Creating a safe and accessible home environment

Creating a safe and accessible home environment
Michelle Ferrari, OTR/L, CAPS
Clinical Specialist in Barrier-Free Design
Rusk Institute of Rehabilitation Medicine, NYU Medical Center

There are frequent architectural barriers in everyday environments that can hinder a disabled person’s ability to function safely and optimally. There may be stairs that are no longer negotiable, a bathtub that has become too difficult to get in and out of, or small space that does not allow freedom of movement from a wheelchair. As the symptoms of the person with ALS change, the home must change as well to adapt to the needs of individuals and their caregivers.

The term “home modifications” classifies a broad spectrum of changes that are made to the home to improve safety and accessibility. It includes small scale changes, as in the addition of durable medical equipment, and also encompasses larger changes to the home regarding reconstruction of existing areas. This article is intended to provide the reader with a general understanding of the potential home modification needs for the person with ALS and other motor neuron diseases.

Generally, the main considerations when thinking about modifying the home for the person with ALS are planning for ways to:
1.     safely enter and exit the home
2.     access all important rooms of the home without having to negotiate stairs
3.     safely utilize a bathroom and its fixtures

Entering and exiting the home
It is important that there is at least one wheelchair accessible entrance to the home for the person with ALS. This is definitely something to consider even before the wheelchair is absolutely necessary as stairs can become a great hazard to someone using a cane, walker, etc. If you do not already live in a place with a no-step entrance, here are some options for modifying an entrance.

Ramps are usually the first to consider, however in order to have a safe ramp, the slope of the ramp is a very important factor. A good rule to go by is that there should be 12 inches of ramp for every 1 inch of rise. For example, this means that on a 20-inch rise (2-3 steps) a 20 foot ramp is recommended. Ramps can be configured in a variety of ways to be able to work best in an existing space. A ramp is not the solution for everyone as there may not be enough space for the appropriate length or the ramp may be need to be so long that it is no longer cost-effective. Generally speaking, when you have more than 30-inches of total rise, other solutions should be explored before making a final decision.

A wheelchair lift (specifically a vertical platform lift) is a good alternative to making an entrance safe and accessible when a ramp is not a feasible solution. A lift takes up considerably less room than a ramp does and therefore can be installed in most scenarios. If possible, installing a lift in a garage is a good solution as then you don’t have to deal with the weather’s effects on the unit. It is important to consider the size and weight capacity needs when looking into this option.

With both the ramp and the lift options, most often some reconstruction to the existing staircase, landing, and doorway is required in order to truly make this entrance safe and accessible. It is important to consult with an accessibility specialist for all information specifically related to your entrance for the best possible outcome.

Navigating within the home
Depending on the layout of your home or apartment, there may be stairs to negotiate within the home, often to access the bedroom and bathroom. In planning for the needs of the person with ALS, the best and safest option is setting up the home to avoid the stairs. Even before a wheelchair is needed, stairs can be a great safety hazard to the person with any mobility impairments. When a wheelchair becomes a necessity, it will no longer be possible to use the stairs. Many people think about installing stair lifts to make the travel up the stairs easier. It is very important to realize that while stair lifts can be very helpful for awhile, these units eventually become unusable to the person with ALS. One way to make plans for truly avoiding stairs in the home is by setting up living arrangements on the first floor. Another option for making the interior of the home safe and accessible is with the installation of a residential elevator.

In thinking about getting from room to room within the home, the doorways should have a minimum clearance of 32 clear inches. This is usually achieved with a 34-inch, or more commonly, a 36-inch door. Some simple solutions to increasing the width of the door (usually by about 2 inches) are removing the door altogether or with the installation of “swing-away” or “swing-clear” hinges. Otherwise, door widening may be necessary for allowing wheelchair passage.

Using the Bathroom Safely

The overall size and location of your bathroom will very much determine its usability for the person with ALS. The addition of durable medical equipment (DME) can really help to improve the safety of the bathroom for the person using assistive walking devices (walker, cane, etc.) Some beneficial DME for the bathroom are raised toilet seats, commodes, toilet safety frames, grab bars, tub benches/shower chairs, and hand-held showers. It is always best to speak with an occupational and/or physical therapist about your needs and which DME can work best for you.

stair lift When a wheelchair becomes a necessity, often more than just the addition of DME is required for the bathroom to be safe and accessible. First of all, the location of the bathroom is obviously a very important thing to consider: Is the bathroom on an accessible route? Are there stairs to negotiate to get to the bathroom? Can you get into the bathroom with a wheelchair? Is there adequate turning space for wheelchair use? Often times, having a truly accessible bathroom means expanding the size of the existing bathroom or creating a new bathroom on an accessible route. The main features of a wheelchair accessible bathroom for the person with ALS are:
1.    Roll-in shower: This type of shower has no threshold whatsoever to negotiate to enter the shower area. Minimum recommended size for a roll-in shower is 3-feet by 5-feet, and often people prefer 5-feet by 5-feet shower size. It is best to use a shower curtain so that caregivers can assist with the use of a hand held shower spray. It is very likely for some water to exit the shower area, therefore waterproofing the floor outside of the shower is always recommended.
2.    Toilet with adequate space adjacent (30”-36”) for transferring from the wheelchair to the toilet.
3.    Wall-hung or countertop sink: These particular sink styles are installed with adequate space underneath the sink to allow room for the wheelchair users' knees.

In conclusion, there are many points of consideration when making changes to your home and individualized design solutions are the best way to meet your particular needs. I hope this article has been helpful in giving you a basic understanding of home modification needs and options.