Making home modifications for a child with physical disabilities
What are home modifications? They are changes made to adapt living spaces to meet the needs of people with physical limitations of any kind, so that they can continue to live independently and safely.
These modifications may include adding assistive technology or making structural changes to a home, and can range from something as simple as replacing cabinet doorknobs with pull handles, to full-scale construction projects that require installing wheelchair ramps and widening doorways.
The main benefit of making home modifications is that they promote independence and prevent accidents.
How can I tell what home modifications are right for me?
The best way to begin planning for home modifications is by defining the basic terms used and asking some simple questions. According to the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), home modifications should improve the following features of a home:
Accessibility. Improving accessibility means making doorways wider, clearing spaces to make sure a wheelchair can pass through, lowering countertop heights for sinks and kitchen cabinets, installing grab bars, and placing light switches and electrical outlets at heights that can be reached easily. This remodeling must comply with the Fair Housing Amendments Act of 1988, the Americans with Disabilities Act accessibility guidelines, and American National Standards Institute regulations for accessibility. The work must also conform to state and local building codes.
Adaptability. Adaptability features are changes that can be made quickly to accommodate the needs of seniors or disabled individuals without having to completely redesign the home or use different materials for essential fixtures. Examples include installing grab bars in bathroom walls and movable cabinets under the sink so that someone in a wheelchair can use the space.
Universal design. Universal design features are usually built into a home when the first blueprints or architectural plans are drawn. These features include appliances, fixtures, and floor plans that are easy for all people to use, flexible enough so that they can be adapted for special needs, sturdy and reliable, and functional with a minimum of effort and understanding of the mechanisms involved.
Where do you begin?
Before you make home modifications, you should evaluate your current and future needs by going through your home room by room and answering a series of questions to highlight where changes might be made.
Several checklists are available to help you conduct this review. The National Resource Center on Supportive Housing and Home Modifications is a good place to start. Go to the center’s website at homemods.org and click on the link to the “Safety Checklist and Assessment Instrument.” In addition, Rebuilding Together, Inc. has an excellent home modification checklist at rebuildingtogether.org.
You can begin your survey by examining each area of your home and asking the following questions:
Appliances, kitchen, bathroom
Are cabinet doorknobs easy to use?
Are stove controls easy to use and clearly marked?
Are faucets easy to use?
Are there grab bars where needed?
Are all appliances and utensils conveniently and safely located?
Can the oven and refrigerator be opened easily?
Can your child sit down while working?
Can your child get into and out of the bathtub or shower easily?
Is the kitchen counter height and depth comfortable for him or her?
Is the water temperature regulated to prevent scalding or burning?
Would your child benefit from having convenience items, such as a handheld showerhead, a garbage disposal, or a trash compactor?
Closets, storage spaces
Are your closets and storage areas conveniently located?
Are your closet shelves too high?
Can your child reach items in the closet easily?
Do you and your child have enough storage space?
Have you gotten the maximum use out of the storage space you have, including saving space with special closet shelf systems and other products?
Doors and windows
Are your doors and windows easy to open and close?
Are your door locks sturdy and easy to operate?
Are your doors wide enough to accommodate a walker or wheelchair?
Do your doors have peepholes or viewing?
Driveway and garage
Does your garage door have an automatic opener?
Is your parking space always available?
Is your parking space close to the entrance of your home?
Electrical outlets, switches, safety devices
Are light or power switches easy to turn on and off?
Are electrical outlets easy to reach?
Are the electrical outlets properly grounded to prevent shocks?
Are your extension cords in good condition?
Can you hear the doorbell in every part of the house?
Do you have smoke detectors throughout your home?
Do you have an alarm system?
Is the telephone readily available for emergencies?
Would your child benefit from having an assistive device to make it easier to hear and talk on the telephone?
Are all of the floors in your home on the same level?
Are steps up and down marked in some way?
Are all floor surfaces safe and covered with non-slip or non-skid materials?
Do you have scatter rugs or doormats that could be hazardous?
Hallways, steps and stairways
Are hallways and stairs in good condition?
Do all of your hallways and stairs have smooth, safe surfaces?
Do your stairs have steps that are big enough for your whole foot?
Do you have handrails on both sides of the stairway?
Are your stair rails wide enough for your child to grasp them securely?
Would your child benefit from building a ramp to replace the stairs or steps inside or outside of your home?
Lighting and ventilation
Do you have night lights where they are needed?
Is the lighting in each room sufficient for the use of the room?
Is the lighting bright enough to ensure safety?
Is each room well-ventilated with good air circulation?
Once you have explored all the areas of your home that could benefit from remodeling, you might make a list of potential problems and possible solutions.
How can I pay for home modifications?
Many minor home modifications and repairs can be done for about $150-$2,000. For bigger projects, some financing options may be available.
For instance, many home remodeling contractors offer reduced rates and charge sliding-scale fees based on a family’s income and ability to pay, or the homeowner may be able to obtain a modest loan to cover urgent needs.
Other possible sources of public and private financial assistance include the following:
Rebuilding Together, Inc., a national volunteer organization, through its local affiliates, is able to assist some low-income seniors with home modification efforts. Visit the following web site to learn more rebuildingtogether.org.
Investment capital from the US Department of Energy’s Low-Income Home Energy Assistance Program (LIHEAP) and the Weatherization Assistance Program (WAP) — Both of these programs are run by local energy and social services departments.
Medicare and Medicaid funds — Although these programs usually cover only items that are used for medical purposes and ordered by a doctor, some types of home modifications may qualify. To find out if Medicare will help to cover the cost of a home modification ordered by a doctor, call 1-800-MEDICARE (1-800-633-4227 or TTY/TDD 1-877-486-2048). You can also find answers to your questions by visiting the website at medicare.gov.
Community development block grants — Many cities and towns make grant funds available through the local department of community development.
Home equity conversion mortgages — Local banks may allow a homeowner to borrow money against the value of his or her home and pay for needed improvements. The homeowner then repays the loan as part or his or her regular mortgage.
Seniors may also choose to bypass public assistance programs and hire a contractor to do their home modifications or even do the job by themselves. Keep in mind these points if you want to have a professional contractor come into your home to work on a large project:
Ask for a written agreement that includes only a small down payment, and specifies exactly what work will be done and how much it will cost (with the balance of payment to be made when the job is finished).
Check with your local Better Business Bureau and Chamber of Commerce to see if any complaints have been filed against the contractor.
Make sure that the contractor has insurance and is licensed to do the work required.
Talk with your family and friends to get recommendations based on their experiences with the contractors they have hired. This step may actually be the most important one, because contractors with a good reputation can usually be counted on to do a good job.
Go to homemods.org/directory and view the National Directory of Home Modification and Repair Programs for a listing of what is available in the state where you live.