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Former Patients Share Ideas for Making a Home Wheelchair Accessible.

When Chris Boshar, 25, sustained a complete C-4 to -5 spinal cord injury in a boating accident last summer, his family and friends in North Andover, Mass., came together in a 21st-century version of an old fashioned barn-raising. Their objective? To provide Chris with everything he needs in his new life, especially accessible housing.

Like every patient at Shepherd Center, Chris received recommendations from his occupational and physical therapists about modifications that should be made to his home. The basic recommendations for most patients modifying existing homes include things such as a ramp to enter the home, widening of doorways and enlargement of at least one bathroom.

In new homes, accessibility is often based on a comprehensive concept known as universal design, which accommodates the needs of both people with disabilities and senior adults. It specifies the width of doors (32 to 36 inches) and halls (36 to 42 inches). It recommends a master bedroom and bathroom on the main floor, an accessible toilet, roll-in shower, handrails, grab bars and roll-under sink. It also includes levers for opening and closing doors and faucets, rocker light switches mounted low on walls, accessible closets and enough space in every room to maneuver a wheelchair.

When modifying a home, however, changes most often include ramps or sloping walks, a mechanical lift, enlarging a bathroom and installing a curbless shower and roll-under sink. Other useful features may include power doors; keyless entry; sensor-operated outdoor lights; kitchen islands with refrigerated drawers; stone flooring; remote-controlled utilities; and even an elevator. One former patient added an elevator to the outside of his home and had it designed to look like a chimney.

For Chris, the supporters were so numerous and organized that they divided themselves into committees, two of which – research and construction – were solely devoted to providing him with an accessible home.

They also factored fundraising into the equation from the start, creating a website and a Chris Boshar Fund, posting a notice on Facebook and sending a letter to extended family and friends, as well as businesses in the area, seeking donations. Fundraisers, an auction and networking raised more than $100,000, with perhaps another $50,000 in donated services.

Chris’ mother and stepfather refinanced their home so they could build an addition for Chris. To make room for the addition, a friend removed six large spruce trees, numerous volunteers helped stretch the budget and a knowledgeable architect donated his services.

But an architect is not always necessary.

Stephen Goot, 68, of Atlanta, a former Shepherd patient and the secretary of Shepherd Center’s Board of Directors, has modified three homes since he sustained a C-5 to -6 spinal cord injury almost 20 years ago. In his experience, even architects certified to do accessible design don’t always recognize the needs of people with disabilities.

Chris’ accessible home includes a work area, roll-in shower, lift over his bed and wide doorways.

“You really have to be in a wheelchair to understand the obstacles we encounter,” Stephen says. “There are things you would never think of. We’re always sitting; we can’t see over things.”

Pat Daviou, an occupational therapist in Shepherd’s Seating Clinic, and interior designer Andrea Hubbard have an Atlanta-area business that combines their expertise and produces everything a contractor needs to make home modifications.

“You need someone who is qualified to help in space planning, and you need someone who understands accessibility needs,” Andrea says. “Contractors do the work, but they may not understand the needs. Pat and I are a perfect partnership: She understands function and equipment, and I understand space planning and construction. Everyone has a different issue, and an inch or even a half-inch can make a difference. We relay that information to the contractor so we’re all on the same page.”

“We start by talking to the person and finding out how they function and what they need,” Pat says. “It’s always about the person, not the structure.”

She recommends that a home be inspected before making significant changes to be sure it can support them. “We’ve gone into older homes and found foundation problems or water damage,” she says, “and it couldn’t accommodate what we wanted to do.”

Given his love of the outdoors, Chris specified that the addition include plenty of natural light. “We designed it to bring the outdoors in,” he says. “There are a lot of windows, and even in the hallway, you’re looking outside.”

The windows themselves were donated, as were bathroom supplies, a water heater, closets, wood flooring. A finish carpenter installed crown molding at no charge and built a desk to Chris’ specifications so he can continue his work as a technical underwriter for Boston Capital.

The foundation was built at cost, and the paint, roof and site work were all donated. And upon learning that Chris spent every moment he could in the garden at Shepherd Center – “I had to be outside and get fresh air,” he says – another donor contributed a design for a back yard garden.

Stephen’s home includes many accessible features, such as an easy-to-reach refrigerator drawer, lift over his bed, a roll-in shower and an entrance ramp.

Despite the good intentions of those who want to help, Pat suggests proceeding carefully.

“I’ve seen roll-in showers with a one-inch lip,” she says. “That’s not a roll-in shower. Just because someone says they specialize in accessible design or construction doesn’t mean they’re good. Like everything else, you should get references, and don’t assume it will be done right. You’ve got to be an active participant in the process. No one knows you as well as you.”


SIDEBAR ARTICLE:  The Need for Accessible Housing

When Mark Johnson, Shepherd Center’s director of advocacy, speaks to civic groups, he asks how many people in the audience have a friend, family member, colleague or someone they know who has a disability. By the time he gets to the end of his list, everyone in the room has raised their hand.

Then he asks how many can entertain that person with a disability in their home. The answer, invariably, is very few because not many homes have ramps or graded walks, no-threshold entries, wider hallways and doorways, and rooms with enough space for wheelchairs to maneuver.

The Fair Housing Act of 1968 prohibited housing discrimination on the basis of race, religion or national origin, and in 1988 it was amended to include disability. But Johnson and others say the housing industry has been slow to respond to the need for accessible housing for people with disabilities and a growing population of senior adults.

According to a study by Metro Fair Housing Services Inc. of Georgia, 25 to 60 percent of all homes built in 2000 will have at least one resident with “severe, long-term mobility impairment.” Metro Fair Housing’s executive director Gail Williams says that in the 2011 Fair Housing Trends Report, “people with disabilities filed the most discrimination claims nationally.”

And last November, Eleanor Smith, executive director of the Atlanta-based advocacy group Concrete Change, expressed her frustration that contractors and home builders still ignore the needs of senior adults and people with disabilities. “It’s been 20 or 25 years,” she told the Atlanta Journal-Constitution, “and the fact is, nothing has changed.”

The problem, Johnson says, is that many builders “want to do things the way they’ve always done them, using the same blueprints or programs they’ve always used to design houses. And sometimes, changes cost money.”

But there are hopeful signs. In 2008, one of the largest construction companies in the United States, the A.G. Spanos Companies, was sued by the National Fair Housing Alliance for building apartments that were not wheelchair accessible. It paid more than $12 million to retrofit 13,200 units.

Also, the National Association of Home Builders now has a process that certifies specialists in home modifications for senior adults and people with disabilities.

The need is obvious, Johnson says. When he asks people if they would like a home they can age in, resell to anyone, that wouldn’t need renovation if something happened to someone and that anybody could visit, they invariably say yes.

“It’s common sense,” says Johnson, who uses a wheelchair. “But it takes a while for people to understand what it’s like for me to live in a neighborhood of 70 houses, and there’s only one I can enter. It’s a big education issue.”

Ultimately, he says, the culture among builders and buyers is going to change, whether they like it or not. Baby boomers are getting older, and Johnson predicts during the next decade, the need for accessible housing is going to explode.

Home Modification Resources

Written by John Christensen
Photos by Louie Favorite and Kelvin Ma

About Shepherd Center

Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems, Shepherd Center is ranked by U.S. News as one of the nation’s top hospitals for rehabilitation. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.