Dementia is classified as a disability and we ask the question in this article whether existing disabled/accessible toilets can be classed as dementia friendly. People living with dementia are arguably some of the most vulnerable people groups who have the greatest need to quickly find, use, and safely exit a public toilet. However, they are also one of the groups that have some of the greatest difficulties in doing so. This is such an important issue as incontinence is a common problem for those who are older and especially in those who develop dementia.
We need to ensure that where churches are providing toilet facilities that we make them as accessible as possible. We must ensure that we avoid the common pitfalls of lack of signage and poor design.
In our experience of carrying out building audits in churches, they are generally very good at providing accessible disabled toilet facilities. However, there is a gap between current disabled toilet design and what is fully dementia friendly. Especially where very modern fitments are used to make statement toilets. Whilst these differences are not significant, as toilets are upgraded or churches embark on projects where new Disabled Toilets are planned the following are worth noting.
Here are a few quick pointers where we commonly see gaps in church disabled toilet provision and what is dementia friendly.
Lack of Signage – Due to incontinence problems we cannot stress enough how important signage is to those living with dementia. This needs to be clear, pictorial and not just there to point the way to the toilet but to also help guide someone back out again and to wherever they may need to go in your church building. As a guide, all signage should use both words, a familiar image or a picture of a toilet and, where directing a clear arrow.
Signage provided is too high – as people age their field of vision reduces and there muscular-skeletal structures begin to deteriorate. What this means in practical terms is that often an older person (especially a person with other visual impairments caused by dementia), have a reduced field of vision and will not see very high up a wall. You could have all the signage in the world but if it is all located at about 1.8m (6ft) up the wall it will not be seen. Signage should be placed at about 1.2m up to a maximum 1.5m up the wall if it is to be seen by someone older and living with dementia, except when it is expected to only be seen at a distance.
Keep signage uncluttered – try not to have a single sign pointing to all different areas of the church as this would be confusing to someone who may have cognitive impairments. Keep signage simple.
Standard toilet height – a disabled toilet should be higher than a standard toilet as this makes it far easier for an older person to use to counteract poor lower limb joints and muscles. We often see standard toilets used in disabled toilets.
Use of Contrasting Colours – As we age, the eyes becomes less efficient, including having a smaller pupil and less effective optical nerves. Many people have the beginning of cataracts which means an impaired ability to see colour and contrast. For this reason, it is really important to ensure that there is a good degree of colour contrast in various areas so that a person living with dementia can see clearly and judge distances. It is important to ensure colour contrast between:-
· the toilet and toilet seat (we often see white toilet seats on white toilets. It is better if a black or dark blue toilet seat is used),
· Grab Rails and wall floor colours,
· Soap Dispensers, Paper Towel Holders, Hand Driers etc and walls (so often walls are white and dispensers etc. are also in white)
· Contrast between doors and surroundings – access to a toilet cubicle where there is a row of cubicles all with the same colour doors and surrounds can look to someone living with dementia like a solid wall. Try, when designing toilets, to use different coloured doors to the surrounds.
However, there are also times when colour contrast can cause confusion. This is especially relevant with floor coverings as if there is a sharp contrast between two surfaces a person living with dementia may see the joining line as a step.
Familiar taps – The moves to modern bathroom fittings can bring much confusion to someone living with dementia. People with dementia may find mixer taps difficult to understand. If you do have mixer taps it is important to ensure that they are well labelled as to which way is hot and which is cold. We have seen in a couple of churches signs warning that the water could be hot but no indication on the tap of which side is hot which side is cold. Traditional cross head taps would be better, ideally with both labels and colour cues to distinguish hot and cold taps.
Lighting – It is really important that the rooms are bright and light for the same reason that the use of contrasting colours is important, deteriorating eyesight
Push Flush Systems – these can require considerable strength in the hands and wrists to use making them difficult to use.
Remember it is important that there are clear way-out signs as such an omission can result in distress, anxiety, embarrassment, and reluctance to use the toilet in the future. It is not uncommon for people living with dementia to need to be rescued by their primary carer or partners as they cannot find their way out of a toilet. Effective interventions, such as putting up clear toilet and exit signs, should be simple and will benefit everyone and not just those with dementia.
If you want to read more about this there is a great book on the subject called Toilet Talk – Accessible design for people with dementia by Mary Marshall ISBN 978-0-9945461-7-3 which can also be downloaded online from -