An Occupational Therapist’s Guide to Preventing Falls in the Bathroom

Bathroom falls are common because the room combines wet surfaces, tight spaces, stepping, turning and sitting-to-standing movements. A safer bathroom does not always require a full remodel. Often, the biggest improvements come from the right grab bars, a stable bathing seat, better lighting, nonslip surfaces and height adjustments that reduce stress on aging joints.

The bathroom is one of the most challenging rooms in the home for older adults. Floors may be wet. Surfaces may be slippery. Getting in and out of a tub, lowering onto a toilet, reaching for towels or turning in a small shower can test balance and strength.

Falls are not an unavoidable part of aging. Falls among adults 65 and older can be prevented, and taking steps such as removing trip hazards, improving lighting, reviewing medications and adding bathroom grab bars. Making changes to bathroom safety such as changing to nonslip mats, bath seats, raised toilet seats with armrests and grab bars in the shower, tub and toilet area may be helpful. 

Before buying equipment, look at the bathroom during the times it is most often used. Many falls happen during rushed or nighttime routines. Ask these questions:

• Is there a clear path from the bedroom to the bathroom?
• Are rugs loose or curled?
• Is the toilet too low?
• Is the shower entry difficult to step over
•  Is there a secure place to hold when sitting, standing or turning?
• Are towels, soap and shampoo easy to reach without leaning?

A safer bathroom should support three movements:

1. walking in.
2. transferring safely and bathing or toileting without twisting.
3. reaching or rushing.

The path into the bathroom should be clear, dry and well lit.

Remove throw rugs or replace them with nonslip, low-profile mats. Keep laundry baskets, scales, trash cans and cords out of the walking path. Use night lights in the bedroom, hallway and bathroom. Consider motion-sensor lighting for nighttime trips.

Doorways matter, too. A bathroom door that swings inward can block access if someone falls inside. For people with significant balance or mobility concerns, an outward-swinging door, pocket door or emergency-access hinge may be worth discussing with a contractor or occupational therapist.

The toilet is one of the most important places to add support. Sitting down and standing up require leg strength, balance and joint control. A low toilet can increase strain on the hips, knees and back.

The sink area can become risky when people lean on towel bars, pedestal sinks or countertops for balance. These surfaces may not be stable enough to support body weight.

Keep frequently used items within easy reach. Store toothbrushes, medications, soap, hair tools and shaving items between shoulder and hip height when possible. Avoid storing daily items in low cabinets that require bending or in high cabinets that require reaching overhead.

If standing at the sink is tiring, consider a stable chair or stool only if there is enough space and the chair has nonslip feet. For people who use a walker or wheelchair, a clear approach to the sink can make grooming safer and less tiring.

A bathing seat can reduce fatigue and lower the risk of slipping. The right choice depends on the shower or tub setup, the person’s balance and how much help is needed.

Shower Chair vs. Bench Chair

A shower chair is usually best for a walk-in shower with little or no threshold. It allows the person to sit while bathing, conserve energy and avoid standing on a wet surface. A shower chair should have rubber tips, a stable base and adjustable legs.

A transfer bench is usually best for a tub-shower combination or any bathing area with a high edge to step over. Part of the bench sits outside the tub and part sits inside. The person sits down outside the tub, then slides across and lifts the legs in one at a time. This reduces the need to step over the tub wall while standing.

In general, choose a transfer bench when stepping over the tub is unsafe, painful or tiring. Choose a shower chair when the person can safely enter the shower but should sit while bathing.

Where to Place Shower Grab Bars

Grab bars should support the movements that actually happen in the shower: entering, turning, sitting and standing.

For a walk-in shower, consider a vertical grab bar near the entrance. This gives support while stepping in and out. A horizontal grab bar along the side or back wall can support standing balance and sit-to-stand movement from a shower chair.

For a tub-shower, a vertical or angled entry bar near the tub edge can help with stepping in and out. A horizontal bar along the long wall can provide support while standing or seated. Avoid relying on suction-cup grab bars for primary support. They may loosen over time and are not a substitute for professionally installed bars.

ADA standards commonly place shower grab bars 33 to 36 inches above the shower floor, though home placement should also consider the person’s height, arm reach, strength and transfer pattern.

Add a Handheld Showerhead

A handheld showerhead allows bathing while seated and reduces twisting, reaching and standing time. A hose at least 60 inches long is often recommended in accessible shower design. Place controls and the showerhead where they can be reached from the seated position.

Small height changes can make a large difference in comfort and safety.

A shower chair should be adjusted so the person’s feet rest flat on the floor. Hips and knees should be close to a 90-degree angle. If the seat is too low, standing requires more strength and puts more stress on the knees and hips. If the seat is too high, the feet may not touch the floor securely, which can reduce balance.

A raised toilet seat should also allow stable foot contact. If feet dangle, the seat is too high. If the knees are much higher than the hips and standing is difficult, the seat may be too low.

A handheld shower mount, soap dish and towel hook should be reachable from a seated position. This reduces twisting, bending and sudden reaching, which can throw off balance.

Poor lighting can make water, thresholds and floor changes harder to see. Add bright, even lighting in the bathroom and along the path from the bedroom. Use night lights or motion-sensor lights for nighttime bathroom trips.

People who wear bifocals or progressive lenses should be extra cautious when looking down at thresholds or steps, because lens changes can affect depth perception. Regular vision checks are part of fall prevention.

An occupational therapist can assess how a person moves through the bathroom and recommend equipment, placement and routines that match the person’s body, home and goals.

Consider an occupational therapy home safety assessment if the person has fallen, feels unsteady, uses a cane or walker, has arthritis or joint pain, has had a stroke or surgery, has trouble stepping into the tub, or needs help with bathing or toileting.

The occupational therapist may recommend grab bar locations, toilet equipment, shower seating, transfer techniques, lighting changes, caregiver training or a larger bathroom modification.

Use this checklist as a starting point:

• Remove loose rugs and clutter from the bathroom path.
• Add night lights or motion-sensor lighting.
• Install grab bars next to the toilet and in the tub or shower.
• Use a shower chair for walk-in showers when standing is tiring or unsafe.
• Use a transfer bench for tub-shower combinations when stepping over the tub wall is difficult.
• Add a handheld showerhead.
• Use nonslip mats or adhesive nonslip strips.
• Adjust toilet and shower chair height so feet rest flat on the floor.
• Keep soap, towels and toiletries within easy reach.
• Ask a health care professional about dizziness, medication side effects, vision changes, foot problems or recent falls.

Where should grab bars be placed in a bathroom?

Grab bars are commonly placed next to the toilet, behind the toilet, at the shower or tub entrance, and along the shower or tub wall. The best placement depends on the person’s height, strength, balance and how they move during transfers. In many accessible designs, horizontal grab bars are installed 33 to 36 inches above the floor.

Is a shower chair or transfer bench safer?

It depends on the bathroom. A shower chair is often appropriate for a walk-in shower. A transfer bench is usually safer for a tub-shower because it reduces the need to step over the tub wall while standing.

Are suction grab bars safe?

Suction grab bars may provide a light handhold for balance reminders, but they should not be used as the main support for body weight. Installed grab bars secured into studs or reinforced walls are safer.

What toilet height is best for older adults?

The best toilet height allows the person to sit and stand with control while keeping both feet flat on the floor. A raised toilet seat or toilet safety frame may help people with arthritis, leg weakness or pain, but the seat should not be so high that the feet dangle.

Can bathroom falls be prevented without remodeling?

Often, yes. Many safety improvements are simple: remove loose rugs, improve lighting, add nonslip surfaces, use a shower chair or transfer bench, install grab bars and keep items within easy reach. Some people may need more extensive changes, especially after a fall, surgery or new mobility limitation.

*This article is intended for informational purposes only and should not be substituted for medical advice. For medical questions and advice, it is always best to consult with your trained physician.

Sources: 

2010 ADA Standards for Accessible Design | ada.gov. (n.d.-a). https://www.ada.gov/law-and-regs/design-standards/2010-stds/ 

Fall prevention: Simple tips to prevent falls - Mayo Clinic. (n.d.-d). https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/fall-prevention/art-20047358 

Household safety checklist for senior citizens. (n.d.-f). https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/household-safety-checklist-for-senior-citizens