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SCI Forum Reports

Home Modification for Persons with SCI

January 13, 2004

Resources are listed at the end of this article.

As eager as people are to go home from the hospital after a spinal cord injury, they may find it's not the hospitable place it once was. Whether it's getting up the front stairs or through the bathroom door, suddenly going home presents a host of accessibility problems.

In the 20 years since he was injured, Kirk Hennig has remodeled his home three times. "Your needs likely will change over time," he said. "You can't expect one remodel to be perfect forever." Changes in health and family circumstances often require modifications over the years. Hennig co-chairs the Northwest Regional Spinal Cord Injury System's Consumer Advisory Board (CAB) and served as moderator of this evening's forum.

Connie Hollerith, who also serves on the CAB, learned the hard way that "accessible home" means different things to different people. After her teenage son Nick Hart was injured, she rushed out to find an accessible dwelling for him to come home to. "I found a place that was called accessible," she recalled. "I brought him home and the carpets were too thick for the wheelchair. Also, it was on the third floor and the elevator kept breaking down."

Hefting him up and down the stairs was too much. "So I went into a condo that already had a ramp," she continued. "I was so excited. But it turned out the ramp was too steep, and he couldn't go up it by himself, so I had to push him up." She also quickly discovered that Hart's wheelchair was wider than the prior occupant's had been, and wouldn't fit through some of the doorways. So she had to give up on that place, too. Listings for accessible homes or apartments only tell part of the story; they need to be investigated thoroughly.

Hollerith now brings this personal experience to her business, Pyramid Affiliates, a real estate, mortgage and escrow firm in Edmonds, Wash. (866-672-8575; http://www.pyramidaffiliates.com ). She and her son, who now works with her, help clients with disabilities identify their accessibility needs when searching for a home.

"If you know what (modifications) a home you want needs, you can write up a purchase and sale based on that contingency," said Hollerith. "You can write it into the financing as well." She and Hart have worked with a variety of creative loan programs that can be used to pay for modifying an existing dwelling or purchasing an accessible home; "some don't even require a down-payment," Hart said. (For funding and other information on home modification, see the "Resources" list at the end of this article.)

For many people, simply getting inside their homes is the main problem. Jerry Otis teamed up with Snohomish County United Way in 2002 to create the Regional Access Mobility Program (RAMP) "so folks can get into the home they want to live in." This program builds ramps for people in Snohomish, Island, Skagit and King Counties of Washington State so they can stay in their own homes or return home from a hospital, rehabilitation center or nursing home. (RAMP; 2812 Lombard Ave., #207, Everett, WA 98201; 425-259-7922; Jerry12102@aol.com ).

Architect Garreth Schuh started his career as a traditional architect, but after his spinal cord injury more than a decade ago he started working with clients who were also injured, or were elderly, aging, retiring, or facing disabling illnesses like Parkinson's Disease. Schuh subscribes to a philosophy he calls "transgenerational design," also known as "universal design," when he designs or remodels a home. By definition, these designs are accessible to everyone, regardless of age, disability or health. They can accommodate you from the prime of life to the frailty of old age. Now in the thick of remodeling his own home, he is acutely attuned to home accessibility issues.

As much as possible, Schuh tries to bring nature and light into the house with more or bigger windows and through careful sighting in new construction. For him, these are quality-of-life issues. "When people are housebound for long periods of time, this can really make a difference," he said.

Personal experience has taught him the value of small details. In entryways, for example, a simple awning keeps people dry and a flat area at the top of a ramp keeps wheelchairs from rolling back while fumbling for keys. Hallways are often cramped and dark, so he opens them up or puts windows along one side whenever possible. The type and placement of hardware on doors, cabinets and windows is very important, and Schuh recommends "levers or generous D-rings." Although he likes pocket doors because they are "nifty" and slide out of the way, they might not be appropriate for people with poor hand function.

Environmental control systems can be very elaborate. "Depending on how close you are to Bill Gates (in wealth), you can install security systems and control your whole house from your phone as you're coming into town on the plane," Schuh mused. "There's no end of options-if you have the budget."

Schuh favors an abundance of electrical outlets ("even inside closets and bathroom cabinets") for meeting all one's electrical equipment needs, present and future. He says lighting is especially important as people age because older eyes have more difficulty recognizing contrast. "I always overlight," he said. "You can put in dimmer bulbs if you want to."

Borrowing a lesson from Architecture 101, Schuh concluded by saying the ideal home should be both a "retreat" from the rest of the world and a "prospect" from which to survey the world around you, providing both comfort and connection. (Garreth Schuh Architectural Design can be reached at 206-988-5956 or garrethschuh@yahoo.com )

Bill Morrell's company Adaptive Installations (800-765-1969 or 206-762-1969; email: medsurgsys@aol.com ; website: http://www.adaptiveinstallations.com ) specializes in accessible home modification and the installation of specialty equipment. When doing a home modification assessment, he first looks at getting into the home. Ramps are often the best solution to getting up the front stairs, but not always. "For every 1 foot of rise you need 30 feet of ramp," he explained. "If you have five steps up to the front door, each 7 inches high, that requires 35 feet of ramp. Plus, for every 30 feet you need a level landing area or a switchback, adding to the length (and cost) of the ramp." A ramp such as this could easily take over the entire front yard, detracting significantly from the home's appearance and taking a big bite out of your budget.

Morrell tries to find creative solutions to access problems that are both economical and attractive. He has created ramps that masquerade as paved pathways through gardens or between trees. The yard can be graded so a path starts in front, gradually moving uphill and wrapping around the side of the house to a back patio entry. When ramps are impractical, he may use a wheelchair lift, often tucking it behind vine-covered screens or lattices.

According to Morrell, the breakeven cost of a ramp versus a lift is about 35 feet. Also, if the ramp is more than 30 inches off the ground, codes require a railing-an added cost. While costs vary depending on the specifics of each home, Morrell installs an enclosed lift for around $22,000, an unenclosed lift for half that, and a little porch lift for $5,000 or less. He said every home should have two wheelchair accessible exits, one for emergencies.

Morrell mentioned that most of his work isn't in "high-end homes, but smaller, three-bedroom ramblers like most of us live in." His attention to details and materials, and his awareness of the complex accessibility issues facing people with disabilities, are based on years of experience, including much trial and error. He has found that tempered glass French doors won't break if a power chair runs into it. He solved a doorway problem by turning a bedroom window into an automatic glass sliding door that opens level the walk. (He charges about $2,100 to install an automatic door.) He's always on the lookout for new materials and better equipment. In much of his work, Morrell refers to the Paralyzed Veterans of America guide Accessible Design: Architectural Solutions for the Wheelchair User (see "Resources" section for details).

Bathrooms present a host of problems for the wheelchair user. Morrell often has to widen doorways, install new sinks, replace tubs with roll-in-showers, knock down walls. According to the PVA guidelines, accessible showers should be 48 inches by 48 inches, but ripping out the tub may not leave enough space since they are typically 33 inches wide. He builds custom roll-in showers and works in tile a lot because he can get the dimensions he wants. "Fiberglass basins and shower stalls only come in certain sizes," he explained. "I've learned that a half-inch can make a big difference to someone."

He has also learned that a wall-hung shower bench can damage the wall eventually, and now he prefers four-legged benches that fold up against the wall when not in use. A collapsible water-retaining edge allows a wheelchair to roll across, then pops right up again to keep the water inside while showering.

Morrell has fashioned a wide variety of customized sink arrangements, including cut-out counter tops to accommodate joy-sticks, offset faucet fixtures, and rearranged under-sink plumbing to make space for a wheelchair.

Bedroom solutions include cabinets that swing around a pedestal in place of drawers, closets with low bars for hanging, and lots of closet organizers. "With medical supplies and such, you can never have too much storage!" he said. Vertical floor-to-ceiling poles that accommodate a horizontal bar or trapeze help with transfers in and out of bed. Overhead lift systems can be permanently mounted into a track, or they can be portable and attach to other tracks located throughout the house. "The lift can be hooked up to a track in the bathroom, in the family room to lift a person into a (reclining chair), or into the hot tub or Miata convertible," he joked, drawing a laugh from the audience. One portable system can be packed up into a bag and brought along on trips.

In homes with more than one floor, Morrell frequently installs stairway lifts. "You can avoid putting in an elevator if a person can transfer to a lift chair and onto another chair at the next level," he said.

"You can solve the problem of needing to go into basement to do laundry with an all-in-one washer-dryer combo that works on 110 watts and doesn't need a vent," he noted. "The unit is $1,100 but that's less expensive than a stairway lift."

Morrell installs a lot of environmental control systems so a person can use voice commands or switches to answer the phone, change the heat, turn on the lights. "It's not difficult technology," he said. He recommends keypads for home security rather than locks, "because you can change it whenever you need to."

Some insurance companies may cover modifications considered medically necessary, and these would need to be outlined in a letter of justification written by an occupational therapist. Funds for modifications are also available from civic and government organizations; see the following "Resources List" below:

Resources:

Rebuilding Together , a non-profit home repair and rehabilitation program that helps low-income seniors, persons with disabilities and others to remodel or repair their homes, with local affiliates around the country.

National office
phone: 800-473-4229
email: info@rebuildingtogether.org
website: http://www.rebuildingtogether.org/

Rebuilding Together Seattle
306 Westlake Ave N, Ste 400
Seattle, WA 98109
phone: 206-682-1231
email: info@rtseattle.org
website: http://www.rtseattle.org

Click here for a listing of other Washington State "Rebuilding Together" office locations.

Pyramid Affiliates , a real estate, mortgage and escrow firm experienced in serving clients with disabilities

8117 240th ST SW
Edmonds, WA
phone: 866-672-8575
http://www.pyramidaffiliates.com

Regional Access Mobility Program

RAMP
2812 Lombard Ave., #207
Everett, WA 98201
phone: 425-259-7922
email: Jerry12102@aol.com

Garreth Schuh Architectural Design specializes in home remodel and new construction designs for persons with disabilities

phone: 206-988-5956
email: garrethschuh@yahoo.com

Adaptive Installations specializes in accessible home modification and the installation of specialty equipment.

phone: 800-765-1969/206-762-1969
email: medsurgsys@aol.com
website: http://www.adaptiveinstallations.com

Paralyzed Veterans of America guideline Accessible Design: Architectural Solutions for the Wheelchair User costs $22.95

to order, call 888-860-7244 or order online at http://www.pva.org/livingsci/architecture/archindex.htm

King County's Home Accessibility Modification (H.A.M.) Program provides financial assistance for low and moderate income tenants to make accessibility modifications to their rental unit

phone: 206-296-7640
website: http://www.metrokc.gov/dchs/csd/Housing/RepairHAM.htm

Master Builders Care Foundation builds free wheelchair ramps at their annual spring Rampathons for qualifying low-income disabled and elderly homeowners. For information and applications, contact:

Master Builders Care Foundation
335 116th SE, Bellevue, WA 98004
phone: 425-451-7920
email: mbcare@mbaks.com

Centers for Independent Living are federally funded programs that provide information, referral and other assistance relating to accessibility and other issues for persons with disabilities.

Click here for a Directory of Centers for Independent Living in Washington State . Elsewhere, look in the blue U.S. Government Offices pages of the local phone book, under "Disabilities" or "Education, Dept. of."

Habitat for Humanity is a nonprofit housing organization the builds affordable houses in partnership with persons who lack adequate shelter. Find the affiliate nearest you by visiting http://www.habitat.org/ .

Click here for a listing of "Habitat for Humanity" offices in Washington State.

Easter Seals of Washington assists children and adults with disabilities and their families with access, mobility, assistive technology and other needs, through a nationwide network of more than 450 service sites.

Washington State office:
Mabel Dilley, 260-281-5700 or 800-678-5708 Ext. 123
website: http://www.easterseals.com/

Community Access Washington State has a "Quick Guide to Accessible Housing for People with Disabilities"

website: http://depts.washington.edu/caws/guide_ho.shtml

Universal Design Home Modification , a resource on the AARP Web site, gives a room-by-room tour of home modification solutions using the principals of universal design

phone: 888-687-2277
website: http://www.aarp.org/universalhome