be considered a pretty boring topic, but I’m honestly excited about this episode. We have some great things to discuss and to consider, especially if you’re thinking about putting up grab bars in your own home or you’re a healthcare or building professional recommending them for your clients. Not all grab bars are created equal and the type and placement makes a really big difference.
[00:01:26] Rebecca: Yes, absolutely true, Sarah. And for those of you who aren’t healthcare professionals, or who may not have any experience with grab bars, I’d like to just first address what they are and how they’re typically used. The fact is, if you’ve ever been in a public restroom, you’ve seen a grab bar. The bars that are located on the side of public toilets?
[00:01:48] That’s what we’re talking about. For a variety of reasons, people install grab bars in their homes as well. People who use mobility devices or wheelchairs often use them to assist with getting in and out of the shower or on and off the toilet, which is often called transferring. Grab bars provide a place for the person to hold on as they make these movements to make sure they don’t fall. Many people who don’t use mobility devices or wheelchairs also benefit from using grab bars in the home just to provide that same stability and safety, a place to hold on in slippery spaces like bathrooms.
[00:02:25] So, back to our listener question. In order to answer it, we turned to our Design Advisors. Our Design Advisors are a team of individuals who either have a disability themselves, are a healthcare professional who works with people who have disabilities, or someone who lives with someone who has a disability.
[00:02:44] We’ll provide a link with more information about this part of our team in the show notes. So we sent out a brief survey to our Design Advisors and had them tell us their preferred types, locations, and uses for grab bars specifically in the bathroom. We ended up hearing back from 11 of our Design Advisors, compiled their insights, suggestions, and thoughts to create this episode.
[00:03:07] Thanks to all of you who contributed. This one’s for you.
[00:03:10] Sarah: Yes. I feel like they gave us so much great information, especially from their firsthand experience. Get it? Hand? Grab bar? Anyway, but yes, their personal experiences really did help in the content for this episode. Before we jump in, I do want to share some of our thoughts about grab bars.
[00:03:31] We typically suggest not even installing grab bars until there’s someone living in the home that needs them. That way they can be mounted at the right height and location for that person’s specific needs. We do, however, recommend putting extra wood between the studs all around the bathroom walls. So it’s easier to secure them in just the right location versus having to do so based on where the studs are located.
[00:03:58] The ADA does have requirements for where to install grab bars. But remember, if this is in a residential home, you aren’t required to follow those guidelines. Their recommendations are designed to generally work for everyone, but if it’s your home, why not make it fit your needs if you need something specific? Having this extra wood between the studs can also be helpful if someone wants to install a shower seat on the wall too.
[00:04:25] Again, that’s their preference in location for their personal needs. In addition, now that you have wood behind the entire wall, you can secure other things like shelves and hooks and hangers to hold things. This important piece in the building process provides a lot of flexibility for grab bars and other uses.
[00:04:46] Rebecca: That makes a lot of sense. Being able to mount your grab bars in just the right spot when you need them can make a difference in use and safety. I also want to mention a few other general grab bar details before we get into the details and preferences of our Design Advisors. First of all, like Sarah mentioned, and one of our Design Advisors affirmed, it’s really important to understand the specific needs of the user within their space before installing any type of safety equipment. While you certainly could select the placement of a bar based on ADA recommendations or where are they just fit in the space, it’s really best to consider that equipment-user interaction to get a good fit.
[00:05:28] Also to reiterate Sarah’s point, you always want to make sure that you mount grab bars into beams and framework work of the wall to ensure stability.
[00:05:36] Sarah: Yes. One of our Design Advisors mentioned that she had a client’s grab bars pull right out of the wall because they weren’t secured properly. Proper installation is so important to consider for safety.
[00:05:49] In addition to making sure they’re installed properly by a contractor or building professional to get a good fit, I recommend making sure an occupational therapist or similar professional weighs in on this with you or a client. They look at how people move their arms and their hands plus evaluate their arm and leg strength to determine where it’s best to be mounted in regard to an ideal location and height. Most grab bars these days are round and have a standard circumference and they’re made to be mounted in a standard width away from the wall. They just come in different shapes, lengths, and configurations, which we will discuss next.
[00:06:30] One thing I do want to mention is that I remember doing a home evaluation for a client. And I saw that they had a grab bar with a really big gap between the wall and the inside of the bar. This was installed a long time ago and I could see how a slippery hand would go right through that bar and go right through the gap and their arm would slide getting stuck right up to the armpit behind this bar.
[00:06:59] If you’re in a home where there’s something similar to this in the shower or around a toilet, please switch it out with a newer option like something we will be discussing today.
[00:07:08] Rebecca: Uh, yeah, that sounds like a recipe for disaster. So definitely get on that if that’s the case for you. So before we dive into the separate spaces of the tub and the toilet, which are two of the most typical places to find grab bars, let’s also briefly discuss some of the pros and cons of vertical (up and down), horizontal (side to side), and diagonal grab bars in general. Our Design Advisors had various perspectives on this, again, highlighting the importance of considering each user individually. But what would you say are the biggest takeaways, Sarah?
[00:07:44] Sarah: Yeah. We had a lot of great responses from our design advisors. And while we can’t discuss everyone’s responses during this episode, individually. We really wanted to make sure everyone’s thoughts are heard.
[00:07:57] So first let’s discuss the orientation of vertical grab bars.
[00:08:02] These are the ones that go up and down and many felt that mounting the grab bar in this way was best for people who prefer pulling to stand at the toilet or the shower. However, you may have to have pretty good upper body strength to do this.
[00:08:18] Rebecca: That’s certainly right. As one of our Design Advisors mentioned, vertical grab bars can present a challenge for people with less upper body and hand strength. This can make the act of pulling to stand really challenging. And this is why a lot of our Design Advisors say that using horizontal grab bars, the ones that go side to side, is generally better. It encourages people to push to stand, which engages bigger muscles in the lower body to support that movement.
[00:08:47] Sarah: Yes. And it’s also easier for someone to brace themselves if they don’t have hand function or hands at all when using a horizontal grab bar. So what they would do is they could put their arm horizontally kind of between the bar and the wall to get that stability if they can’t grab the bar well with their hands.
[00:09:09] That’s why you don’t want that big gap there like I was discussing earlier. This orientation may also be easier for someone without leg movement or strength, as well. Most likely they aren’t going to be pulling up to stand due to their leg weakness. So they will probably be transferring from a wheelchair to the toilet or a seat in the shower by scooting, sliding, or squatting from one surface to another and that horizontal bar is more ideal.
[00:09:38] Rebecca: In terms of diagonal grab bars, we heard mixed reviews. While these bars can provide more margin for error and can be versatile in terms of where someone can grip them, they may not always accommodate the grip and upper body strength needed to stand. Many people who use them just end up with their hands sliding down the bar, which is a definite fall risk.
[00:10:01] Sarah: Yes, definitely. But this diagonal orientation may be a good fit for some people too. Some of our Design Advisors saw it as helpful because it offers a variety of heights to grab from whether they’re sitting or standing depending on their needs for specific tasks. But I could see the issue of hands slipping down being a very big problem for some people too.
[00:10:28] Rebecca: Yeah. So as you can already see, a lot of this does come down to a personal preference and finding what’s a good fit for you. Now that we’ve addressed some of these general grab bar thoughts, let’s dive deeper into two of the most common spaces that people use grab bars — around the toilet and around the shower.
[00:10:48] These are two of the most notoriously slippery places in the home. We asked our Design Advisors to tell us where they typically prefer to mount grab bars in each of these locations. Let’s start with the area around the tub or shower. Actually, there was a pretty consistent response among our Design Advisors about this area.
[00:11:08] Many of them highlighted the value of having both horizontal and vertical bars in this area. A vertical grab bar near the outside of the shower or around the showerhead is helpful for transferring in and out of the tub shower. Then, horizontal grab bars mounted on the longer side of the shower wall can be used for stability while actually in the shower.
[00:11:32] Of course, it really depends on your shower set up. But overall, we heard from our Design Advisors that having both horizontal and vertical bars in and around shower is great because it allows a variety of places to grab so that a person can continuously have that opportunity for stability.
[00:11:49] Sarah: Exactly. I’ve seen some great adjustable handheld shower heads that double as a vertical grab bar in the shower. I also think it’s so important to have an occupational therapist help people evaluate this for anyone who may be struggling to get in and out of the shower or tub. I’ve seen people rely on curtain rods, towel racks, and doorknobs, or lever handles for stability. And that’s just not really safe at all.
[00:12:18] I think it’s also important to note that people may use different seats in the shower too. And pairing someone’s functional needs with the best seat for the type of tub or shower they use is essential. Then it’s helpful to consider where those grab bars are going to go based on the factors I mentioned before.
[00:12:38] So there’s a lot to piece together with how people move and do their bathing. Shower seats and shower or tub configurations can be a conversation for another day, but I will note, please, don’t put a grab bar behind a seat that’s mounted onto the wall. If someone leans against that wall for support, they don’t want to lean into a grab bar.
[00:13:01] Plus, most people aren’t reaching behind their body to hold on while seated in the shower.
[00:13:06] Rebecca: Yeah, without diving too far into the shower seats and chairs, that seems like a good general rule of thumb to throw out there. Now, shall we move on to the toilet area? This is another tricky spot for a lot of people.
[00:13:21] Sarah: Yes. That sounds great.
[00:13:23] Rebecca: So, what I heard most from our Design Advisors was that horizontal grab bars are particularly useful in this area because of how they can be used to help with sitting down on the toilet and standing back up. Bars that are mounted horizontally force people to grip them in such a way that they are pushing to stand rather than pulling, as they may do with a vertical grab bar as we mentioned earlier.
[00:13:47] And I know I mentioned this briefly earlier, but I think it’s worth mentioning any again and elaborating a little bit. Without getting into the nitty gritty anatomy of it, basically when you are pushing to move from sitting to standing, you’re able to use the big muscles in your legs to push off the ground.
[00:14:07] But, when you’re pulling to stand up, you rely more on your arms and shoulder muscles, which are often not as strong. And therefore this can be dangerous for people.
[00:14:17] Sarah: Right. You don’t want to hurt your shoulders or strain a muscle in your arm. If you injure yourself, then it’s going to make all the other tasks you do during the day more difficult, like dressing, reaching, or moving a wheelchair, walker, or using forearm crutches.
[00:14:33] Rebecca: Right. The goal with grab bars is to stay safe. So if using one is putting undue strain on your muscles, that is not a good fit. I also want to add two other points that our Design Advisors mentioned about toilet area grab bars. First, if you’re only able to have one grab bar around the toilet, try to mount it on your dominant side, just ahead of the toilet, if possible. That way you’re using your stronger side to reach forward and assist with getting on and off the toilet. Also, if you’re really not sure where to mount grab bars in this area, just please don’t put it behind the toilet! Within a week it will be converted into a towel rack because quite frankly, behind the toilet is not a spot where most people can reach and use it.
[00:15:21] Sarah: Right. Your dominant side or the side that’s the strongest would be a good recommendation. However, some people prefer both sides of the toilet, just in case something happens to that dominant side. But really getting that OT to look at your specific situation is essential. And Rebecca, I agree with what you’re saying with the bar behind the toilet.
[00:15:43] The only time I’ve seen it used is in a rehabilitation setting where a gentleman wanted to stand facing the toilet to use the bathroom. However, that grab bar was mounted fairly low and it required that person to bend over to use it. They actually ended up trying to reach for a large towel rack — you know, the ones that you see in a hotel that can hold a ton of towels and washcloths — and so that person actually reached up to hold that towel rack, which was mounted above the toilet, instead.
[00:16:14] Rebecca: Yeah. So what we’re saying is, none of that behind the toilet nonsense, cause it’s probably not going to end up working the way you want it to. In most cases, it’s just not a great fit.
[00:16:27] We also asked our Design Advisors to share their thoughts about some other grad bar topics. We asked them, for example, whether they preferred textured or smoothly finished grab bars. Were you surprised about what they said, Sarah?
[00:16:39] Sarah: Oh, no. I was not surprised at all by their answers, as they all seem to be very safety conscious in this regard.
[00:16:46] Pretty much everyone suggested a textured to grab bar was helpful to assist in reducing slippery hands from sliding on the bar. Not only does it promote stability, but several people said it made them feel safer and more confident with that texture actually being there. Just as we mentioned earlier, the bathroom is one of the biggest areas of the home where a fall can occur.
[00:17:09] So why not add a few extra safeguards to reduce the potential of a fall?
[00:17:14] Rebecca: Right. This all makes complete sense and is spot-on, in my opinion. I can’t say I was shocked by what they all said, but I was kind of shocked about how much this Design Advisors agreed on this issue.
[00:17:27] Sarah: Yeah. And what a great shout out to our volunteers.
[00:17:30] That’s why they’re so helpful in giving us their opinions on the things they experience on a daily basis. And when they’re all on the same page, that’s even better. And it helps us make the decisions we’re working on more functional for a wide variety of people.
[00:17:45] Rebecca: So true. Thanks again to our Design Advisors. We really love you and couldn’t do this work without you.
[00:17:52] I was particularly curious about the other question that we asked them though, about traditional versus modern grab bars. For those of you who may not know, there are a lot of companies nowadays that make these attractive, sleek, very nonmedical looking grab bars.
[00:18:08] They function in the same way, but have a completely different aesthetic than what you may see at a hospital or clinical setting. The idea with this type of design is that it can fit into anything space without standing out or calling attention to it. As one of our Design Advisers mentioned, sometimes it’s hard for people to come to terms with the fact that they need to install grab bars.
[00:18:29] And this makes sense. No one wants to live in a space that feels clinical or antiseptic, but these new modern grab bars are made such that they can be built into a design without ruining the look of the bathroom. Sometimes they look like soap dishes or shelving for shampoo and razors in the shower. They have a more finished look as opposed to traditional grab bars that appear unmistakably medical. We’ll include links to images of these types of grab bars in the show notes.
[00:18:59] Our Deisgn Advisers had a few good points about these new age grab bars. What stood out to you in their responses, Sarah?
[00:19:06] Sarah: Yeah, I have always loved the look of these modern grabbed bars as well, because I feel it does provide a really good option to providing stability in wet spaces. Plus the fact that they double as something else makes it really unique and functional.
[00:19:21] One of our Design Advisors shared this thought, and I’m going to summarize it here. It’s often hard for people to grieve losses in function when they’re injured or maybe aging, and it causes them to need a grab bar. So some of the newer ones are often easier to get people to accept. If they were built into the design, as opposed to being an afterthought, that would be even better. People tend to grab towel racks, so why not just make them secure and usable as grab bars? Go along with people’s natural instinct.
[00:19:54] And I really loved that response. And I have seen this situation play out frequently. However, some of our Design Advisors really had some reservations about these appealing features and it made me pause to think about their concerns.
[00:20:08] They were worried that having it double as a grab bar and a towel bar or soap dish could compromise their use as a grab bar and some of the curves on the newer designs wouldn’t support as good of a grip as it could cause their hands to slide, just like we were discussing with the diagonal grab bars before. I thought these were some really good points to consider.
[00:20:32] Are there times where function trumps beauty? I’d love to hear what some of our listeners have to say about this topic too. Most of our Design Advisors really liked the new ones though and would prefer to purchase them if money wasn’t a concern.
[00:20:46] Rebecca: Sure. What I took away from the weigh-ins on this debate is that, of course function should always come first. The purpose of grab bars is safety. So if a product will not keep you safe, it is not a good fit, no matter how pretty it is. But if you’re able to find a grab bar that is safe, functional, and attractive, then by all means, go for it.
[00:21:08] So the final question we posed to our Design Advisors was about whether or not they had any experience using grab bars as anything other than grab bars. Like we’ve kind of mentioned throughout the episode, people can get pretty creative in the way they use equipment in their spaces. So we were curious. What we heard more than anything else was that people often use grab bars, especially in the bathroom, as towel racks. Which can actually be dangerous if someone goes to grab it and their hand slides off with the towel. We heard a lot of similar thoughts and realized…it’s probably best not to use a grab bar as anything else unless it is intended to be used as something else, since that’s the only way you can be absolutely sure you’re using it safely.
[00:21:55] Sarah: Yeah. I tend to agree with this too. I have seen people use them as a shelf to rest medical supplies on. Even bottles of soap and shampoo, in addition to hanging a towel or a washcloth like you and our Design Advisors mentioned.
[00:22:09] Someone also mentioned they used it to rest their handheld showerhead when they weren’t using it during their shower. I think this brings up the topic of needing better storage around the toilet and shower. If there were little nooks and hooks and shelves in these spaces to store things, then the integrity of that grab bar wouldn’t be compromised.
[00:22:31] I think that’s the value of seeing how people use their current spaces to adjust the way we design things by observing their modifications and making changes to accommodate their needs.
[00:22:43] Rebecca: Exactly. That’s one of the beauties of being an OT, I think, is really seeing a client in their space and understanding how they use it.
[00:22:53] It makes it so much easier to help them find the best safety solutions and accommodate to their needs, just like you’re saying. Before we wrap up though, I know that we had a request to briefly discuss folding, rotating grab bars and suction cup grab bars. So what’s the team consensus on these guys, Sarah?
[00:23:13] Sarah: Well, the consensus on the folding or rotating grab bars was to use them only when needed in a renovation where there was absolutely no option to mount a traditional grab bar to an adjacent wall.
[00:23:27] If you’ve never seen one of those folding grab bars, they actually mount onto the very back of the wall behind the toilet. And they fold up and down kind of like a changing table folds down from the wall. And some of the rotating grab bars can be mounted onto the floor and they swivel side to side .
[00:23:45] They do work for some people, of course, but more often than not, it seems like they’re not the best fit. So let’s explain why.
[00:23:54] Here are a few reasons that our volunteers noted. The mechanism of the bar could actually wear down over time, weakening the brackets, causing parts to need to be replaced. So more moving parts means more things could break over time. This movement of the bar up and down also requires one more step for someone to you get on and off the toilet.
[00:24:17] Some people don’t have the ability to do this cognitively or are physically limited and can’t reach back once they’re on the seat to pull the bar down beside them. So, they would still require additional assistance from a caregiver. This design also needs to be very securely reinforced into the wall so it isn’t pulled out with all of the force being applied on the bar in the opposite end.
[00:24:42] Rebecca: Yeah, these definitely seem like a last resort, but it is good to know that they’re out there because if installed and used properly they’re, of course, better than nothing. And there was suction cup ones Sarah? The ones that aren’t actually screwed into the wall, but just suctioned on there? I know I have significant reservations about them. They’re not a great choice either, if you ask me.
[00:25:08] Sarah: Oh, definitely not. No, I am not a fan of these grab bars or suction cup thingies. They suggest you recheck the grab bar frequently to make sure it’s secure. But who would remember to do that? And unfortunately it could just pop off the wall unexpectedly. Plus you can’t mount it onto any grout lines as it doesn’t have enough suction to stick when there’s a gap under there.
[00:25:34] So these actually remind me of the suction cup bowls my daughter uses when she eats. They mostly stay stuck to the high chair, but if she lifts up the base or pulls really hard multiple times, she’s been able to get that bowl off of her high chair. Is this something we want adults pushing and pulling their weight around on? I’d say no.
[00:25:57] So stay away from these suction cup grab bars and give yourself some peace of mind by installing something securely into the wall.
[00:26:05] Rebecca: Very solid advice. And I actually think this is a good place to wrap up this episode because at the end of the day, the point of grab bars is safety. One more time — safety first!
[00:26:18] And so that’s the most important thing that I took away from our Design Advisors in this exercise. Regardless of what it looks like, the best fit for a grab bar is the one that keeps you safe and makes you feel comfortable doing what you need to do in your space.
[00:26:32] Sarah: Yes. And I just wanted to thank our Design Advisors one more time for taking a few moments out to share their thoughts on grab bars and to help our listeners for how you could use them within your home and also recommend them to your own clients. Your feedback really helped add to this conversation.
[00:26:51] Rebecca: Do you have any other questions for us, or our Design Advisors that you’d like to hear in an episode?
[00:26:57] If so, let us know at [email protected], we’d love to hear from you. Thanks for joining us and we’ll talk again soon.
[00:27:08] Sarah: Thanks for listening to Good Fit Poor Fit. I’m your host Sarah Pruett, Program Director and Occupational Therapist at The Universal Design Project. Learn more about our work at universaldesign.org, and find more episodes and links to subscribe at goodfitpoorfit.com. If you have questions or topics you’d like to discuss, email us at [email protected].
[00:27:39] Thanks for fitting us into your day!