2000 Conference Proceedings
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EXAMPLES OF STATE FUNDED HOME MODIFICATION PROJECTS FOR
PEOPLE WITH PHYSICAL DISABILITIES
Christopher D. Kruse
Nebraska Assistive Technology Partnership
5143 S. 48th Street
Lincoln, NE 68516-2204
402-471-0734 (Voice, TTY), 402-471-0181
Email: firstname.lastname@example.org@atp.state.ne.us Website: http://www.edneb.org/ATP/TECHome.html
The Nebraska Assistive Technology Partnership (NATP) has
pioneered systems for delivering accessibility services to people
with disabilities of all ages through partnerships with other
agencies such as the Nebraska Department of Health and Human
Services and Nebraska Vocational Rehabilitation. The system is
set up to assess a consumer's needs and recommend possible
solutions, as well as fund and implement the solutions. Although
solutions include vehicle modifications, electronics solutions
(such as a environmental control units or modifications to
computers), and aids to daily living (ADLs), architectural home
modifications are very frequently the solution to a consumer's
needs, and are the subject of this paper.
Services are provided by a staff of 10 Technology Specialists
with backgrounds in occupational therapy, architecture,
electronics, and machining. Each Technology Specialist relies on
the others' experience and expertise for consultation and
The Technology Specialists are located in 5 cities across
Nebraska and serve consumers in their area. This reduces the
amount of travel required to visit consumers in remote locations,
and thus reduces the overall waiting period before consumers are
Consumer involvement in a solution includes first hand
communication of their needs, their goals, and preferences. NATP
considers it important to treat the consumer as a person who
contributes to finding solutions, as opposed to a "client" who
has complete control but no guidance when finding solutions, or a
"patient" whose preferences and opinions are irrelevant to the
problem solving process.
The following are the steps through which a typical project
The drawing and/or specification is sent to contractors who are
given 2-3 weeks to submit a quote. It is often difficult to get
quotes for projects that are very small, remotely located, or
located in areas where work for contractors is plentiful. Once
quotes from contractors are collected, the Technology Specialist
give a written authorization for work to be done. It can take
from weeks to months for a contractor to start a home
modification project - the only way to shorten this time period
is to select a contractor from multiple competitive quotes. A
project rarely takes more than a few days to complete once it has
been started. After the contractor has finished, the Technology
Specialist is responsible for inspecting the work and ensuring
that the project meets the goals of the consumer. Because
Technology Specialists are considered consultants to the
consumer's service team, they do not have regular contact with
consumers until and if there is another referral submitted by the
- A project usually starts with a referral by a consumer's
services coordinator. The referral includes address and contact
information, general disability information, and general
information on the consumer's needs.
- Preliminary funding for a solution for the consumer's need is
usually in place by this time - funding is usually tied to the
services coordinator's agency.
- The Technology Specialist's
assessment and design services are funded by contracts already in
place with the referring agency.
- Although funding sources and eligibility are a vital part of
every project, this paper is not intended to addressed these
- The Technology Specialist schedules an in-home visit to the
consumer where the consumer's abilities and environmental
barriers are assessed.
- The Technology Specialist will later make a recommendation
based on the information gathered at the home visit including the
consumer's input, and consultation with the consumer's
therapists, family, and caregivers as needed.
- Often, a Technology Specialist will talk through the problem
solving process with the consumer, describing the benefits and
drawbacks of particular solutions.
- This allows the consumer to understand the issues that need
to be addressed and gives the consumer a chance to voice any
- The consumer has the opportunity to ask questions at this
time and any later time throughout the process through a
toll-free phone number.
- Typically the consumer will not have to wait for more than 30
days before a home visit is conducted.
- A drawing and/or a specification is created for the work that
is needed so that comparable quotes can be requested.
- The actual drawing and/or specification may take only a few
hours to complete, but because other projects are proceeding
concurrently, it may be 1-2 weeks after a visit before a
drawing/specification is completed.
- Other activities go on in this phase such as verification of
home or vehicle ownership, consultation with other professionals,
and reviews of the proposed solution by the consumer.
- The project can be delayed if the proposed solution is not
agreeable with a consumer or a landlord, in which case the
solution might be modified to better satisfy all parties
Every successful solution should satisfy the following three
goals: to increase the consumer's independence, to increase the
consumer's safety, and to increase the consumer's dignity/quality
of life. A successful project also must be done in the most cost
efficient manner possible.
Increasing the consumer's independence includes increasing
activities necessary to daily living (including bathing and
toileting, dressing, eating, and exit and entrance to the
residence as well as driving or riding in a vehicle) that the
consumer can do with less assistance or no assistance. Increasing
a consumer's independence affects the lives of the caregivers,
family members, and friends as well.
Increasing safety includes limiting the consumer's exposure to
dangerous or potentially dangerous situations due to
environmental barriers (steps, narrow doors, etc.). Many times
people with disabilities take unnecessary risks to perform daily
activities because they have no safe way to perform the task.
Caregivers are also put at risk when they have to physically
exert themselves to assist a consumer over an environmental
barrier. An injury to a caregiver often means that the consumer
will need to spend time in a long term nursing facility until the
caregiver is well, or other arrangements can be made, especially
if the caregiver is a relative. In this sense, eliminating
barriers increases the reliability the caregiver for the
Increasing the consumer's dignity includes improving the
consumers quality of life. Many consumers experience unintended
indignities due decreased mobility and/or inaccessible
environments. Some consumers are forced to seek assistance with
bathroom issues because they are physically unable to perform
those activities. Others are forced to give up their standards of
personal cleanliness because even with assistance, they cannot
access the bathroom.
Some common home modification solutions to entrance problems are
ramps and vertical platform lifts. Although both solutions help
people overcome vertical barriers between a residence and the
sidewalk, each solution has characteristics that better suit them
to certain consumers (with differing abilities and needs) and
certain locations (with differing site constraints).
The consumer who lives in the house pictured in "Figure 1" has
very little strength and uses a power wheelchair. His mother is
his primary caregiver. The consumer had difficulty getting in and
out of the house because of the three steps between the door and
the sidewalk. Before the wood ramp was built the consumer had to
transfer to a manual wheelchair (the power wheelchair was too
heavy) and he was "bounced" down the stairs. To get back into the
house, the caregiver had to ask for assistance from other family
members to lift the consumer and the wheelchair back up to the
house level. Since the ramp was built, the consumer has been able
use his power wheelchair to get from the house level to the
sidewalk level whenever he wishes with no assistance.
Since the entry to the house is too close to the driveway to
construct a single length of ramp between the driveway and the
door and maintain the desired slope, the ramp was designed with a
"switchback" that allows a longer length of ramp in a smaller
short space. The guardrail is designed to be resistant to
climbing (children) and there is a set of steps on the other side
of the ramp. This ramp cost less than $3000 and took less than a
week to complete.
The consumer who lives in the house pictured in "Figure 2" is an
elderly woman who uses a manual wheelchair in and outside the
home. Her daughter is her primary caregiver. The consumer cannot
propel the wheelchair by herself. The consumer had difficulty
getting into and out of the house because she couldn't get up the
steps to the house. Other barriers were a single step at the end
of the house's sidewalk which leads to the city sidewalk and the
street, as well a 1" high threshold at the door going into the
house. Site constraints also included a narrow, shallow, side
sloping front yard that made a ramp impractical. Before the lift
was installed, the consumer could not leave the house for months
at a time. Since the modifications have been made, a single
caregiver can assist her to leave her house safely for necessary
activities like doctor's appointments, as well as social and
The solution for this consumer included an inclined sidewalk (to
eliminate the step), the vertical platform lift shown in the
photo and a concrete slab large enough for the wheelchair to
enter and exit the lift comfortably, and an aluminum threshold
ramp at the house door so the wheelchair could go through the
door with ease. This project cost $5300 and took approximately 1
week to complete.
Some common home modification solutions to bathrooms are
roll-under lavatories and curb-less showers. Not only does the
clear floor space to both enhance the usability of the fixtures
themselves, but their roll-under/in features promote better
general access to the bathroom. The following example is a
project where these modifications were used to renovate an entire
The consumer who lives in the house pictured in Figures 3
through 5 uses a manual wheelchair. She has enough strength to
propel herself in the wheelchair. She has the ability to
independently perform bathroom activities such as brushing her
teeth, washing her face, showering, and toileting. Before
modifications were made, she couldn't get to the fixtures to
perform these activities because of the size and arrangement of
Because the counter-mounted sink pictured in "Figure 3" allows
her wheelchair and legs to fit under the counter and sink, she
can get close enough to perform sink activities by herself. The
design features a plywood shroud that protects her legs from
potentially hot pipes; a mirror/medicine cabinet that is mounted
so that she can see into the mirror and reach the medicine
cabinet while in her wheelchair; a sink that is shaped to extend
beyond the edge of the cabinet to catch most spills; and a faucet
that operates with a single lever handle so she can operate it
with one hand and with less grasping force.
The curb-less shower ( located adjacent to the counter mounted
lavatory, above) pictured in "Figure 4" allows the consumer to
use a shower wheelchair to get into and use the shower without
assistance. When the shower is not being used, the consumer can
use the shower floor area to supplement the existing wheelchair
The shower base itself is made of fiberglass and is
prefabricated to fit in the same space a typical bathtub uses.
The base is only 1" high at the edges and slopes gradually to the
drain. A 12" wide ramp in front of the shower base makes it
possible for the wheelchair to roll into the shower with ease.
The shower base is mounted on the top of the floor, but it can be
recessed so the top edge is level with the floor. Recessing the
base would cost more to install, but is necessary in some
situations where there is no space for a ramp.
The 1" tall vinyl roll-over water dam positioned between the
edge of the shower base and the ramp is necessary to prevent
shower water from "flooding" all over the floor, but is not a
barrier to wheelchairs. Consumers have reported that as long as
they are careful that the shower curtain is closed and is kept on
the shower side of the shower dam, water will not escape to the
The walls of the shower extend all the way to the ceiling are a
pebbled waterproof surface backed with plywood. This provides the
support needed for mounting all grab bars that may be needed. The
shower fixture is hand held and can be mounted to the wall on an
adjustable height bracket. The shower valve has a scald preventer
and a lever handle to add to the ease of adjusting the water
The toilet pictured in "Figure 5" is positioned across from the
shower. The floor space including the shower floor can be used
for turning and positioning. The toilet and adjacent grab bar is
sized and positioned so that the consumer can transfer easily
from her wheelchair to the toilet and back.
The floor is a hard surfaced sheet vinyl floor which makes it
easier to move around in a wheelchair - the wheels do not "sink"
in as they would with carpet. A vinyl floor also makes cleaning
wet areas and sanitizing easier than a carpeted floor.
This project, which also included widening 3 interior doors and
an exterior door, cost $5700 and took approximately 1 week to
The system the Nebraska Assistive Technology Partnership has set
up to assist people with disabilities to overcome environmental
barriers has produced numerous successful solutions that increase
the consumer's independence, dignity, and safety. This program
solves consumers' problems using assistive technology, which not
only enables them to stay at home, but reduces state expenditures
by avoiding unnecessary stays in long term care facilities.
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Reprinted with author(s) permission. Author(s) retain copyright.