When is a Changing Place not a Changing Place?

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A somewhat heated debate has begun regarding Changing Places – toilet spaces which include a hoist and a bench for disabled people.

Partly this is due to two things:

  1. A new type of toilet called Space to Change
  2. Changing Places being built which do not meet the British Standard for space requirements.

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Space to Change

Space-to-Change-Closomat_360_360_int.png A campaign from Firefly, and supported by Clos-o-Mat, is promoting a toilet with a 7m square Space to Change (3m x 2.5m min). This space has a hoist, changing bench and many of the facilities you would find in a regular wheelchair accessible toilet.

The campaign has been going since 2014 and this minimum size and fixtures/equipment is a useful alternative for businesses who just don’t have the space for a Changing Place.

Clos-o-Mat provide more information on this section of their web-site.

They are to “bridge the gap between typical ‘Document M’ accessible toilets and the ultimate, a Changing Places facility”.

It is marketed as a ‘if you have to provide a wheelchair accessible toilet then you might as well add a bit of extra space for a bench and a hoist’.

Advantages

  • This seems very sensible as the reality is that small venues may simply not have space for a large CP toilet layout which has a minimum of 12 m square.
  • Might encourage more toilets to move from Doc M basics to Space to Change.
  • Costs may be less

Disadvantages

  • Not currently referenced in Doc M (will it be included in the future?) unlike CP toilets. CP toilets are mentioned as desirable.
  • Not included in the current British Standard like CP toilets are.
  • Hoist may be a portable hoist – which in this small space, might make it unusable for people with extra large powered wheelchairs and two carers, or moving between toilet and bench via hoist.
  • Large venues like stadiums and shopping centres/leisure complexes might drop down to this small format when they could easily accommodate a full CP toilet.
  • Should not be listed on the CP toilet map – but maybe the map should include CP and STC toilets? I personally don’t want to trawl through two separate toilet maps or lists of different ones held by two organisations to find a toilet.
  • Changing benches do not have to be height adjustable.
  • A large waste bin for pads is not specified aside the regular bin inclusion for sanitary waste and a ‘waste bin’ found in regular toilets.

It is important to note that neither a CP or STC toilet are required within the law for building regulations.

Further debate on the size of installation…

People are spotting toilets included on the CP toilet map which are smaller than the British Standard. It is worth noting that in the early days (prior to June 2013) of CP toilets, the standard was 7 m square – and are included on the map. Many people are getting these confused with ‘Space to Change’ toilets going on the map.

A more recent (2014) installation at Emirates Stadium is said to be smaller than the CP standard yet heavily promoted as a full CP toilet.  From the photos it does look a lot smaller than standard.

For other people, branding is a big issue – some toilets using the CP symbol where no hoist exists and other CP toilets calling them other things like ‘Adult Changing Room’ and ‘High Dependency Unit’.

I have been in small changing places fitted before 2013 – and space was an issue. However, often the layout is poor – space is more about location of equipment not just physical room size. My bathroom at home is fairly small yet I still have room to hoist with carers.

What we found out

So, the debate continues, meanwhile the new British Standards are being looked at and we had the opportunity to submit thoughts and recommendations from our readers and project contributors.

There was a clear need for a range of toilet spaces in size and equipment for small buildings. Also that in larger buildings such as cinemas, stadiums, shopping areas, hospitals, parks/tourist venues and large work places – then even a full CP toilet isn’t meeting people’s needs and that the Standard needs to be raised to support the large number of people who need adjustable toilet risers and washing/drying bidets.

 

 

 

 

 

 

Guest blog: Audio described toilets

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This month we are looking at accessibility features for blind and visually impaired users.

We came across an interesting product that audio describes toilet layouts -so we were delighted to hear all about it from the company, ADi Access. Please contact them directly if you are interested in purchasing this access feature.

Find out where they are installed on this map if you are looking for a toilet with audio description.

About ADi

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ADi Access is a Cornish company formed in 2014 to imagine, design and build products that give disabled users increased dignity and independence in their everyday lives.  Their first product is the RoomMate ®, which provides an audio description of the room layout for Visual Impaired users.

Visit: www.adiaccess.co.uk for prices and information.

 

My fellow writers mention hospitals a lot so let me start by asking how would you use a disabled access toilet if you were Visually Impaired?

Ask a friend to help perhaps? Or more likely your significant other? A member of staff? A complete stranger even?

Whichever answer you decided on the fact is that all four strip you of the very thing that we are constantly campaigning for, Dignity and Independence.

Related: Scots fear blindness more than other long-term health conditions

Regardless of your disability, whether you are wheelchair bound or Visually Impaired the options available to you are still extremely limited and having someone there to help you for such a private task is a necessary evil.

But then we had an idea..

RoomMate.jpgWhat if we could take the notion of the ‘helper’ who verbally explains where everything is in the facility and lose the human presence?

18 months on, through successful trials and 5 prototypes we’ve done just that with the RoomMate [room mate]

The RoomMate  ® solves a very big problem very simply. 

Unlike many of today’s solutions there is no need for technical input from the user, this means it can help everyone from children to the elderly.

Each unit is uniquely programmed to its location and, on detecting anyone that enters, offers to provide them with an audio description of the facility.


 

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Steve Holyer was a BT Engineer at Goonhilly Earth station until failing eyesight forced him to retire early. He is now almost totally blind.

My vision for the future is for ADi to expand and provide further products to address the difficulties that I experience every day as a blind person.

He shares his experiences and tells us more about the benefits of this product

The Equalities Act has been responsible for many wonderful innovations over the years, with inspirational initiatives and products being invented that provide help, dignity and Independence for those of us living with a disability.

But, in my experience the words ‘dignity’ and ‘independence’ only really begin to mean anything when you, or someone close to you, loses them. 

Toilets are mostly built around convenience, cost and speed for the plumbers and electricians and although a facility must be designed to comply with regulations, this doesn’t mean they necessarily have to make sense. 

Believe it or not, Helen and I have yet to find two identical toilets, even in the same building…  

This probably sounds a bit far fetched when you consider the amount of regulations that have been written over the years but is it really that surprising? 

Can you imagine the electrician actually sitting on the loo and deciding the best place for the Emergency pull-cord instead of just choosing the easiest spot to wire it in?

Crucially, if you are confined to a wheelchair then you can at least see where the pull-cord is or that the hand drier is in the wrong place, miles from the sink but how do I?

The trouble with toilets is that they are just THERE, an everyday thing that people just don’t think about until a disability forces them to. 

It reminds me of a quote: ‘People aren’t against you, they are just for themselves’.

Even disabled access toilets suffer the same fate beginning with the simple sign on the door. 

The sign tells me that the facility is wheelchair friendly, not disabled friendly, so for me as a blind user I know that there is more than likely no provision to help me use it without a friendly pair of eyes to guide me. Where’s the dignity and independence in that?

Developing the RoomMate has meant we’ve met a ton of people, MP’s, business owners and doctors, you name it we’ve probably met them and I keep reminding myself of the quote above, that people aren’t against me they just don’t understand how they can help me’, well now they can.

The RoomMate is an electronic, wall-mounted device, which offers Blind and Visually Impaired visitors bespoke audio description in a disabled access toilet, thus freeing the person to use the facility independently.

Each unit is programmed to explain the layout of the room that it is in to enable the visitor to visualize the layout for themselves.

Having a RoomMate means that no third party needs to be present, whether a partner, member of staff or even a total stranger which avoids the potential for embarrassment for everyone. 

Each unit also comes complete with a high visibility door sign to indicate that the facility has a RoomMate installed.

Guest blog: Rising to the toilet challenge.

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Fiona very kindly agreed to be our guest blogger this week. Find out about her experiences accessing the toilet inside her home, at work and when out and about.

We discussed lots of toilet challenges – which we’ll be popping in another blog post around April. 

What was your earlier method of using the toilet?

From a very early age my gran and mother was of the “hover” at public loos brigade. I now find myself 33 with MD, a muscle wasting disease, and no longer able to “hover” or stand up from sitting on a toilet.

Which kind of adaptations have worked well for you at home and work?

Everyone is different. But in general I need a loo that rises to either stand me up or line up with a chair.
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At home I have a purpose built wet room which includes a Riser (adjustable height)Lima Lift, Clos-o-Mat wash/dry WC. Riser Sink (adjustable height) so I can access sitting or standing dependent on task or energy that day.

I have an open level floor wheel-in shower with Body Dryer and multi positioned grab bars in shower and beside sink and WC.

I also have full length mirrors to suit me sitting or standing. My shower is mounted at a height suitable to operate from my wheelchair or standing.

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In my (original) upstairs bathroom (and workplace) I still use a Mount-way riser seat. For me this is great as space in my small bathroom is an issue, I can only access the WC and have different solutions for hand washing as my chair doesn’t fit in the room.  The Mount-way is great for me as I can still weight load but for some the angle of tilt is not suitable due to weak legs. The tiles are also a little more dangerous in a bathroom that is used for washing when the floor may become slippery.

It’s worth noting that their can be a problem with my Mount-way riser loo batteries running out. I’ve  been left well.. sitting duck on the potty comes to mind when there is simply no “up” left in me.

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All of the above along with my riser wheelchair are priceless to me as it gives me total independence and privacy when at home.

What about outside the house – that must be difficult?

Now in an ideal world I would have my home loo set up every time but sadly not.

So for many people like myself have to resort to withholding fluid. This is a gradual thing done over many years that you dont notice it happening. I am at the point when I can’t sit to stand unaided without grab bars, riser toilet/chairs or helpers.  So as well as being denied access to the WC, the restriction in toileting,  bars me from eating out, cinemas, visiting friends, key social activities everyone else takes for granted.  

I can’t eat or drink socially as I cannot independently toilet and it is worth noting that not every disabled person has access to family or paid carers.

How have you adapted to changes in your strength, do you worry about the future?

I have been evolving with my condition for forever.  I have always had the eye on what’s next to fix that. Well unfortunately the world wide WC problem has me stumped. There are various gadgets for ladies to pee standing and from chair and all are great inventions. However,  sadly I think the only viable step would be catherisiastion as balancing in unsuitable bathrooms is dangerous or even finding enough WCs –  and frankly this makes me both sad and angry that yet another function will be taken away from me before it is medically necessary. My bladder is fine I just can’t hold it for up to 8 hrs and eat and drink.

What else would you like readers to take from your experiences?

This is not luxury. We need clean safe loos and lots of them. We have a right to open the door without that intake of breath and worrying about ‘what have we got this time’. We have a right to have enough room for us and up to 2 carers to work. A right not to be fed or changed on the toilet floor. To be able to leave our homes without being catheterised before we are ready. Being catheterised should be my design or for medical reasons and not based on the lack of suitable WCs in the community. Please give us our dignity let us pee in peace.

Fiona, Glasgow, Scotland 


 

[Sub note: Whilst Changing Places offer a large space, adjustable height bench and a hoist, many people are not at ‘hoisting stage’ because they can still weight bear. To hoist requires the ability to carry a sling with you and be with someone trained to take it on and off.  Like Fiona says, not everyone has assistants/carers or family who can help them, with them at all times outside the house. When people can still stand (but not get from a sitting to standing position), it is a height adjustable toilet or toilet riser system that is needed, not just hoist facilities.

We feel height adjustable, wash/dry toilets should be standard in all Changing Places toilets.]

 

 

Guest Blog. It meant I could have a drink.

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This month we are focusing on the needs of people who need help or equipment to stand up from the toilet.

Find out more about our topic and people who might experience difficulties in this post.

Our first guest blogger shares their enlightening story …

(Guest blogger has chosen to remain anonymous, South UK)

I live with a muscle wasting disease. It is progressive and over the years I have had to adjust to my declining physical state. I have come to terms with the loss of dignity and independence and I am accustomed to family, friends, carers and strangers assisting with the most intimate of tasks. The times I got stuck on toilets and had to be helped up by strangers of either sex was no fault of mine. This disease progresses as it will it seems; one day I could get off a regular water closet with a great struggle, the next I could not get off even with the knowledge that I was about to invite a stranger to rescue me from the most embarrassing of positions.

You would think that a hospital would have the facilities and knowledge to ensure that all people who use it could use the toilet. It is the most basic of needs! I have had surgeries when I would not be allowed to leave until I had used the toilet. Now, even with the help of carers, there is hardly any toilet in my local hospital that is accessible to me. I have had to resort to even more creative solutions when enduring any of my frequent hospital visits. There is no point wearing a diaper as there appears to be no toilet that has a hoist or a changing table. I try not to drink before most hospital visits but sometimes the appointment is for a scan and the instructions are to drink 2 litres of water before the procedure. 

For now, I can just about manage to pass urine into a bottle. I cannot sit on the toilets as even if I wanted to attempt a side transfer my carer could not fit into most toilets with me and my bulky wheelchair. Even when we do fit in a toilet the toilet is too low for a transfer and there isn’t enough space to park parallel to the toilet. So, whenever I need to go to hospital I use Imodium and Desmomelt when I want to avoid the toilet. Yes, it is drug abuse, but I consider it a pre-emptive strike so I do not have the indignity of needing the toilet and not being able to use it. 

More space to transfer helps. If there could be height adjustable toilets that would be great. 

I remember my excitement when I visited the Essex Coalition for Disabled People and saw a raised toilet seat in the toilet. It meant I could have a drink.

[Thank you to ‘anonymous’ for sharing this story for our project)

Unable to stand up from the toilet?

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Our topic for this month looks at what people do if they can not stand up from a toilet (sitting to standing) – yet may be able to walk or get in and out of a modern powered wheelchair, unaided. How do people manage inside and outside their home?

We will be adding links below to our guest bloggers and hearing about this dilemma which affects hundreds of thousands of people in the UK.

Building Robots

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More to the point – what has it got to do with accessible toilets?

Well, we need to understand the complexity of normal body movement and posture – to learn about what can go wrong.

Only then can we see why so many people might not be able to use even the best of accessible toilets outside their home, such as Changing Places.

Human movement is amazing – when it works.

Because humans have a complex body to replicate, even the best robotic designers find it a major challenge to reproduce our abilities.

 

In a very simple form, humans need:

  • A solid framework to attach muscles to (skeleton of the right shape and material)
  • Muscles, tendons, connective tissues (allowing us to push, pull, bend, rotate etc)
  • Nerves and brain function to co-ordinate / activate muscles (for tone, balance etc)
  • Feedback and fine tuning network 
  • Fuel to ‘use up’ when performing the actions (nutrients, oxygen and a range of chemical exchanges to make electrical impulses for example).

Can you imagine how a problem with just one element of the above might prevent people form being able to remove clothing, sit on a toilet, clean themselves, stand up again etc.

Standing up from the toilet

From the muscles in your toes right through to the muscles in your head and neck (and all the electrical and chemical activity between your brain/spine/muscle) that’s a lot of things that need to be functioning well to go from a sitting to standing position.

So what type of impairments might someone have that could cause difficulty or an inability to stand up from a regular toilet?

The key problem areas are medical conditions which affect balance, muscle strength and co-ordination.

  1. Cancer (weakness, balance, thinking – varied effects on the body depending on severity/location)
  2. Stroke (balance and muscle weakness)
  3. Cerebral Palsy (affecting movement and co-ordination)
  4. Lower limb amputation(s) (balance, movement range)
  5. Spina Bifida (nerve damage with varying affects)
  6. Spinal Cord Injury (nerve damage with varying affects)
  7. Fibromyalgia (chronic pain condition)
  8. Osteoporosis (can cause limbs to twist, pain, joint movement problems)
  9. Chronic Fatigue conditions
  10. Chronic Arthritis and Rheumatoid Arthritis (range of movement, deformity, pain, balance)
  11. Multiple Sclerosis (can affect strength, balance, memory, thinking, vision)
  12. Neuromuscular Disease (hundreds of different types and sub-types causing muscle weakness  e.g. Muscular Dystrophy, Motor Neurone disease, Spinal Muscular Atrophy, Guillain-Barre Syndrome, Polymyositis)
  13. Weakness caused by old age
  14. Brain disorders
  15. Medications (medication to lower cholesterol can cause limb weakness for example)
  16. Parkinson disorders (stiffness, balance, movement, thinking, co-ordination, fatigue)
  17. Leg trauma (fractures, sprains, strains)
  18. Spinal degeneration, abscess or tumour

 

Solutions at home

riserSome people manage at home by have a toilet seat riser – making a standard toilet seat 4-5 inches higher. Riser frames and other types are also available to provide a fixed height.

All wheelchair accessible toilets in the UK must be able to take the addition of a raised toilet seat (but are almost never provided probably because if you have that level of impairment you’re unlikely to be able to fit one without help).

Many people still find these too low or it leaves them dangerously high with their legs dangling in the air, unable to touch the floor for balance whilst seated.  These people require the use of a toilet seat or toilet pan that can be electronically raised and lowered to suit their requirements.

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Above, Aerolet vertical and tilt from Clos-o-Mat [Source: Clos-o-Mat.com]

Often people ‘drop down’ onto a lower toilet (and to be able to sit with feet on the floor for balance) then raise the toilet very high, so they can slide down onto their feet, to get off. Changing Places and ‘wheelchair accessible’ toilets do not provide a removable raised toilet seat nor height adjustable toilets as part of their standard of provision.

People who are unable to stand at all, or push up with their arms, will use a hoist to get to and from the toilet.

No solution outside the home

There are hundreds of thousands of people who can walk (or raise their wheelchairs up to help them stand) and don’t have full time carers or assistants with them, yet can not stand up unaided from the toilet.

Clinics might provide perch stools or extra high seats in hospital waiting rooms for example, yet provide only toilets with low seat heights. Hospital staff won’t help pull you to your feet because of policies which forbid lifting/assisting in this way.  If that’s the level of support you get in a hospital – what about generally out and about?

Public venues could easily provide a raised toilet seat and staff to secure it, if they wanted to help people – but they don’t. Outside the home, if you can’t stand up from a toilet your can’t use it.

In one instance, this meant a disabled lady had to deficate into her hands in a standing position. We should be ashamed at not providing proper facilities in the UK. 

This month, we are publishing the stories of individuals who have the dilemma of not being able to use toilets outside their home – and why Changing Places are not meeting the needs of people who need height adjustable / higher toilets.

No toilet = No inclusion

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A simple message for International Day of Disabled People.

I’ll say it again and again and again until the day I die.

How are we (disabled people) supposed to be included and have opportunities to do the regular stuff (work, education, leisure, travel, family life) and stay healthy if we can’t go out because there are no usable toilets we can access.

No toilet = no inclusion = a message ‘we don’t give a &*£@’.

We need things to change NOW please.

Yours Sincerely, a person who can rarely find a usable toilet.


 

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This toilet needs your help

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What if toilets had feelings?

Toilets need your help, today.

Today we bring you a toilet and a sink which have not been treated equally like the other toilets.

Left neglected and abandoned by their owners. No toilet should have to be this way.

They have been incapacitated by the lack of care and maintenance given to the ‘regular’ toilets and if they could ask for your help – they would. They are crying out in desperation.

All they want to do is provide a safe, hygienic place to go to the toilet. A place of comfort and dignity. Many will see only pain, tears and distress. Wrong fittings, missing support rails, cramped spaces … the list is long. All they can do is watch helplessly.

Today a frail elderly man fell because there was no support rail – and no emergency cord to get help.  I felt responsible.

Yesterday a severely disabled little boy had to be changed on the floor, right next to me and the bin. He was too heavy for the baby changing table.  I kept willing him to try not to wave his arms around and touch me because of all the germs. Of course he couldn’t help it. My heart was breaking. I wanted to help. There was nothing I could do. My room didn’t have anything better to offer.

[Anonymous Toilet in Kent, UK]

Isolated

People stay at home more where they have fully accessible bathrooms – leaving toilets like these isolated and lonely.


We can change things

Act now and together we can change things. You can do something to help toilets like this.

Customers – tell people what is wrong. It costs you nothing and provides businesses with an opportunity to put things right.

Managers and architects –  offer hope to these poor toilets.  No toilet should have to suffer this way.

Just £67 could buy this toilet room a new tap or fix the existing one.  £100 could enabling local people to fix the flush and understand why it needs to be reachable from the space beside the toilet.

 

 

You could use ‘Euan’s Guide’ cards to remind people not to tie up the emergency cord and take away help from people who might desperately need it.

[We took the opportunity to provide one for the ‘accessible’ toilet at the Fairway pub, Ickenham, Middlesex featured in our video]

Save a life

You could save a life and help toilets provide a safer, cleaner and more dignified experience for their users.

Thank You.


World Toilet Day 2015

World Toilet Day is THE day for action. It is the day to raise awareness about all the people who do not have access to a toilet, and the urgent need to end the sanitation crisis. And it is the day to stand up (or sit down or squat if you prefer) to do something about it.