2. Who is this guide for:
This guide is for ward staff, consultants & contractors, with additional advice for families
and carers.
This guide will aim to summarise the best bathroom design advice from healthcare
professionals, to help create dementia-friendly bathrooms in hospitals and homes.
All aspects of bathroom design will be covered; lighting, flooring, taps, showers, heating,
support rails and signage.
Key Considerations:
- Protect the individual
- Safety
- Familiarity
3. Protecting the Individual
There are 7 major challenges to tackle:
1. Protection against scalding
- Consider temperature regulated taps.
- Use low surface temperature radiators or underfloor heating.
2. Fall protection
- Avoid sharp edges.
- Remove bath and install a level access shower/ wet room.
- Use plastic shower screens, not glass.
- Underfloor heating ensures no hot radiators to fall on.
- Use shower curtains made from a breathable fabric.
3. Memory Loss
- Consider choosing a shower that turns off automatically after a certain amount of time.
- Use flood-proof plugs.
4. Retro Memory
- Choose familiar looking fittings, not modern, as these will not be easily recognised.
- Select basins that can hold a toothbrush holder.
5. General Confusion
- Include a mirror, but one that can easily be covered/ uncovered (maybe with a roller blind).
There are 7 major challenges to tackle:
6. Floor Colour Perception
- Ensure floor is a single colour – a colour change may cause a person with dementia to think
there is a step up or down, and may fall.
- Avoid very dark colour flooring as this can resemble a hole, making a person with dementia
reluctant to enter the bathroom.
- Avoid shiny flooring as this could be perceived as being wet.
- Avoid flecked, or small patterned flooring, as this could be perceived as being dirty – a person
with dementia may lean over to pick up something off the floor and could fall.
4. 7. Visual Confusion
- Use matte contrasting colours.
- The shower curtain must be a different colour to the wall behind it.
- The shower seat must be a different colour to the wall behind it.
- The toilet needs to be a different colour to the wall behind it.
- The toilet seat needs to be a different colour to the toilet pan/ cistern.
- Toilet roll holders and grab rails also need to be a contrasting colour to the wall they are
attached to.
It may be easier to have white walls and a grey floor, and pick one contrasting colour such a
dark blue and use this colour for the shower seat, curtain, toilet (if possible) and toilet roll
holders and grab rails. You then just need a different colour toilet seat, which could be red.
Underfloor heating may be more suitable to the home environment than in a hospital.
Protecting the Individual
5. - Avoid patterns and three dimensional representation of objects because these can cause
visual confusion.
- Avoid white tiles as these can be seen as being clinical and not homely.
- Avoid flooring that contrasts in tone with flooring in the adjoining bedrooms or corridors,
as the colour change can be perceived as a step resulting in falls at the threshold.
- Also ensure that the bathroom floor is a single colour.
- Avoid the use of level access trays as a person with dementia may assume the colour
change means there is a step up or down and this can lead to falls. The safest solution is a
wet room that is fully tiled or has safety flooring.
- Use non-slip flooring in all wet room areas.
- Avoid very dark coloured flooring as can look like a large hole, discouraging a dementia
suffer from stepping onto it.
- Flooring should be plain and non-reflective. Flecks and speckles can cause confusion as it
may look like crumbs or dirt and this can lead to falls if the user tries to pick them up.
- Avoid a shiny floor surface as this can give the appearance of being wet.
- The floor colour must clearly contrast with the walls and sanitary ware.
- For wet rooms, ensure a minimum floor gradient of 15mm. The maximum recommended
ratio is 85:1 (this means that for every 85mm the incline travels towards the drain, the floor
level will fall 1mm).
Design Advice: Flooring
6. - Choose a thermostatic care shower to guarantee a safe and stable temperature and ideally
choose a shower with easy to use and familiar controls.
- Ensure the shower has an adjustable flow as skin can become hyper-sensitive.
- To avoid accidental flooding (if a shower is left running), ideally choose a shower that
automatically shuts-down after 30 minutes use and a flood-proof plug.
- Avoid overhead deluge shower heads as these can cause fright. It helps if a dementia sufferer can
see where water is coming from and that they can control its flow.
- Ensure shower has controls that are visible against the shower body – i.e. the controls should be a
contrasting colour.
- Place shower head and controls close to open/ front side – this ensures carers can easily access it
without getting wet whilst helping the person with dementia.
Screens
- Ideally choose PET plastic safety screens not safety glass,
as being a softer material these reduce the likelihood of impact injury
should they be fallen against.
- Choose a frosted screen as these don’t show the
reflections that can frighten someone with dementia, making them
think that someone else is in the bathroom with them. The added
advantage of a frosted screen is that it offers greater dignity if the
carer needs to stay in the room.
Curtains
- Choose curtains that are a different colour to the walls
and the floor. This creates a clearly recognisable showering area. If
the bathroom user is susceptible to falls then ensure the curtain
fabric is breathable to avoid the danger of suffocation if the curtains
are pulled down in a fall.
Design Advice: Showering
7. - Choose a different colour toilet seat to the pan and cistern so the user can
easily locate it.
- Choose familiar looking tap controls and toilet flush levers.
- Avoid push button or infra-red flush controls as these can cause confusion.
- Make sure that the toilet roll holder is a contrasting colour to the wall so it can be easily seen.
- Avoid the use of hidden cisterns.
- Ensure the basin is big enough to accommodate toothbrush mug, toothpaste tube and soap.
- Ideally position the toilet so that it can be seen from the bed - this is especially important in
nursing homes.
- Consider using flood-proof plugs that pop-up if the basin overfills.
Design Advice: Toilet, Basins and
Support Rails
8. Doors:
- It may be necessary to remove the bathroom door lock, or replace it with a lock that can be
opened from outside. Someone with dementia may lock themselves in and panic or they may fall
and a locked door may delay the carer being able to reach them.
- The door to the bathroom should open outwards in case the person falls against it from the
inside, therefore blocking entry.
- Ensure that door into the bathroom contrasts with the walls on both sides.
Signage:
- Use signs on the bathroom door that include words and pictures as shown above - some
people may recognise the word and others may recognise the picture.
Heating:
- Provide extra heating as tasks take longer to complete.
- Consider using LST (low surface temperature) radiators or under-floor heating (at home) but
don’t leave exposed pipework as it can get extremely hot.
- If the person is more prone to fall, consider installing under-floor heating so there is no radiator
to fall against.
Design Advice: Heating, Doors,
Locks & Signage
9. Lighting:
- Dementia sufferers become more sensitive to glare from lights, so maximise natural light where
possible.
- Install at least two lights that are positioned to avoid shadows.
- Install task lighting e.g. over the basin, shower and toilet.
- Consider using motion sensor lighting with a long cut-off time.
Taps:
- Use loose taps, with long handles so they are easy to turn on and off.
- Ensure the taps are temperature regulated to prevent scalding.
- Clear red for hot tap, and blue for cold tap – easy to see.
Mirrors:
- Place one mirror at standing height, and one at sitting height, just above the sink.
- If it is not suitable to have two mirrors, have one high mirror, and a smaller mirror on a stand,
or that folds away easily.
- Also ensure that mirrors can be covered/ uncovered easily, if needed.
Design Advice: Lighting, Taps
& Mirrors
10. Storage:
- Use shelves rather than cupboards so that items can be easily found.
- Avoid low level furniture that can be fallen against.
Changing Spaces:
- Place clothes hangers within easy each of the shower, but far enough away to ensure they don’t
get splashed.
- Ensure there is a drop down bench to place clothes on and lean on.
Design Advice: Storage and
Changing Spaces
12. Examples: Good storage system, good colour contracts, clothes hangers, better shower position,
lots of support rails.
Design Advice: Example Colour
Scheme
13. References:
The AKW Guide to Creating Dementia-Friendly Bathrooms by AKW.
http://www.wayfindersystems.ie/projects/wayfindingandsignagefordem
entiafriendlyenvironments/ - Signage information
http://dementia.stir.ac.uk/design/virtual-environments/importance-
colour-and-contrast - University of Stirling
Designing interiors for people with dementia, 4th edition – Liz Fuggle,
2013.
Dementia Services Development Centre l DSDC, Stirling
http://www.wetroomexperts.co.uk/wetroom-experts-blog/16455-
designing-wet-rooms.html - Wet room gradient information
Product Suggestions:
- Raised coloured (red or blue) toilet seat, with lid, with drop down rails.
Minimum 2 inch height. Range of heights as needed (2 – 6 inches).
- Possible design development for us if unavailable on market.
- Drop down bench for bathroom changing area – red or blue in colour,
if possible.
References & Product Suggestions
