Choosing and Fitting Grab Rails

INTRODUCTION

The aim of this Information Sheet is to provide information on the types of grab rails available to help with specific difficulties, and details about their useful features and positioning.

Although primarily used in the bathroom and toilet, grab rails can be positioned anywhere in and around the home to provide support. Conveniently placed rails will provide help in four ways:

  • To push or pull against when standing up.
  • To provide a steadying support while sitting down.
  • To provide a firm grip when transferring from one position to another.
  • For balance when standing, walking or dressing.

Most are attached to the wall, although floor to ceiling rails are available. The type required will depend upon the situation and the hand or arm strength of the person. A combination of vertical and horizontal rails is often helpful.

For up-to-date information on specific products and suppliers in Ireland, visit the ‘Products Directory' and 'Suppliers’ sections of the Assist Ireland online database (www.assistireland.ie). The information in this resource can also be accessed using the telephone support service on 0761 07 9200 during office hours, or by emailing support@assistireland.ie.

The information contained in this document is strictly for information purposes only. There are hazards with all equipment and the suitability of any solution is totally dependent on the individual. It is strongly recommended to seek professional advice and assistance before you consider buying any type of equipment mentioned in this Information Sheet.

WHERE TO GET HELP AND ADVICE

Before making any decisions about buying any equipment, or making alterations to your home, it is strongly recommended to contact an occupational therapist (OT). An OT is qualified to assess your daily living needs. The OT will advise on possible solutions and will arrange for the provision of suitable equipment to those who are eligible eg medical card holders. The OT can also advise on home modifications, where appropriate, and on grants that may be available to help with the cost.

You can contact the OT for your area through the Community Care section of your Health Services Executive area. Contact details for your local services are in your local area phone book.

PROVISION OF RAILS

Grab rails are generally regarded as daily living equipment, and may be provided by an occupational therapist (see above). If you decide to buy equipment privately it is strongly recommended to seek the advice of an occupational therapist on the suitability of that equipment to your condition or situation.

Mobility Aids Housing Grant Scheme

Since 2007, the Mobility Aids Housing Grant Scheme is available. The scheme is designed to fast track grant aid to cover basic adaptations to address mobility problems primarily associated with ageing. The work allowed under the scheme can be varied and can include grab rails, access ramps, level access showers, and stairlifts. All applications for grant aid under the Mobility Aids Housing Grant Scheme are assessed on the basis of household means. The maximum grant is €6,000. This may cover 100% of the cost of the works and is available to those with gross annual household incomes of up to €30,000.

In cases where grant aid is required for larger work and where the cost of the work is expected to be in excess of €6,000, applicants should apply to their local authority for grant aid under the Housing Adaptation Grant for People with a Disability.

How to apply
The Mobility Aids Housing Grant Scheme is administered by your local authority. All applications must include one itemised quotation from a contractor indicating the cost of the adaptation. The local authority will decide whether it is necessary to refer the application to an Occupational Therapist. This decision is based on the report of the authority's Inspector, the applicant's General Practitioner, and the long term needs of the applicant. For full details of the Mobility Aids Housing Grant Scheme, contact the Housing Department of your local authority.

Private Purchase of Equipment

Private purchase may be necessary if the user is not eligible to obtain the necessary equipment from the local area health services. Some people may also choose to buy privately because they want the wider choice of equipment available on the private market.

Private Purchase – Applying for a VAT Refund

VAT paid on certain equipment which is privately purchased for use by a person with a disability can be reclaimed from Revenue. The relief applies to VAT on the purchase of goods which are aids and appliances designed to assist a disabled person to overcome a disability in the performance of their daily functions. Most aids to daily living and communication aids are included. Goods designed for leisure purposes are not. An invoice clearly stating the VAT content of the total amount paid must be included with the application. Form VAT 61a is available from Revenue or can be downloaded from their website (see Useful Addresses).

Private Occupational Therapists

Occupational therapists in private practice can carry out assessments in the home or workplace, and if home modifications are being considered, provide a report detailing the recommendations. It is important to ensure the therapist is experienced in relation to your particular needs. Make sure to discuss fees before engaging anyone’s services, and also check what the assessment fee includes (or does not include). The profession’s representative body, the Association of Occupational Therapists in Ireland (AOTI), keeps a list of contact details of member occupational therapists working in private practice in Ireland. This list is available from the AOTI (see Useful Addresses).

Private Physiotherapists

Physiotherapists can assess for movement, strength and balance training equipment, walking aids and exercise devices and recommend accordingly. If you wish to consult a physiotherapist you can go directly to your local chartered physiotherapist or ask your GP to refer you. It is important to ensure the therapist you consult is experienced in relation to your particular needs. Chartered physiotherapists work in hospitals and in the community where treatment is covered under the public health service. They also work in private practice and can be contacted through the profession’s representative body, the Irish Society of Chartered Physiotherapists (see Useful Addresses), or through the Golden Pages.

If you do decide to buy assistive equipment privately, it is strongly recommended to seek the advice of an appropriate therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.

TYPES OF GRAB RAIL

When choosing a grab rail there are a number of factors to consider.

  • Check that the rail is comfortable to hold and there is sufficient room between the rail and the wall to allow the person to secure a strong handgrip.
  • It is recommended that there should be a space of about 4-6.5cm between the wall and the rail.
  • Ensure that the rail is comfortable to hold especially if the person has weak or painful hands. It is recommended that the rail should have a diameter of between 3-4.5cm.
  • Coloured rails that contrast with the wall colour are useful for people who have a visual impairment.

Straight rails

Straight grab rail

These are wall-fixed rails which run in one direction only. They can be fixed in a horizontal or a vertical position, or at an incline.

Angled rails

These are wall-fixed rails. The top portion is fixed in a vertical position and the lower, angled part acts as a forearm support whilst pulling up.

Angled grab rail

This enables the body weight to be distributed through his/her forearm which is useful for someone with painful hands or wrists.

Right-angled rails

Right angled grab rail

These are wall-fixed rails with a 90° bend to give both a horizontal and a vertical handhold. Useful in confined spaces.

Floor to ceiling rails

Floor to ceiling grab rail

These are vertical rails which are attached to both the floor and the ceiling. They are particularly useful when positioned on the outer edge of the bath to provide support when turning round to step in or out.

System rails

System grab rail

These are rails which can be put together to provide support over a large area, eg round a bathing area. They attach to the walls and the floor and can be cut to the required length with a hacksaw.

FINISH OF RAIL

The finish of the rail may be important from an aesthetic point of view and also for the grip surface it provides.

Polished/Chrome finish

This finish is attractive and hard wearing but can be quite slippery to hold, especially when hands are wet. The rails are usually supplied with earth bonding kits.

Epoxy/Paint/Plastic finish

This provides a warmer feel to rails, is hard wearing and will reduce the effects of condensation. Choice of colours allows for colour co-ordination of bathroom accessories.

Slip-Resistant/Knurled/Ribbed finish

This is a moulded/coated textured surface which provides extra grip even when wet. This finish may be uncomfortable for those with sensitive hands.

POSITIONING OF GRAB RAILS

Correct positioning of grab rails is important to ensure that they provide the support, where necessary, to perform specific tasks.

GENERAL

Horizontal rails

These help when pushing up from sitting and provide support when lowering, eg on to a toilet. Most people find it easier to push down on a rail rather than pull on one, so horizontal rails are more commonly used.

Inclined rails

Rails that are fixed at a slight angle to the horizontal enable someone with weak or painful arms or wrists to support his/her forearm on the rail whilst pushing up, thus spreading the body weight over a larger area.

Vertical rails

These help when pulling up into a standing position.

One rail fixed at an angle of 45° is not a good compromise as it is not easy either to push or pull on.

Angled rails

For a person who needs a steadying support eg to stand from a bathboard to shower, a rail can be placed at an angle of 45° upwards and away from the user. This keeps the wrist in a neutral position. It is not necessary to lean far forward to grasp the rail at the lower end, and the hand can travel up the rail to maintain the support once the person is standing.

FOR GETTING IN AND OUT OF THE BATH

The bather will often use one wall-fixed grab rail and the outer rim of the bath to push against to help him/her stand up.

For guidance on the positioning of horizontal, inclined and vertical rails to assist with getting in and out of the bath, refer to Building for Everyone (see Useful Publications) published by the National Disability Authority and the Building Regulations 2000, Part M available from the Department of the Environment (see Useful Addresses). Other factors such as the height of the person should also be taken into account.

Other types of support:

Bath side rails

Bath-fixed grab rails

These clamp onto the side of the bath and can be adjusted to the thickness of the bath sides. A vertical loop projects above the sidewall. Rails that attach solely to the bath itself are not recommended, as great care needs to be taken to ensure that the fixing mechanism, usually a screw system, remains secure. This needs to be checked on a regular basis and tightened when necessary. Particular care must be taken when attaching one to a plastic bath, and there is a possibility that the surface may crack. Rails should be both bath- and floor-fixed for full stability.

Cross bath rails

These fix to the wall behind the taps and rest on the bath rims. When sitting in the bath, the rail will be directly in front of the person at about chest height. In this position it will provide stability whilst in the bath, but may not be in an ideal position to help the user to sit down or stand up from the base of the bath.

Tap-fixed rails

These rails are not recommended as they clamp around the bath taps and are therefore only as strong as the tap fixtures. Taps are not designed to withstand a full body weight pulling against them. These rails fold down to rest on the bath rim and can be folded up against the wall when not required.

GETTING UP AND DOWN FROM THE TOILET

For ambulant people it is best to have supports fixed on both sides of the toilet so that the person can use both arms.

  • guidance on the positioning of horizontal, inclined and vertical rails to assist with getting up and down from the toilet, refer to Building for Everyone (see Useful Publications) published by the National Disability Authority and the Building Regulations 2000, Part M available from the Department of the Environment (see Useful Addresses). Other factors such as the height of the person should also be taken into account.

Other types of support:

Drop down rails

Hinged or drop-down support rail fixed to the side of a toilet

These rails are useful when there is no suitable wall on which a standard grab rail can be fixed, or where space is a problem. In areas where there is a wall on only one side of the toilet, they can be used in combination with a fixed rail to provide support on both sides but can be folded up out of the way to allow access for a wheelchair user or helper.

Hinged rails may be wall-fixed (at the back of the toilet) or mounted on a floor-fixed console if the supporting wall is not strong enough. Some rails can be supplied with a support leg which rests down on the floor when the rail is horizontal, transferring some of the load from the wall to the floor.

Wall-fixed and floor-fixed rails

These are static right-angled rails that attach to the wall behind the toilet and the floor in front of it. They are useful for providing support and stability where there is no adjacent wall.

Toilet seats with frames

Toilet surround frame

These are tubular frames, which are designed to provide horizontal support for pushing up from a toilet, or for steadying the body when lowering onto a toilet. The frame, which stands over the top of the toilet, can either be free standing or fixed to the floor. It is essential to fix it to the floor if the person has poor balance or co-ordination, or pushes down more heavily on one side than the other.

GETTING IN AND OUT OF A SHOWER

Shower area with assorted grab rails

  • guidance on the positioning of horizontal and vertical rails to assist with getting in and out of the shower, refer to Building for Everyone 2012 (see Useful Publications) published by the National Disability Authority and the Building Regulations 2000, Part M available from the Department of the Environment, Community and Local Government (see Useful Addresses). Other factors such as the height of the person should also be taken into account.

FIXING OF GRAB RAILS

Grab rails are only as strong as the wall to which they are fixed and the fixings that are used. Unfortunately many modern houses which were built as cost effective, thermally efficient buildings, do not have internal walls that are ideal for the installation of wall fixtures such as support rails and shower seats.

You will need to ensure that you are using the correct type of fixing for the material of the wall.

Traditional brick and concrete blocks

  • Good quality traditional masonry and bricks should cause no problems if the recommended fixtures and procedures are followed. A plasterboard or tiled surface should not effect the fixing, although ensure that the whole depth of the fixing is supported by the masonry.
  • Most dense concrete blocks are strong enough to support rails. However, care should be taken as their composition may make it difficult to drill a straight hole through them.

Lightweight aerated and hollow bricks

  • If the wall is made of lightweight, aerated and hollow brickwork, even the most appropriate fixings may not be able to withstand the loads which can be suddenly applied to rails and hinged arm supports.
  • The insides of the hollow blocks are often filled with a polystyrene type insulating material which will not provide enough support for fixtures screwed into it.
  • Similarly, aerated concrete blocks, which are often used in bathrooms and toilets as the waste pipes are carried through their cavities, are made of a very lightweight substance which limits their fixing support qualities. Supporting fixtures should be attached to this type of wall using specific wall- mounted support products.

Prefabricated partitions

  • Even if a partition or stud wall is physically strong and stable and has a suitable flat surface to take a grab rail, the addition of a backboard on the outside wall is advised when fixing a grab rail to it.
  • This should be a flat, unknotted piece of wood, which is screwed into the vertical joining pieces of the partitions. The grab rails can then be attached to the board. Self-tapping screws should be used when attaching rails to metal stud partitioning.
  • Particular care should be taken when attaching rails to domestic sandwich partitions eg plasterboard with a hardboard facing.

EARTHING OF GRAB RAILS

The Health and Safety Act, 1989 contains regulations to promote safety and reduce the risk of injury from electrical accidents. They require that any metal parts of a building which could become live should be earthed.

If you are installing a metal grab rail in a wet area such as the bathroom, you must ensure that there is no possibility that any metal part which may be touched by the person, including fixing screws, will come in contact with electric cabling. The following types of metal grab rails do not have to be earthed:

  • Metal rails which have a plastic or other non-conductive coating, and a snap- over cover plate providing an insulating layer over the wall-fixing screws.
  • Metal rails where the screws are fixed through plastic seats, and covered by a plastic cap, effectively isolating the screw from touching the rail.
  • Metal grab rails which are fixed to a non-conductive material, such as brick or timber, which definitely has no conductive parts running in it, eg metal pipes which could make contact with the rail via a fixing screw.

There is a small chance that metal pipes within the wall could become live by making contact with a faulty electrical appliance in another part of the building. If one of the fixing screws of the rail is in contact with the pipe, the rail could become live.

If a metal grab rail does need earthing, you will need to attach an earth cable to the rail and run it to the earth terminal in the main consumer unit.

Detailed information on guidelines for installation of metal grab rails in the bath area are covered in the regulations so seek advice from an architect or builder who will be aware of regulations covered in the Health and Safety Act, 1989.

OTHER TYPES OF RAIL

Stair or corridor rails

  • Long lengths of rail are available to provide support for people when walking up and down stairs or along corridors. An interconnecting system of rails can be slotted through wall-fixed brackets or attached to floor fittings. Various lengths, colours and finishes are available.
  • Most staircases have a handrail on one side although this may not extend to the full length of the staircase. Most DIY stores sell handrails which can be used to extend the existing handrail all the way up the staircase if it is required. Adding a handrail to the other side of the staircase will provide more support where needed.
  • Newel rails are designed to turn through 90° around the newel post (the upright post of the stair banister). They provide a continuous grip as the user reaches the bottom or top of the stairs and turns the corner. They are available in a choice of colour and sizes.

USEFUL PUBLICATIONS

  • Building for Everyone (2012)
    Publication which examines buildings and the external environment to achieve equality and inclusiveness for everyone. Available from:
    National Disability Authority
    25 Clyde Road
    Dublin 4
    Tel: 01-608 0400
    Fax: 01-660 9935
    Email: nda@nda.ie
    Website: www.nda.ie

USEFUL ADDRESSES

  • Association of Occupational Therapists of Ireland (AOTI)
    Office 1 & 2
    1st Floor
    Haymarket House
    Smithfield
    Dublin 7
    Tel: 01-874 8136
    Email: info@aoti.ie
    Website: www.aoti.ie

  • Irish Society of Chartered Physiotherapists (ISCP)
    Royal College of Surgeons
    St Stephen's Green
    Dublin 2
    Tel: 01-402 2148
    Fax: 01-402 2160
    Email: info@iscp.ie
    Website: www.iscp.ie

  • Department of the Environment, Community and Local Government
    Custom House
    Dublin 1
    Tel: 01-888 2000
    LoCall: 1890 202 021
    Website: www.environ.ie

  • Revenue Commissioners
    FREEPOST
    Central Repayments Office
    M: TEK II Building
    Armagh Road
    Monaghan
    Tel: 047 621 000
    LoCall: 1890 60 60 61
    Email: cromon@revenue.ie
    Website: www.revenue.ie

  • Disabled Living Foundation (DLF)(UK charity providing advice and information and a comprehensive up-to-date database of disability equipment available in the UK)
    Ground Floor
    Landmark House
    Hammersmith Bridge Road
    London W6 9EJ
    England
    Tel: 0044 207 289 6111
    Email: info@dlf.org.uk
    Website: www.dlf.org.uk

  • Rica(independent research body in UK which produces guides for older and disabled consumers based on professional research)
    G03, The Wenlock
    50-52 Wharf Road
    London
    N1 7EU
    England
    Tel: 0044 207 427 2460
    Fax: 0044 207 427 2468
    Email: mail@rica.org.uk
    Website: www.rica.org.uk