designing better products
for in-home care
a. levy
master of design program
nscad university
2018

    acknowledgements
I would first like to thank my thesis advisor Dr. Rudi
Meyer, whose guidance was elemental in conducting
and completing this project, as well as developing
myself as a designer and academic.
I would also like to thank associate professors
Michael Leblanc and Christopher Kaltenbach for
expanding the horizons of my perception of design
and for supporting my research over the course of this
year.
Finally, I would like to express my gratitude to my
family for providing support and encouragement
throughout my years of study and during the process of
researching and writing this thesis.

i

  ABSTRACT
With a large portion of the population nearing
old age, an increasing number of Canadians are
receiving long-term care in their own homes for
health conditions that are the result of aging and
illness. In most cases, receiving care in the home
requires the purchase and installation of various
products and implements to facilitate mobility for
the receiver of care, as well as caregiving activities.
These products are designed from the basis of use in
the setting of a health care facility and not the home.
Therefore, their institutional aesthetic qualities are
found to be un-homelike, and thus unsettling for their
users as well as anyone else who shares the space
they occupy. A new methodology is needed for the
design of products for caregiving activities in the
home. This methodology will be informed by models
developed in the disciplines of Universal Design and
Occupational Therapy to make these devices more
comfortable, effective, and well-suited to the home
environment. This methodology will be developed
through the design of a commode chair.

iii

  table of contents
Abbreviations....................................................................... vii
Introduction........................................................................... 1
Theoretical Framework....................................................... 3
Research Design.................................................................. 9
Methodology....................................................................... 11
Research Process/Results.................................................. 13
Recommendations.............................................................. 41
References............................................................................ 43
Appendix A.......................................................................... 47
Appendix B........................................................................... 53
Final Infographic Poster...................................................... 61

v

  abbreviations
CAD - Computer Aided Design
CAOT - Canadian Association of Occupational Therapists
CNC - Computer Numerical Control
OT - Occupational Therapy
PEO Model - Person Environment Occupation Model
UD - Universal Design

vii

 introduction

 With a large portion of the population nearing
old age, an increasing number of Canadians are
receiving long-term care in their own homes for health
conditions that are the result of aging and illness. In
2012, 2.2 million Canadians were receiving care
in their own homes (Bleakney and Sinha, 2014).
This situation comprises challenges in ergonomic
considerations and mobility for both the caregiver
and receiver of care, as well as the emotional
effects of care, maintaining dignity for the patient,
effectively designed objects for caregiving, and
designing spaces where giving care can be done
effectively. As time passes, and the care relationship
becomes normalized and built into a routine, the
actual relationship between the carer and the receiver
of care is lost, and replaced with the necessary
interactions of giving and receiving care. Having
experienced caring for a loved one with a terminal
illness, and reflecting on my education as a product
designer, I believe there is a relationship between the
design of the home environment, as well as the objects
and implements within that environment, and the
interpersonal relationship of the caregiver and care
receiver. Using principles of Universal Design (UD),
as well as the Person-Environment-Occupation (PEO)
framework for assessing occupational performance
(Law et. Al. 1996), I will investigate the impact of
design on the relationship and activities of daily living
experienced by people in a caregiving situation. The
results of this investigation will inform the development
of a methodology for designing mobility aids and
furniture for people receiving long-term care in their
home. This will be achieved through the design of a
group of mobility devices and furniture pieces which
are optimized to facilitate caregiving activities, as well
as foster a positive rapport between the caregiver
and the care receiver.
	 How can the design of objects and spaces,

specifically for caregiving, be informed by other
disciplines which treat factors of caregiving? Which
disciplines have the most potential to inform this
design? If the number of people receiving care in
the home is increasing, why are the devices that
facilitate care and mobility designed as if they are
being used in hospitals? How can the objects within a
space be designed to facilitate the caring interactions
between a member of one generation of a family
providing care for a member of an older generation
of that family, within the same home? How does one
provide care for an adult or aging family member
while maintaining that person’s dignity, and avoiding
the embarrassment and discomfort that often arises
in caring interactions? How can design reduce
the burden often felt by both the caregiver and the
receiver of care?
Universal design and Accessibility design
are concerned with making sure spaces in public
buildings and homes are designed in a way which
accommodates all users including the physically
disabled. The design of medical implements such as
commodes and grab handles are concerned only
with ergonomics, safety, function, ease of cleaning
and vaguely accommodating the largest number
of users. As such, this project will draw from the
disciplines of universal design, industrial design,
and interior design, as well as conceptual models
developed in the discipline of Occupational Therapy
as the basis of designed objects and spaces which
are meant for caregiving situations inside a home. The
physical environment, according to Sumsion (2017), is
the traditional domain of occupational therapists and
the one with which they are most familiar.

1

 theoretical
framework

2

 The institutional nature of the daily activities
involved in providing care for an ailing or disabled
family member has resulted in the products
released for these situations having certain distinct
characteristics. The implements and furniture designed
for people with reduced mobility and chronic illnesses
are designed in a way that prioritizes function,
maintenance, ease of sanitation, and adjustability
for different users. However, this priority of design
features has resulted in products that appear medical
and institutional in nature. This is signified by stainless
steel and aluminum frame construction, neutralcoloured plastics for touch and seating surfaces, with
a non-slip texture on most surfaces. Aesthetically, this
institutional appearance is unsettling to users, receivers
of care, givers of care, and most people who spent
time in the same spaces as these devices. When these
implements are placed in a home, they subtract from
the feeling of homelikeness. In the case of elderly
people, for example, research has shown that they
prefer homelike (that is, non-institutional) residential
settings, even when choosing an extended care
facility (Crews, 2005). The built environment exerts
emotional, psychological, and physiological effects
on its residents, as well as anyone who experiences it
(Crews, 2005).
Initially, the aesthetic that is commonly associated
with hospitals was the result of a style of designed
objects that emerged from the modernist movement
and the Bauhaus. The wheelchair developed by
Everest and Jennings in 1932 was the first to be made
from tubular steel (Pullin, 2009). Made from the same
material and finishes as Marcel Breuer’s Wassily
chair, and Mies van der Rohe’s cantilevered MR
chair, the Everest and Jennings wheelchair reflected
the modernist aesthetic of the time. While furniture
design moved on to molded plywood, resins, and
bright colours, tubular metal remained the material of

choice for implements used in hospitals: beds, carts,
crutches, and others (Pullin, 2009). Consequently, the
aesthetic of these objects followed them into the home
environment.
Mostly, these products are derived from (or
are themselves) products originally developed for
institutional use, but have been marketed and sold
to people for use in their homes. In the context of
medical facility use, the device must be durable,
easily sanitized (often multiple times per day), have
a predictable and lengthy useful life, and easily
adaptable to be used by people of different heights
and body types, necessitating height adjustability. The
ergonomic effectiveness of these devices is critical to
the wellbeing of their users. Many types of devices
are part of this category of product. Shower and
bath seats, walkers, commode chairs, grab handles
and railings, adjustable motorized beds, adjustable
motorized chairs, and many other height-adjustable
implements designed to facilitate the activities of daily
living of people who experience limited mobility as
the result of an illness or disability.
These products are limited by the materials
from which they are made, their intended use, their
adjustability to suit different users, and, most strikingly,
their physical form. Ideally, improved versions of
these products would be produced from materials
that are just as durable as the existing examples, but
have more tactile considerations for the user, and
more satisfying aesthetic qualities, while retaining
the characteristics that are necessary to be effective
for this use. For example: curved plywood, softer
plastics, anodized and plated finishes would all be
an improvement over the current industry standard
devices. Aesthetics and form should be more closely
suited to a home environment. These products should
perhaps appear as high-quality furniture and suit
the aesthetic feeling of the houses in which they

3

 will be placed. Users should also be able to order
these products in their own pre-determined sizes,
instead of having to adjust each device to their own
dimensions. Additionally, many of the characteristics
of these objects are the result of mass manufacturing.
It is difficult to make a product that encourages
customization to suit the user, when a very large
number of similar units must be produced to take
advantage of economies of scale, and cover the cost
of tooling. The production model for these products
should be one that encourages customization and
unique features for each user.
UNIVERSAL DESIGN
The Canadian Mortgage and Housing
Corporation has published a series of guides for
adapting an existing home or building a new
home to meet the needs of those who experience
limited mobility or who are physically disabled.
The overarching principles of the guide are those
of Universal Design. Being one of the most designintensive spaces in the home, the guide for bathrooms
provides lengthy and in-depth guidelines on applying
Universal Design. It provides conceptual reasoning
for certain features as well as specific dimensions
for openings, counter height, types of handles on
cabinets, etc.
Universal Design, first coined by Ron Mace
of North Carolina State University (Center for
Universal Design,1998), is a type of design meant to
accommodate all types of users. Universal Design
intends “to simplify life for everyone by making
products, communications, and the built environment
more usable by as many people as possible at little
or no extra cost. Universal design benefits people of
all ages and abilities” (Center for Universal Design,
2008). As such, Universal Design is the suggested
framework for approaching the design of spaces

4

for public buildings as well as homes that are being
built or upgraded for accessibility. The principles of
Universal Design indicate that products or features (in
our case, spaces as well) should 1) provide equitable
use, 2) have flexibility in use, 3) be simple and intuitive
to use, 4) provide perceptible information, 5) have
tolerance for error, 6) require low physical effort to
use, and 7) provide adequate size and space for
approach and use (Center for Universal Design,
1997). For this study, Universal Design guidelines will
be part of a greater methodology of designing for
long-term illness and receiving care in the home. They
will be employed to satisfy the essential ergonomic
and physiological requirements of the objects. A more
comprehensive methodology is needed to satisfy the
needs of individual people receiving care in their
homes and experiencing mobility issues as the result of
their illnesses, or aging, or both.
INTERVIEW WITH DR. GRACE WARNER
Giving care in the home involves the input of
different types of professionals. Doctors and other
medical professionals determine the impairment of
the care receiver and what their treatment will be, as
well as treating negative symptoms and conditions.
However, once institutional treatment has been sorted,
long-term care outside a medical health facility is
facilitated by the assessment of an Occupational
Therapist. Knowing this, an authority on Occupational
Therapy with specific expertise in caregiving for
chronic illness, terminal illness, and aging was
consulted to gain insight into this subject. Dr. Grace
Warner is an Associate Professor at Dalhousie
University’s School of Occupational Therapy, School
of Nursing, and the Department of Community Health
and Epidemiology.
The commode chair is a product that resurfaced
several times during our conversation, as it

 encompasses many of the shortcomings Warner
identified in existing products for home use in
caregiving. Commode chairs are essentially portable
toilets. Typically, they are placed next to the bed
of an individual who is too debilitated to get to a
bathroom easily. Commodes are typically composed
of a frame, with a seat resembling that of a toilet,
with a waste receptacle that can easily be cleaned
for reuse. In their most common form, commodes
are not very technologically sophisticated, and their
appearance contributes to an un-homelike feeling.

living. Exposure to this model is what confirmed the
possibility that the design of an environment and the
objects within it can be optimized by being informed
by models and principles contained in Occupational
Therapy.

The Person Environment Occupation Model over ongoing development.
Source: Law et. al. 1996

Typical bedroom commode chair. Source: Aosom.ca
Expressing my interest in the environmental
aspect of caregiving in the home, Dr. Warner briefly
explained a common model used in Occupation
Therapy known as the Person-EnvironmentOccupation (or PEO) model, which is explained later
in this paper. Evidently, the environment of the person
receiving care is evaluated along with other aspects
of their lives to determine what can be improved
to allow the person to perform activities of daily

OCCUPATIONAL THERAPY	
In cases of care being given inside the home, an
occupational therapist may be consulted to evaluate
the person receiving care. The occupational therapist
will assess occupational performance, which is
defined as the “dynamic experience of a person
engaged in purposeful activities and tasks within
an environment” (Law et.al., 1996). In this context,
“occupation” refers to a series of daily activities
and abilities, not the more common meaning of
occupation meaning job, work, or career. One of the
most popular frameworks for assessing occupational

5

 performance is the Person-Environment-Occupation
Model, which examines the fit between the person,
their occupations and roles, and the environments
in which they live. These three variables in one’s
life interact differently over the course of a person’s
development. The objective of the use of this model
is for the occupational therapist to determine which
variable is missing attention or can be improved
in some way to create a greater fit between them,
thereby increasing occupational performance.
For people who are receiving care in the home as
the result of a physical impairment due to illness,
disability or aging effects, the physical environment
is an important variable in improving occupational
performance, as it must be adapted for their use, as
well as the use of the caregiver.
	 Another model of Occupational Therapy
that may be applied in designing for caregiving is
the model of environmental interactions developed
by Roann Barris (1982). The concept of “press” is
the unspoken demand for a certain behavior within
a setting (Barris, 1982). Essentially, a physical
environment will often influence the behaviour of those
who are familiar with that milieu. This is most evident
in public places, but can also apply to a home in
which care is being administered. In the home, people
have a certain level of comfort and familiarity, which
stimulates normal behaviour. However, if the home
environment is changed in a drastic way, which may
occur when installing implements needed for aiding
mobility and caregiving activities, the behaviour of
those who inhabit the environment can be affected
in a negative way. Currently, the mobility devices
available for home use have aesthetic and tactile
qualities which are vastly contrasting to those of the
home environment. Their installation and placement
in the home creates an abrupt change in that
environment, which can be unsettling to anyone

6

inhabiting it. The sight of these objects in the home is a
reminder of a difficult situation, and can foster feelings
of resentment and embarrassment between those
receiving care, the family member caregivers, and
other family members living in the same home.
PERSPECTIVES ON DISABILITY	
In Design Meets Disability, Graham Pullin explains
that the perspectives about disability and ability
can be approached in different ways. The common
perception is that a disabled person is a person that
lacks the ability to do certain tasks. However, people
are disabled by the environment and society. The built
environment has been designed for people who have
an accepted amount of abilities, and does not grant
certain people the ability to do certain things. People
who are receiving long-term care as the result of
medical conditions or aging may experience mobility
challenges for an extended period. The current
products facilitating mobility for these people are
conceived as additions to an existing environment to
compensate for the user’s lack of abilities. However, if
mobility aids were designed in a way that was more
integrated into the home design and the daily activities
of the user, perhaps the environment would be less
disabling for them.

 7

 research design

8

 Initial research for this study was in the frame
of a social issue, which is the increasing number of
young Canadians living in a situation where they give
care for a family member of an older generation
within their own home. Data was gathered from
Statistics Canada to determine the real proportion
of the Canadian population affected by this issue.
Exploratory research of literature was done in the
disciplines of public health, policy, psychology, and
anthropology.
Being an industrial designer, with experience in
product design, retail design, and interior design,
once the domain of research was established, the
focus of research was shifted towards disciplines
that influence the design of devices and furniture that
are relevant to caregiving in a home. Most situations
requiring an in-home caregiver, such as certain
chronic and terminal illnesses and aging involve a
physical impairment that limits mobility. Research
was performed on designing homes for accessibility.
Sources that were found gave specific guidelines
(including ergonomic figures and features) necessary
for an accessible home, but also referred to Universal
Design as the overarching discipline for this type of
design work. Universal design takes into consideration
all possible users (especially physically disabled
and aging users) by applying the seven principles
mentioned in the literature review of this paper.
Through my personal experience of caring for
a family member, I was aware that the services of
an Occupational Therapist are suggested when the
home becomes a place of caregiving for one of
the family members. Occupational Therapists often
suggest improvements to be made to the physical
environment to facilitate mobility of the care receiver,
as well as caregiving activities. I decided to consult
an authority in the field of Occupational Therapy,
specifically concerned with matters of aging and in-

home caregiving to gain a better understanding of the
discipline. Through the consultation with Dr. Warner,
as well as research of existing literature on the topic,
several concepts and models were determined to
be of use in informing the design of objects inside the
spaces where a family member gives care for another.
Though Occupational Therapy is concerned with the
physical environment of care and the use of designed
objects, there is not much interaction between the
disciplines in the frame of informing actual design.
The intention of this research is to develop a
methodology for designing the type of products used
in caring for aging, injured, or ill people in their own
homes. This will be achieved through the design of a
commode chair, informed by consultations with OT
professionals and existing product design methods.

9

 methodology

10

 Following design Action Research as an
approach, a design methodology and production
model will be developed for mobility devices and
furniture specifically conceived for use by adults
receiving long-term care in their own homes for
medical conditions as the result of illness or aging.
Occupational Therapists have techniques,
checklists, and rubrics which they use to assess people
in various situations for the specific products they need
installed or provided to them in their own homes.
The assessment process used by most occupational
therapists dealing with illness and aging in the home
in Canada is informed by client-centered practices
in Occupational Therapy, as well as the PEO model
for occupational performance. These techniques will
form the basis of making improvements to existing
mobility products and developing new features.
Two or more existing types of product will be
chosen as a starting point for my research into the
existing product environment for my identified user
group. These objects will be analyzed for their
functionality and ergonomics, as well as aesthetic and
tactile qualities from my own perspective as a product
designer.
A consultation session will be organized with
a small group of occupational therapists to receive
their feedback about the objects, and other mobility
devices and furniture currently available for people
receiving care in their homes, as well as what may
not be available, but they feel is needed. Relevant
information from the consultation session, as well as
my analysis of existing products will be synthesized
and used to inform my initial designs.
Preliminary design sketches, renderings and
development prototypes showing function will be
produced with the information distilled from my
analysis of existing products, as well as the first OT
consultation session. Reflecting on progress until this

point may lead to the discovery of new problems, and
open new design possibilities to be tested further.
In a second consultation session, the preliminary
design sketches, renderings, and experience models
will be presented to the same group of occupational
therapists that participated in the first consultation
session. The functional prototypes will allow the
participants to interact with the objects in a realistic
way. Feedback on these preliminary designs (in
comparison to the existing products and in general)
will be recorded throughout the consultation and
analyzed afterwards. Feedback from both sessions,
as well as initial analysis of existing products will be
reconciled and used to inform the refined iterations of
the designs.
Following analysis of both consultation sessions,
refined iterations of the products will be developed
in the form of final renderings and finished functional
prototypes.
A conceptual model for manufacturing the
implements will be developed that will encourage
customization and unique features for each user.
Inspired by an existing model used by Leckey, a
company which manufactures furniture for children
with disabilities, production will be centered around
the use of computer-aided design and CNC
(Computer Numerical Control) manufacturing
techniques.
Finally, there will be reflection on the entire
process and the development of a new design
methodology as a result. This will be achieved by
intensively documenting the design process, analyzing
the documentation, and formulating the methods into
a replicable process. This method will be able to be
applied by other designers in the future as guidelines
to continue designing objects for people who receive
care in their own homes as the result of illness or
aging.

11

 research process/
results

12

 After establishing the basis of my design research
by identifying a problem with the way products
were designed for use in caregiving situations
in the home, I suggested that the design of these
implements is currently done as if the intention of
use is institutional, not that of a home. Occupational
Therapy is the discipline concerned with assessing
medical patients in recovery, people with disabilities,
and aging people in terms of their care and living
environments. As previously mentioned, it was
clear to me that Occupational Therapy can inform
the methodology for designing products that will
be used in medium and long-term care. With the
considerations highlighted in my research of OT,
and advice from Dr. Warner, I set out to develop a
new design methodology for these implements. The
way I attempted to do this was to design a radically
improved version of a commode chair, drawing from
participatory research, and my prior research in
OT, disability, and Universal Design, while using the

Industrial Design process as a baseline design and
development process. I chose the commode chair
as the focus of my research because it appeared
to the worst perpetrator of the flaws I identified with
this product category of in-home care. As such, I
recognized that the design of a commode chair
would be the best incubator for researching this type
of product design, and for facilitating the development
of an improved design process. A commode chair
is essentially a portable toilet for those who are
unable to quickly access a washroom due to reduced
mobility, incontinence, or reduced control of other
bodily functions.
With anecdotal knowledge and secondary
research of the product, I began sketching conceptual
ideas about the new object. My first inclination
was to change the semantics of the object from an
institutional or medical form to that of home furniture,
so that it would fit the home environment in a way
that is aesthetically pleasing and comfortable. This is

13

 in contrast to existing examples of the product, which
appear cold and out of place in the home and are
potentially unsettling for the user, caregiver, and
anyone else using the space it occupies. As previously
noted, the existing design process for these objects
favours functionality over every other aspect of the
product. In response to these deficiencies, my earliest
concept sketches showed materials and textures more
closely related to furniture products: molded plywood,
sheet metal, and brightly coloured textiles. Then, since
the commode is frequently placed next to the bed, I
explored integrating the product into various styles of
bed frames (including a concept that shows the ability
for the commode to retract underneath the bed). I
also began exploring options for height adjustment
and different arm rest and frame shapes, attempting to
develop the most comfortable and effective solution.
It was clear, however, that my development needed
more enrichment in the form of research.
After some time, I realized that it is crucial to
physically experience an existing version of the
14

product I was attempting to drastically improve. I
decided to visit a distributor of home care products
and obtain an example of a commode chair, so that
I could experience it for myself, as well as record
others’ impressions of the object. I went to Harding
Medical, a distributor in Halifax, Nova Scotia, where
a sales associate guided me through the range of
available products. The prices of commode chairs
ranged from $75.00 to nearly $3500.00. I quickly
determined that there was no example of a commode
which was clearly designed for home use, and that
the aesthetic appeal and tactile sophistication did not
improve with increased retail price. Rather, customers
are charged more for extra features such as padded
seats, removable arm rests, casters for portability, and
extra seat width for bariatric cases. After exploring the
showroom and handling some of the other products
meant for in-home care, increasing mobility, and
facilitating self-care, I purchased the most common
model of commode chair available.

 15

 CONSULTATION WITH OT PROFESSIONALS
In attempting to gather informed advice about
my design process, I attempted to establish contact
with as many OT practitioners as I could. I managed
to establish contact with three people involved in the
field: two students from Dalhousie University (each
at different levels of the undergraduate program in
OT) and one current professional with fifteen years
of experience in the field. In attempting to establish a
common meeting time for all three and myself, I only
received a positive response from one participant,
and settled on a meeting time with her.

Consultation Session #1
Profile:
Cherry Au, year 2 OT student at Dalhousie University.
At the time of writing, she was on her first work
placement session at a large hospital in Halifax. Her
position consists of prescribing equipment for patients
who will soon be discharged and allowed to return to
their homes. In addition to her work and educational
experience, Ms. Au’s personal history was highly
relevant to my research, as her father suffers from
Parkinson’s Disease, and makes use of a commode
chair in his daily life.
Our meeting consisted of a short interview about
her experience and thoughts on caregiving in the
home, as well as some interaction with the commode
chair I obtained earlier to receive her impressions of a
typical example of the object.
Observations:
1) The device has no accommodation for sanitary
paper or disinfectant products. Perhaps the improved
version should have some provision for these
products?
2) The existing product is shown in muted or dull
colours. The device is to be used by aging people,
whose depth perception tends to deteriorate over
time. Perhaps more contrasting colours would make
the device easier to use for those whose visual acuity
is declining.
3) In general, these devices do not provide any
privacy for the user. She indicated that her father
would not use the commode placed in the family living
room because of embarrassment and vulnerable
feelings. Perhaps creating a more private experience
for the portable commode would make the user feel
more comfortable and less embarrassed.

16

 Occupational Therapy student Cherry Au examining the Drive Medical commode chair during a consultation session

17

 FURTHER CONCEPT EXPLORATION
Having obtained an example of a commode
chair, and consulted with an OT professional,
I realized that my research required a deeper
understanding of toilets and their proper usage and
design. In my experience, we tend to be discreet
about the activities and bodily functions which take
place within the washroom, because they are not
discussed openly in social situations, or even within
one’s own family. Further, different cultures have
different habits when it comes to defecation and
urination. One important issue is that the typical shape
of a toilet seat is not ergonomically optimal. When
humans sit on a surface, they apply most of their
weight to the two lowest points on the pelvis, called
the Ischial Tuberosities. However, on a typical toilet
seat, those ischia are unsupported. Therefore, the
pressure is distributed to the thighs instead, causing
discomfort after a relatively short amount of time. For

18

people who make use of a commode, this can restrict
blood circulation and cause numbness.
It also became clear that perhaps the size
and height of the commode is not actually ideal
for defecation. Kira (1976) suggests that during
defecation, a squatting position is more effective
at encouraging healthy release. My following
conceptual exploration reflected this idea. I
generated several concepts for the new commode
chair that involved the user straddling the sides of the
commode, rather than sitting on top of it like a chair.
Some also featured foot rests and leaning posts that
encouraged a squat-like position. I attempted to
draw inspiration from upright massage chairs and
other devices that encourage a similar posture. Alas,
after presenting my new ideas to my peers, it became
clear that these concepts were becoming increasingly
complex and would elicit apprehension from users.

 19

 20

 21

 To advance my design, it was important to determine
certain exact parameters for height, width, and length
measurements for the seat, arm rests, and back rest to
optimally accommodate potential users. Anthropometric
data was used to best inform these choices. I determined
that the seat height would be adjustable by 4 inches,
with a maximum height of 20 inches, as per the average
seating height (popliteal length) of males in the 99th
percentile of the population (Tilley, 2002). The minimum
height of 16 inches is consistent with the 1st percentile of
the population. Between the arm rests, there must be at
least 18 inches of distance to coincide with the female
sitting hip width of the 99th percentile (Tilley, 2002).

22

 23

 refined concept 1
After some rudimentary sketches, 3D modeling
software was used to develop a realistic concept
incorporating the features deemed necessary for
a successful concept. The main body features two
nesting volumes made from molded plywood. The
arm rests would be made from solid wood (preferably
oak) and are integrated into the backrest support. The
seat design is carried over from the previous concept
and is still designed to support the ischial tuberosities
of the user with its hourglass-shaped opening. The
backrest and armrests are supported by an external
structure and platform made from heavy-gauge steel,
brushed and treated with a stain-proof coating. The
waste container is accessible via an access door
24

on the front of the device, which is bottom-hinged.
The container itself is made from stainless steel and
features two handles for safe and comfortable
manipulation. This concept is designed to gently
lower the user into the optimal position for defecation
as advised by Kira (1976). The user supports him
or herself by holding both armrests and lowering
themselves onto the seat. As weight is applied to the
seat, the whole upper shell (including the seat) lowers
slowly with the help of a pneumatic piston. The full set
of presentation board images that were produced for
critique can be found in Appendix A.

 Pictured here: seat in lowest position

25

 CRITIQUE:
Upon presenting this concept to my peers, several
flaws in my design became apparent: Ideally, a cover
for the seat should be developed. This device will
be used often during the night and in other instances
where the contents of the waste container may not
be able to be emptied immediately. Therefore, a seat
cover would contain odours until the waste container
could be emptied. Additionally, a seat cover could
add a functional dimension to the device as a
26

comfortable occasional seat. Another noted negative
aspect of this concept was the steel external structure.
Visually, it makes the device heavy (and would add
considerable heft if produced). It may also present
a hazard for the user’s ankles and feet, as the shape
of the base demonstrates some sharp intersections.
Additionally, it was noted that a set of locking casters
would perhaps contribute to the room-to-room
portability of the device, which is necessary for it to be
considered convenient.

 27

 refined concept 2
Following the critique of the previous concept,
this concept was supposed to appear lighter and less
dangerous than the previous one. To advance my
process, I determined that constructing and interacting
with a physical prototype would generate more
useful ideas about the design. Therefore, I decided
to develop a full-scale mock-up prototype made
from corrugated cardboard. Using a combination of
sketches and 3D modeling software once again, I
constructed the main body volumes and the armrest
assembly. In this concept, the heavy and dangerouslooking steel structure used in the previous concept
was eschewed for a simpler assembly which makes
28

use of two new nesting molded-plywood shells (of
more organic form than the previous iteration) for the
central structure. The armrest assembly, incorporating
the backrest, is supported on either side and in the
back by large sheet metal brackets, which fasted to
the lower of the two plywood shells. Like the previous
concept, the lower shell is designed to nest into the
upper shell, and the seat is designed to lower into the
optimal position for healthy elimination. The armrest
now features a stepped profile to help users support
their own weight as they lower or raise themselves
from the seat.

 CRITIQUE:
With limited time at my disposal, the prototype
was built with the intention of demonstrating physical
presence, proportions and basic user interaction with
the device. As such, some features were not shown.
In response to the presentation to my colleagues, the
focus of their critique was on those specific features. I
was advised that perhaps my concept would benefit
from a certain amount of simplification and refinement.
	 Reflecting on these two concepts, I realized
that my approach to the design of the device lacked
direction in terms of overall form. Though I held the
intention of designing a device that fit into the design
language of home furniture, I was, in effect, attempting
to compile a bulk of features and attributes into an
object that had no clear form or silhouette. I was
allowing the ergonomics and features to determine
an overall form. This approach to the design was not
leading to the well-balanced, desired result.

29

 LC7 Swivel Chair (1927) by Charlotte Perriand

30

 On the advice of my thesis advisor/supervising
professor, I began to research existing chairs for
inspiration. It was clear that my design would require
a different perspective. If I was to design a commode
chair with the design language of home furniture,
perhaps it would be better to start with the form
of a chair, then adapt the form to incorporate the
necessary features. Seeing a photo of one specific
furniture piece stimulated an idea that would lead to
my next (and final) concept. This piece was the LC7
Swivel chair, designed in 1927 by Charlotte Perriand,
A designer who worked closely with Le Corbusier
and Pierre Jeanneret. With chromed steel tube
construction, the chair is an icon of the Bauhaus era of
furniture design. It remains modern-looking today, in
2018, despite its 91-year-old design.

31

 final concept
This commode chair is designed to fit comfortably
within the home environment. It features warm
materials, height adjustability, locking casters for
portability, and a seat cover that allows the device
to be used as a regular chair when not being used
for its primary task. The device is built around two
tubular-steel subassemblies. The upper subassembly
forms the supporting chassis for the seat, seat barrel,
and armrest/backrest assembly. It is constructed
from 0.75-inch diameter tubular steel, which has
been chrome plated and coated in a stain proof
enamel. The seat is made from CNC-machined oak
and features the hourglass-shaped opening used in
previous concepts, which supports the user’s ischial
tuberosities. It is attached to the seat barrel via a
nickel-plated hinge system. The seat barrel, which is
the largest and most prominent part of the assembly,
is made from molded birch plywood, with details that
would be machined by CNC router.

32

The arm rest assembly integrates the backrest
to form a continuous sweeping shape around the
perimeter of the device. It is padded with foam and
trimmed with a bacteria-resistant leather substitute
called EnviroLeather, by LDI. It is stain-resistant,
chemical resistant, and designed for easy care and
cleaning. This cushion slides over the top of the seat
frame and fits snugly in place.

 33

 The base of the commode is made from the
same 0.75-inch steel tubing as the upper chassis and
finished in the same chrome plating and clear enamel
coating. At the centre of this assembly is a 2-inch
inside diameter tube which houses the backbone of
the overall assembly: a 2-inch diameter pneumatic
piston. This component allows the height of the
device to be adjusted by 4 inches to accommodate
users of different statures, or according to the user’s
preference. The maximum seat height is 20 inches,
which is consistent with the suggested maximum seat
height for the 90th percentile male North American.
The minimum seat height is 16 inches, which is
consistent with the maximum seat height of the 1st
percentile of the female North American population.
This feature is activated by a level accessible through
an opening on the front of the seat barrel.

34

 Height adjustment is activated by this lever, which is accessed through an
opening in the front of the seat barrel

35

 To access the waste container, the user or
caregiver lifts the right side of the seat via a recess in
the seat barrel, and flips it open to the left. Once the
lid is open, the user can lift the waste container out
of it tray by the larger wire handle, and then hold the
second handle (which is molded into the body of the
container) to keep it stable during transfer.

36

 37

 Portability is an important criterion for this device. It
must have the ability to be moved within and between
rooms easily, so that the user may be accommodated
in whichever room they please if they decide to
spend more time in a different room each day. For
this reason, the commode is equipped with locking
caster wheels. They are 3 inches in diameter, and
their mounting points are offset from centre to allow
the wheels to rotate in alignment with the direction
in which the device is being pushed. The locks are
activated by pushing the large, red, semi-circular lever
on the face of the caster.

38

 Finally, in response to critique of the first refined
concept, a padded seat cover would be included
with the device, foam-padded and trimmed in the
same bacteria-resistant EnviroLeather as the armrest
assembly to match. This cover will be used to conceal
odour between initial use and emptying the waste
container. Additionally, the cover can be used to
convert the commode into a normal chair, when not
being used for its primary purpose.
The original presentation slides for this concept
can be found in Appendix B.

39

 reflection/
recommendations

40

 Earlier in this paper, I identified the origin of the
design typology that resulted in the style of products
for in-home care we see today, specifically with
regards to the commode. The design of medical
products adopted the industrial aesthetic and
manufacturing processes popularized by the Bauhaus
era of furniture design of the 1920s and 1930s
in the form of tubular metal. This style allowed the
mass-manufacturing of products that were easy to
clean, durable, lightweight, and easy to design with
modularity in mind. However, over time, wooden
components were replaced with less costly plastic
ones, and chrome and polished finishes were
replaced with painted or anodized finishes that were
easier to apply. This lead to the current institutional
aesthetic of medical devices. The inappropriate
application of this aesthetic to the design of
products used for in-home care creates an unsettling
appearance and feeling inside the home environment.
For my final concept, I took inspiration from a
furniture piece that epitomizes the design style which I
initially identified as the origin of the deficiencies held
by existing examples of commode chairs and most
other in-home care products. This was employed as
a way of demonstrating that products for in-home
care can (and should) be designed in a way that is
appropriate for the home environment, regardless of
the origin of its design typology. Further, the design of
an object that serves a specific function for a human
being should maintain the dignity of the user. Current
devices are more concerned with function than
ensuring a dignified user experience. I am confident
that the final design of the commode chair presented
in this project provides a dignified experience for the
user and caregiver and would elicit considerably
less embarrassment from the user than with a typical
commode. Perhaps I am optimistic in assuming the
user would possibly have a sense of pride in owning

this type of product if it resembled the one presented
here.
One of my initial goals for this project was to
develop a methodology for designing products for
in-home care through the design of a commode
chair: a product that encompasses many of the
issues I identified with existing products of this nature.
While developing my final concept it became
evident that producing a specific framework or
systematic method of designing these products would
not necessarily result in better design (it may even
continue the propagation of the poor examples of
design we already have). Rather, it is more important
that designers draw from multiple disciplines and
perspectives during the research phase of the design,
consider a more diverse range of stakeholders in the
usage of the product, and especially consider the
environment in which the product will be used for the
entirety of its useful life. The research presented in
this paper was informed by Occupational Therapy,
Industrial Design, Universal Design, Physiological
Anthropology, and anthropometric data.
If the research conducted in this project was
to be continued beyond this stage, a functional
prototype would be developed and shown to care
professionals. With the proper permission obtained, a
refined version of that prototype would then be shown
to willing care receivers. These participants would be
interviewed to gather their impressions of the product,
as well as insights they might have into the experience
of needing and receiving care and using these types
of products. From that stage forward, a final prototype
would be made and, if deemed economically viable,
that design could be developed to be produced and
marketed for the public.

41

 references

42

 Barris, R. (1982). Environmental Interactions: An Extension of the Model of Occupation. The American Journal
of Occupational Therapy. 36 (10). 637-644.
Bleakney, A. and Sinha, M. (2014) “Receiving Care at Home.” Statistics Canada General Social Survey.
Statistics Canada. Catalogue no. 89-652 – No 002.
Canada Mortgage and Housing Corporation (2016). Bathrooms. Accessible Housing by Design. https://
www.cmhc-schl.gc.ca/odpub/pdf/65686.pdf
Center for Universal Design (1997). “The Principles of Universal Design.” The Center for Universal Design.
https://projects.ncsu.edu/ncsu/design/cud/about_ud/udprinciplestext.htm
Center for Universal Design (2008). “About Universal Design” The Center for Universal Design. https://
projects.ncsu.edu/ncsu/design/cud/about_ud/about_ud.htm
Crews, D.E. (2005) Aritificial Environments and an Aging Population: Designing for Age-Related Functional
Losses. Journal of Physiological Anthropology. 24 (1), 103-109.
Crews, D.E., Zavotka, S. (2006). Aging, Disability, and Frailty: Implications for Universal Design. Journal of
Physiological Anthropology. 25 (1), 113-118.
Kira, A. (1976). The Bath Room: New and Revised Edition. The Viking Press Inc. New York, NY, USA.
Law, M. Cooper, B. Strong, S. Stewart, D. Rigby, P. Letts, L. (1996) “The Person-Environment-Occupation
Model: A transactive approach to occupational performance” Canadian Journal of Occupational Therapy. 63
(1), 219-234.
Pullin, G. (2009) Design Meets Disability. MIT Press. Cambridge, MA, USA.
Strong, S., Rigby, P., Stewart, D., Law, M., Letts, L., & Cooper, B. (1999). Application of the personenvironment-occupation model: A practical tool. Canadian Journal of Occupational Therapy, 66(3), 122-133.
doi:10.1177/000841749906600304
Sumsion, T. (2006) Client-Centered practice in Occupational Therapy: A guide to implementation. Churchill
Livingstone. Philadelphia, PA, USA.
Tanizaki, J. (1933). In Praise of Shadows. Translation from Japanese by Leete’s Island Books Inc. Stony Creek,
CT. USA.
Tilley, A. Henry Dreyfuss Associates. (2002). The Measure of Man and Woman: Human Factors in Design,
Revised Edition. John Wiley & Sons, New York, NY. USA.

43

 INTERVIEWS
Dr. Grace Warner, Associate Professor at Dalhousie University’s School of Occupational Therapy, School
of Nursing, and the Department of Community Health and Epidemiology. Interviewed October 25, 2017.
Dalhousie University School of Occupational Therapy.

44

 45

 appendix a

refined concept 1 - presentation slides

46

 Commode chair

overview

An increasing number of Canadians are receiving long-term
care in their own homes as the result of illness and aging.
The available devices for facilitating care are not aesthetically
suited to the home environment, and are unsettling for the
user and caregiver to interact with. Informed by principles
in Occupational Therapy and Industrial Design, an enhanced
methodology for designing in-home care devices was developed through the design of this commode chair.

MArch 6, 2018

47

 Commode chair

overall dimensions
18”

18”

29”
21”

MArch 6, 2018

48

 Commode chair

usage

WASTE CONTAINER DOOR

SANITARY WIPE STORAGE

MArch 6, 2018

49

 Commode chair

adjustability

To encourage the proper posture during defecation, the seat
lowers into a pre-set position for each user. This automatically
raises the user’s knees above the waist, facilitiating evacuation.

MArch 6, 2018

50

 Commode chair

MArch 6, 2018

51

 appendix B

final concept - presentation slides

52

 overview
An increasing number of Canadians are receiving care in their
own homes as the result of illness and aging. Currently-available
devices that are used to facilitate activities of daily living are
functionally compromised andaesthetically inappropriate for the
home environment.
This commode chair is designed to fit comfortably within a
modern home environment. It features warm materials, height
adjustability, locking casters for portability, and a seat cover for
more versatile use.

53

 OVERALL DIMENSIONS

18”

23.25”

20.63”

28”
20” MAX

54

 55

 exploded view
PART/SUBASSEMBLY

1

1
2
3
4
5
6
7
8
9

2
3
4
5
6
7
8
9

56

ARMREST/BACKREST COVER
SEAT
SEAT HINGE ASSEMBLY
WASTE CONTAINER
SEAT BARREL
SEAT FRAME
ADJUSTABLE CHAIR PISTON
CHAIR BASE
LOCKABLE CASTERS

DESCRIPTION
“LEATHER” OVER FOAM PADDING
OAK WITH POLYMER COATING
ZINC-COATED STEEL
HIGH-DENSITY POLYETHYLENE
MOLDED BIRCH PLYWOOD
0.75” STEEL TUBE, CHROME-PLATED
STANDARD 2” DIAMETRE, PNEUMATIC
0.75” STEEL TUBE, CHROME-PLATED
OFFSET SWIVEL CASTER, PLASTIC

 WASTE CONTAINER

ON THE RIGHT SIDE OF THE SEAT BARREL, THERE IS A SLOT FROM WHERE TO LIFT THE SEAT

LIFTING THE SEAT REVEALS ACCESS TO THE WASTE CONTAINER

THE CONTAINER LIFTS OUT BY ITS WIRE HANDLE

THE CONTAINER IS MADE FROM HIGH-DENSITY POLYETHYLENE AND
FEATURES A SECONDARY HANDLE MOLDED INTO THE UPPER RIM FOR
EASIER HANDLING

57

 height adjustment

ON THE FRONT OF THE SEAT BARREL, THERE IS THE SEAT ADJUSTMENT LEVER

PULLING UP ON THE LEVER ACTIVATES THE PNEUMATIC CYLINDER AND ALLOWS HEIGHT ADJUSTMENT

20”

58

WHEN THE LEVER IS PULLED, A STEEL ROD ROTATES AND PRESSES THE TRIGGER ON THE TOP OF THE PISTON

16”

 MORE FEATURES
A PADDED SEAT COVER, COVERED IN THE SAME WATERPROOF BACTERIA-RESISTANT
MATERIAL AS THE ARM REST CAN BE USED TO BLOCK ODOUR, BUT ALSO ALLOWS THE
COMMODE TO BE USED AS A REGULAR CHAIR OTHERWISE

PORTABILITY IS IMPORTANT FOR THIS DEVICE. IT MUST HAVE THE ABILITY TO BE MOVED WITHIN AND
BETWEEN ROOMS EASILY, TO ACCOMMODATE THE USER IN THE MOST CONVENIENT WAY POSSIBLE.
THIS COMMODE IS EQUIPPED WITH 3” LOCKING CASTER WHEELS. ITS MOUNTING POINTS ARE OFFSET IN ORDER TO ALLOW THE WHEELS TO ROTATE IN ALIGNMENT WITH THE DIRECTION IN WHICH
THE ASSEMBLY IS BEING MOVED. THE LOCKS ARE ACTIVATED BY STEPPING ON THE LARGE, RED
SEMI-CIRCULAR LEVERS ON THE OUTSIDE FACE OF THE CASTER.

59

 final infographic poster

60

 designing better products for in-home care
An increasing number of Canadians are receiving care in their own homes
as the result of illness and aging. Currently-available devices that are used to
facilitate activities of daily living are functionally compromised and
aesthetically inappropriate for the home environment.

2.2 MILLION:

The number of Canadians receiving long-term care in their own
homes as the result of illness and aging as of 2012

current products
Products which are used to
facilitate in-home care were
originally developed for use in
medical facilities. The design of
medical products adopted the
industrial aesthetic and
manufacturing process
popularized by the Bauhaus
era of design in the form of
tubular metal. The inappropriate
application of this aesthetic to
the design of products used in
in-home care creates an
unsettling appearance and
feeling inside the home.

grab bar

bed safety handle
commode

An enhanced methodology for designing products
for in-home care was developed through the design
of a commode chair:

Occupational Therapists were
consulted to gain an
understanding of the challenges
of prescribing equipment for
in-home care

Design methods typically
employed in designing furniture
for home use were applied to the
product development process

The final concept designed
for the home environment
ALEX LEVY
MDES 2018

61

 62