When DOT issued regulations requiring accessible lavatories on twin- aisle aircraft in 1990, single-aisle aircraft were used primarily for shorter distances. However, technological advancements—such as the use of lighter, stronger composite materials—have enabled aircraft to fly longer distances with greater fuel efficiency. As a result, both Airbus and Boeing now offer single-aisle aircraft designs that can routinely fly 3,000 to almost 4,000 nautical miles—or easily from coast to coast in the continental U.S. as well as some overseas routes to and from the U.S. Of the eight U.S. carriers we interviewed for this review, five of them operate only single-aisle aircraft and the remaining three fly a mixture of single- and twin-aisle aircraft. As shown in figure 1, twin-aisle aircraft are rarely used for domestic flights by U.S. carriers. In 2018, 99 percent of U.S. aircraft departures for domestic flights occurred on single-aisle aircraft: 71.7 percent on the larger single-aisle aircraft; 26.61 percent on smaller, regional aircraft; and 0.68 percent on turbo jets. According to the 2010 U.S. Census, 57 million Americans (roughly 1 in 5) have a disability, of whom half have mobility issues that may require accommodations when flying. Furthermore, older Americans are representing a greater share of the U.S. population. By 2020, 16.5 percent of the nation’s population will be over age 65, and by 2030, 20 percent of the population will be over age 65, and the likelihood of this group’ needing assistance to access lavatories may increase as they age. As an indication of the number of people with reduced mobility flying, DOT’s monthly aviation travel data indicate that for the first 6 months of 2019, aviation passengers checked a total of 294,216 wheelchairs and scooters. Over the past 30 years, some efforts have been made to address the issue of ensuring non-discriminatory treatment of aircraft passengers, including access to aircraft lavatories. The enactment of the ACAA, which prohibits discrimination by airlines on the basis of disability, charged DOT with promulgating implementing regulations. DOT promulgated a final rule in 1990, in which it required aircraft with more than one aisle (twin-aisle aircraft) in which lavatories are provided to have at least one wheelchair accessible lavatory. DOT, however, deferred setting regulations for single-aisle aircraft, noting cost and feasibility concerns for carriers. Since that initial regulation, DOT has taken several steps to study the issue of accessible lavatories for single-aisle aircraft, but as of December 2019, none of these actions has resulted in a regulation for accessible lavatories in single-aisle aircraft. These steps include: DOT issued an advance notice of proposed rulemaking (ANPRM) to study, among other things, the issue of accessible lavatories on single-aisle aircraft that was issued in conjunction with its final rule mandating that twin-aisle aircraft must have a lavatory that is accessible to passengers who use wheelchairs. DOT created an advisory committee in 1992 to provide guidance to DOT concerning access to lavatories on single-aisle aircraft for persons with disabilities, including persons who rely on the aircraft’s onboard wheelchairs. In 1996, the committee reported to DOT that it would be feasible to provide accessible lavatories on single-aisle aircraft but acknowledged that there could be a cost to doing so. As part of a final rule that DOT issued in 2008 to amend the ACAA regulations to include foreign carriers that fly to the U.S., DOT acknowledged that requiring accessible lavatories on single-aisle aircraft was an ongoing issue. While the department noted that accessible lavatories on single-aisle aircraft would benefit passengers with disabilities, it also expressed concerns that revenue loss and other cost impacts could be too great for the carriers. The department said that it would continue to study the issue and review ongoing developments. DOT published a notice of intent in December 2015 to explore the feasibility of conducting a negotiated rulemaking concerning, among other things, accessible lavatories on single-aisle aircraft for travelers with disabilities. As a result of the 2015 notice of intent, DOT established the ACCESS Advisory Committee in 2016—composed of representatives from air carriers, aircraft manufacturers, disability groups, and other aviation stakeholders. Its charge was to negotiate and develop a proposed amendment to DOT regulations for DOT’s consideration concerning accommodations for air travelers with disabilities that would address whether to require accessible lavatories on new single-aisle aircraft, among other issues. The committee noted that the issue of requiring accessible lavatories on single-aisle aircraft merited exploration because of two developments: (1) the increased use of single-aisle aircraft on long flights, and (2) the availability of new accessible- lavatory designs for single-aisle aircraft. In late 2016, the ACCESS Advisory Committee agreed on proposed amendments that included short-term and long-term solutions to address the challenges persons with mobility impairments face when traveling on single-aisle aircraft. The committee, taking into account costs to industry, recommended accessible lavatories on new aircraft, did not recommend requiring the retrofit of existing aircraft, and proposed a multi-tiered approach to meet this goal. In 2019, DOT publicized its intent to issue notices of proposed rulemaking regarding accessible lavatories to address the ACCESS Advisory Committee’s final resolution, which we discuss in more detail below. Both Airbus and Boeing offer their customers a range of standard lavatory designs. For example, both Airbus and Boeing offer a lavatory with a contoured design (see fig. 2). This design offers a smaller sink and different dimensions than previous lavatories and has a contoured or angled wall on the exterior allowing seats in the last row to recline into the bottom portion of the contour. Air carriers can also choose to move the last row of seats back into the contour and then add an extra row of seats after making other changes to the configuration of seating rows. Airbus and Boeing also offer flat-wall lavatory designs that are similar to the standard flat-wall lavatories that had previously been available on single- aisle aircraft for years but have slightly different interior dimensions. Compared to the contoured lavatory design, this current flat-wall lavatory design could offer a larger sink or more countertop space. According to measurements and diagrams the aircraft and lavatory manufacturers provided for these lavatory styles, some interior lavatory dimensions have decreased while other dimensions have increased. For example, changes in these two lavatory styles have resulted in increased interior space in some areas, such as the sitting knee space and diagonal shoulder width, and decreased space in other areas, such as the entry width and door height. These changes were to provide carriers options to help them meet their business strategies. In addition to making changes to the standard lavatories, since 2015, both Airbus and Boeing offered lavatory configurations for their single-aisle aircraft designed to provide greater access for passengers who rely on the use of onboard wheelchairs. According to officials for Airbus and Boeing, both manufacturers use a design that connects two adjacent lavatories with a retractable wall or partition. As shown in figure 3, when the folding partition is open, this configuration is designed to enable the person who relies on the aircraft-onboard-wheelchair to enter in one of the lavatories and then transfer or be transferred to the toilet in the other lavatory. While there are differences between the Boeing and Airbus models, they operate similarly. Both the Airbus and Boeing designs are for the rear of the aircraft and take up space in the area normally used for the galley where food and drink carts are located for flight attendants’ access. According to officials we interviewed from two carriers that have purchased aircraft with this design, a reduced galley area is less of a concern because their flights provide limited food and beverage service and do not need a full galley. They said that the space where the traditional lavatories were located could be used for other purposes, such as more seats. According to the manufacturers, the lavatory models that are designed for greater accessibility accommodate the onboard wheelchair to varying degrees. Airbus offers two designs to accommodate a passenger with an onboard wheelchair. The Space Flex version 1 design consists of two adjacent lavatories with a connecting retractable partition. This retractable partition can open to allow for a passenger who relies on the aircraft onboard-wheelchair to enter the lavatory with or without the help of an assistant. A representative from a disability organization was generally positive about the Space Flex version 1 and said it was a good design for both carriers and travelers with disabilities. Airbus also offers another lavatory design specifically for its A220 single-aisle aircraft model. Airbus officials told us that it is a single lavatory that is designed to accommodate a wheelchair but cannot accommodate both a passenger in an onboard wheelchair and an assistant. Boeing offers one lavatory designed to accommodate a passenger using an onboard wheelchair for single-aisle aircraft for its 737 aircraft family. This design, known as the Pax Plus, consists of two adjacent lavatories with a removable partition designed to enable a wheelchair and assistant to enter. In addition, officials from the eight selected air carriers told us that their crews are trained to assist passengers with reduced mobility to use lavatories. These officials from the eight air carriers stated that they provide their cabin crew with initial and, in some cases, recurrent training about how to assist passengers with reduced mobility, pursuant to DOT regulations. DOT regulations further stipulate that if there is an on-board wheelchair, the carrier must provide assistance to enable the passenger to move to and from the lavatory if, in general, such assistance is requested by or on behalf of a passenger with a disability. While aircraft manufacturers offer lavatories designed to accommodate passengers with mobility impairments, carriers do not often choose to acquire them. Of the eight U.S. carriers we interviewed, we found that four have some aircraft—all of which are Airbus aircraft—with lavatories that are designed to accommodate passengers with mobility impairments to some extent. Only one of these carriers is among the four with the largest number of aircraft in their fleet. Specifically, these four carriers have either the Space Flex version 1 or the Airbus A220 lavatory. Despite Boeing’s offering of the Pax Plus lavatories since 2017, Boeing officials told us that as of November 2019 no U.S. carriers have ordered these lavatories for their current or future single-aisle Boeing aircraft. Overall, about 4.5 percent of the combined single-aisle fleet of the eight selected carriers have lavatories designed to provide some measure of greater access to passengers with reduced mobility, including those who require the use of the onboard wheelchair (see fig.4). According to the carriers we interviewed, they consider the configuration of the aircraft among other factors, including their business strategy, when ordering lavatories for new aircraft. Providing a lavatory designed to accommodate onboard wheelchairs on single aisle aircraft may require financial tradeoffs for carriers, such as reducing the number of revenue generating seats in the aircraft cabin. According to airline officials, this reduction can result in higher costs for carriers that subsequently might be passed onto consumers through higher fares. Officials from all eight selected carriers, however, stated that all of their aircraft lavatories have features designed to increase access to certain lavatory functions, such as assist handles or grab bars, accessible call buttons, door locks, and faucets that passengers with disabilities can use. Carrier officials also stated that they need to make trade-offs between competing priorities; for example, taking into account how onboard wheelchair-accommodating lavatory designs may affect food service. According to officials from two carriers, an onboard wheelchair- accommodating lavatory can result in less galley space, and a full galley at the back of the aircraft is needed for the type of services they wish to provide to their customers without compromising customer seating capacity. Conversely, officials from two other carriers told us that trading galley space for onboard wheelchair-accommodating lavatories did not affect their food service, as they do not provide full meal service. For example, they said that because they did not need the full galley space, the Space Flex lavatory enabled them to add not only a lavatory that accommodates onboard wheelchairs but also an additional row of passenger seats. Representatives from stakeholder groups we interviewed told us that the lack of accessible lavatories makes flying challenging for persons with reduced mobility. They described how some passengers with reduced mobility take precautionary measures to avoid the need to use an aircraft lavatory, such as severely limiting food and fluid intake in advance of the flight, risking dehydration; using a catheter; or wearing a protective undergarment. Some passengers with reduced mobility reportedly may avoid long flights altogether by purchasing flights with connections or layovers. However, according to one stakeholder group, these precautionary measures may not alleviate the fear and anxiety that passengers who rely on the onboard wheelchair to get to the lavatory may face during air travel as there is always the possibility of having to deal with circumstances beyond their control. For example, unforeseen events such as increased flight time or delays in getting to the gate can increase the time a passenger has to postpone attending to normal bodily functions. Finally, stakeholder groups report that passengers may choose not to travel at all, or to drive rather than fly, choices that may increase the cost and time of travel, particularly if it involves an overnight stay. Even when an aircraft has a lavatory that can accommodate an onboard wheelchair, which exists on about 4.5 percent of the combined fleet of single-aisle aircraft for the 8 airlines included in our review, passengers may have difficulty determining whether or not their flight has such a lavatory. According to officials of air carriers, passengers may call the carriers’ customer service department for this information, although not all phone representatives may have this information readily available. In addition, our review of selected carriers’ websites revealed that most do not have information about which flights or aircraft may have such a lavatory, although we found that two carriers include descriptions of aircraft amenities or diagrams denoting onboard wheelchair- accommodating lavatories. However, even if this information were made available, it may not guarantee that a passenger with a mobility impairment will be able to fly on an aircraft with this type of lavatory because air carriers sometimes switch aircraft at the last minute without notice, such as when, for example, an aircraft has a mechanical problem. While stakeholders described challenges, neither air carriers nor DOT receive a large number of complaints regarding the lack of lavatories designed to accommodate passengers who use onboard wheelchairs or lavatories in general. As we have previously reported, DOT receives and processes complaints from passengers and uses complaint data to help identify which carriers to inspect for consumer protection violations. From 2014 through 2018, DOT received 59,846 complaints about U.S. carriers. Of these, we reviewed 1,263 complaints related to accessibility, inadequate facilities, and flight delays and identified 69 complaints about lavatories in general and 5 about the accessibility of lavatories. Of the 69 lavatory complaints identified: 64 related to non-functioning lavatories (e.g., non-operational or unclean lavatories, sinks lacking running water, etc.); 5 related to lavatories being inaccessible by persons with disabilities (e.g., lavatory grab bars at an improper height, passenger using onboard wheelchair unable to enter lavatory); and 2 related to lavatory size (e.g., lavatory size has been reduced). We also discussed lavatory-related complaints with the eight selected air carriers, three of which reported that these complaints made up about 1 percent or less of the total passenger complaints they received in 2018. Four air carriers reported that lavatory complaints related to accessibility made up an even smaller portion—around 0.05 percent or less of their total passenger complaints in 2018. However, the small number of complaints related to lavatory accessibility does not necessarily indicate that individuals who use onboard wheelchairs are not affected by inaccessible aircraft lavatories, as some may choose not to fly, and others may take precautionary measures as described above to avoid having to use the aircraft lavatory. Furthermore, because accessible lavatories are not required on single-aisle aircraft and there is no expectation that the lavatory would be accessible, passengers may not see grounds to complain or may not take the time to submit a complaint. As we have previously reported, complaint data are inherently limited because, according to academic literature, a substantial portion of dissatisfied individuals never complain and are therefore not represented in the complaint data. Finally, when they do complain, their complaints may not be representative of other individuals. We also found that there were very few complaints about non-functioning lavatories. As noted above, DOT received 64 passenger complaints on non-functioning lavatories. Carrier officials also told us that they have received few complaints about non-functioning lavatories. According to the air carrier officials we interviewed, depending on the flight, some flights may operate with one or more lavatories not functioning. However, most carrier officials reported that according to data they collect, this occurred on less than 2 percent of flights. In such instances, some carrier officials stated they would notify passengers of nonoperational lavatories to give them the opportunity to use the airport lavatories prior to boarding. These officials also stated that if all lavatories are inoperable it is the responsibility of the pilot—in consultation with flight dispatchers—to decide if the aircraft will take off or, if lavatories become inoperable during a flight, to divert to an airport other than the destination. Carriers further noted that flights with no operational lavatories are extremely rare. As previously noted, in late 2016, the ACCESS Advisory Committee reached a consensus on proposed amendments that would require accessible lavatories on single-aisle aircraft. DOT announced in 2019 that it would address the issue in rulemaking. On December 16, 2019, DOT issued a notice of proposed rulemaking to solicit comments on short-term accessibility improvements on single-aisle aircraft through the installation of accessibility features within the lavatory, such as assist handles, call buttons, and lavatory controls, without changing the size of lavatories. In addition, DOT has announced its intention to issue an advanced notice of proposed rulemaking to address long-term accessibility improvements, also addressed by the Advisory Committee, and to solicit comments and gather information on the costs and benefits of requiring carriers to increase the size of the single-aisle lavatory on new aircraft models to enable passengers using an onboard wheelchair to enter and use the lavatory with an assistant, if necessary. In addition to the two rulemakings, DOT has recently established another advisory committee. The ACAA Advisory Committee was created in response to a requirement in the FAA Reauthorization Act of 2018, has a 2-year charter, and is required to report its findings to both DOT and Congress on current DOT regulations on barriers to persons with disabilities who want to travel by air. The ACAA Advisory Committee is also required to determine the extent to which DOT is addressing those barriers, recommend improvements to implement the ACAA, and improve the flying experience for travelers with disabilities. The committee— comprised of members representing aircraft manufacturers, national disability organizations, air carriers, and airports—plans to hold its first meeting in early 2020. According to DOT officials, although it is within the purview of this committee to consider issues regarding accessible lavatories, it does not plan to do so at the present time given that the two proposed rulemakings are proceeding and that there is a Congressional mandate for the committee to report on other issues within 6 months of the first meeting. We provided a draft of this report to DOT for review and comment. DOT provided technical comments, which we incorporated as appropriate. We are sending copies of this report to the appropriate congressional committees, DOT, and other interested parties. In addition, the report is available at no charge on the GAO website at http://www.gao.gov. If you or your staff have questions concerning this report, please contact me at (202) 512-2834, or vonaha@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made key contributions to this report are listed in appendix I. In addition to the individual named above, other key contributors to this report were Ed Laughlin, Assistant Director; Martha Chow, Analyst-in- Charge; James Geibel; Geoffrey Hamilton; Elke Kolodinski; Gail Marnik; Malika Rice; Amy Rosewarne; Travis Schwartz; Pamela Snedden; and Elizabeth Wood.

Summary: Flying can pose significant challenges for persons who rely on wheelchairs, including the lack of wheelchair accessible lavatories on most flights. In 1990, DOT required wheelchair accessible lavatories on twin-aisle aircraft used mainly for long flights. It did not require them for single-aisle aircraft, although DOT continued to study the issue. Since 1990, technological advances have enabled single-aisle aircraft to fly longer distances, and these aircraft now make 99 percent of domestic flights. In 2016, a DOT advisory committee recommended that DOT require accessible lavatories in certain single-aisle aircraft in the future. The Federal Aviation Administration (FAA) Reauthorization Act of 2018 included a provision that GAO examine the availability and designs of lavatories on commercial aircraft and the ability of passengers with disabilities to access them. This report describes (1) what is known about lavatory designs and accessibility for persons with reduced mobility and (2) the challenges wheelchair-bound passengers and others face while traveling on single-aisle aircraft without accessible or functional lavatories. GAO reviewed DOT's guidance and rulemaking and analyzed DOT's aircraft complaint data and fleet data for the eight largest U.S. air carriers. GAO interviewed officials from the eight largest mainline carriers and reviewed their fleet and lavatory data. GAO also interviewed officials from Airbus and Boeing and subsidiary lavatory manufacturers, as well as representatives from cabin crew labor associations and consumer groups representing persons with disabilities. Aircraft manufacturers offer lavatories that carriers can provide and that are designed to accommodate users of onboard wheelchairs, but carriers do not choose to acquire this option for their single-aisle aircraft. We found designs for lavatories that enable a passenger in an onboard wheelchair to use them, to varying degrees. In recent years, both Airbus and Boeing—makers of single-aisle aircraft—began offering similarly designed lavatories to provide greater access for these passengers. For example, one design consists of two adjacent lavatories located in the rear galley area with a connecting retractable wall to allow for a wheelchair-bound passenger to enter one lavatory and transfer or be transferred to the toilet in the other lavatory. Another design is a single lavatory large enough to accommodate a passenger using an onboard wheelchair. Four of the eight U.S. carriers—and only one of the four with the largest fleets—GAO interviewed have Airbus aircraft with an adjacent lavatory design (Space Flex version 1) or the single lavatory design found on the A220 aircraft, constituting about 4.5 percent of the carriers' combined single-aisle fleet (see figure). None of the eight U.S. carriers have purchased a similar lavatory for their Boeing's single-aisle aircraft. Carrier officials told GAO that they consider many factors when ordering lavatories, including financial and service tradeoffs such as the potential to lose seating spaces, or reduced food and beverage service for passengers. While the Department of Transportation (DOT) receives few complaints on lavatory inaccessibility, consumer groups told GAO that the lack of an accessible lavatory on single-aisle aircraft presents challenges for persons with reduced mobility. For example, some passengers take precautionary measures to avoid the need to use the aircraft lavatory and others avoid flying altogether. Additionally, although some aircraft have wheelchair-accommodating lavatories, they are not well advertised to passengers, making it difficult for passengers to know whether their flight may have such a lavatory. To address such challenges and the findings of its 2016 advisory committee, DOT issued, on December 16, 2019, a notice of proposed rulemaking to require carriers to install accessibility features without changing the size of the lavatories. DOT also expressed intent to study the costs and benefits of enlarging single-aisle aircraft lavatories to enable use by passengers using the onboard wheelchair.