The bathroom is where falls happen. Here is how we make it safe.

Ask any home health therapist where their patients get hurt and you will hear the same answer: the bathroom. Wet tile, a high tub wall, a towel bar somebody grabbed on the way down. On the first visit to a new patient's home I go straight there, and most of what I find can be fixed for under a couple hundred dollars.

Here is the checklist we use.

Grab bars, mounted into the studs

Suction cup bars are not grab bars. They are decorations that fail at the worst moment. Real grab bars screw into wall studs or use proper anchors and hold a person's full weight. Put one vertically at the tub or shower entrance, one horizontally along the back wall at about hip height, and one next to the toilet. Keep the towel bar for towels.

A place to sit

Standing on a wet surface with your eyes closed to rinse shampoo is a fall waiting to happen. A shower chair or bench turns bathing from a balance exercise into a seated task. For a tub, a transfer bench straddles the tub wall so you sit down outside, slide across, and swing your legs in without ever stepping over the edge. It is the single most useful piece of bathroom equipment we recommend.

A handheld shower head

Paired with the seat, a handheld sprayer lets you wash without twisting or standing. They cost little and install in minutes.

Non slip surfaces, inside and out

A rubber mat with suction cups inside the tub, and a rubber backed mat on the floor outside. Throw rugs without backing go in the trash. If the floor tile is glossy, non slip strips or a treated coating help.

Water temperature

Set the water heater to 120 degrees or lower. Older skin burns faster and reflexes are slower, and a scald is a serious injury. Test the water with your hand before getting in.

A raised toilet seat and a clear path

A raised seat, sometimes with arms, makes sitting and standing far easier on new hips and weak knees. Clear the path from bed to bathroom completely and add a night light, because the middle of the night trip is the highest risk trip of the day.

The routine matters as much as the equipment

• Gather everything before you start: towel, clothes, soap, phone within reach.
• Sit to wash, sit to dry, sit to dress.
• Never lock the bathroom door. A cracked door lets help reach you.
• If you feel dizzy standing up from the shower, sit back down and wait. Blood pressure drops after warm water, especially on blood pressure medication.
• Do not bathe when you are exhausted or right after pain medication makes you drowsy.

When to have someone nearby

For the first weeks after a joint replacement, a stroke, or a hospital stay, we generally ask that a family member be within earshot during bathing even if they are not in the room. Occupational therapists practice the whole sequence with the patient in their own bathroom until it is safe to do alone, and they will tell you when that is.

What Medicare covers

Medicare treats most bathroom safety equipment as convenience items, so shower chairs, transfer benches, and grab bars are usually paid out of pocket. Raised toilet seats and commodes may be covered with a physician's order in some situations. The good news is that a transfer bench, a shower chair, and a set of grab bars together typically cost less than a single emergency room copay.

Where a therapist fits in

A home safety evaluation is a routine part of physical and occupational therapy under Medicare home health. We look at the bathroom, the bedroom, the stairs, and the way in and out of the house, then teach the safe way to do each task in your own space. If you or a parent has had a fall or a close call, ask the physician about a therapy referral, or call us at 844-808-9096. Physicians can fax orders to 904-638-8752.

This article is general information, not medical advice. Equipment recommendations should be individualized by your therapist.