Illustration: Michael Kirkham

Grab-bars in restroom stalls are one of the most ubiquitous and visible improvements that have come about since the 1990 passage of the Americans with Disabilities Act (ADA). Yet a design team from MKM Architecture + Design, working on a rehabilitation facility in Grand Rapids, Mich., found that the standard grab-bars weren’t working for patients on the mend from automobile accidents, closed head wounds, and strokes. Achieving ADA compliance, in other words, was in step with the law, but out of step with reality.

In consultation with therapists and staff, the architects conducted a study and found that the standard grab-bars were too high. They instead designed a facility with grab-bars that were lower, closer together, and on both sides of the commode. Michigan’s Barrier Free Design Board agreed, and the design was approved.

When President George H.W. Bush signed the ADA into law in July 1990, after years of advocacy from disability rights organizations and others, it immediately galvanized the architecture profession. In particular, interpreting and implementing Title III of the ADA, which deals with public accommodations for federal and commercial buildings, frequently fell under the purview of architects, who had to get up to speed quickly.

“When the ADA came out, it really changed how people designed and constructed buildings,” says Dodd Kattman, AIA, a partner with MKM and a co-chair of the AIA’s Design for Aging Knowledge Community. “Everyone had to understand this act right away. There were seminars to attend, and as more architects came to understand what was involved, architects themselves became a leading voice in sharing this information. Clients and building owners would hire architects to craft action plans and design modifications. It changed everything for the better.”

Yet, over the past quarter century—even as accessible design has become standard practice—architects have faced numerous situations like the Michigan rehab facility, where standards of accessibility alone failed to adequately provide for a certain population. It is not uncommon for clients to push back on ADA accommodations they feel are unnecessary or too expensive. How much leeway do architects have? And when it comes to the next 25 years of ADA-compliant design, where do they go from here?

A generation of architects has come of age since the passage of the ADA and some architects practicing today have never known a time without it. During that same period, however, the United States has experienced a surge in the elderly population, a trend that is expected to continue as Boomers continue to retire. With more people living longer—and with disabilities—there is broader awareness of the varying needs of disabled populations.

When the ADA was passed, many of the resulting accommodations were designed for wheelchair users—such as disabled veterans— who had a certain amount of upper-body strength which would allow them to transfer up and out of their chair when needed. But for frail older people, or those with other impairments, that type of movement might not be possible. The original ADA also failed to recognize the widespread dependence on caregivers. Restrooms that technically comply with the 1990 regulations might not allow enough space for a caregiver to provide assistance, and multistall bathrooms do not allow in a caregiver of a different gender.

Seven years ago, the Department of Justice issued an update to ADA regulations, the 2010 ADA Standards for Accessible Design, which provide more wide-ranging accessibility standards for a greater diversity of people. Among the more significant changes related to the design of restrooms were provisions for the side transfer on and off a commode from a wheelchair (the original regulations required users to make a turn from chair to commode and back again), more space for caregivers, and accessible stalls for both ambulatory disabled persons and wheelchair users.

The AIA, for its part, is working to increase the knowledge base around the ADA by offering guidance on how the ADA can be interpreted and adapted for different situations, including ranges and tolerances for grab-bars and counters. AIA Knowledge Communities like the Academy of Architecture for Health, the Design for Aging group, and the Committee on Design all deal with the ADA in different ways. Members of the Design for Aging group, for instance, participated in a 2012 white paper by the Rothschild Foundation suggesting new standards around toileting and bathing for nursing facilities and assisted living communities. Among other things, the study found that up to 98 percent of nursing home residents require some level of assistance with bathroom activities, something that should be reflected in a facility’s design. According to Kattman, the foundation’s paper has already been successfully employed as an alternative to the ADA standards.

Since its launch two years ago, AIAU, the Institute’s continuing education platform, has offered several courses on ADA compliance that are regularly among the site’s most popular: “Applying the ADA on Existing and Altered Buildings,” “ADA Tolerances and Acceptable Measurements,” and “Why are ADA-Compliant Toilet, Bathing, Dressing, and Locker Rooms so Tricky?” This last course, taught by Karen L. Braitmayer, FAIA, included 10 mistakes architects make most often when designing these areas, including the wrong placement of side grab-bars and overcrowded areas around rear grab-bars.

What is particularly exciting for architects working in this sphere is how the ADA has changed the landscape of accessibility and allowed architects to go beyond technicalities into more innovative and holistic design. One change that was not required by the ADA, but is the direct result of the culture it created, according to Kattman, is the “family restroom.” Frequently found alongside typical multistall restrooms in airports, museums, and other large public spaces, the family restroom has a door that locks and ample room for a caregiver (regardless of gender) to assist, as well as space for a wheelchair user to turn, a mother to change or nurse a baby, a double-stroller, and so on.

Universal design is increasingly being rewarded, too. The Design for Aging Review, jointly sponsored by the AIA and LeadingAge (a nonprofit devoted to aging populations), is a biannual design competition that rewards innovation in design for aging and disabled people. And manufacturers are finally producing stylish-yet-ADA-compliant grab-bars, sinks, and bathing equipment, further reducing the clinical feel of these accommodations and increasing their appeal.

Going forward, Mark J. Mazz, AIA, who has spent more than 30 years working on accessibility issues and now frequently consults on plan reviews, would like to see even more design competitions require that projects comply with accessibility standards.

“Projects should have that ‘wow factor,’ and they should be accessible,” Mazz says. “The best accessibility is when you make it invisible to people. The whole concept of universal design is to make it good for everybody.”