Academy of Architecture for Health

As a recent patient, with a hip replacement, I can say the issue goes beyond just toilet spacing. the whole turning radius needs to be rethought. It appears that clearances are set based upon the requirements of the chair with the legs in a down & vertcial position. The minute the legs are elevated the require claearance changes & current standard dimensions do not work.

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Burton L. Roslyn, FAIA
President
Roslyn Consultants, LLC
Roslyn Heights, New York
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For the most part, the accessibility standards and guidelines are not meant for the transitory user, but for the permanent condition that individuals might have.  We hear quite frequently that the ADA standards do not meet the needs of the healthcare facility and do not provide the level of access needed.  This is a particular refrain with rehab facilities.  Unfortunatley, we as architects are bound to comply with the established standards in order to achieve building permits and occupancy permits.  Maybe the healthcare industry can lobby to establish standards that really work for their needs.  Unfortunately, this would take years to get implemented if successful.
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Kerry Hogue AIA
HKS, Inc.
Dallas TX
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Burton L. Roslyn, FAIA
President
Roslyn Consultants, LLC
Roslyn Heights, New York
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Kerry:
Unfortunately I do not agree with the conclussion that we are powerless in this conversation.
It is up to us as the designers to ensure that standards are appropriate. The Healthcare Industry will look only at the cost of lost square footage. It is up to us to see that the standards are approriate and truly workable.






Original Message:
Sent: 09-27-2011 08:43
From: Kerry Hogue
Subject: Toilet & Wheelchair Clearances


For the most part, the accessibility standards and guidelines are not meant for the transitory user, but for the permanent condition that individuals might have.  We hear quite frequently that the ADA standards do not meet the needs of the healthcare facility and do not provide the level of access needed.  This is a particular refrain with rehab facilities.  Unfortunatley, we as architects are bound to comply with the established standards in order to achieve building permits and occupancy permits.  Maybe the healthcare industry can lobby to establish standards that really work for their needs.  Unfortunately, this would take years to get implemented if successful.
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Kerry Hogue AIA
HKS, Inc.
Dallas TX
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The ADA is meant to primarily apply to "common use" elements available for independent access by the public, including persons with disabilities.  The actual provisions have been arrived at through a version of the usual rule-making process like any other code.  So what got in is a reflection of who was at the table, and often represents a compromise.  And like all codes, it is a blunt instrument that may not fit any particular actual person.  But there is an attempt to serve as broad a percentage of the diverse population as possible, both able and differently able, without resorting to segregated facilities (with the exception of parking stalls, where so far no one has come up with a desegregated approach).

Hospital wards are not "common use"; they are managed environments with the exception of the elements that serve the general public.  Patients do not self-select their room any more than at any other hotel, nor do they provide their own care on a DIY basis (the 10% rule recognizes the commonality of a hospital and a hotel as overnight sleeping facilities).  The operational plan for the unit is at least as important in providing reasonable accommodation as the physical environment.  There is no realistic way for one-size-fits-all design to properly serve the range of people with the range of medical/surgical conditions of a hospital's customers, any more than reasonable accommodation of an employee's disabilities can be standardized and provided in advance.  
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Edward Kuharski AIA
Principal Architect
Green Design Studio
Madison WI
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Original Message:
Sent: 09-28-2011 07:20
From: Burton Roslyn
Subject: Toilet & Wheelchair Clearances



-------------------------------------------
Burton L. Roslyn, FAIA
President
Roslyn Consultants, LLC
Roslyn Heights, New York
-------------------------------------------
Kerry:
Unfortunately I do not agree with the conclussion that we are powerless in this conversation.
It is up to us as the designers to ensure that standards are appropriate. The Healthcare Industry will look only at the cost of lost square footage. It is up to us to see that the standards are approriate and truly workable.

Burton, I did not say we were powerless.  I said it would take years to implement. 
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Kerry Hogue AIA
HKS, Inc.
Dallas TX
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Original Message:
Sent: 09-28-2011 07:20
From: Burton Roslyn
Subject: Toilet & Wheelchair Clearances



-------------------------------------------
Burton L. Roslyn, FAIA
President
Roslyn Consultants, LLC
Roslyn Heights, New York
-------------------------------------------
Kerry:
Unfortunately I do not agree with the conclussion that we are powerless in this conversation.
It is up to us as the designers to ensure that standards are appropriate. The Healthcare Industry will look only at the cost of lost square footage. It is up to us to see that the standards are approriate and truly workable.

Hello Everyone,

I agree that ADA standards does not meet certain requirements in Healthcare
environment. As an practicing person in architecture I believe that the standards
or guidelines provided are for minimum requirements to comply with, but it doesn't
stop the designer to exceed those standards. This all again goes to the Architect
to research and either follow the minimum standard or exceed those standards to
accomplish the task and satisfy the owner/ developer.
Someone have to educate/ convince the owner/ developer as a professional expert
to do  the right things at the right time.
Standards are written and implemented by Humans and can be changed also for the Welfare
and Safety of Humans.

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Amer Chaudhry Assoc. AIA
Urban Green LLC
Chicago IL
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Original Message:
Sent: 09-28-2011 07:20
From: Burton Roslyn
Subject: Toilet & Wheelchair Clearances



-------------------------------------------
Burton L. Roslyn, FAIA
President
Roslyn Consultants, LLC
Roslyn Heights, New York
-------------------------------------------
Kerry:
Unfortunately I do not agree with the conclussion that we are powerless in this conversation.
It is up to us as the designers to ensure that standards are appropriate. The Healthcare Industry will look only at the cost of lost square footage. It is up to us to see that the standards are approriate and truly workable.

Burton, I did not say we were powerless.  That is your term.  I said it would take years to implement. 
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Kerry Hogue AIA
HKS, Inc.
Dallas TX
-------------------------------------------







Original Message:
Sent: 10-04-2011 11:47
From: Amer Chaudhry
Subject: Toilet & Wheelchair Clearances

Hello Everyone,

I agree that ADA standards does not meet certain requirements in Healthcare
environment. As an practicing person in architecture I believe that the standards
or guidelines provided are for minimum requirements to comply with, but it doesn't
stop the designer to exceed those standards. This all again goes to the Architect
to research and either follow the minimum standard or exceed those standards to
accomplish the task and satisfy the owner/ developer.
Someone have to educate/ convince the owner/ developer as a professional expert
to do  the right things at the right time.
Standards are written and implemented by Humans and can be changed also for the Welfare
and Safety of Humans.

-------------------------------------------
Amer Chaudhry Assoc. AIA
Urban Green LLC
Chicago IL
-------------------------------------------







Original Message:
Sent: 09-28-2011 07:20
From: Burton Roslyn
Subject: Toilet & Wheelchair Clearances



-------------------------------------------
Burton L. Roslyn, FAIA
President
Roslyn Consultants, LLC
Roslyn Heights, New York
-------------------------------------------
Kerry:
Unfortunately I do not agree with the conclussion that we are powerless in this conversation.
It is up to us as the designers to ensure that standards are appropriate. The Healthcare Industry will look only at the cost of lost square footage. It is up to us to see that the standards are approriate and truly workable.

The standards are minimum requirements - that is, the worst allowable configuration.

Title III of the ADA requires that "No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation ..."

In designing for "full and equal enjoyment," the architect must, of course, study the actual needs and workings of the facility.

Not too long ago, I was on my back, being wheeled into surgery. I asked the folks in the operating room how they enjoyed their workspace. One fellow remarked, "They just spend six million dollars renovating this place - and it is terrible. It doesn't work. Nobody asked US what we needed."

On the way back to recovery, we wheeled  past the nurses' station. I asked a nurse how she enjoyed her new work station. She replied, "There's not enough counter space. It's terrible. Nobody asked US."

Yes, when a person using a toilet requires two assistants, then the "standards" must be trumped by reality.
This is always an interesting exercise in design, since people have differing abilities, and one size doesn't fit all.



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Steven Kirk Mason AIA
Realms Architectural
Harpursville NY
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Original Message:
Sent: 09-27-2011 08:43
From: Kerry Hogue
Subject: Toilet & Wheelchair Clearances


For the most part, the accessibility standards and guidelines are not meant for the transitory user, but for the permanent condition that individuals might have.  We hear quite frequently that the ADA standards do not meet the needs of the healthcare facility and do not provide the level of access needed.  This is a particular refrain with rehab facilities.  Unfortunatley, we as architects are bound to comply with the established standards in order to achieve building permits and occupancy permits.  Maybe the healthcare industry can lobby to establish standards that really work for their needs.  Unfortunately, this would take years to get implemented if successful.
-------------------------------------------
Kerry Hogue AIA
HKS, Inc.
Dallas TX
-------------------------------------------

The Department of Veterans Affairs (VA) Community Living Centers Design Guide 2011 addresses the issue of assisted transfers and use of toilets.  Section 3-9 states: " Assisted transfer requires dimension of approximately 2'-8" [813 mm] from the centerline of the toilet to the sidewall or other obstruction (such as the edge of a sink, vanity, or tissue holder). This dimension allows space for a standing staff member, wheelchair, or lift." this toilet location requires "Fold-Up Grab Bars - the bars accommodate lifting and assisted transfers and are securely mounted to the substructure in the wall. Wall hinged, fold-up bars are installed to individually and safely swing up and out of the way." 
In reference to the turning space clearance dimensions, the VA  requires a 5'6" clear turning space for wheelchairs.   The VA also requires that 100% of the resident/patient bathrooms are accessible. 
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Carol Peredo-Lopez AIA
Accessibility Consultant
Kensington MD
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Original Message:
Sent: 09-27-2011 08:43
From: Kerry Hogue
Subject: Toilet & Wheelchair Clearances


For the most part, the accessibility standards and guidelines are not meant for the transitory user, but for the permanent condition that individuals might have.  We hear quite frequently that the ADA standards do not meet the needs of the healthcare facility and do not provide the level of access needed.  This is a particular refrain with rehab facilities.  Unfortunatley, we as architects are bound to comply with the established standards in order to achieve building permits and occupancy permits.  Maybe the healthcare industry can lobby to establish standards that really work for their needs.  Unfortunately, this would take years to get implemented if successful.
-------------------------------------------
Kerry Hogue AIA
HKS, Inc.
Dallas TX
-------------------------------------------

I found the same problem, when after ankle surgery last year, I had to keep my foot elevated in the wheelchair for a month through rehab. The wheel chair turning radius didn't work for me either with raised leg extensions.
It seems perhaps, they may be designed to the absolute minimum with the leg rest down.
Clients need to know that the handicap code is a difficult compromise on issues, and for places specifically catering to the handicap, consideration for a more distance in situations may be preferable.

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Gregory Stock AIA
Project Architect/planner
Rogers, Lovelock & Fritz, Inc.
Winter Park FL
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