Consent Preferences

Home modifications – sometimes dreaded, sometimes welcomed, but usually necessary for any person with a disability or person caring for someone with a disability. Before discussing the modifications, it’s important to look at the word “home.” Home is more than a structure. Spaces, objects, memories, routines, people and beloved pets all comprise a place called home. So it is no wonder that families react strongly to the thought of modifying their home. Some of the primary concerns seem to focus on money. What will these modifications cost? Will they decrease the value of my home? The next set relates to what do we need to do. How much or how little to modify? Will our home look like an institution? Where do we go for help? Finally, questions about their child’s current and future needs. Am I limiting my child by adding additional supports? Will these modifications isolate my child more? Am I giving up on my child’s ability to gain more skills by doing these modifications now? Is my child too young to benefit from modifications? All of these questions require a personal and individual response. The area of home modifications is broad. Home modifications are not just about the individual with a disability, they also are about “taking care of the caregiver” as the key factor in sustaining an individual with disabilities in their own home.

Parents can’t collect Workman’s Compensation for “on the job” injuries. These injuries can include Carpal Tunnel Syndrome, rotator cuff tears, back injuries, herniated disks, hip injuries, knee replacements and abdominal hernias. These injuries are classic repetitive use injuries that do not heal completely unless the “job” that caused them is eliminated or modified. The surgeries to repair these injuries can cost anywhere from $10,000 to $25,000+, not to mention that parents do not get “paid leave” from their parenting job. These conditions are usually accompanied by significant pain and discomfort prior to any surgery. All of this can lead to increased stress trying to maintain a consistent level of care. So when evaluating the cost of home modifications it is equally important to assess the “cost” of not doing them.

Just as it’s hard to believe it’s actually October, it’s often difficult to believe how quickly children become young adults. When did this 1 ½ lb premie become this 60 lb child? Lifting and moving a human being is not the same as lifting a box. Humans have the ability to assist in being lifted, like a ballerina assists her partner as he lifts her over his head. Often children with special needs are more difficult to lift than other children of equal size and weight because they cannot help with the lift. Lifting can be dangerous to the caregiver and the child especially when soap and water are added to the mix. Just because you can still lift your child doesn’t mean that you should.

Just as a home is more than a house, a family is more than the individual with special needs. Removing barriers that limit a family’s ability to enjoy daily routines is what home modifications are all about. Home modifications make homes last a lifetime.

Once you’ve decided that you need to have a more accessible home, it is important to look at your neighborhood, community, schools and commute. This will help you in deciding whether it’s worth the expense to remodel or if you would rather build new. Remodeling is significantly more expensive than new construction. According to a National Homebuilder’s Association study, home modifications added only 1% to the total cost of new construction. In most cases, a quality remodel will not decrease your home’s value and, in some cases, it may increase it.

The “Baby Boomers” have and will continue to shape our society. They are “graying” now and are looking for homes and products to assist them in being independent for as long as possible in their own homes. This means that there are a growing number of people who want step-less entries, step-less showers, open floor plans, and full baths on the main floor. All of this is good news for people with disabilities as it means that there are more products available, with better design and decreased cost.

Next you need to decide on what and how much to modify. It is important to examine what would make the greatest impact on your family. You don’t have to modify everything all at once, but you need to have a plan. Most families find that a covered step-less entry and adapted bathroom are the primary concerns. These concerns apply to the aging population as well, which is why the “Easy Living” movement has three minimum requirements for new construction: (1) at least one step-less entry from the outdoors into the home; (2) all doors and hallways are at least 3 feet wide, and (3) one main-level full bathroom. These three requirements make your house “vist-able” by anyone, from the elderly to people with disabilities to parents with small children.

As you begin to decide what spaces you wish to change, you’ll need to speak with a professional. The most common misunderstanding among building professionals and families of individuals with special needs is the Americans with Disabilities Act (ADA) building guidelines. These guidelines are for commercial construction – not residential. They were developed by looking at the needs of 20+ paraplegic soldiers who have excellent trunk control, vision, upper body strength, and cognition. They are not meant for and are often inappropriate for homes. They are good as a “jumping off” point for home modifications. For example, it is not necessary to have grab bars in your step-less shower if your child is completely dependent in bathing. However, you may need to know the average length of an adult reclining shower chair so it will fit in your shower when your child is older. Or you may want to include blocking in your shower at various levels so you can add grab bars in the future. If a contractor tells you not to worry he knows all about the ADA – you should worry.

How do you find a professional to help you? Word of mouth is always a good way to find someone reliable. Second AARP, National Home Builder’s Association, and American Occupational Therapy Association have developed a certification program for “Aging in Place Specialists” (CAPS). It is an intensive course for builders, remodelers and others that focus on home modifications. You can look on the AARP website and the Greater Atlanta Home Builder’s website for professional who are CAPS certified. Finally, a qualified Occupational Therapist can help you determine what your family member might need to maximize their potential. By analyzing activities, and looking at the family as a whole, s/he can relate to the building professional what is needed in the environment be it equipment or modifications.

So, when should you start to think about home modifications? As soon as the disability is diagnosed. Will it decrease your home value? Not necessarily, and it may increase it. What about the cost? It is vital to seriously consider the cost of not doing them. Who should I hire? You should consider a team approach, ask other parents whom they used, and look for a construction professional with a CAPS designation. What needs to be done? Customization is the key to happiness it is only limited by your imagination and pocketbook. We can’t remove the barriers of spasticity, decreased mobility or strength, limited vision, but we can remove the arbitrary physical barriers from an individual’s home. In the end, you can have a home without barriers that will last a lifetime.

Erin diChiara has been an Occupational Therapist for 15 years in the Atlanta area. Her current business specializes in working with families and building professionals to make homes last a lifetime.


This article was originally published in FOCUS.