American Disabilities Act Appendix A to Part 36 -- Standards for Accessible Design 4.20 - 4.21.5 Bathtubs and shower 4.26.2* Size and Spacing of Grab Bars and Handrails.
Falls are the greatest source of injury and accidental death around the home, so it's no wonder more and more people are installing grab bars to make their bathrooms safer. These basic tips and grab bar installation instructions, are to be used as reference and NOT intended to replace your local professional.

Safety bars Safety bars are the easiest to install. Some models require only 10 minutes, a socket wrench and a screwdriver to tighten the clamps. Also, you can remove one of these safety bars later without leaving permanent marks on the bathtub or toilet. Keep in mind that many bathtub and toilet safety bars aren't designed to support a heavy weight and don't meet safety codes for people with disabilities. Consider them strictly as an assist. Also, many bathtub safety bars only attach well on smooth, parallel bathtub sides. If you install them on a bathtub with a tapered profile or textured surface, the support brackets won't clamp as securely as they should, and the safety bars may give way when you apply a load. Toilet safety bars use the existing bolts that hold your toilet seat. Make sure these bolts are metal before installing toilet safety bars.

Wall or Floor mounted Grab bars Grab bars not only handle heavier loads (as much as 1,000 pounds for single piece tubular bars), they can be installed anywhere you need them: in the bathtub and shower areas, next to a toilet or sink, even near door sills and steps in other parts of the house. Grab bars are your best choice if you're outfitting a bathroom for a disabled person. A large selection of ADA compliant grab bars and shower seats configurations.

Positioning a Wall mounted Grab Bar
Wall mounted grab bars come in several lengths. Deciding which length to install depends on how the grab bar will be used. For example, if you're putting a main grab bar on the side wall of a bathroom tub enclosure, the National Kitchen and Bath Association recommends using a grab bar at least 24 inches long. If you're adding a second grab bar for support on the shower head wall, it should be at least 12 inches long.

Horizontal grab bars offer better leverage to a person trying to get out of a bathtub or up and down from a toilet, but a grab bar placed at a 45 degree angle to the toilet or bathtub's rim is easier for people of differing heights to reach. Another advantage to angling the grab bar is a 24 inch bar installed at a 45 degree angle will exactly span wall studs spaced 16 inches apart, and you can screw into the studs on each end for maximum support, with no need for blocking.

Horizontal grab bars should be located 33 to 36 inches above the finished floor around toilets, and 33 to 36 inches above the floor of the bathtub and close enough to the shower head wall to support a person adjusting water temperature. If the drywall above your tub enclosure is exposed, you can use any of the standard techniques for locating the studs. But if the studs are buried behind a tiled wall, you'll need to use a few tricks of the trade to find them.

Most building codes require that they be capable of withstanding a 250 pound load. To support this weight, you must screw the grab bars into wall studs or into additional blocking. Molly bolts, nails, or screws into sheetrock are not adequate. "Cats" 2-by-4s that you nail in between the studs, or "Plates" plywood or another substantial material that spans the wall studs, are both common practice.
 

Here are the key steps for installing a wall mounted grab bar at a 45 degree angle on a fully tiled wall.
 

1. Locate the wall studs. Using one of these techniques, find the studs you'll attach the grab bar to: Run an electronic stud finder along the wall until it detects a stud, and then mark the location with a fine point marker. Or make a hole in the grout line using a variable speed drill with a 1/8 inch masonry bit or glass and tile bit. If you don't hit a stud on the first try, bend a piece of stiff wire and insert it in the hole. Spin the wire left and right until it contacts a stud. Redrill in the new spot, and you should hit the stud. Measure 16 inches from this point to find the second stud.

To patch a hole, shoot in a dab of silicone caulk, flatten it so it doesn't protrude into the grout channel, and give it two to three hours to dry. If you're using powdered grout instead of premixed, mix up a small amount in the lid of a jar. A Popsicle stick makes a good touch-up applicator its rounded edge nicely matches the concave shape of most grout lines.

You can spare the tile if you have access to the other side of the wall maybe in a bedroom or closet. Use a stud finder to locate studs on the other side of the wall, measure the distance to the nearest perpendicular wall, and then transfer the measurements to the tiled wall.
 

2. Mark the screw locations. Measure up from the base of the tub and mark the height where you want to install the grab bar. Then, hold the grab bar against the tile with each end over a stud, and mark the locations of the holes in the mounting brackets.

3. Drill mounting holes. If you try to drill through tile without first marking a starting point, the bit may skate over the slick surface. So, before you drill, scribe the tile to create a starting point for the drill bit. Use a sharp awl or the tip of a carbide glass and tile drill bit or masonry bit; twist the tool to grind a slight impression into the surface. Don't use a center punch you're likely to crack the tile. Drill holes through the tile with a glass and tile drill bit. If you have to use a masonry bit, go slowly and put tape over the tile to help prevent shattering. To avoid fracturing the tile when you turn the mounting screws, leave a little clearance as you drill the holes. Use bit that's at least 1/32 inch wider than your mounting screws. Mount the bit in a variable speed drill and start the bit at slow speed to keep it from sliding off your mark. Apply light, even pressure as you drill so you don't crack the tile. Drill only through the tile and its backing. Then switch to a wood bit that's 1/16 inch narrower than your screws, and drill pilot holes in the studs.

4. Mount the grab bar. Apply silicone caulk to the holes before you mount the brackets. This keeps water from leaking behind the screws and damaging the backing board under the tile. Screw the grab bar to the wall. If it comes with plain steel or chrome plated screws, replace them with stainless steel screws. Common steel and even chrome plated screws will rust over time. Tighten the screws firmly, but don't over tighten, or you could crack the tiles.
 

The optimum diameter for grab bars is 1 1/4--1 1/2" for adults. For a child or person with a very small hand, the ideal diameter is 1-1 1/4". The distance between the wall and the grab bar should be 1 1/2". A wider space can be dangerous if you slip and your elbow lodges between the wall and the bar. A narrower space is not adequate for fingers and knuckles. Tubs and Showers Transferring someone from a wheelchair to the tub is one of the most hazardous activities you may ever have to attempt at home. Getting into the tub is also hazardous for semiambulatory persons. To accommodate these individuals, your tub area must be carefully designed to provide maximum safety for a minimum effort.
 
 

Toilet transfer
Wall to floor mounted grab bars are the most stable, and straddle grab bars with sheltering arms provide the best support for getting up and sitting down on a toilet from a standing position. Grab bars designed for wheelchair users aren't always satisfactory for people who use crutches, canes, or walkers to get around. Many elderly people find getting up from or sitting down on a toilet difficult because they've lost muscle strength in their legs and knees. For this reason, sheltering arm grab bars are superior to wall mounted grab bars. The sheltering arm grab bar surrounds you, providing support similar to the arm rest of a standard chair. It allows you to use your arm and leg muscles to lower yourself onto the toilet and return to a standing position. Sheltering arms also provide better balance support while you are seated on the toilet. Make sure that these bars are firmly secured to the toilet to prevent instability or shifting. Tightly attach the bolts to the toilet using rubber washers and check them every few weeks. Toilet safety bars use the existing bolts that hold your toilet seat. Make sure these bolts are metal before installing toilet safety bars.
 
 

Support for getting up and sitting down	Staddle grab bar with sheltering arms	Wall mounted grab bar	Wall to floor mounted grab bar with wheelchair accessibility	Wall to floor mounted grab bar

Shower or bath
Since many people prefer a bath to a shower, think about your preference before deciding which is the most appropriate unit to install. If you have poor circulation in your extremities, you may find that soaking in a warm tub at the end of the day is an excellent way to relax and get more comfortable.
 

Tub seats allow persons in wheelchairs or others who have poor strength in their legs to transfer and sit in the tub and take a bath or shower without having to lower themselves to the floor of the tub. A tub seat also works well for those who tire easily and need to sit while bathing. Several types of tub seats are available.

You can also install a built-in tub seat, which will be more stable and safer than a removable seat. Be sure to carefully design this seat for drainage, so that water runs back into the tub and not out the side when you bathe.
 
 

Shower and Tub Controls and Accessories
As with lavatory faucets, single lever shower and tub controls are the best. Anti scald temperature controls are available that prevent the water temperature from exceeding an established limit. If the water temperature in your house is above 115' Fahrenheit, you should consider installing this feature. Shower curtains and doors are the two primary means of containing water within showers or tubs. But sliding doors with tracks can present a formidable barrier if you are transferring from a wheelchair to a tub seat. The lower tracks often have sharp edges which can injure persons who try to slide over them. For this reason, you should try to provide a shower curtain in a tub to be used by a person transferring from a wheelchair. Shower Units Accessibility standards call for two types of showers in accessible facilities: roll-in showers and transfer showers. Roll-in showers provide a gentle, easily crossed threshold that keeps water in the shower area. A person in a wheelchair can easily roll from the shower area to the rest of the bathroom. In most cases, people who will roll into the shower will use a special commode chair. Because its small wheels can catch on ridges, thresholds, and cracks, it's important to have smooth thresholds between the bathroom and the shower. Roll-in showers normally require a larger space than standard showers, but they should be equipped with the same hardware and controls as standard showers. Transfer showers require that you transfer from your wheelchair to a seat in the shower compartment. The dimensions of a transfer shower are critical. When you're seated in the cubicle you should be able to easily reach the surrounding grab bars and controls. You can probably transform your existing shower into a transfer shower by simply installing a seat and the appropriate controls. Make sure that a clear floor area is available for a wheelchair to approach the shower area and allow an easy transfer to the shower seat.

Hand-held shower heads are a necessity for many people, particularly those who are seated in a shower or tub. These fixtures often come with adjustable height rods and/or fixed hooks to allow the shower head to become a fixed level unit. It's imperative to have at least 5' of hose attached to the shower head so that it can reach the end of the tub or shower. Many manufacturers provide special adapters that replace the existing shower head or tub spigot with a nipple for attaching the shower hose. Safety Issues You're more likely to have an accident in your bathroom than in any other room in your home. Therefore, your bathroom should be designed and equipped to help you avoid slipping or injury when you use the facility.

Floor Surfaces
Non-skid adhesive strips, flowers, or dots are a low cost solution to the problem of slippery walking surfaces, both inside and outside of the bathing unit. Replacing the existing floor surface with a slip-resistant surface, such as a non-skid ceramic tile or indoor/outdoor carpeting, is another solution that is more costly, but may be more aesthetically acceptable.

Grab Bars
Securely mounted grab bars where a person may be off balance. They must be capable of supporting at least 250 pounds of force (more if anyone who is a frequent user of the facility weighs more than 200 pounds). To make sure they are capable of supporting this weight, view the specifications, and screw the bars directly into the studs in the walls or a secure form or blocking that has been applied to the studs. Screws fastened into tile or sheetrock are not adequate anchoring.

Lighting
Make sure you have adequate lighting in your bathroom so you won't trip, slip, or hurt yourself. It's especially important to light the area around the lavatory or sink for convenience, personal grooming, and easy reading of medicine containers and directions. It's also important that your lights shine on the object being viewed, rather than directly into your eyes. Direct light sources create special problems for people who wear glasses that refract light, causing glare problems. Cover bulbs with some kind of shade to create indirect, soft illumination.

Electrical Shock
If you use any electrical appliances in the bathroom (hair dryers, electric shavers, electric hair curlers, etc.) their circuits should be Ground Fault Interrupted (GFI). This type of equipment virtually eliminates the possibility of electrical shock and is part of the bathroom building code in many states. Hire a professional electrician to install GFI outlets to make sure they are properly grounded, and test the circuits regularly to make sure that they are operational, using the button on the outlet.

Storage
Many older homes don't have adequate storage space for medicine, equipment, and linens in or near the bathroom. If your space is limited, you may want to install medicine cabinets or shelves to hold these items. If you or others in your home have equipment ordered by your doctor or rehabilitation therapist to assist you with personal hygiene, make sure the items you use frequently are stored within easy reach.