Making Your Home, Vehicles, and Workplace Accessible for a Wheelchair
THe House My Wife and I lived in prior to my injury was a lovely English Tudor-style home built in 1929. A flight of steps led to the front door, and the primary bedroom and bath were on the second floor. There were lots of doorways and thresholds and corners to turn as you went from room to room. After my accident, we discussed remodeling plans with three different contractors, but it soon became apparent that the cost to make the house accessible—to meet my new needs—would be prohibitive. Fortunately, we found a townhouse that had everything I needed. Saying goodbye to our old house and all the happy memories we made there was difficult. But staying was not an option we could afford. The relative ease of living in the townhouse made the transition easier, which helped me focus on rehabilitation and my goal of returning to work as soon as possible.
Depending on your mobility and needs, it is quite likely that you’ll need to make some modifications, especially if you’re going to use a wheelchair. The three most important areas to optimize for functionality and mobility are: 1) your home (entrance and doorways, bathroom, bedroom, and kitchen); 2) your transportation (a van or a modified car); and 3) your workplace (accessible). The changes that will matter most to you are safety and return on investment—spending money on things that will have the biggest impact on your quality of life. Your occupational therapist, social worker, and members of your support group can provide you with advice on how best to navigate this new situation.
The first major decision in making your home accessible is determining if it’s possible and how much it will cost. The second is determining how much renovation you really need. Are you a committed chef who will need lower countertops and special appliances, like ovens with shorter depths, to enable you to reach in and pull out pans without burning yourself? Do you really need an accessible hot tub in your bathroom? For most of us, the answer is no. The three most important design features in your home will be an accessible bathroom (frequently with a roll-in shower for a shower commode chair), a first-floor bedroom and bathroom, and no carpeting and few rugs, if you are using a wheelchair or a cane. Having hardwood floors makes it easier to push your wheelchair or walk with crutches, a cane, or a walker. Even if you reach a point where you don’t need assistive devices, you may consider removing wall-to-wall carpeting and area rugs, as they can be trip hazards.
Before you make any renovations, try to visit the homes of people with disabilities similar to yours; ask your friends and support group members to put you in touch with people who have similar needs to learn about their modifications. Check out home designs online. Talk to your physical and occupational therapists, and have them visit your house to see the space. Contact your chamber of commerce for a list of local builders with experience in accessible renovations. Many contractors follow the design/build method, which means their plans only need sign-off from an engineer (and not an architect) to obtain a building permit. If you decide to hire an architect, be sure to hire one with expertise in accessible living and ask to see at least three previous projects.
Entrance and doorways: While newer homes, especially ranch-style houses, may be readily accessible, many older homes have stairs to all entrance doors. All homes should be equipped with two accessible exits for emergencies, such as fire. If you live in an area with significant snowfall and have an attached garage, you’ll want a ramp installed from the garage into the house. Every state has its own building codes, but a typical ramp would be at least 3 feet (91 cm) wide, with a pitch of less than 12 inches (30 cm) length for every 1 inch (2.5 cm) in rise, and with a railing that is at least 32 inches (81 cm) high. If the ramp has to change direction, there should be a 5-foot-by-5-foot (1.5 x 1.5 m) platform at that intersection. Ramps can be made of wood, wood-plastic composites, or metal (usually aluminum), and should have a nonskid material covering the surface. Wood (pressure-treated lumber or durable wood, like teak) is used most frequently because it is the least expensive material. Engineered wood-plastic composites are becoming more popular as their prices approach that of wood. They have several advantages over wood ramps: no warping, splitting, or splintering, and no need for repainting or re-staining. Lightweight aluminum, though most expensive, is also a good material, especially if the ramp needs to be relocated, because it’s the easiest to disassemble and move.
For doorways, a minimum width of 32 inches (81 cm) is recommended to enable easy passage in a wheelchair. If the doorway is too narrow (many older homes have 30-inch/76 cm wide doorways), you are likely to scrape your fingers, hands, and arms as you pass through. You are also likely to scratch the paint on the doorway, and you may damage your wheelchair’s arm supports. To widen your doorways, you can remove the doors or install pocket doors that slide into the wall. If you have standard doors in your home, you may consider changing the doorknobs. Opening a standard door with a doorknob requires significant reach and grasp capabilities, which may be beyond your ability. Replace your doorknobs with a mechanism that is easy to grasp with one hand and doesn’t require much strength to move, like a lever. To modify existing doorknobs, attach a rubber snap-on lever that fits over them. A remote-controlled door opener, like those commonly used for garage doors, is another good solution. Thresholds should be no higher than ¾ inch (2 cm) in height. If your thresholds are higher, you may need to install a small wooden or aluminum ramp to make it easier to roll over them.
Bathroom: The bathroom, of all the rooms in the home, usually requires the most remodeling. A standard bathtub and shower won’t work if you have problems with strength, coordination, balance, and vision. If you’re able to transfer from your wheelchair independently, your existing shower may work, as long as it isn’t part of a bathtub and the entrance is close to a wall and wide enough so that you can transfer onto a bench. In most cases, you will need to add a shower chair or bench, grab bars, and a shower wand so you can shower on your own. If you’re unable to transfer independently, you will need to transfer from your bed or your wheelchair onto a specialized shower chair that you or an aide can roll into the shower.
If you use a wheelchair, you will likely need to modify your bathroom sink; if not, you should be OK with a standard sink and a grab bar. To control the water temperature and flow, a single-handle faucet is the best choice. The sink should measure about 30 inches (75 cm) wide, 19 inches (50 cm) front to back, and less than 6.5 inches (16.5 cm) deep. It should be mounted to the wall, 27 to 32 inches (68–81 cm) high, without a cabinet underneath so that you can roll up to it in your wheelchair, with adequate space below the sink to accommodate your knees. Hang mirrors over the sink (and other places in the house) so that you can see yourself from both a seated and standing position.
The toilet should be standard height (14–18 inches/35–45 cm from the floor to rim) with a minimum of 18 inches (45 cm) of space on both sides of the bowl. You may need to install a grab bar on one or both sides of the toilet, if it’s in an alcove. Maintaining the bathroom at a warm temperature (70–78°F/21–25°C) is critical and can best be achieved with infrared lights or heat lamps, which are faster and more efficient (and less expensive) than a heated floor.
Kitchen: How much time do you spend in the kitchen? While some people will want a customized kitchen they can cook in, for many of us, being able to reach into the fridge and put a prepared meal in the microwave is sufficient for a typical meal. This can be accomplished by having a drawer refrigerator or a side-by-side refrigerator in which you keep your most commonly used items on the lower shelves if you are in a wheelchair, or at chest level if you are standing with a walker or cane. You can place a microwave on a table or countertop at a height of 27 to 32 inches (68–81 cm) for easy access. Ovens and dishwashers can be challenging due to their pull-down doors, which can make putting items in and taking them out quite difficult, but there are few commercially available solutions. I use a large countertop convection toaster oven (16 x 20 x 11 inches/40 x 50 x 28 cm) that can accommodate six slices of toast, a whole roast chicken, a personal pan pizza, and other large items. It has a handle so I can easily open and close it, and it’s shallow, so I can easily reach in and out.
Bedroom: The most important features of a bedroom are easy access to the bathroom and sufficient space around the bed to maneuver a wheelchair easily, especially for transfer to the bed. There should be a minimum of 3 feet (1 m) on your side of the bed for transfers, and 4 feet (1.2 m) at the end of the bed for turning.
Other features you may wish to consider include a bed that is the same height as your wheelchair seat; a light switch, telephone, and clock that are easily accessible at the bedside; drawers that you can open with one hand; and storage for items that you use frequently, such as braces, prostheses, bedclothes, gloves, alcohol wipes, urine bags, and other medical supplies. Don’t use electric blankets, because you could quickly develop a burn without feeling it.
Other modifications: If you’ll be using a wheelchair, walker, cane, or crutches, you’ll have difficulty maneuvering on plush carpeting. The Americans with Disabilities Act Standards for Accessible Design recommends that carpet pile should be no more than ½ inch (1 cm) thick. Throw rugs can move or bunch up under wheelchairs equipped with a docking pin (for securing the chair in a van), and they present a trip hazard if you’re on crutches.
You may also need to make modifications to your electrical appliances. If you are remodeling your home, new electrical outlets should be placed at least 15 inches (38 cm) above the floor, and light switches and thermostats should be no higher than 48 inches (122 cm) above the floor. If your light switches and electrical outlets are not accessible to you, you can use a smart plug that works with your home automation systems (Amazon Echo, Google Nest, or Apple HomeKit) to allow you to control lights or other electrical devices without touching them.
As the baby boomer population ages, builders and developers are creating new homes with single-floor living, walk-in showers with no thresholds, built-in shower seats, “comfort height” toilets, grab bars, and open floor plans that only have doors to bedrooms and bathrooms. New construction often includes pocket doors for bedrooms and bathrooms, rather than hinged doors. This trend is to your advantage if you decide your best option is to move to another house.
Driving with a disability often means relearning how to drive. The rules of the road don’t change, but the controls do. Depending on your needs, an adapted vehicle (a van or modified car) may include something as simple as a spinner knob attached to the steering wheel for one-handed steering, if one upper limb is much weaker than the other. More complex devices include hand controls for braking and accelerating mounted on the steering wheel. There are also power-assist devices to enable you to drive by essentially moving a joystick.
Choosing the right vehicle and controls: Once you’re ready to drive, you should take a driver’s education course again. Most communities offer driving lessons for people with disabilities. Don’t be surprised if this process is difficult for you. Slowly braking on a downhill slope in a 5,000-pound van isn’t easy! Driver’s ed teachers who help people with disabilities will have hands-on experience and knowledge of what type of vehicle and special controls you will need. In my experience, it’s wise to underestimate your abilities so that if you hurt yourself, get sick, or develop chronic musculoskeletal problems, you will still be able to drive your vehicle.
Once you’ve completed driver’s ed, you should be able to answer the most important question: Do I want to drive independently, or should I find someone to be my driver? I found driving to be mentally and physically tiring, so I ultimately decided not to drive myself.
If you’re living with paralysis, ask yourself what kind of vehicle is right for you and whether adapting a car you already own is possible. Will you be driving from a wheelchair, thus requiring a van, or can you transfer to the car seat of a smaller passenger car? If you can transfer into a car, you will be able to purchase a less expensive vehicle, and you’ll have many more choices. If you choose to drive from your wheelchair, will you and your wheelchair fit in the vehicle? If you’re on the taller side, you may have difficulty getting into a car without your head hitting the door frame or pressing against the ceiling while you drive.
So, make sure to buy your wheelchair before you buy your vehicle. Proper wheelchair size is also important, so that your knees fit under the steering wheel, and your arm position is comfortable, particularly if you’ll be driving for more than an hour at a stretch. Can the vehicle accommodate hand controls or other needed equipment such as a ramp, a place to store your wheelchair (not likely with a convertible), and a mechanism to lock your chair?
Will a full-size van fit in your garage? Once the van is parked in your garage, is there room for you to get out safely, especially if you need a ramp?
Once you decide what type of car would best suit you, you’ll need to figure out how to pay for it. This usually requires significant financial assistance. Start with your state’s Department of Vocational Rehabilitation and if appropriate, the Department of Veterans Affairs. If you are fortunate, as I was, your employer may make a significant contribution as part of their employment policies regarding people with disabilities. Other sources include not-for-profit agencies that have grant programs for individuals with disabilities; workers’ compensation, if you were injured while working; rebates from automobile manufacturers; and state waivers for sales tax, if your physician prescribes the vehicle as medically necessary.
In most cases, you’ll need to modify your car or van to your specifications. The cost of modifying a vehicle varies greatly. A new vehicle modified with adaptive equipment can cost anywhere from $30,000 to $90,000. If you receive funds to cover the cost of your modified car or van, make sure you ask about what will be covered; get precise details. Then have the seller provide detailed written specifications for the vehicles that are approved by the funding agency.
There are many available options for cars and vans, depending on whether you plan to buy one new or used. If you can afford it, the best approach is to purchase a new vehicle from the manufacturer and have it sent directly to a nationally recognized company that specializes in modifications of vehicles, like BraunAbility or Amerivan. If you plan to adapt a used van or car, be careful; unlike most people, if your vehicle breaks down, it won’t be easy to find a loaner car! Therefore, you should have the vehicle inspected by a competent mechanic before buying it. When seeking out auto body shops to do the modification, choose ones that have proven expertise. In my metropolitan area of 1 million people, there’s only one auto shop that has enough expertise to install locking systems and repair broken ramps. The best shops, like the one I use, make sure that they get it right. Shops that lack experience or cut corners will deliver a subpar vehicle that is always in need of repair.
Once you’ve determined what the specifications for your van or car need to be, it’s time to learn more from friends, online forums, and community groups. Ask your friends what they like about their cars or vans and what they would change if they could do it all over again. Then make sure that your driver’s ed instructor, occupational therapist, and physical therapist agree with your selection of vehicle and controls.
Public transportation: Federal laws, such the Americans with Disabilities Act (ADA), require all transportation providers to accommodate wheelchairs. Many states have antidiscrimination laws that require companies to treat all customers equally. Several large US cities (e.g., Chicago, New York, and Washington, DC) have mandated that taxi companies maintain a certain number of wheelchair-accessible vans, and most cities have buses with lifts to enable them to transport people using wheelchairs or rolling walkers. With advance notice, some public bus and taxi companies will send a vehicle to you. Subways are usually wheelchair-accessible, but getting to them may be difficult. For example, in New York City, only one in four subway stops has elevators, so you may need to travel on the sidewalk for five to twenty blocks to get to your destination.
Trains are probably the most accessible form of transportation in the US. All stations have an accessible entrance to the train, such as a ramp or an elevator, and the trains all have wheelchair-accessible seating. But getting on and off the train can be difficult, because sometimes there are many people crowding the exit. It may also be difficult for the conductor and other employees to assist you. To ensure that you get to your destination safely, talk to an employee prior to your scheduled stop so that they can be nearby to help you get off. Air travel is much friendlier for people with disabilities—we’ll discuss that in chapter 17.
Companies with more than fifty employees are required to modify the workplace to make it accessible as mandated by the ADA (see below for modifications). But even smaller companies that are exempt from ADA rules are usually willing to accommodate disabled employees, and national organizations exist to help small businesses make their workplaces accessible. Companies are also supposed to accommodate acquired cognitive disabilities, as may occur with ANI, especially TBI. If this applies to you, you should have a formal neuropsychology exam performed and the results submitted to your employer.
Employer-mandated responsibilities: The ADA mandates accessibility in schools, workplaces, public spaces, and transportation, and increased awareness of the need for universal design principles that make indoor and outdoor spaces accessible to people with disabilities. Title I of the ADA prohibits private employers, state and local governments, employment agencies, and labor unions from discriminating against qualified people with disabilities when it comes to job applications, hiring, firing, promotion, pay scale, job training, and other conditions and privileges of employment. A qualified employee is simply someone who, with or without reasonable accommodation, can perform the essential functions of the job in question.
Making work accessible and comfortable: Reasonable accommodation is an adjustment to make the existing workspace accessible and usable by people with disabilities. These might include ramps for entrance and emergency exit, wider doorways, room to maneuver in your office, desk and computer in ergonomic positions, and an accessible bathroom. It also includes other accommodations such as changing work hours. I changed my starting time from 7:30 am to 9:30 because it takes me two hours to get ready for work, compared to 20 minutes pre-injury. Depending on your abilities, you may need assistance throughout the day to help you work, use a bathroom, go to meetings, and translate (e.g., sign language, if you’ve lost your hearing or have aphasia).
Resources to prevent discrimination: While there’s a legal responsibility for employers to make reasonable accommodations, things don’t always go smoothly. The good news is that there are several federal and state laws that will support your efforts to work. The bad news is that after you initiate an action against your employer, you may face hostility because the process is time consuming, expensive, and distracting for all parties involved. If you feel you’ve been a victim of discrimination, the resources available to you include the United States Equal Employment Opportunity Commission (EEOC), the Disability and Business Technical Assistance Centers, the Fair Employment Practice Agency (FEPA), and the Ticket to Work and Work Incentives Improvement Act (programs within the Social Security Administration). The EEOC is usually the first resource to turn to, since all major employers will have someone in human resources who can work with you and the EEOC.
Involve your family and your therapy team to help you improve your access to all the things that contribute to your quality of life—at home, at work, and on the road. That discussion will include:
• your home and what needs to be done to it to accommodate your new needs
• your transportation needs and whether you should drive or enlist someone to drive you, as well as whether your car or van can be modified or will need to be replaced
• your workplace and what may need to be done to accommodate you before you return to work.
• a support group—one that meets in a physical location or online (Your fellow group members can guide your choices with their real-life experiences.)