2000 Conference Proceedings

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EXAMPLES OF STATE FUNDED HOME MODIFICATION PROJECTS FOR PEOPLE WITH PHYSICAL DISABILITIES

Christopher D. Kruse
Technology Specialist
Nebraska Assistive Technology Partnership
5143 S. 48th Street
Lincoln, NE 68516-2204
402-471-0734 (Voice, TTY), 402-471-0181
Email: ckruse@atp.state.ne.usckruse@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 training.

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 served.

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 proceeds:

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 services coordinator.

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 consumer.

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 family activities.

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 bathroom.

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 the bathroom.

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 turn-around area.

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 floor.

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 temperature.

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 complete.

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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