Within the bathroom, it can be tempting to focus on whether a particular transfer or bathing task can be completed safely. But two bathrooms could both allow someone to complete the same task while placing very different physical demands on them.

One might require reaching, stretching, repositioning or repeated transfers. The other might allow the person to remain well positioned, minimise unnecessary movement and use equipment that can be adjusted to suit them.

Both may be described as accessible. But they don’t necessarily provide the same experience.

For someone with reduced muscle strength or fatigue, the details of a bathroom layout can matter.

• Where is the toilet in relation to the washbasin?
• How far does someone need to move between the different stages of their routine?
• Where is the bathroom positioned in relation to the bedroom and other key areas of the home? If someone is fatigued or has limited mobility, the journey to and from the bathroom can be just as important as what happens once they get there. Minimising unnecessary distances and considering how the bathroom fits into the wider layout of the home can help reduce the overall physical demands of using it.
• Can controls be reached without stretching?
• Does the person need to maintain an uncomfortable position while washing?
• Is there somewhere they can pause or rest?
• Can a carer provide assistance without having to work around the person or the equipment?

These may seem like relatively small considerations. Together, they can make a significant difference to how demanding a bathroom routine becomes.

One recent Astor Bannerman project illustrates this particularly well. When Dan’s family were adapting a new home, his previous bathroom had been too small and the standard bath was too shallow and low once a bath seat was in place. Carers also found it difficult to support him effectively, making bath time physically demanding.

The new bathroom was therefore designed around the whole bathing process. The height-adjustable Astor Comfort bath provided better access for carers, while an Astor Neatfold stretcher meant Dan could be dried over the bath rather than being transferred again while wet.

It is a useful example of how reducing physical effort isn’t necessarily about one piece of equipment. Sometimes it is about removing unnecessary steps from the routine altogether.

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Bathing or showering is rarely one isolated activity. There is getting into the bathroom, preparing to wash, transferring, washing, drying, dressing and leaving. For someone experiencing fatigue, the energy required across the whole sequence matters.

Dan’s bathroom is a good example of this approach. Being able to carry out bathing and drying in the same space removed an unnecessary transfer from the routine, while the height-adjustable bath supported carers at a more appropriate working height.

The result wasn’t simply a bathroom that met a set of accessibility requirements. It was a space designed around how Dan and his carers actually used it.

The ability to adjust the height of equipment can be particularly valuable where strength, mobility or transfer ability varies. A washbasin positioned at the right height can support someone who uses a wheelchair or approaches it differently from a standing user.

And height adjustment can benefit the people providing care too. In Dan’s case, the adjustable height of the bath was specifically chosen to improve access and comfort for carers during bathing.

Independence doesn’t always mean doing everything without help. For someone with muscular dystrophy for example, the right adaptation may allow them to continue doing some parts of their routine independently while making it easier for a family member or carer to assist with others.

The Astor ABW height-adjustable washbasin is a good example of this approach. The original ABW was developed in conjunction with Muscular Dystrophy UK specifically to address the needs of people with muscular dystrophy and progressively changing conditions, with the aim of supporting independence as needs change.

Its features are designed to give the user as much control as possible. Height adjustment allows the basin to be positioned appropriately for different users and situations, while large lever taps and optional infra-red touch-free taps can make using the water easier for people with limited arm movement. The wide, weight-bearing basin surround can also provide additional support for someone who is able to stand with assistance.

These features might seem relatively small individually, but together they can make the difference between needing someone else to complete a task and being able to do more of it independently.

The aim isn’t necessarily to remove assistance. It’s to give the individual as much control and independence as their abilities allow, while making it easier and safer for others to provide support when needed.

That principle is important when designing any accessible bathroom, particularly where someone’s abilities may change over time.

A recent Astor Bannerman project for a wheelchair user moving into their own adapted home demonstrates the importance of considering both sides of this relationship. The client had used the same Astor Kiva height-adjustable bath for 17 years, and the new bathroom was designed with two-sided access around the bath to allow carers to work safely.

The project team also chose to replicate the client’s familiar bathing setup in the new home. Although alternative equipment was considered, changing to unfamiliar equipment would have introduced additional disruption for the client and their carers. This is an important part of accessible design that can be easy to overlook. Familiarity can be part of accessibility too.

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This is where accessible bathroom design becomes more than a question of today’s requirements.

Muscular Dystrophy is a group of progressive muscle-wasting conditions. As strength and mobility change, the physical demands of everyday activities can change too. If changing needs have been considered from the beginning, adjustable equipment, sufficient space and a flexible layout can provide options for adapting the way the room is used.

The project mentioned in the last section was a good example of designing with both continuity and the future in mind. The client was moving from long-term foster care into their own home, and the new bathroom recreated the bathing setup they had successfully used for many years. The familiar Kiva bath could continue to be used alongside a ceiling-track hoist and a layout that provided appropriate space for carers.

The aim wasn’t to predict exactly what the client would need in five or ten years. It was to create an environment that worked for their needs now, while avoiding unnecessary limitations as those needs evolved.

Good accessible design isn’t always about helping someone do more. Sometimes it is about helping them do the same thing with less effort.

For someone living with muscular dystrophy, saving energy in one part of the day can mean having more available for something else – work, family, social activities, hobbies or simply enjoying time at home. That makes energy an important consideration in bathroom design.

Getting the right solution starts with understanding the individual.

That’s why our At Home team has been built around experienced, knowledgeable people who can act as trusted assessors, supporting disabled people, their families and the professionals working with them to understand what will work best for their individual circumstances.

A good assessment isn’t simply about identifying a product. It’s about understanding the person’s abilities, their environment, their routines, the support available to them and how their needs may change.

That wider perspective helps ensure that equipment is selected because it is appropriate for the person – not simply because it is available.

For us, that’s an important part of creating an accessible bathroom that genuinely supports independence, dignity and everyday life.

When considering an accessible bathroom, it can be useful to ask:

“Can this person do it?”

But perhaps the next question should be:

“How much does it take out of them?”

That second question can change the way we look at the whole room.

It encourages us to think about positioning, transfers, reach, height, movement, assistance, fatigue and the sequence of everyday activities. And it reinforces an important principle:

An accessible bathroom isn’t simply a room where someone can complete a task. It’s an environment designed around how that person actually lives.

Our latest article, Bathroom Adaptations & Muscular Dystrophy: Designing for Change, explores the importance of taking a longer-term approach when adapting bathrooms for people living with progressive conditions.

We’ve also created a practical Bathroom Adaptations & Muscular Dystrophy fact sheet for Occupational Therapists and specifiers, bringing together key considerations when planning an adaptation.