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.
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. Contact Revenue’s Central Repayments Office to request Form VAT 61a (see Useful Addresses), or you can apply online for a VAT refund using eRepayments in Revenue’s myAccount service.
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).
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
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.
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
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
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
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 or ordered to the required length. Bends and angles can be fitted where required.
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.
High contrast rails
It may be helpful to choose grab rails in a colour that contrasts with the wall it is to be installed on if the person has low vision.
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. The ideal position for you will depend on your own unique needs, preferences, measurements and home environment.
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.
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.
Getting in and out of the bath
When standing from a sitting position in the bath you may find it helpful to hold one wall-fixed grab rail and the outer rim of the bath to push against to stand up. Grab rails in the bathroom should have a ribbed or textured surface to give extra grip when wet.
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 Housing, Planning and Local Government (see Useful Addresses). Other factors such as the height of the person should also be taken into account.
Other types of support:
Bathside rails
Floor-mounted bathside rails
These are screwed to the floor and also clamp onto the side of the bath. They can be adjusted to the thickness of the bath sides, and some models are adjustable in height. A vertical loop projects above the bath’s sidewall and is held when stepping in/out of the bath. The fixings need to be checked on a regular basis and tightened when necessary. Side rails are likely to be in the way of someone using a bath board, or bath transfer bench, when they swing their legs in/out of the bath.
Bath-mounted bathside 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 which is likely to be in the way of someone using a bathboard or bath transfer bench when they swing their legs in/out of the bath. Some models are adjustable in height. 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. Ensure that the wall is strong enough to take the weight of this type of rail.
Tap-fixed bath 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. These rails should only have downward pressure applied so the weight is taken by the bath rim.
Getting in and out of a shower
The following specifications should be used only as a generic guide as personal factors such as the height of the person should always be considered.
Horizontal rails
Folding armrests or safety rails attached either side of the shower seat can help to prevent somebody sliding off a wet slippery seat (BSI, 2009). A rail can be fixed on to the wall at the side of the shower seat, approximately 20cm above the height of any seat. This may be used for help when standing and may assist wheelchair users to pull on to transfer across onto the seat from a wheelchair.
In shower cubicles it may be useful to have an additional horizontal rail fixed on the wall opposite the shower seat at a height of 1m from the ground if it can be easily reached from the seat.
Vertical rails
A vertical rail at least 50cm long can be fixed at the entrance to the shower compartment for use when stepping in/out of the cubicle. The rail should be mounted at a height that the user can reach when outside the cubicle and in the cubicle.
Vertical rails can be installed on the wall opposite a shower seat. The lowest fixing should be fixed 80cm above floor level. However, the distance between the front of the seat and the rail must be less than 55cm if it is to be used successfully.
For further 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).
Getting up and down from the toilet
There are many different types of equipment available to assist in transferring on and off the toilet. It is important that you select the equipment that is safe and appropriate for you. It is recommended you arrange an assessment with an appropriate health care professional such as an occupational therapist to discuss your difficulty standing/sitting on the toilet and the many factors that can affect what is appropriate for you.
For example, some equipment may not fit if there are pipes running along the wall at the back of the toilet. Raised toilet seats vary in their maximum user weights, and grab rails may not be appropriate if the wall is too far from the toilet. Thus you may wish to discuss your difficulties with a health care professional before considering purchase of this kind of equipment.
Grab rails by the toilet are often fixed to the wall alongside the toilet, but if this is not possible (due to the toilet being too far from the wall, a partition wall or a radiator being in the way), then a drop down hinged rail that extends from the wall behind the toilet could be used (see below).
Straight grab rails
If you have the same strength on both sides of your body it is best to have supports fixed on both sides of the toilet so that you can use both arms. For 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 Housing, Planning and Local Government (see Useful Addresses). Other factors such as the height of the person should also be taken into account.
If you are using two rails:
- A vertical rail for support when standing from the toilet (this can provide a hold for pulling up from if you have strong upper limbs). The lowest point of the rail could be 6–8 inches (15–19cm) in front of the knee while seated on the toilet (approx 30cm in front of the edge of the toilet pan) and 2–3 inches (5–7cm) above the inside of the elbow crease (DLF, 2014). Part M of the Building Regulations suggests that the rail should be at least 60 cm long and can be fixed to the wall at a height of 80 cm above the floor (NBS, 2010). If you place your hand where the rail would be, you can check that the position is correct for you, and that the rail is sufficiently far forward to maintain a stable position once standing.
- A 60cm long horizontal rail 68cm from the floor beside, and extending in front, of the toilet pan for use when sitting down on the toilet. This rail can be horizontal or set at an angle of up to 15 degrees (NBS, 2010). Alternative suggested measurements are a minimum 50cm long rail, at a height of 60cm from the floor, with the rear fixing 40cm from the wall at the rear of the toilet (COT, 2006)
If you are using one rail:
- The rail is fitted starting at a point about 1 inch (2.5cm) forward of your knee and about 2-3 inches (5-7cm) above your elbow (when seated on the toilet with your arms down against your side), at an angle running at 45 degrees forwards and upwards away from you (DLF, 2014). This may help you to support the weight of your arm whilst pulling with your hand higher up the rail.
Before fitting the rail/s sit on the toilet and check you can reach the points where you intend to install them. Check the distance between the toilet pan and the wall. If you have to lean sideways to reach the rail, it may not provide appropriate support. Therefore a drop down rail fitted to the back wall, a wall to floor rail or a toilet surround frame may be more appropriate (DLF, 2014). The measurements are a general guide only, the ideal location of the rails will depend on your individual size, reach and toilet location.
If you are a man and you wish to use the toilet standing, then a vertical rail placed just in front of your knuckles when your arm is held at a right angle may steady you.
Drop down rails can be used where there is no adjoining wall next to the toilet.
Other types of support:
Drop-down hinged rails
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. These provide a horizontal bar in their lowered position. They should be fitted at waist/elbow level and approximately a fist width away from your thigh when sitting on the toilet. 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-to-floor 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 like hinged and drop down rails but they cannot be lifted back out of the way.
Toilet surround frames and toilet seats with frames
If there are obstructions beside the toilet, such as a radiator, or the walls are not suitable for installing rails, possible alternatives to rails are available. These include 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.
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 or battens.
Partitions and stud walls
- 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.
Fixing to UPVC plastic door frames should be avoided as the frames are unlikely to have the necessary internal materials in the required area to support a grab rail’s fixings.
When rails are installed outside or in a bathroom and are likely to become wet consider using brass or chromium-plated screws to avoid the formation of unsightly rust stains (COT, 2006).
In many areas Age Action run a handyman scheme or older and vulnerable people . For a small charge, and if you are over 60, this scheme may be able to assist with small jobs such as fitting grab rails, spy holes in your door, replacing tap washers, and fitting smoke alarms or telephone extensions. Find out more about your local Age Action Care and Repair service or call 01-4756989.
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
Rails for stairs and corridors
Long handrails
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. Long lengths of rail are available and may also be installed along corridors.
A wide range of finished hand rails are available from DIY chains for you to choose from. A plain 5cm mop head cross section softwood rail may be used. It is recommended that it is run continuously from the bottom to the top of your flight of stairs (including the perimeter of any landings). The handrail should be allowed to continue past the top and bottom steps by 30cm (COT, 2006, DLF, 2014). The height will depend on your needs, often at the same height as an existing banister rail. This is usually between 90-100cm above the pitch line of the stairs (COT, 2006), 90-110cm (NBS, 2013a).
The handrail should have a fixing at least every 100cm and no more than 15cm from each end. It may require mounting on a pattress or backboard (see ‘Fixing grab rails’ below) which is then secured to the wall (COT, 2006).
Newel rails
Newel rails are designed to turn through 90 degrees 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 range of sizes.
Please note that left turning and right turning Newel rail models are available. Which one you require depends on which way your staircase turns after the newel post.
Further guidance is available in the Assist Ireland Information Sheet Equipment to get up and down stairs
Grab rails at a main entrance
Grab rails at a main entrance may be installed to assist you when ascending or descending steps to enter your home. Standard straight metal or plastic grab rails can be used (see diagram on right) but offset or cranked rails are also often used (see diagram on left). The offset angle is designed so that you can step up to and pass through the doorway without releasing your grip on the rail. Alternatively the rail is occasionally fitted the other way around with the handhold away from the doorway when a traditional straight grab rail would be too close to your door handle or lock.
The ideal height for the rail will depend on your height and reach, personal preference and the structure of the door frame or wall. As a general rule the bottom fixing of a 45cm long vertical rail may be positioned 79cm above the internal floor (see dimension a) (COT, 2006).
However if the difference in height between the internal floor level and the external path level is over 36cm, an external hand rail such as a ground to wall, or ground to ground handrail may be more suitable than a grab rail (COT, 2006).
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
Email: nda@nda.ie
Website: www.nda.ie
Useful addresses
- Age Action Ireland
30-31 Lower Camden Street
Dublin 2
Tel: 01-475 6989
Email: info@ageaction.ie
Website: www.ageaction.ie - 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
Email: info@iscp.ie
Website: www.iscp.ie - Department of Housing, Planning 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)
England
Tel: 0044 207 289 6111
Email: info@dlf.org.uk
Website: www.dlf.org.uk - Research Institute for Disabled Consumers (RIDC) (independent research body in UK which produces guides for older and disabled consumers based on professional research – formerly known as RICA)
England
Tel: 0044 207 427 2460
Email: info@ridc.org.uk
Website: www.ridc.org.uk
