Doing Home Modifications the Right Way: A Functional Perspective
By Rob Horkheimer, Bridgeway Independent Living Designs (BILD)
We are fortunate to live in a time where there are a growing number of products and resources for people who are living with disabilities or aging and would like to remain safe and independent in their homes. If it's not something that affects you personally, chances are you know more than one family member or friend who can benefit from environmental adaptations to improve their lives.
With the myriad of different products and services which are becoming available to address independence and safety in the home, having the right approach can assist individuals in finding solutions that are safer, more attractive, more effective and all around better.
It's all in the approach.
With all of the gadgets and devices out there, there is a temptation to buy any product that makes the promise of providing safety and independence in the home. However, a gadget-focused approach often leaves us ineffective solutions that don't work very well, or with expensive or intrusive adaptations that could be better, less costly and safer. There is also a tendency to focus on products with medical or ADA label which actually may not work as well as other products or fixtures that were not specifically intended for accessibility, but have better suited characteristics to address the environmental needs that we have.
I can recall meeting with a woman whose child had a disability, and had hired a contractor to put in an "ADA" walk-in shower with a 6" step. It had an ADA height grab bar which was not ideal for the parents or the child, and didn't have backing to place grab bars at any other locations. Though this may have been an improvement over a standard tub, they would find the threshold very limiting as their son grew and as they got older. Alternate systems can provide advantages such as customization of fixture locations, a truly barrier-free design and integrated backing of the walls to allow for placement of grab bars at custom locations.
Before:
After:
It is extremely important for anyone considering modifications—whether simple or elaborate—to examine activities from a functional perspective. Occupational and physical therapists are highly trained experts in the process of task analysis and can be extremely helpful in determining the best solutions for home accessibility.
The essence of task analysis is to break down any specific activity into its separate and required components to perform that activity. For example, for an individual who performs scooting transfers into and out of the tub or shower, break down components of what is required to perform the transfer (which can vary greatly for individuals):
- What objects in the environment may be an obstacle or a support for this transition
- How the person shifts their weight to scoot forward in their chair
- How they manage legs into or out of a tub and what supports or barriers are present
- When in the tub how can one balance themselves and reach for controls
- How can they manipulate the controls for adjusting temperature and turning water on and off
- How they reach the towel to dry off
- How do they manage balance while drying off
From this meticulous analysis, we are able to determine what supports will assist an individual to be secure and self-sufficient and which obstacles need to be removed for independent personal cares and mobility, or for one's caregivers to safely and easily assist.
This functional task analysis can pertain to any application such as selecting and placing grab bars, accessible bathroom remodeling, building a wheelchair ramp and using a stair lift, ceiling lift or transfer device. When moving forward with any accessibility project, it is important to tailor the solutions and designs to the individual needs of the person, caregivers and household members. Often it is the details such as the seat height of the stair lift, configuration or slope of the wheelchair ramp, setup of a porch lift which can render a solution effective or ineffective for the individual. As you consider accessibility, attention to detail will be key to creating effective results for the accessibility of your home.
A closer look at the way we accomplish tasks and breaking those tasks down into the required elements will help us to find solutions that are affordable, aesthetic and effective for independence and safety. Employing this functional perspective along with knowledge of available options, we can create an environment that is comfortable, beautiful, and safe, which increases our health, happiness and quality of life.
Rob Horkheimer, MPT, CAPS, CEAC, ECHM is a physical therapist and accessibility consultant as well as a national instructor accessible designs and home modifications. His company, BILD – Bridgeway Independent Living Designs LLC, is a home modification company which provides custom remodeling, lifts, elevators and accessibility products in Wisconsin and Illinois. Visit www.bildnow.com for more on accessibility solutions and resources as well as upcoming educational events.
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