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Here’s How to Find – or Make – the Perfect Accessible Home to Meet Your Needs

Former patients and experts share insight on home modifications to accommodate mobility impairments.

Believe it or not, the first step in finding or making an accessible home may be to do nothing.

Shepherd Center advised us not to do anything to the house before we got home and tried it out,” recalls former patient Ken Johnson. “They told us stories that people had their entire house redone for handicap accessibility, and when they got there, the handicapped individual was not able to use the house because it wasn’t done to their specifications.”

When they returned to their suburban Atlanta home from Shepherd Center in October 2013, Ken and his wife, Cathy, had already experienced numerous life-altering changes. The changes began suddenly in September of that year when Ken dropped to the floor and couldn’t move from the waist down. Ken had experienced a dissection of the aorta, an uncommon and often fatal condition where part of the aorta falls apart from the inside. His aorta had clogged, which stopped the blood from reaching the parts of his spinal cord that transmitted messages from Ken’s waist to his toes. The hospital staff told him he had a T-10 incomplete spinal cord injury. He’d neither be able to move nor feel anything from the waist down.

“Unlike some injuries where you have some movement and some of the muscles can be built back, my spinal cord is completely dead,” Ken says. “There are no electrical impulses, no messages traveling from the brain to my lower extremities.”

At Shepherd Center, he learned to move around in his new manual wheelchair and do just about everything he needed to do to return to work as a marriage and family counselor. But returning home was another challenge.

“We’ve heard a lot of people say their home was one of the worst, but our home really was one of the worst to have someone in a wheelchair,” Cathy says. “We had all of our bedrooms upstairs, and even our front door had a threshold of about three to four inches, so we would’ve had to build a ramp.”

Even so, Ken’s physical and occupational therapists at Shepherd Center told Ken and Cathy to go home and see where Ken could get around and where they would need to make changes.

“The last thing you want to do is make assumptions,” says Mark Johnson (no relation), director of advocacy at Shepherd Center. “You want to roll in and out of spaces to make sure you can get around with no problem.”

“Shepherd Center counsels patients and their families not to make any major decisions right away,” Cathy says. “You want to go out and change your whole life because your whole life has just changed. But they tell you to just come home and don’t worry about making decisions until you’re ready. Just make it livable and then go from there.”

So Ken and Cathy did just that. They had friends and people from their church come to help them turn the living room into a bedroom. They installed doors for privacy. They flipped the bathroom door around to allow Ken and his chair to enter. They built ramps from the garage into the kitchen, and another one from the back door to the patio. These were just temporary changes they made while figuring out what they wanted to do to their current home, which they plan on being their last.

SIDEBAR: What is Universal Design?

Searching for a New Space

Many people with mobility impairments rent their homes or apartments and have to work with their landlords to get their needs met. It’s either that, or find a place that’s more accessible. The Fair Housing Act of 1991 makes it easier for people with disabilities to find a place that works for them, but so do good business practices..

“People have the right to ask their landlord to make certain modifications,” says Dan Meacham, an architect at Niles Bolton Associates in Atlanta. “But the reality is, in terms of most of the clients I work for, when someone comes and has special needs that they can reasonably accommodate, most of the clients tell me they will do that because the tenants tend to stay longer. That’s very accommodating, but it’s also good business.”

And just like the Johnsons needed to look at their home with new eyes before making any big changes, it’s important to see a property in person to make sure it’s navigable.

“When someone acquires an injury, everything is heavy on them,” says Minna Hong, peer support manager at Shepherd Center. “It’s the fear of the unknown. But the people who fare well are the ones who have the audacity to ask questions and work with other people.”

Shepherd Center peer supporter Karen DeVault, who has used a wheelchair since sustaining a spinal cord injury as a teenager, advises: “The best approach to take is to be diplomatic in anything you do and not come into it telling people what they’re going to do for you. You really have to get out there to let them see that you’re a person and let them see what is and isn’t going to work.”

If an apartment complex was constructed after 1991, then the apartments on the ground floor – or, if there’s an elevator, the apartments on every floor – must meet the requirements of the Fair Housing Act. That means the external and internal doors have to be wide enough to accommodate someone in a wheelchair, Meacham says.

It’s not just the inside of the apartment or house that needs a close look, though. Karen says it’s important to look at the surrounding area, as well.

“Move around the community; see if it’s navigable,” she advises. “Sometimes accessible housing can be surrounded by an inaccessible neighborhood.”

Check out the routes to the trash area, the leasing office and the mailbox. That includes the specific mailbox for the apartment, because some complexes assign boxes to each apartment and can’t or won’t allow residents to switch.

“If you plan on getting around via public transit, see if there is transit close by,” Karen adds. “How many transfers, if any, does traveling to the areas you need to get to require? Will that work for you?”

It’s important to decide what things are non-negotiables for you.

“Everything is not going to be exactly the way you want it,” Minna says. “You have to narrow down what is a need versus a want. If it meets most of your needs, or needs some modifications that can be handled, then you can just go with it.”

For people who are in the market to purchase, it sometimes pays to find houses before or as they’re being built.

“You can try to catch a single-family development in progress,” says Joseph Frazier, chairman of Metro Fair Housing Services in Atlanta. “If you request to look at the floor plan, you may be able to make modifications as it is built.”

When dealing with leasing and purchasing agents or contractors, specificity is key.

“Don’t assume the folks you’re talking to know what you’re talking about,” Mark Johnson advises. “The question, ‘Are you accessible?’ doesn’t cut it. Be very descriptive about what you need. For example, ask if there’s a no-step entrance. Find out where it is. For bathrooms, find out if there is a walk-in tub or a roll-in shower. Don’t be afraid to ask follow-up questions.”

If you’re looking at a home that’s already been built you’ll want to know how it was constructed, especially for the bathrooms where you might want to take out a tub and install a roll-in shower, he adds.

“Find a trusted contractor, like a certified aging-in-place specialist, who can do an inspection,” Johnson advises.

Accessible Living

Whether it’s a new place or an existing space, it’s likely that some modifications will need to be made.

Links to Accessible Housing Resources

Although it’s tempting to rush the home modification process, it’s important to research and determine the real cost of any renovations. Also, if selling the home someday is a possibility, then it’s beneficial to be conscientious about style in addition to function.

“You still want the house to reflect the person that you are, rather than having it say, ‘Oh my gosh, there’s a person with a disability living here,’” Minna says.

For example, when Minna wanted to have an appealing ramp in front of her house, she made it a meandering pathway with landscaping around it.

“It’s really important to incorporate the integrity of the place along with your needs,” Minna adds.

And, while function might be top of mind, don’t ignore how you might be feeling.

“There’s a mechanical part of the whole thing, but you cannot ignore the personal feelings and emotions that go into going through this sort of a rebuild,” Ken says. “There are a lot of emotions about loss that we have had to work through.”

The Johnsons took a few months and explored all of their options before beginning their remodeling. They found a builder through their connections to friends. They had an architect draw up plans that were compliant with the Americans with Disabilities Act. This ensured that the door and entrance sizes were large enough so that the bathroom provided ample space for Ken to turn around in his chair.

Although they plan for this home to be their last, they took great consideration with making their space attractive to almost anyone for when it’s on the market in the future. In doing so they ended up following the principles of a concept known as universal design (see sidebar).

“The bedroom downstairs ends up being a really great master suite for either the owners of the house, or if someone has an elderly parent moving in, or a child moving back home,” Ken says. “There are a lot of options for this room, and the resale value on the house has increased because of the way we did the addition.”

Some of the touches they added to the bedroom include lights that turn on and off automatically when leaving the room, a ceiling fan with a remote control and raised electrical outlets so Ken doesn’t have to lean out of his chair to use them. They installed laminate floors throughout the house to make it easier for maneuvering a wheelchair.

In the kitchen, they lowered cabinets so Ken can reach them and put false fronts on the cabinet underneath the sink to accommodate his chair. In addition, they built a lower space for the microwave and added a pull-out spice rack and cutting boards.

Many fixes can be done cheaply by finding accessories at home improvement stores. Lowering the door thresholds is common, as are handheld shower wands and door handles that are levers rather than knobs. Rearranging furniture, installing remote-controlled lighting, flipping doors around, or using a Z-hinge to allow a wheelchair to get through can be done for next to nothing. Cathy also recommends Pinterest as a great resource for finding design solutions.

Whether you’re looking to renovate, build or move, “Take your time,” Cathy says. “We talked to everybody.”

SIDEBAR: What is Universal Design?

When the Ken and Cathy Johnson had to renovate their home to accommodate Ken’s mobility needs, they wanted a new space that would allow him to move around with ease. But they also wanted a pleasing residential design that could be used by anyone, thus allowing them to sell .their home when the time came. Those are the very reasons for a concept called universal design.

“Universal design is integrating accessible features into everyday design,” says Dan Meacham, an architect at Niles Bolton Associates in Atlanta.

“It’s not a different way of designing; it’s a different way of thinking about design,” adds Jon Sanford, director of the Center for Assistive Technology and Environmental Access at the Georgia Institute of Technology. “Instead of thinking about design for a fraction of the population, we’re talking about designing for as many people as possible.”

The term was created by Ron Mace at North Carolina State University in the late 1980s.

“He’s one of the people who made the Americans with Disabilities Act happen,” Sanford explains. “After a while, he became disenchanted with the idea that things needed to be special and different. So he came up with the concept of universal design, which is all about designing for everyone.”

In living spaces, universal design can be virtually invisible, with features such as expanding entryways by a few inches to accommodate people using wheelchairs or arranging fixtures in a bathroom to allow someone in a wheelchair to turn around and close the door.

“When you go into an apartment, you don’t necessarily see it; you don’t notice it. It feels like everything else,” Meacham says.

This is in contrast to accessible design, which is meant to be used by a specific population of people, Meacham adds.

Some examples of accessible design include grab bars on a shower and a ramp that runs from the sidewalk to an entryway.

Both have their uses. Accessible design might work for some pieces of a home, like the grab bars in a shower. But a homeowner may also want to incorporate some elements of universal design, like hardwood floors around the house.

“In a single family house, the architect can customize a unit to a customer’s specific needs,” Meacham says.

But for a multi-family dwelling, like an apartment, universal design might be better at suiting the needs of a wider population.

“The concept of universal design is what I would consider the holistic approach of integrating accessible features into the entire environment, whereas when dealing with an individual’s house, they may need more specific features,” Meacham explains.

The Johnson’s renovations include elements of both accessible design – like railings in the shower – and universal design, like hardwood floors throughout the house, wider hallways and spaces to accommodate Ken’s chair and lowered thresholds. Both concepts have allowed them to create a house that feels like home for the entire family.


The Seven Principles of Universal Design

There are seven principles that guide the design process for spaces and products intended for universal design. They were created in 1994 by a team of investigators led by Mike Jones, Ph.D., now Shepherd Center’s vice president for research and technology in the Virginia C Crawford Research Institute, and Jim Mueller, project director for the Wireless Rehabilitation Engineering Research Center.

“In the early 90s, the term universal design was emerging as an approach to achieving more accessible products and environments without prescribing specific solutions,” Jones says. “The idea was to encourage designers to think creatively about how accessibility could be achieved within mainstream design solutions.”

The effects of universal design have been far-reaching.

“Jim Mueller and I recruited a team of architects, designers, engineers and accessibility advocates to establish the principles of universal design to guide design without prescribing specific solutions,” Jones says. “They have been remarkably effective and enduring. They have been translated into at least 10 languages and adopted globally as the basis for promoting the adoption of universal design.”

Principle 1: Equitable Use The design is useful and marketable to people with diverse abilities.

Principle 2: Flexibility in Use The design accommodates a wide range of individual preferences and abilities.

Principle 3: Simple and Intuitive Use Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills or current concentration level.

Principle 4: Perceptible Information The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities.

Principle 5: Tolerance for Error The design minimizes hazards and the adverse consequences of accidental or unintended actions.

Principle 6: Low Physical Effort The design can be used efficiently and comfortably and with a minimum of fatigue.

Principle 7: Size and Space for Approach and Use Appropriate size and space is provided for approach, reach, manipulation and use regardless of the user's body size, posture or mobility.

Here are links to some helpful resources:

By David Terasso
Photos by Louie Favorite

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.