Probably the most important issue within the topic of properly fitting accessibility codes to the health care field is the need for assisted toileting and bathing in skilled nursing facilities and assisted living residences. The International Code Council (ICC) Committee on Healthcare (CHC) is to be credited for spearheading the needed changes in the ICC and American National Standards Institute codes to make them more user-friendly to the mobility needs of the injured and elderly receiving care and assistance.

The 2021 International Building Code now has alternate provisions for assisted toileting and bathing contained in Chapter 11, Accessibility, and members of the ICC CHC are working on getting these provisions into the next edition of the ICC A117.1, Standard for Accessible and Usable Buildings and Facilities.

Since the ICC has approved code language providing for exemptions to existing barrier-free requirements in favor of design changes to facilitate patient care, this precedent also makes it easier to obtain waivers or equivalencies for similar situations. 

Some state rules allow the authority having jurisdiction (AHJ) to accept equivalencies that function equally as well without compromising health and safety. Thus, even in states that are still on an earlier version of the building code or Facility Guidelines Institute’s Guidelines, the AHJ may allow the facility to design to meet emerging patient needs following newer codes. 

In some cases, the building owner may need to submit the alternate design to the state’s Barrier Free Design Board for a formal exception. These exceptions are often accepted; however, approvals can take time.

Another source of code conflict is within psychiatric facilities and areas of the hospital where behavioral health patients are at risk for suicide. Fortunately, local AHJs and state Barrier Free Design Boards have allowed exceptions such as removing the fixed shower bench due to potential ligature risks as well as a slight modification to the design of required grab bars. 

As the code community comes to understand these emerging patient care and safety needs with the help of health care advocates, the field can expect that new code provisions will emerge to further resolve these conflicts.