A grab bar is only as good as what it is bolted to. The position matters, the angle matters, and the thing behind the tile matters most of all. Get the anchoring wrong and the bar becomes a hazard with a handle on it, because someone will trust it at the exact moment they cannot afford for it to move.
A grab bar has to reach solid structure. That means a wall stud, or solid blocking installed between studs, or a mounting system rated by its manufacturer for the wall construction you actually have. Drywall anchors are not structure. Neither is tile, and tile on its own gives a very convincing impression of being solid right up until it is not.
Properly anchored, a bar should hold 250 pounds or more of sudden force, which is the load a real fall applies. Anchored into drywall alone, it can pull out under far less than a person's body weight.
Where the studs are not where the bar needs to be, the fix is blocking. That means opening a small access in the wall, fixing a solid wood block between the studs, closing the wall back up, and mounting into the block. It is more work than driving an anchor and it is the difference between a fixture and a safety device.
Published guidance puts bars roughly 33 to 36 inches above the floor, which is the range the ADA uses for public buildings. That is a starting point for a house, not an answer. A home is not a public restroom, and the bar exists for one specific person.
Horizontal bars suit pulling across and steadying. Vertical bars suit pulling up and stepping in over a tub wall. A diagonal bar, often around 45 degrees, lets a hand slide along it and change height mid-movement, which helps someone whose grip is weak. Which one is right depends on how the person moves, which hand is stronger, and whether they sit.
The way to decide is to watch. We ask the person to show us how they get in and out now, where they reach, and what they hold on to when nothing is there. The bar goes where the hand already goes.
A towel bar is not a substitute and neither is a soap dish. Both get grabbed in an emergency and neither is fixed to anything that will hold.
Horizontal, vertical or diagonal, decided by how the person moves rather than by a rule. Horizontal helps with steadying and pulling across. Vertical helps with pulling up and stepping over a tub wall. Diagonal, commonly near 45 degrees, lets the hand travel and change height during the movement, which suits a weaker grip. We watch the person use the space before choosing.
The ADA range for public buildings is roughly 33 to 36 inches above the floor, and it is a reasonable starting point. In a home the right height is the one that matches the person's reach and the way they actually move, which can sit above or below that band.
Yes, when there is something solid behind the tile. Tile is a surface, not structure. We locate the studs or install blocking behind the wall, then drill through the tile with the correct bit and seal the penetration so water cannot get in behind it.
Nothing requires it. What matters is whether the bar reaches solid structure and whether the wall was sealed properly afterwards. The two failures we get called about are bars anchored into drywall, which eventually let go, and unsealed holes in a wet wall, which cause damage that shows up months later.
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