A Truly Accessible Public Bathroom
Have you ever taken your child to the bathroom, only to find the supposedly accessible public bathroom is not even remotely accessible? Almost every single bathroom we have ever visited has been unsuitable for my daughter's needs as a child who uses a wheelchair and cannot sit up.
In my opinion, the standards set forth by the Americans with Disabilities Act (ADA) are completely unacceptable. While you can read through the maze of diagrams and official recommendations, I'll try to sum up the general gist. The ADA only requires that the toilet be a certain height, that there are grab bars behind and to the side of it, and that the toilet paper is within reach. They also specify the minimum width and size of the floor space within a stall (usually about 56 inches by 60 inches), the door width, and that the stall can be reached by an accessible route. Of course, even these standards can be minimized if the project is a retrofit and simply will not allow enough space.
The first problem is just getting in the door. I can't tell you how many times we have gotten into the stall, only to find that unless we push the wheelchair literally into the toilet, we cannot close the door behind us. I have heard from several adult friends who say they routinely have to pee with the door open for this very reason. Then there are the dramatic turning movements, which require you to literally turn the wheelchair on a dime to move in any direction. While my daughter's wheelchair is a little larger than most because it is tilted back, I am guessing this is hard for many wheelchair users, particularly those with power chairs. Many times we need to park the wheelchair in the hallway outside of the stall because we simply cannot get in otherwise.
Next we come to transferring to the toilet. While this is not something we do with my daughter, several friends have told me how impossible it is. Unless you can easily get out of your wheelchair and walk, transferring is almost out of the question. Many friends I know transfer by parking their wheelchairs next to the toilet and simply sliding over. The majority of bathrooms do not leave space next to the toilet for the wheelchair, and there is rarely enough of a turning radius to turn yourself around and back up next to the toilet. Other bathrooms place a sink right next to the toilet, thereby blocking access. The majority of bathrooms require a wheelchair user to park in front of the toilet, use the one grab bar that may be on the completely wrong side for someone with use of only one arm (they are only required to be on one side and behind the toilet), and then do a stand-pivot transfer onto the toilet. This is by no means easy.
Then there is the even bigger issue of changing your child's diaper or cathing your child. Many children with special needs, including teenagers, still use diapers, and most wheelchairs are not designed to allow diaper changes in the chair. There are no federal laws requiring changing tables in bathrooms. When changing tables do exist, they are often restricted to children under 40 pounds and most are placed in the public part of the bathroom. It is definitely no fun to cath your five-year-old on an itty-bitty baby changing table while ten little kids watch and point!
When it comes to bigger kids, you must lift them out of their chairs, place them on the dirty floor, and proceed with changing or cathing. Then, of course, you have to lift them back up off the floor and put them into their chairs. Is your back hurting just thinking about it? If you don't think this is a huge problem, please take a minute to watch this video.
It is a wonder that any of us ever leave home.
Finally, there is the issue of taking your opposite-gender child to the bathroom. Not only is this a dignity issue for the child--what sixteen-year-old boy wants to use the women's room?--but it can raise lots of eyebrows among other patrons. Many places have even begun regulating this issue. For example, our local park district bans children above age six or eight of the opposite gender from their bathrooms. While there is an exception for kids with special needs, in order to use the exception, you need to track down the manager of the facility, have him clear the bathroom, and then go ahead and use it. I really feel for the child with cerebral palsy and bladder spasms who only gets about one minute of warning before he needs to use the bathroom.
So what can we do about this?
In the UK, a campaign called Changing Places is hard at work on this very issue. They have proposed guidelines for a truly accessible bathroom, one that is a separate gender-neutral facility, includes an adult-length changing table, has plenty of extra space, and even provides a lift for transferring larger children and adults to the changing table and toilet. This is a truly accessible bathroom, as pictured in the diagram below.
Changing Places has been quite successful thus far. They have more than 60 facilities throughout the entire UK, and more than a dozen in the works. [UPDATE: As of 2014, they have nearly 700 facilities, mostly in the UK!] They also have a mobile facility that can be rented through a regular portable toilet company. Not only that, but they are getting the message out that standard accessible bathrooms simply are not acceptable for the majority of people with disabilities.
Changing Places Accessible Bathroom
1) Fold-down, height-adjustable changing table; 2) Track or portable lift; 3) Plenty of free space, about 23 square feet; 4) Centered toilet with room on either side for transfers; 5) A curtain or privacy screen; 6) Wide paper towel holder that can also be used to cover the changing table; 7) Large waste basket for diapers and pads; 8) Non-slip floor; and Grab bars throughout the entire facility, including movable ones next to the toilet.
No such campaign like Changing Places exists in the United States to my knowledge. Instead, we depend on federal and local laws that most builders follow exactly. In order to truly address this issue in the United States, we need to make major changes in the language of the Americans with Disabilities Act.
The ADA, like most acts of Congress, is not a permanent and everlasting document. It can be changed and improved. This, unfortunately, takes time. For example, in 2004 there were many changes proposed, including some revisions to the bathroom stall design that would be ever so slightly helpful. These were not signed, published, and opened up for comment until the summer of 2008. It could be quite some time before they are put into effect.
The most important thing you can do is to document how ineffective the so-called accessible bathrooms are for your child's needs. Write letters, make videos, and submit stories to newspapers and television. Complain to corporations and send your state and federal senators or representatives letters and videos.
I can't tell you how many times I have heard someone tell me that they refrain from drinking water when going out because they simply cannot find a truly accessible bathroom. I also can't tell you how many times I have heard of people who are fully capable of regulating their bladders who have ended up wearing diapers when out because of a lack of accessible bathrooms.
It is time for these sorts of unfortunate practices to end. Let's bring a campaign similar to Changing Places to the United States.