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Cerebral Palsy - Back to News Menu
Adapting Your Home To Maximize Mobility
Work to Accommodate Disabilities Can Allow Owners to Age in Place
By Sandra Fleishman
Washington Post Staff Writer
February 18, 2006 - Stephen Bennett doesn't need a wheelchair-accessible bathroom. But the president and chief executive of United Cerebral Palsy has lots of friends and professional acquaintances who do and says "when I have friends over, I want them to be able to go to the bathroom in my house."
Bennett, though, has found the process of getting one frustrating. "I spent a year trying to find a townhouse in Dupont Circle where I could make the main floor visitable," and during the search, "my Realtor went berserk," he said.
John Canning, whose multiple sclerosis was diagnosed in 1990, modified his master bathroom to accommodate his wheelchair.
Bathroom Safety
It's never too early for safety-minded bathroom upgrades, says Elinor Ginzler, director for livable communities in AARP's office of social impact, who shares suggestions in this interactive photo gallery. "The earlier you do them," she says, "the longer you have to appreciate them."
Adaptations for Universal Design
The Americans With Disabilities Act, the 1990 law that requires public spaces to be accessible, does not establish guidelines for building accessible private homes or adapting them. The key, according to design experts, is to make the changes that best suit the person who lives or visits there.
Research Before You Remodel
For more information: · "The Do-Able Renewable Home," published by AARP in 1991 and updated in 2000, is 36 pages of practical advice on making residential spaces accessible. Free download is available at http://www.universaldesign.com/ .
Bennett eventually found a 100-year-old house that could be outfitted with a ramp to the back door, but his plan to tackle the first-floor bathroom was delayed by contractor problems and pressing repairs. An architect's estimate that fully modifying the powder room would cost $9,000 "also kind of stopped me in my tracks," he said.
Still, the District resident is determined to do the project soon: "I'm willing to pay to open up the doorway and put in grab bars because I want people to be comfortable when they come here. In today's world, as a practical matter, what most people do is find a private space and set up a urinal pot because it's so hard to use the bathrooms. But I just want it to be better."
Bennett has run into a problem that many Americans may find familiar.
As baby boomers hit their sixties, many are learning that even something as simple as getting into their own bathrooms becomes quite difficult if they suddenly need a wheelchair to get around.
There are "more than 54 million Americans living with disabilities, an aging population expected to reach 70 million by 2030 and baby boomers concerned about finding homes they can grow old in as an alternative to nursing homes and retirement communities," James E. Williams Jr., president and chief executive of Easter Seals, said last summer in a statement advocating accessibility. His call for action came on the 15th anniversary of the Americans With Disabilities Act.
Easter Seals and the Century 21 real estate firm have put together a checklist and resource guide for making homes accessible. Other guides are being published nationally and locally, because virtually none of America's houses were built to accommodate those on wheels.
Even lately, during the age of the mega-mansion, new homes aren't being built to make it easy for wheelchair users. Not even in active-adult communities. Sometimes doorways and hallways in new construction are wider than the standard 30 and 36 inches, but not as a rule. New higher-end homes, though, sometimes offer the potential for widening doorways and later adding features such as roll-in showers or elevators.
The situation is something of a paradox: At the same time that most builders resist adding "aging in place" features to new houses, most older Americans are saying they want to grow old at home. About 84 percent of AARP members surveyed last year said they want to remain at home as long as possible. About 87 percent, however, acknowledged that their homes will not meet their needs as they grow older.
And small bathrooms are a sizable part of the problem, accessibility experts say. If a wheelchair user can't fit into the bathroom, or there's not enough room for a user and an attendant, or a way to carve space from other rooms, it can mean moving to a new home or to alternative care.
The good news, those who specialize in accessible design say, is that small bathrooms can be modified without spending a fortune to accommodate many situations, although modest changes may not allow full accessibility for every type of disability. And the better news, they say, is that the more interest there is, the more the home building industry may respond.
John Canning of Reston says he's proof of the potential. He just had a tiny powder room modified to help him cope with advancing multiple sclerosis. "It's really made a difference, and it wasn't all that expensive," said Canning, retired owner of an office coffee service.
Canning hired the same remodeling firm that he used seven years ago to redo the main living spaces in a three-story townhouse. At the time, he was still walking but knew he would someday need a power scooter. The latest work cost about $6,000, including the new fixtures, tile work, flooring and painting done to update the 20-year-old bathroom and make it accessible.
For the first renovation, Butler Brothers Corp. of Clifton "did the usual stuff -- grab bars in the bathrooms, and the elevator -- but I also had them do over the master bath entirely, at their suggestion," Canning said. Vince Butler, who chairs the Remodelors' Council of the National Association of Home Builders, is an advocate of "universal design," design that provides as much accessibility as possible to as many people as possible. And he convinced Canning, as he has other clients, that it would pay to " 'handicap' the master bathroom" ahead of time, Canning said.
The contractor gutted the room, which was a bit bigger than the standard 5 by 8 feet, and added space from an adjoining closet to make room for a roll-in shower, instead of the tub. The shower has grab bars and a handheld showerhead as well as a regular one. The sink is set up without a vanity cabinet beneath, so he can roll his chair right up to it.
"Everything has come in wonderfully handy at this point, obviously particularly the shower," said Canning, whose disease was diagnosed when he was 40 and who now, at 55, depends on a powered wheelchair. Canning says he is "lucky enough to still be able to stand up, if I lock my knees, as long as I am holding on to something."
But recently, the Reston resident decided to also make over the small downstairs bathroom "because I couldn't get into it with the wheelchair and that caused problems."
The powder room, though, didn't have space for a wider doorway, so Butler put in a pocket door, which slides into the wall. Then the space was outfitted with accessible fixtures.
Such upgrades can be a relatively inexpensive solution for some.
"The answer is yes, but," said Richard Duncan, senior project manager with the Center for Universal Design at North Carolina State University, when asked if tiny spaces can be modified.
The "but," he said, means the answer depends on the decision's variables: the needs of the person who is going to use the bathroom, the extent of the disability, the space and the budget available.
"Those kinds of bathrooms are very challenging," Duncan said of a 4-by-7 powder room in a 1958 house. "In most cases, with one that is smaller than five by seven, you will have to make it bigger, by stealing space from an adjacent closet or hallway."
Duncan and others say a 5-by-8 space is generally considered the minimum space if a homeowner wants to fit an accessible toilet, sink and roll-in shower; a 5-by-5 space is the absolute minimum for a sink and toilet. Most wheelchairs need a clear five-foot circle to make a turn.
The typical master bath in the United States, from the beginnings of suburbia in the late 1940s until the last decade or so of mansionization, has been about 5 feet by 7 or 8 feet.
The traditional powder room, which has only a sink and a toilet, is even smaller.
Still, "you can do it," said Takoma Park architect John P. S. Salmen, who wrote "The Do-Able Renewable Home" for AARP in 1991. "We have a whole bunch of ideas that can be done for low to no cost on how to stay in your house as you age, including modifying bathrooms." The book was updated in 2000.
Among the simplest ideas, Salmen said, is having the bathroom door open outward, instead of inward.
"The width of the door also depends on how you go in," Salmen said. "If you can go straight through the door, without having to make a turn, then I personally think you can get through a 30-inch door."
In some situations, a wheelchair user who can't make the full turn inside the bathroom to use the facilities but who can still maneuver out of the chair may also be willing to live with going in straight ahead and then backing out of the space, he said.
Even a small bathroom can have a roll-in shower, with no threshold or curb to block passage, if the floor is rebuilt to slant toward a drain, if the whole space is tiled and if the owner doesn't mind that a fold-up shower seat and the toilet might get wet, said Arlington architect Kim A. Beasley.
Beasley, head of Beasley Architectural Group and former national architecture director for the Paralyzed Veterans of America in Washington, co-wrote a guide to accessible design for the PVA in 1999. An updated version, expected in March, shows a very small bathroom that Beasley modified. The book also looks at a wider array of designs, including accessible outdoor rooms and second homes.
While the federal government's codes are meant to address the needs of all disabled Americans, "there aren't codes for private homes," said architect Thomas D. Davies Jr. of Annapolis, who co-authored the PVA's design guidebook.
"It's really hard to generalize what will work," Davies said. "If someone has an attendant, then the bathroom has to accommodate two people. If you have arthritis, you may need a certain type of arrangement. . . . If a shower has a window in it, you can't put a grab bar in some places."
"In terms of the size, it depends on who's going to use it," he added.
The differences affect not only the type of construction but also the price.
Beasley said he can design an accessible bathroom that runs between $8,000 and $12,000.
Making a bathroom fully accessible, with a no-threshold shower, new tiles and flooring and a full-floor waterproof membrane, can easily run $25,000 and up, depending on the finish, Butler said. But just making a bathroom "much more accessible and easier to use" typically runs about $12,000 to $15,000.
Architects and accessibility experts caution that homeowners should consider the big picture before embarking on one piece of the accessibility puzzle.
"You have to ask yourself: 'What are the long-term goals of the owner?' " Salmen said. "Are they going to stay in the house long enough to make it cost-effective? Are they going to live long enough to take advantage of the changes? What is the individual's physical condition, their age, the physical condition of their house, the value of their house and the location of the house in a neighborhood? Is it, for instance, in a neighborhood where they can get to critical amenities if they aren't able to drive? And what is their financial situation?"
"Sure, you can fix up a bathroom, but the really accessible house would have no steps and would be wide enough throughout for a wheelchair," Salmen said. "In some cases it's not worth it to modify the house you're in. In other cases it is."
Lynn Anderholm, an Alexandria homeowner, hired Beasley's firm to modify her house three years ago. The 52-year-old has had Parkinson's disease for about 12 years and had lived there for about 20 years without modifications.
Anderholm got a variance to add a first-floor accessible bedroom and an accessible powder room, and then made the second-floor bedroom and master bath wheelchair-friendly. The house now has wide hallways and 36-inch doorways in most rooms.
The addition and new bathrooms were less expensive than renovating the old rooms, Anderholm said. Experts say it is generally cheaper to build in accessibility from the start than to redo an older home.
Anderholm and others, though, say builders should embrace universal design. "If it were up to me," she said, "all builders would put in 36-inch doorways and at least 48-inch hallways. It's not that difficult to do in new houses, but if you try and do that once the house is there, it's very, very difficult."
Some remodelors and industry officials, however, say surveys of home buyers show that they generally don't want features identified with aging or disabilities, even if they don't cost much more.
Buyers "just don't want to think about it" until they have to, said Jim Lapides, communications manager for the Remodelors Council. "It's a psychological issue," said Gopal Ahluwalia, research director for the National Association of Home Builders.
But builders also know that bathrooms are the second-most-popular remodeling project, after kitchens, that remodeling is a $10 billion-a-year business and that there is growing interest in aging in place from some very vocal corners, such as AARP.
Prince William County officials agree. County leaders a year ago set up an aging committee to promote accessibility. The committee published the pamphlet "Easy Living With Universal Design" and is working with designers, businesses and Centex Homes on a demonstration home expected to open in Bristow this fall.
Prince William is "reaching out to builders because we have learned that, time and time again, seniors are tending to follow their children into Prince William County but, time after time, they've learned that the houses they've moved into are not accessible to them," said Toni Clemons-Porter of the Prince William Area Agency on Aging. "If anything happens, if a child or an adult becomes temporarily disabled, it's an eye-opener."
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