Beyond Patient Accessibility: Development of a Caregiver-Centred Framework for Hospital Bathing Environments

AbstractHospital accessibility is commonly assessed through provisions such as ramps, elevators, accessible entrances, circulation spaces and toilets. While essential, these do not necessarily indicate whether patients can perform everyday activities when assistance isrequired. Bathing is particularly demanding because it combines wheelchair movement, transfers, personal care, wet conditions and close patient–caregiver interaction. Building on the authors' earlier identification of caregiver accommodation within accessible hospital bathing, this study places the patient–caregiver–environment relationship at the centre of assisted bathing assessment.A qualitative framework-development approach synthesized literature and guidance on healthcare accessibility, Universal Design, hospital planning, assisted bathing and caregiver ergonomics. The Caregiver Working Zone (CWZ) is proposed as an activity-based spatial concept representing the unobstructed area required by a caregiver to perform specific bathing or transfer tasks. Building on CWZ, the Caregiver-Centred Accessible Bathing Evaluation Framework (CCABEF) comprises five dimensions—Spatial Accommodation, Transfer Support, Caregiver Ergonomic Conditions, Environmental Safety, and Functional and Dignified Assistance—with 25 proposed architectural parameters.CCABEF is intended as a design and evaluation framework, not a statutory standard or clinically validated ergonomic instrument. It provides architects and healthcare planners with a structured approach to considering the spatial needs of both patients and caregivers. Future research should examine the framework through expert review, direct observation, ergonomic assessment and application across diverse hospital settings.