A couple move into an extra care apartment in their late seventies. He walks a little slowly after a knee operation. She's as active as she was at sixty. They chose the scheme because they wanted their own front door, with help close by if they ever needed it.
Ten years on, she has arthritis in both hips and he uses a wheelchair for longer distances. The care team visits twice a day. They're still in the same apartment, and the bathroom they chose on move-in day now has to work for two people who need very different things.
That's the challenge of designing bathrooms for extra care housing. You're designing for the residents who move in, and for the residents they're likely to become.
The short answer: extra care bathrooms should feel like a normal home bathroom on the day residents move in, and be ready to adapt without major building work as their needs grow. That means planning space and fixings from the start, and choosing supports that look good, not clinical. Equipment should be added in stages, from discreet rails and a little extra height through to powered lifts or adjustable toilets. It should also work for couples with different needs and for the care staff who may later help in that room.
A home first
People choose extra care, assisted living and retirement apartments because they want to keep living independently. The bathroom is one of the first rooms they judge a scheme by. If it looks like a hospital, the message is that this is somewhere you go to be looked after, not somewhere you go to live.
That doesn't mean ignoring accessibility. It means building it in quietly. Our article on the rise of "stealth accessibility" in UK home design explores this idea: bathrooms that are easy to use for everyone without announcing that they've been adapted. Stylish grab rails are a good example. They offer support from day one without looking like medical equipment.
Planning for the resident they'll become
The most useful thing a scheme can do is plan for change before it's needed. As we argue in the architecture of ageing, adapting ahead of time is almost always easier than adapting in a hurry after a fall or a hospital stay.
In practice, most residents' bathroom needs change in stages.
On move-in day, many residents need little more than a toilet at a comfortable height and something to steady themselves on. Discreet rails beside the toilet and at the basin, and a clear, uncluttered floor, cover most of it.
As mobility declines, standing up from the toilet is often the first thing to become difficult. A modest lift from a 50mm toilet seat riser may be enough at first. Where there's nothing solid to push on, a riser with built-in support rails adds support on both sides. Our guide to knowing when a toilet riser is no longer enough helps residents and staff recognise when to move to the next stage.
When more support is needed, a powered lift such as the Wash-Able Toilet Elevator can help with sitting and standing, and it fits over the existing toilet. Where needs are complex or likely to vary, a rise and fall toilet gives the most flexibility. Adding arm and back support helps residents who struggle to sit securely.
Planning for these stages from the outset means each change is a simple swap or addition, not a refit.
Two people, one bathroom
Extra care schemes often house couples, and couples rarely age in step. One partner might need a higher toilet while the other finds it too high. One might sit to wash while the other stands.
This is where adjustable equipment really proves its worth. A rise and fall toilet can suit both partners at the touch of a button. A height-adjustable sink can be lowered for one and raised for the other, solving what we've called the shared basin dilemma.
Equipment that lets each partner manage their own personal care can also protect the relationship itself. It means one partner isn't gradually becoming the other's carer. We explore this in the "invisible carer".
A bathroom that works for visiting carers too
In extra care, on-site care staff may start helping residents in their own bathrooms as needs grow. A bathroom designed only around the resident can become difficult for staff to work in.
A few things help. Leave space on at least one side of the toilet for a carer to stand, not just a wheelchair. Choose supports that can be folded away when they're in the way. Consider equipment that reduces how much staff need to bend or take a resident's weight. The thinking in our article on reducing manual handling strain applies here too, even though the setting is someone's own home.
Plan now, add later
Many future adaptations depend on decisions made during the build or refurbishment:
- Space. Enough room beside and in front of the toilet for a wheelchair or a carer, even if nobody needs it yet
- Floor. A level-access shower or wet room floor, so a step never becomes a barrier. Our guide to wet rooms vs level-access showers compares the options
- Fixings. Talk to your contractor about where rails and supports might be added later, so the walls can take them when the time comes
- Power. Consider where a powered toilet or adjustable basin might one day need a supply, and discuss it with your electrician at the design stage
None of these adds much to a project at the planning stage. Each can save a great deal of disruption for a resident later on.
Consistency across the scheme
Where apartments share the same basic bathroom layout, care staff can work more confidently from one apartment to the next, and equipment can be moved or reused as residents come and go. It also makes it easier to agree a standard set of options residents can choose from as their needs change.
Every resident is different, though. A consistent starting point should always leave room for individual choices about finishes, support and equipment.
Frequently asked questions
What is extra care housing?
Extra care housing is a form of housing for older people that combines self-contained homes, usually apartments with their own front door, with care and support available on site. Residents live independently, and care can be arranged as their needs change. Arrangements vary between schemes and providers.
How can you future-proof a bathroom for older residents?
Plan space for a wheelchair or carer beside the toilet, choose a level-access shower, and make sure walls can take rails and supports later. Start with discreet support such as stylish grab rails, and add equipment in stages as needs change, from seat risers and support rails to powered toilet lifts or adjustable toilets.
Can an accessible bathroom still look like a normal home bathroom?
Yes. Modern grab rails, integrated supports and adjustable toilets and basins can all be chosen to suit a contemporary home bathroom. The aim is a room that's easy for everyone to use without looking adapted.
Talk to us about your scheme
If you're planning or refurbishing bathrooms in an extra care, assisted living or retirement scheme, we'd be glad to help you think through equipment that works on move-in day and for years afterwards. Call us on 01745 346226 or send us your project details, including the number of apartments and the stage your project is at.
