Home Retro-fits
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Home Retro-fits
Caring for a child with disabilities at home has many emotional, financial, and
physical challenges. This page will look at some ways a family can change their home
to help with these challenges and provide the best care for a child with special
health care needs. As this topic is huge—and because each family’s challenges are
specific to their home and their child’s needs—we will not try to cover everything
here. Our main focus is the safety and mobility for children who use wheelchairs,
but we welcome your comments and ideas for future topics. Please click on the
Feedback link at the bottom of every page to email us your input.
Some home adaptations are needed to help a family care for their child and
keep him safe, while others help with the child’s independence, so he can get out of
bed, use the toilet, move between floors, grab a snack, and get out the door without
help.
On this page, we have put home retro-fits into three broad
groupings:
- Ramps/Entry – Access to the home itself can be the biggest concern for a family with a child who uses a wheelchair or other mobility device.
- Bathrooms – The size and floor plan of bathrooms is often the greatest challenge within the home.
- Other rooms – Hallways, bedrooms, kitchens, garages, and other living spaces each bring their own set of challenges.
Ramps/Entry
Families that will be caring for a child who uses a wheelchair should
think about their options: Can they carry their child? What kind of chair will they
use? Can they carry the chair? Does their home have room for a ramp? How might these
things change over the years?
Wheelchairs - One key question each family must think about is
which type of chair will be best for their child: a power chair or a non-motorized
(manual) chair? Motorized or battery-powered chairs allow children to move
themselves forward easily, without employing their own strength or needing outside
help, but they are much heavier, and often larger, than non-motorized chairs. (See
the Wheelchairs and Adapted Strollers
Technology Review to help with this decision.)
Ramps - Entry ramps may take up more room than families might
think. Building standards state that the wheelchair ramp should not rise more than 1
inch for every 12 inches of ramp length (i.e., a ramp that rises two feet would need
to be 24 feet long). Also, building codes often require that a 5 x 5 foot landing be
put in after a set amount of rise, to give the pusher of a manual chair a rest
between ramps. Ramps can be hard to put on homes with small yards, such as condos,
or in urban settings.
Bathrooms
Bathrooms pose many challenges for households caring for a child in a
wheelchair.
Size - Not only must a bathroom must be large enough
for a wheelchair to enter and move, but it must have enough space for a parent or
other adult to be in the room to help the child.
Sinks - If possible, the bathroom sink should be built
without cabinets underneath it, so that the child can wheel up to the sink to wash
their own hands. 2010 ADA standards state that the sink top should be 31 inches
maximum above the floor with 24 inches of knee clearance for sinks used mainly by
children 6 to 12 years. (From ADA.gov)
Counter Space - Many children who live with chronic illness, or
have special needs, have help with diapering throughout life. Parents will need a
place to change their child’s diapers — the bathroom is the best place to set that
up. Changing and cleaning an older child calls for a large shelf or cabinet where
the caregiver can safely lay the child down.
Toilets - For children who can use the toilet, it may be
necessary to raise the level of the toilet so the child can move from the chair to
the toilet seat. This can be adapted with a toilet riser or a pedestal at the base.
Bathing - There are many ways to add safety and functionality in
the bath or shower. The simplest and cheapest way is to put a shower chair in a
regular bathtub or shower stall. Such chairs come with straps and other supports so
children who have difficulty supporting themselves don’t slide while being bathed.
These supports also allow a parent (or caretaker) to focus on bathing the child,
instead of a safe way for them to sit up.
As children grow, lifting them in and out of a shower chair becomes more
and more difficult, or even impossible. One answer to this problem is a roll-in
shower, which has no stop or rise between the level of the bathroom floor and the
shower floor itself, letting a manual chair be wheeled right into the shower.
One more solution, and a newer product, is a tub with a drawer-like
cutaway in the side. The drawer pulls open so a chair can simply roll in. The drawer
is then closed, sealing the tub for bathing.
No matter what choice, handrails and grab bars should be mounted
throughout the bathroom to aid in movement and safety.
Other Rooms
Families who care for children with life-long health issues at home, such as those
who use wheelchairs, suggest a series of retro-fits throughout the rest of the home
as well.
Bedrooms - Medical beds and other standing equipment can take up
a lot of space. You may want to move the child into a larger bedroom, if one is on
hand.
One challenge for parents as their child grows is the task of lifting him
or her from the bed to the wheelchair, and vice-versa. One very useful tool is a
lift–a mechanized sling attached to the ceiling above the bed. The caregiver (or the
child, if he or she is able) places the sling under the child. The sling then lifts
the child slightly and moves him or her over to the chair and back again when
needed.
Some children, such as those using a ventilator or other specialized
medical equipment, need round-the-clock monitoring. Those who have had this
challenge suggest putting the child’s bed in an open area near other conveniences:
the kitchen, a bathroom, and perhaps a living room and TV.
Kitchens - Specially designed drawers can be installed into the
kitchen. These drawers can be pulled out without a lot of effort, letting a child to
get food on her own and giving added freedom.
Therapy Rooms - Many children have routine physical
therapy, and sometimes have bulky equipment for that. Some households are able to
set apart a room as a “therapy room;” a space that has room to move, and to use and
store equipment.
Other Adaptations and Considerations
Doors - In newer homes, doors are often built wide enough (32”)
to fit a wheelchair. However, in older homes, doors are sometimes too narrow for a
wheelchair to pass through and will need to be made wider.
Rugs and Carpets- A thick carpet, or thick padding under a
carpet, can make wheelchair movement very hard. Those who can build a new home will
often choose hardwood floors, tile, or very thin carpet throughout the
house.
Families able to build a custom home can look at other ways to help with
inside mobility. They may choose an open floor plan, making it easier for a chair to
move around. A home that is built all – or at least mostly – on one level is ideal,
although it is more costly than a multi-level home. If you live in a multi-level
home, you can have an elevator put in so the child can move easily between floors.
Furniture should be arranged with care, or even removed, to allow easy
passage for a wheelchair.
Other Considerations:
- Added lighting will help with safety in areas such as stairways.
- Push/pull lever faucets are helpful for children with limited hand strength.
- Side-by-side refrigerators are easier to reach for children in wheelchairs than vertically arranged ones.
- Entry and inner door lever-type door knobs are easier to use than regular doorknobs.
- Wide swing hinges allow use of the whole doorway.
- Reinforcement of walls will better support grab bars.
Costs
Adapting a home can be costly, but it is worthy to think about the range of costs
involved. One family may choose to design and build a new home, tailored to a child
in a wheelchair or some other condition. Another family might put in an entry ramp,
renovate their bathroom, and make a few other changes, such as changing lighting and
adding safety railings and support bars.
Someone with a lower income may struggle to make even minor changes. They
may need to count on organizations that help families with children who have
disabilities. The need for the services of such groups often exceeds their funding.
(See the bottom of this page for contact information for such groups.)
Families who have been through the process of building a custom home
recommend seeking a builder with this type of experience—someone who is able to
change things and knows the special challenges of planning and building a home for a
child with special health care needs. Families often need to alter their plan and
ask for added changes throughout the building process.
It is not easy to put an exact cost to these changes. One family that
built a home designed for a child in a wheelchair said it cost them roughly $40,000
more than building a standard home. This family chose to live in a suburban location
because their dollars would stretch further there and allow them to live in the home
they truly wanted.
Resources
Information & Support
For Parents and Patients
Easter Seals/Century 21 Easy Access Housing
Easter Seals and the Century 21 System's Easy Access Housing for Easier Living Program provides homeowners with information
about accessible homes and how to find one; site includes helpful educational brochures, an expert panel with additional resources
and easy-to-implement tips for making an accessible home a reality.
Homemods.org
Dedicated to independent living for persons of all ages and abilities, this site provides many ideas and resources for home
modification, including funding programs; for both consumers and professionals.
The Home Wheelchair Ramp Project
Offers instructions and reading material for design and construction of wheelchair ramps, as well as specific information
about modular ramps and long-tread low-riser steps that can improve safety and home accessibility.