Creating Accessible Homes

Different physical conditions affect different people in different ways, so defining an appropriate job scope can be tricky. For instance, the modifications you make for someone with a permanent injury will likely serve him or her for years. By contrast, the needs of someone with a progressive condition like multiple sclerosis (MS) or Parkinson's will change, so you need to know how long the client plans on staying in the home, and how the disease will progress during that time.

Some contractors think they can cover all the bases by following Americans with Disabilities Act (ADA) requirements. In a private home, however, accessible features need to be customized for the particular client, and the ADA's one-size-fits-all specs for grab bar heights and sizes, clearances around toilets, and many other items, may not be the best choice.

"Each client will have developed a lifestyle that suits them, and because it suits them it's usually safer," says Weiss.

Get a Medical Partner

Of course, the average builder or remodeler isn't qualified to make medical diagnoses or to decide which of the client's preferred modifications are, in fact, safe. To make matters worse, says Weiss, some clients understate their problems and then blame the contractor for not solving them. This leads to the most important piece of advice for working in this market: Know when to seek medical help.

A relationship with an occupational therapist (OT) is as valuable in this market as a designer is to a design/build company. The OT won't be needed on every job. "If the client is someone in a wheelchair that doesn't have a progressive disease, then they usually need simple things like wider doorways and an accessible shower," says Houston remodeler Jeff Hunt, who also teaches CAPS classes. "However if the client has a specific diagnosis, I recommend reaching out to an OT to determine what's needed."

Cincinnati OT Marnie Renda says that when a contractor introduces her to a client it tends to clinch the deal. "If it's a competitive bid situation, I have a 100% batting average for getting the contractor the job when they hire me to go in and interview the clients," she says.

Not doing so can be asking for trouble. "I knew someone who had her bath remodeled [without input from an OT] and who couldn't use it a year and a half later," says Renda. "Her diagnosis was progressive and the space ended up not being wide enough for the new wheelchair she had to get."

The OT can predict what modifications a particular client will need at different points in time. For example, MS and Parkinson's usually progress slowly, so you can often plan modifications now that people may not actually need for a few years. On the other hand, says Renda, "someone with MS could be walking today but in need of a power wheelchair in a year." Each person is different, and a good OT can make a prediction based on the client.

Renda usually works with the contractor to create an allowance for accessibility features. "I act as advocate for [the] family. I help them choose products like toilets and grab bars," she says. "When they're choosing tile, I go with them to check the color contrast and friction coefficient, and can help them get special-order items like weighted curtain rods and trench drains." She also recommends products that won't make the completed space look like a nursing home. This has gotten easier in recent years, as manufacturers have introduced stylish and functional products that are a far cry from the institutional-looking offerings of the past.

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