Challenges Encountered in Adapting Homes for Individuals with Special Needs

As I write this, my wife is less than a week out from her second heart surgery. It took an hour and a half for me to bathe her for the first time since she has been out of the hospital and her mother is currently doing her hair in the living room of our Airbnb in Cleveland, OH. Albeit her condition is only temporary, it is a stark reminder of how ill equipped our homes are for our needs throughout our lives. With a staggering 27% of adults in the United States having some type of disability that affects their daily living, one would think that home construction and design would adapt for people of all abilities. We are starting to see a movement in new construction to be more inclusive, but what about older homes? How can we modify them to be more inclusive and create safe spaces that foster independence?

Why is it so Difficult to Modify Homes for Disabilities?

Question posed by Kassondra on Facebook

First-hand Experience

There’s nothing like first hand experience so I wanted to give a little background perspective before I go into my recommendations. My first eye opening experience into these issues was when my mom had to have hip replacement surgery. The surgery itself went extremely well and to my surprise she was up and walking the same day. The recovery takes a little bit of time and does require some attentiveness so I moved in with her for a short period of time to assist. After a week or so, she said she didn’t need me there anymore and was comfortable being on her own. Less than 24 hours later, she had twisted improperly closing her sliding door. Her prosthetic broke out of her femur leaving her basically immobile on the floor in agonizing pain. She crawled from one room to the next to get her phone. She called me instead of 9-1-1 and in an exasperated voice said “you know those Life Alert commercials?!”

Don’t be my mom! Please call 9-1-1 first, then family!

The next 3 months included another, much more invasive surgery and 3 months of exhausting rehabilitation. She was a 30+ year kitchen and bath design veteran who had just finished her own remodel on her entire home. Knowing she wasn’t going to be there in her later years, she planned for her current ability and not the future. We both learned together the importance of future planning no matter the occupant’s age or current abilities.

My second major experience was when one of my fraternity brothers invited me to San Diego to go to Comic-Con with him (yes, I’m a kitchen-nerd and a nerd-nerd too). While we were in college, he was injured in one of those Tough Mudder runs and was left paralyzed from the neck down. He has limited range of motion in his arms which allows him to use a wheelchair. Though his hands and lower half of his body were rendered completely immobile. As I watched how he navigated his apartment, especially his kitchen and bathroom, I learned how these different limitations made what seemed like simple tasks unbearable or even impossible.

These events alongside my wife’s heart surgeries have changed the way I design my spaces. For example, when I am doing a bathroom remodel, I don’t care if it’s for an elderly couple, a healthy child, or an athlete at the top of their game, I plan for the future. The elderly couple may face a fall, the child could develop an autoimmune disease, and the athlete could get a career ending injury. Statistically nearly everyone of us will face some sort of temporary or permanent disability at some point in our lives. Although we don’t want to believe something could happen to us, we need to our homes to work for us if and when they do!

Medical Equipment

My experience with 3rd party medical equipment other than what I have used for the examples above is limited. As a designer, my role comes in typically for clients who are remodeling or building for their future or for clients whom are remodeling an existing space in order to adjust for a loved one’s specific needs. I would recommend consulting with an professional occupational therapist to discuss medical equipment for existing spaces.

Modifying Our Perception

Accessible design, aging-in-place design, living-in-place design, and universal design are all terms with the intent to create spaces that help us live and use our homes as safely as possible at varying degrees of abilities. My favorite term of these would be Universal Design which is the idea that anyone no matter their abilities should be able to fully use a space safely and independently.

As a Certified Aging in Place Specialist (CAPS) and Certified Living in Place Professional (CLIPP), there are many ways we can design and plan a space so it is both functional and beautiful. Most people struggle with the beauty aspect because they think of more utilitarian ideas for accessibility. Let’s take grab bars for example. Most people hear that term and think of gas station or fast food restaurant bathrooms with their oversized and ugly stainless steel bars. But a quick google search will show that most of the leading bathroom accessory manufacturers offer matching grab bars so that you can continue the same styling and finishes as your faucet and towel bar throughout the space. If the thought of grab bars in the shower at your age makes you question your vitality, I totally understand. I have heard that from numerous clients who aren’t ready to have them yet. We still plan blocking inside of the walls around the toilet and the shower so that if and when the time comes, grab bars can be installed properly into something that can safely support a person’s weight.

Bathrooms

This is a large topic and could cover multiple posts so for now I am just going to focus on bathrooms and save other spaces for a follow up post. I find that bathrooms are where I focus the vast majority of my time future planning. That’s not to say that I don’t pay attention to other rooms, but we’re just extra vulnerable in these spaces. Between being typically tighter spaces covered in hard slippery materials and the varying movements associates with using items like tubs, showers, and toilets, these spaces are one of the hardest to navigate for someone facing alternate abilities. And we use them every day.

Shower Spaces

We are seeing an increasing amount of curb-less showers. These showers are more difficult to construct than a tradition tiled shower because they typically require notching depth out of the floor joists to recess the shower space down into the floor for a seamless transition, sistering new joists (as we’ve just compromised the originals by cutting into the top of them), and waterproofing much further out to protect from the water that escapes from not having a curb on the shower. Despite the additional costs the achieve them, they make the use of mobility aids much easier. Curbs often get in the way and create a trip hazard getting in and out of the shower. As we get older, we lift our feet up less and a small misjudgment of the curb height could turn an ordinary shower into a really bad one.

One of my favorite things to do is to include a bench seat. When I remodeled my last home, I added a master suite with an oversized shower with a bench and I have been spoiled ever since. In our current home, we are not so lucky spatially, so we opted for a teak bench in the shower. These can be freestanding units or mounted to the wall (as long as there is proper blocking behind the tile).

My wife had bacterial endocarditis and 2 strokes last year. The infection was eating away at her mitral valve which is what regulates blood flow out of the heart after it’s been oxygenated by the lungs. This condition was causing blood to go out, but to “regurgitate”, basically leak back, into her heart causing her to be extremely weak. This lasted for 4 months of degradation leading up to the diagnosis and included 3 months of recovery. Leading up to the second stroke, she couldn’t even shower herself or go up and down the staircase without taking 4-5 times longer than normal. The cardiologists, cardiovascular surgeons, infectious disease experts, and everyone else involved to this day cannot explain it because she didn’t fit the profile by 30-40 years. She was 32, exercised 7 days a week and ate salads for basically every meal. This simple bench seat coupled with an inexpensive 2-in-1 removable shower head allowed me to take care of her and keep her safe while doing so.

Another thing we can do to prepare is to not have our shower controls directly under the shower head. You remember these right? You may even have one right now. You turn on the water and jerk your arm or even your body back as to not get hit with freezing or scalding water. Moving the shower controls to a location where you can reach them without being assaulted by the water when turned on will give you greater control and an increased level of safety. There are also a number of manufacturers working with digital control pads inside or even outside of the shower as well. They can be programmed to specific user preferences so your shower is the same temperature you like it at every time.

Tub Spaces

This is an area that I think we have regressed in our safety. We have deviated from safer built-in tubs to freestanding tubs. Some freestanding units may have a larger side wall where you can sit and pivot into them, but the trend has been leaning towards slightly thinner and more delicate looks. These tubs require you to lift your leg all the way up and over and transition in. This is a difficult transition already, but what makes it worse is getting out. You lift your wet leg out and put it down on slippery tile floor or a loose rug. Your other wet leg is extend in the slippery tub to get you out. It’s a dangerous situation all around. Larger side walls on freestanding tubs or undermount built-in tubs will increase the safety and usability for those with disabilities and in injury prevention.

Toilet Spaces

This is another space that we are often very vulnerable. In most new construction and remodels, our toilets are designed behind doors in small water closets. They provide great privacy, but limit our accessibility. Someone using a walker would have to back up into the space – assuming their walker fits through the typically smaller than normal doorway. Even if they are able to get in there, they may or may not be able to close the door behind them. Someone in a wheelchair can basically forget using that space altogether unless it’s planned with the appropriate dimensions. I’d put money down that 99%+ of them are not. Planning the toilet space with a proper entry width with additional space inside may take more space from the bathroom floor plan, but can potentially make the space safer, more functional, and still maintain the privacy you are looking for.

Although Americans are still warming up to the idea of bidets, Europe and Asia are well beyond us in this department. These units don’t need to be separate like they use to be. Many well known toilet manufacturers offer them built into the toilet or as separate seats that can be purchased. I lived in Japan for a short while and travel there and to Europe quite often and it took me a while to open up to them. Especially after embarrassingly shooting myself in the face with the water spray when I was standing up trying to decode the Japanese Kanji symbols when I was 19 in Tokyo. Bidets are great options to increase cleanliness and reduce movement needed in the case of someone with mobility restrictions.

Vanity Spaces

Needs around a vanity space will also change depending on the user. One thing to keep in mind is height of items. If a person a 6′-8″, their vanity probably shouldn’t be at 36″H. It should be moved up so they don’t have to bend down as far to wash their face. The same can be said for someone who is vertically challenged or in a mobility aid. A lot of times, we can lower the vanity space to make it more reachable. For someone in a wheelchair, this may mean a floating vanity or just a skirt to hide the sink where their chair can roll under. When we think of height, we also have to think of arm extension and depth of the items in use. If you are designing for someone with a modern aesthetic and a floating vanity and want to put the faucet coming out of the wall, it may be a little harder to reach to turn on. Keeping in mind the ergonomics on top of safety of the person you are planning for will make for a better finished product.

Flooring Selections

Making proper flooring selections is also vital to a safe home environment. People often make their selections solely on aesthetics, but there’s often other things we should keep in mind. Having a flooring with a matte finish, better slip rating, or from a material that is natural slip resistant can keep you safe when entering, using, or exiting your shower, toilet, or tub.

The Consultant’s Thoughts

Home modifications for people of all abilities play a pivotal role in creating inclusive and accessible living spaces. These modifications are not just about adapting physical surroundings but also about fostering independence and improving the overall quality of life for individuals with disabilities. While the specific modifications required may vary depending on the individual’s needs, the goal remains the same: to ensure that every person can call their home a safe and comfortable haven. If you or a loved one has a disability, consider reading my article on consulting with a professional to explore the best home modifications to meet your unique needs and enhance your daily life.

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