Küster Dental Blog

Posts Tagged ‘ADA’

Accessibility Along the Wine Trail

Posted on: June 18th, 2014 by James Kuester No Comments

This past Memorial Day Weekend I went with friends on a tour of wineries in Western Wisconsin along the Great River Road that runs alongside the Mississippi River. We tasted some good and some not-so-good wine, and we had a great time visiting the shops that are abundant in the small towns all along the trail.

As we toured in and out of the shops and restaurants I couldn’t help noticing the wide variety of interpretations of the American’s with Disabilities Act implementations there were in regards to restroom accessibility. The ADA is fairly straightforward in its guidelines as to what makes for compliant design and what does not. Here are some of my favorites from our trip.

A towel bar doesn't make a good ADA grab bar

A towel bar doesn’t make a good ADA grab bar

One – a towel bar does not a grab bar make.   Towel bars are not the same diameter as grab bars and consequently are not as easy to grip if one needs some added stability. Additionally, towel bars are designed to hold towels, not the weight of a person, so even if this one happened to be installed with proper backing behind the drywall, chances are it would give way if someone actually used it for support.

Two – installing at a diagonal does not count as two bars. The ADA requires both horizontal and vertical supports around a toilet. Additionally, the horizontal support needs to extend down one side and across the back of the toilet. Installing the bar at an angle does not meet the requirement for both horizontal and vertical support. Nice try, but no.




Angled mounting doesn't count for two.

Angled mounting doesn’t count for two.

As in the first example I’m curious as to how well this bar would hold up mounting into the rough stone of an old barn if someone actually needed the support. Neither the mounting bolts nor the bar itself struck me as too stable.

Three – this restroom gets an “A”. Not only have they installed all of the proper bars, they are installed in the proper locations with distances that meet ADA guidelines for spacing from floor to bar and toilet to wall. Of course, they also get brownie points for designing a nice looking restroom while they were at it.



This is how an ADA compliant bathroom is supposed to look.

This is how an ADA compliant bathroom is supposed to look.

When was the last time you were in the public restroom at your dental office? Take a look and see just how whether all of the proper bars are installed and in compliance. Adding bars is a fairly easy thing to do and will make patients with disabilities dental experience much better should they need to use the facilities while there.

Design for Accessibility

Posted on: May 19th, 2014 by James Kuester No Comments
Mom & Dad

Mom & Dad

I recently traveled with my aging parents to my sister’s wedding on Chesapeake Bay. It was a lovely weekend and everyone had a great time, yet while I see my parents every week, living and traveling with them for four days reinforced to me just how much care we, as designers, need to take in designing for accessibility.

My parents are both in their mid-80’s and I think they get around pretty well. They are both in good health, yet do suffer from typical effects of aging such as diminished hearing, vision, balance, and mobility. Consequently, traveling to unfamiliar places poses a challenge. They don’t hear instructions by TSA agents, hotel clerks, and restaurant servers well when there is a lot of background noise. They get tripped up when floors and transitions are not smooth or stairs are of an uneven height. They don’t immediately identify signs and wayfinding clues. Watching my parents navigating unfamiliar terrain made me realize just how much work we have cut out for us in creating designs for our clients that work to diminish these challenges.

The elderly are not the only ones that need good accessibility design. Anyone who has ever broken a leg or ankle or for whatever reason was restricted to crutches or a wheelchair can tell you just how challenging getting around can be. Entrance ramps that are supposed to provide accessibility are often at the wrong angle and require tremendous effort to mount. Restrooms that do not follow ADA accessibility guidelines are next to impossible to navigate alone. Most operatories are designed for the efficiency of the staff and do not take the ability of the patient at all. Good signage in dental offices is almost non-existent. Patients of all ages can benefit from better accessibility design. Our job as dental office designers it to make sure our clients’ practices excel in providing it.

Always On the Lookout

Posted on: March 17th, 2014 by James Kuester No Comments
A common concrete trough sink.

A common concrete trough sink.

We’re always on the lookout for new and interesting design ideas that hopefully, one day we’ll be able to incorporate into a project for one of our clients.  While we’re not exactly sure how we’d work this into a dental office design, the Coup d’état restaurant that recently opened in Minneapolis’ Uptown District really has a fun twist on restroom design.  Rather than completely separate facilities for men and women or the increasingly popular unisex arrangement, they still separated the main facilities between the sexes but combined the hand-washing station into a single, long, poured concrete trough with several faucets positioned along the length.  This common area not only affords a great pattern interrupt from the same ol’, same ol’ in restaurant restrooms, it makes great use of the long, narrow hallway that so often accompanies access to restrooms.  Plus, because it is unexpected patrons to the restaurant engage in spontaneous conversation while washing their hands before returning to their tables.  What a great way to get people off their phones and talking to one another!

Of course, we cannot forget those with disabilities.  One end of the trough was lowered and had its own sink at a height and design compliant with the Americans with Disabilities Act.  This feature was also poured concrete and integrated into the whole so it felt natural and a part of the design rather than an afterthought or special accommodation.

The ADA compliant sink at one end.

The ADA compliant sink at one end.

We applaud the designers for Coup d’état on their creativity and originality and look forward to the chance to flatter them by “copying it” in one of our own.  (Oh, by the way, the food is really good, too.)

Why Don’t They Just Do Things Right?

Posted on: December 2nd, 2013 by James Kuester No Comments
A bad example of a restroom

A bad example of a restroom

We get around and see a lot of design work.  It is kind of an occupational hazard critiquing buildings and designs that we visit.  We just can’t help ourselves.  Of course, since our specialty is dental office design we tend to pay even more attention in dental offices than in other types of businesses and be especially critical of bad design in these facilities.

The one room we see the most problems in is the restroom.  The International Commercial Codes and Americans with Disabilities Act are fairly clear on what constitutes proper accessible design for restroom facilities.  They lay out the differences for shared facilities, single user facilities, and multiple user facilities.  These codes dictate everything from spacing from walls to toilets and sinks, the distance between these items, the height of mirrors, the height of lights and light switches, the placement of paper towel and toilet paper dispensers, and the clearance for door swing.  The biggest challenge for the designer is to create a restroom that meets all of the codes and still has some design aesthetic and doesn’t just come off as a big box.  So, why do people get this room so wrong?

Take, for example, the sink photo we’ve posted here.  The sink is too close to the wall, the soap and towel dispensers are too close to the sink and the waste basket is in the way to even access the sink.  Of course, the placement of the wastebasket isn’t something the designer has any control over.  Trust me when I say we’ve revisited clients who have filled up the clear access space in their restrooms with waste baskets, storage cabinets, and even just decorations.  The clear floor space is there so people in wheelchairs can maneuver in the restroom.  It isn’t just because we designers like large restrooms and open space.

We would hope that there aren’t any dentists out there that would tolerate short cuts or shoddy craftsmanship from their staff when it comes to working on patients’ teeth.  So, why do they accept such work from their designers and contractors that build their offices?  We hope it isn’t because they are just hiring the cheapest possible firms to do their work.

A Better Bath Design

Posted on: January 28th, 2013 by James Kuester No Comments

Exposed pipes

I have written several times about poor designs in bathrooms, but the other day I actually came across a dual-sink bathroom counter that almost passed mustard with me.  Each sink had its own hands-free soap dispenser and the waste receptacle cutout in the counter top was placed in the center between the two sinks.  Each sink also had its own paper towel dispenser so no one had to drip across the counter to grab a towel, dry their hands, and throw away the towel.  These are things I find to be problems in so many dual and multi-sink baths.  I also liked the visual appearance the glass vessel sinks.  They really added a nice pop to the bath giving it style and character.

So, what is my issue with this particular bathroom?  The drain pipes under the sinks were not covered by a modesty panel or insulation wrapped to prevent contact with someone in a wheelchair’s legs or knees.  This is a basic requirement to be in compliance with the Americans with Disabilities Act (ADA).  I did like that the installer used chrome pipes rather than ugly PVC like so many are prone to do, but while this garners some style points compliance inspectors really aren’t interested in those.

One other small thing that bothers me in the execution of this particular dental office bathroom design is that the water doesn’t drain 100% from the vessel sinks.  This strikes me as unsanitary and just a bit gross.

What Will Your Dental Office Look Like in 2014?

Posted on: January 23rd, 2013 by James Kuester No Comments

Here we are still at the start of 2013 and in the grip of a cold, dark January and one would think it too soon to start thinking about 2014 already.  However, now is exactly the time to be thinking about what you want your office to look like at the start of 2014.  “We’ve barely gotten started on 2013,” you say. “Why would I need to be thinking about 2014 already?”  Well, typically an office remodel takes about 90 days in design and then another 180 in construction.  This time doesn’t even include the amount of time to think about what changes you actually want to make in your office design as part of the remodel or to interview and select a design team.

In the U.S. there are many things coming down the pike that are going to impact dental office designs in the next 24 months, and we find that many offices have barely started their planning.  There are new ADA requirements for making one’s office more accessible and there are electronic health records requirements as part of the Affordable Care Act.  There are also new enforcement demands as part of HIPAA.  Don’t be fooled into thinking that the HIPAA stuff only applies to hospitals and large health care organizations.  We’ve been hearing that dentists, optometrists, and chiropractors have all been included in this first round of random inspections and they have not been faring well because they made that assumption.

Lastly, the pressures of competition continue to mount, and the need to provide an ever more customized patient experience increases.  Do your 2013 business and marketing plans include enhancements to your dental office design that will enhance the patient experience in your practice?  So, as one can see 2014 really isn’t that far away and now is an excellent time to start the planning process for how your office will reach the next level.

Creating a Positive Experience for Disabled Patients

Posted on: December 12th, 2012 by James Kuester No Comments

Bathroom design that fails ADA standards

We are always amazed when we find bathrooms that are not compliant with the Americans with Disabilities codes.  These codes provide for universal accessibility and safety for everyone, whether they are experience a permanent disability or a temporary one from an accident.

In this bathroom we visited recently there were several issues, but two of the most glaring were the height of the counter and the pipes underneath.  The counters are not to be more than 34” above the floor with the faucet set back from the edge by no more than 19”.  This particular bath fails on both these measurements.

As far as the pipes underneath, they must either be thermal wrapped or covered by a barrier so one will not burn their knees when rolled up to the counter.

These seem like really simple things to protect one’s patients from harm and make their time at the dental office more pleasant, but as we’ve said, we continue to be amazed at how often these little things fall through the cracks.

An Accessibility Rant

Posted on: October 31st, 2012 by James Kuester No Comments

A very unfriendly lavatory

I get rather worked up when I walk into dental office restrooms and find them to be out of compliance with the Americans with Disability Act.  Seriously people, why is it so hard to make sure your dental office is welcoming and inviting to your patients that are physically challenged?  Do you want to offend this significant portion of the population?  I’ve come to believe that if I were a dentist I’d make the most accessible friendly office around and promote the heck out of it and I’d end up with more patients than I’d know what to do with since so many offices seem oblivious to making sure their offices are inviting to this group.

Here is a snap shot of a lavatory counter in a recent dental office that I visited.  The lavatory counter should be no more than 34” above the floor, but in this instance I think the people building it thought they were putting in a bar.  The counter is a full 42” above the floor.  If I were in a wheelchair I have no idea how I’d be able to reach the faucet to turn the water on and off let alone do so comfortably.

Getting patients to return and become regular patients is strongly influenced by how welcoming and comfortable they are during their visit.  Do not forget this includes those with disabilities, even if only temporarily.

Oh, and by-the-way.  Those pipes are required to be wrapped or covered to protect one’s knees from burns due to hot water in them.  Another not-so-friendly experience.

ADA Accessible Counter

Posted on: October 15th, 2012 by James Kuester No Comments

Recently we wrote about making sure the check-in and especially the check-out counter in your dental office design are ADA accessible.  We thought uploading a quick sketch of a counter design we’re working on would help illustrate this point.  The ADA accessible portion of the counter needs to be between 28″ and 34″ in height and a minimum of 36″ in width.  A person in a wheelchair needs only to be able to roll up alongside this portion of the counter and does not need to be able to roll straight on from the front, so this does afford some design flexibilty of the space.

Check-out Counter Design with ADA accessible portion

Not All Remodels Have to be Major

Posted on: October 10th, 2012 by James Kuester No Comments

Front Desk – before

We’re working on a little remodel right now of a dental office that opened five years ago.  During the past five years the dentist and his staff have learned what works and what doesn’t work in the current floor plan and want to correct some of the patient flow issues that they’ve discovered.  One of the key elements of this remodel is a complete redesign of the front desk and the check-in and check-out procedures.  The dentist and staff also want to create more of a day-spa feel to the dental office design.

So, for check-in we are moving a desk up front closer to the front entrance and restyling it as more of a concierge desk rather than a traditional reception counter.  Two staff members will sit at this concierge desk and greet patients as they enter the dental office and get them checked in for their appointments.

The check-out desk will be farther back in the office closer to the operatories.  The physical separation of the two activities – check-in and check-out – assures HIPAA compliance.

One of the things we noticed in the current design and were amazed at was that the current front desk has no lower portion for disabled individuals.  The Americans with Disabilities Act (ADA) is really clear on the need for a portion of all transaction counters to be at a comfortable height for those in wheelchairs.  With this office only being five years old, we were surprised that the original designer and building code examiner both missed this.  A member of the dentist’s staff asked if they really needed that, as they only have one patient that uses a wheelchair.  My response was that they never know when they may get more, and besides, one is more likely to be confined to a wheelchair temporarily due to an accident than need to use one permanently.

With just a few minor tweaks to the layout the redesigned dental front office will bring the practice into ADA compliance and better HIPAA compliance along with solving bottleneck and patient flow issues.  We can’t wait to share some “after” shots!