Understanding Criteria for Assisted Toileting and Bathing in 2021 International Codes

While there have always been provisions for accessibility for persons with disabilities in the International Code Council’s (ICC) International Codes® (I-Codes®), these provisions were based on allowing independent access into and throughout a building, including independent use of the fixtures in a bathroom.  

As people age, they may not be strong enough for total independence. It is critically important to address the unique needs of older adults in the places where they live and are cared for, such as assisted living facilities, nursing homes and rehabilitation centers. 

Improving Safety for Residents and Caregivers 

While the 2024 I-Codes® are available, many communities and jurisdictions are still using the criteria in the 2021 I-Codes® for assisted toileting and bathing. These criteria provide for better access and improve safety for the residents and their caregivers. 

The ICC Committee on Healthcare utilized research from the Mayer-Rothschild Foundation to help develop several successful proposals for the 2021 International Building Code® (IBC). The Mayer-Rothschild Foundation is a national philanthropic organization exclusively committed to person-centered care in long-term communities. Their study worked with residents that used a variety of mobility aids, including canes, walkers and wheelchairs; as well as asked for input from the caregivers. This resulted in changes to the codes that include options for bathrooms to be designed to allow for both access with mobility aids and assisted use of the toilet and shower in assisted living facilities, nursing homes and rehabilitation facilities. 

Assisted Toileting  

The intent for assisted toileting and bathing is to allow for someone who has a physical disability to still feel as independent as possible and at the same time, address the need for additional safety. For example, some elders lose their strength or have stability issues, which makes it difficult for them to stand up and down. However, having some assistance when needed will help their confidence and provide a level of independence. 

Feeling safe when moving on and off the toilet is important for residents as well as caregivers. Assisting someone from the front when using the toilet has become a safety concern for both residents and caregivers over the years. Instead, having fold-down grab bars on both sides of the toilet and moving the toilet away from the wall so assistance can be offered from one or both sides will make it easier, as well as safer, for both residents and caregivers. Space for a resident using a wheelchair to maneuver for a side transfer is still provided adjacent to the toilet. 

Assisted Bathing 

Research also looked at assisted bathing. It was found that mounted seats within the shower limited options for both residents and caregivers. A moveable seat will provide more options for positioning and easier access to assist with bathing.  

In addition to a standard roll-in shower with three walls, alternatives include showers with two walls to allow additional flexibility for the person bathing and any caregiver. Space for a resident using a wheelchair is provided in front of the shower. 

Additional Bathroom Accessibility Features 

Bathrooms will still require other accessibility features, such as a 32-inch clear-width door with maneuvering clearances, and a turning space within the room and a lavatory with knee and toe clearances.  

These new options are designed for the specific needs of the population they serve and as a result will provide higher level of accessibility. The intent is to allow for design flexibility and address the safety of both residents and caregivers. 

What’s Next 

Originally, both the scoping (what, where and how many) and the technical (how to) for assisted toileting and bathing was placed in the IBC based on the immediate need for such direction for the industry. In the 2027 I-Codes, the technical criteria (how to) has been moved from the 2027 IBC into the 2026 edition of the ICC A117.1 Standard for Accessible and Usable Buildings and Facilities.   

With Americans living longer and in greater numbers, building codes continue to evolve to assure the utmost comfort and accessibility for these generations.  Facilities that have already implemented this fresh approach have been able to demonstrate an improvement in access, comfort and safety for residents and caregivers.