Nancy Baker Curtis demonstrates using an adult-size changing table with her son Charlie at a rest stop near Adair, Iowa. The table is motorized, so it can be lowered when a person needs to get on and then raised to change it easily. (Tony Leys/KFF Health News)
ADAIR, Iowa — The blue and white highway sign for the eastbound rest stop near here displays more than the standard icon of a person in a wheelchair, indicating the facility is accessible to people who cannot walk. The sign also shows a person standing behind a horizontal rectangle, preparing to perform a task.
The second icon indicates that this rest area along Interstate 80 in western Iowa has a bathroom equipped with a full-size changing table, making it an oasis for adults and older children who wear diapers due to disabilities .
“It’s a ray of hope,” said Nancy Baker Curtis, whose 9-year-old son, Charlie, has a disability that can leave him incontinent. “I thought, ‘Oh my God, we’re finally here.’”
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The white changing table is 6 feet long and can be lowered and raised with a handheld controller connected to an electric motor. When not in use, the table folds against the wall.
The table was recently installed as part of a national effort to make public bathrooms more accessible in places like airports, parks, stadiums and gas stations. Without these options, people with disabilities often end up being changed on the bathroom floor, in the car, or even on the floor.
Many families are hesitant to go out due to the lack of accessible bathrooms. “We all know someone who is tied to their house by bathroom needs,” Baker Curtis said. She doesn’t want her son’s life to be limited in that way. “Charlie deserves to be in the community.”
He said the need can be particularly acute when people travel to rural areas, where bathroom options are scarce.
Baker Curtis, who lives near Des Moines, heads the Iowa chapter of a national group called “Changing Spaces,” which advocates for adult-sized changing tables. The group offers a online map showing dozens of locations where they have been installed.
Advocates say the federal Americans with Disabilities Act does not explicitly require such tables. But a new federal law will require them at many airports in the coming years, and states can adopt building codes that require them. CaliforniaFor example, it requires them in new or renovated auditoriums, stadiums, amusement parks and similar facilities with a capacity of at least 2,500 people. Ohio requires them in some environments, including large public facilities and highway rest stops. Arizona, Illinois, Maryland, Minnesota and New Hampshire Measures have also been taken to require them in some public buildings.
Justin Boatner of Arlington, Virginia, advocates for more full-size changing tables in the Washington, DC area. Boatner, 26, uses a wheelchair because of a disability similar to muscular dystrophy. He uses diapers, which he changes often himself.
You can lower an adjustable changing table to the height of your wheelchair and then get on it. Doing that is much easier and more hygienic than getting on the floor, changing and then sitting back in the wheelchair, he said.
Boatner said it’s important to talk about incontinence, even though it can be embarrassing. “There’s a lot of stigma around this,” he said.
He said adult changing tables are still in short supply, even in health care facilities, but he is optimistic more will be installed. Without them, she sometimes delays changing her diaper for hours until she can get home. That has caused serious skin rashes, he said. “It’s extremely uncomfortable.”
In recent years, Iowa lawmakers have considered requiring adult changing tables in some public restrooms. They refused to pass such a bill, but the discussion made Iowa Department of Transportation leaders aware of the problem. “I’m sorry to say it was one of those things we’d never thought about,” said Michael Kennerly, director of the department’s design office.
Kennerly oversees rest stop planning. He remembers an Iowan telling him about moving a family member outside in the rain, with only an umbrella for shelter. Others told her how they changed their loved ones on the bathroom floors. “It was just awful,” he said.
Iowa began installing adult changing tables in rest areas in 2022 and has committed to including them in new or remodeled facilities. So far, nine have been installed or are in the process of being added. Another nine are planned, with more to come, Kennerly said. Iowa has 38 rest areas equipped with restrooms.
Kennerly estimated it would cost up to $14,000 to remodel an existing bathroom to include a height-adjustable adult changing table. Adding adult changing tables to a new rest stop building should cost less than that, he said.
Several organizations offer portable changing tables, which can be set up at public events. Some are included in mobile and accessible toilets. transported on trailers or trucks. Most permanent changing tables for adults are installed in “family bathrooms,” which have a toilet and are open to people of any gender. That’s good, because the act of changing an adult is “very intimate and private,” Baker Curtis said. It’s also important for tables to be height-adjustable because it’s difficult to lift an adult onto a fixed-height table, he said.
Advocates hope that adult changing tables will become almost as common as baby changing tables, which were once rare in public restrooms.
Jennifer Corcoran, who lives near Dayton, Ohio, has been advocating for adult changing tables for a decade and has seen interest increase in recent years.
Corcoran’s son, Matthew, 24, was born with brain development problems. He uses a wheelchair and cannot speak, but he accompanies her when she pushes for improved services.
Corcoran said Ohio leaders designated $4.4 million in federal pandemic relief money this year to be distributed as grants for shifter projects. The program has led to facilities at the airport and the Dayton art museum, as well as libraries and entertainment venues, he said.
Ohio is also adding adult changing tables to rest stops. Corcoran said those tables are priceless because they make travel easier for people with disabilities. “Matthew hasn’t been on vacation outside of Ohio in over five years,” she said.
Kaylan Dunlap is part of a committee that has worked to add changing table requirements to the International Building Codewhich state and local officials often use as a model for their rules.
Dunlap, who lives in Alabama, works for an architecture firm and reviews construction projects to make sure they meet access standards. She hopes more public agencies and companies will voluntarily install changing tables. Maybe one day they will be a routine part of public bathrooms, he said. “But I think, unfortunately, there’s a long way to go in the future.”
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF, an independent source of research, polling and health policy journalism. More information about KFF.
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