As the Centers for Disease Control recommend that older adults use grab bars in the bathroom to reduce falls, it is crucial that grab bars in the bathing area be installed properly so they do not pull out during a fall. It is well reported in the literature that the best installation methods to meet both building codes and safety standards are to install grab bars either into blocking, into studs, or into tile using a special fastening system. However, many handyman and city-funded agencies install grab bars with only anchor bolts and stainless steel screws, directly into the bathroom tile wall without regard to the placement of the studs. Several community agencies who serve low income older adults are hesitant to utilize these city-funded services, as they are afraid their clients may sustain injuries during a fall.
Last year, GEM convened a preliminary meeting to examine the issue. The first meeting only brought the complexities of the problem to the forefront: lack of documentation on the incidents of grab bars that pull out of the wall when installed with only anchor bolts, cost increase of utilizing methods other than anchor bolts, and confusion over what installation methods did and didn't meet New York City Code requirements.
The meeting on March 21, 2002 brought together various experts in the field. In attendance were Sal Sisto, engineer and President, WingIts, Maggie Higgins, Director of Home Repair Program, New York Foundation for Senior Citizens, Ken Lewis, Director, United Home Services, Jack Kupferman, Attorney, Verone Nelson, Contact Administrator, Housing, Department of Aging, Dana Smith-Acosta, Physical Therapist, Visiting Nurse Service, Vera Prosper, Housing Policy Analyst, New York State Department of Housing, Ron McLearie, Director of Architecture, EPVA, Kathleen McNeil, Product Development Maddak, and Rosemary Bakker, Director GEM (interior designer/gerontologist).
Rosemary Bakker gave an introduction. One purpose of this meeting was to critique various methods of current grab bar installation techniques. One of the goals of the meeting is to change the way grab bars are currently installed by home repair agencies. What installation methods will sustain 250 pounds of force, Which is the requirement of New York City's building code? What are the typical bathroom wall structures in New York City? If we the change the current installations method, cost-efficiency need to be addressed. Currently grab bars are installed into ceramic tile using just plastic anchors and stainless steel screws, without regard to stud placement. The purpose of making homes safer is to get people living at home longer, and to prevent falls. GEM has been recommending to social work agencies that they install grab bars in the residents of their older clients, but are the current installations safe? Many experts state that if the wall is secure, grab bars can be used as a grip, but if a person falls, the force could pull that bar out. The meeting today will examine various ways to install grab bars and examine who is liable if the grab bar pulls out and a person falls. Is the tenant, installer, or landlord liable.
This task force is meeting to explore what is the correct way to install grab bars in order to prevent falls and liability.
Ron McLearie, an architect, representing Eastern Paralyzed Veterans Association (E.P.V.A.) gave an overview of some of the issue regarding the NYC code for shear and tensile forces. Mr. McLearie spoke of New York City's Building Code mandating that a grab bar should support 250 pounds of force. There are two main forces they take into account, shear force, which breaks a bar in half and pull out force. The directional force of falling exerts more pressure.
There are three ways to install grab bars: into blocking, into studs, or into a WingIt fastener (information is available on WingIts on www.WingIts.com.) The WingIt can sustain up to 800 pounds of force. Plastic anchors and steel screws do not meet building code code. Mr. McvLearie mentioned that he was going to ascertain that EPVA's installers were only using one of the code compliant methods, and not just using anchor bolts and screws.
Ms. Bakker spoke about an interview she conducted with a contractor who used Wingits. The contractor reported that the grab bar installer must be trained to install this fastener, and be prepared to use other installation methods as the Wingits Fasterner cannot always be used, especially when the wall is against another tenant's space and space inside the walls is inadequate. With WingIts, you should not go into a stud, so you need to know where the studs are.
Attorney Jack Kupferman discussed liability issues. If an agency installs grab bars using only screws and plastic anchor without asking the landlord, who is liable? Mr. Kupferman addressed this generally. The liability issue depends on permission and who did the installing. If the tenant requests the grab bar and the landlord uses a city agency, probably the liability is between the landlord and installer. A key question is: "Is there a reasonable expectation that something could occur?"
Mr. Kuperferman also spoke about the need to address housing stock issues. There might be eighty year-old tenement buildings with crumbling walls, pre-war buildings with solid walls, or new buildings with sheet rock. If studs have been in for 90 years and are still structurally sound, should the landlord give permission for grab bars? The integrity of the building structure is an issue. If the tenant signs off, sometimes a liability case still holds up, sometimes not.
Maggie Huggins, Director of Home Repair Program, talked about how her agency uses tub-mounted hand-grips instead of wall mounted grips, whenever possible. ...which are used as a guide, or for support, but not fall prevention. They will come out if you fall. She said her program hadn't taken into account the factor of extra force for a fall, and wanted to learn more about it so that they could do a better job.
Sal Sisto of WingIts gave information about his grab bar fastener, WingIts. Rosemary Bakker read a quote from a grab bar instruction sheet from a major grab bar manufacturer: "Warning: Grab bars are not stronger than the anchors and walls to which they are attached and must be firmly secured in order to support the loads for which they are intended." (Bobrick Technical Data Sheet 8113660, 2001). Mr. Sisto said that his company had first started with aerospace testing, and that he has tested more grab bars than any other organization he is aware of. He spoke of the various forces that are involved during grab bar usage. American with Disability Act (ADA) recommends 250 pounds dead load force, but there was also pullout force, moment force, and other forces. Shear force is measured parallel to the wall; vector forces and vibratory forces are measured three inches from wall; and slipping creates momentary forces. Mr. Sisto then demonstrated the effects of a three hundred pound man (Mr. Sisto himself) stepping on a grab bar installed on a prototype wall (1/2" sheetrock with ceramic tile) with a WingIts fastener, and. the bar did not pull out. Mr. Sisto stated that 300 pounds of weight creates 450 pounds of moment force. Pulling out on the bar would exert 150 pounds of force or less, but slipping and grabbing on would generate much more force. Mr. Sisto does not agree that it is safe to install grab bars into studs. If the drill hits outside the 3/8 inch stud, on either side, it splinters (thus you have _ inch span left.) The fastener must maintain 250 pounds in every direction, and dry wall loosens up over time. What will it look like in 40 years?
Kathleen McNeil, in Product Development at Maddak, spoke further about handgrips, which are useful as a guide, or to assist balance, but not to support full body support. ADA has exact guidelines for placement of grab bars.
Sal Sisto elaborated on WingIts and the question of needing space inside a wall to install them. He spoke about the different wall structures in the U.S. Reverse WingIts with threaded members should be used for 2 by 3 walls, which often exist in hotels and NY City where space is an issue, and regular WingIts, which should be used for 2 by 4 walls. For a solid wall, WingIts are not needed. WingIts will certify their work only if it will sustain 450 pounds of force in every direction indefinitely.
Maggie Higgins, Director of Home Repair Program, said that they dealt with clients in their 80's on limited incomes living in 100 year-old houses, or fifty year-old houses, and the grab-bar issue makes her organization nervous. Grab bars on the edge of tubs is her chosen method as wall integrity may not be there forever. They encourage bath chairs and home attendants for the frail populations they serve. Ms. Bakker mentioned that tub mounted bars are not useable on tubs that have angled walls or curved rims, which is exactly the type found in older residences where many of the elderly live. Ms. Bakker also stated that tub bars are not meant to be used to pull oneself up from the bottom of the tub floor, but only while "standing". Ms. Bakker mentioned that tub mounted grab bars could be dangerous if used improperly as they can easily dislodge.
Jack Kupferman said that much depended on the type of deterioration or disability of the person. Sometimes a grab bar would be needed "just in case". It might be used only once or twice in a lifetime. Others needed it on a daily basis. The group discussed universal design, and raised the question of when grab bars should be installed for prevention. Should we install them in our bathrooms at sixty-five? Seventy-five? Some expressed the feeling that anyone can slip, and we should all have grab-bars.
For a "hands on" demonstration, Rosemary Bakker passed around various wall mounted grab bars including brushed, peened, knurled, true grit surface cover, nylon, rippled, and satin epoxy coated, and addressed the issue of the importance of a "non-slip" finish. Sal Sisto said that the friction coefficient for epoxy coated grab-bars is good until you put on soap and then it is lowered. Ms. Bakker also spoke about the variety of diameters that grab bars are available in for home use, from 1" to 1-1/2". She mentioned that in a small study conducted by the American Association of Retired Persons, most older adults preferred the smaller diameters (1 to 1-1/4") as they were easier to grip. Mr. Sisto stated that it is important not to choose a bar that is too thin as it can be hard and painful to grip during a fall, and for people with large hands, there is not enough surface to grip.
Rosemary Bakker spoke of the importance of colors not just for aesthetic reasons, but also for people with low vision (not white on white). She spoke of the general guidelines on locating wall mounted grab bars. Horizontal bars are easiest to grab onto during a fall. She spoke of the various complaints regarding angled and vertical bars: hands can easily slip during use and these positions are not appropriate for transfers.
The group spoke about the importance of proper installation techniques, including caulking so the inside of the walls remains dry. Another technique for drilling into "slippery" ceramic tile is to put masking tape over the drill area. This will help the drill bit from slipping
Ms. Bakker asked Ms.Verone Nelson what the City's position was on funding city agencies that install grab bars that do not meet code and may be dangerous to use. Ms. Nelson stated that the topic had not be addressed previously, but that this was an issue that she was very much interested in exploring and is currently working with Ms. Bakker is writing an article for GEM's website. Mr. Kupferman expressed the conviction that the city would not accept liability for accidents, since they contract out the work.
Rosemary Bakker raised the key questions: What is safe, what is unsafe, and what do we as a group want to promote? Dana Smith Acosta, a physical therapist with Visiting Nurse Service (VNS), said that her agency was nervous about recommending wall-mounted grab bars. Their clients are primarily older adults with a high incidence of falls. VNS recommends transfer tub benches that can be used without wall mounted grab bars, rather than grab bars. Ron McLearie vouched that transfer tub benches are safe for wheel chair transfer.
The group discussed fastening systems further, and the importance of using the appropriate fastening system for the wall or stud composition. Plastic and metal anchors were briefly discussed. According to Sal Sisto, a #10 is the only screw that should be used when installing directly into a stud, and a #12 screw for blocking. Mr. Sisto also stated that toggle bolts, even when installed into metal studs, can deteriorate over time (from a month to two years) and loosen up. Mr. Sisto stated that this installation method does not meet code.
Vera Prosper, a Housing Policy Analyst raised the issue of aesthetics. She felt that designing grab bars to be appealing was important to encourage usage. Mr. Sisto agreed but stated that it increases cost. A stainless steel grab bar is $15; a decorative one would raise the price to $30. Government aid would not cover this differential. He added that if the customer wants the item installed in a way that is not done to code, it is important to get a waiver from the customer that you are doing this at the consumer's request.
Rosemary Bakker stated that it is difficult to find installers in Manhattan who will install grabs bars according to code; she only know of two installers, including the EPVA, who have a three-month waiting list. She stated that the next step in increasing safe bathing practices and reducing fall risk in older adults is to sponsor training of installers in "Grab bars 101".
Meeting was adjourned at 4:00pm
Directly following the meeting, Ron McLearie of EPVA asked for GEM's participation in testing different grab bars fasteners in their lab in Fort Totten, New York. For information on the test data, please see Grab Bar Fastener Test Data.