Home Modifications

By: Erin Darnell, Colleen Day, Andrea Hammons,

Paige Hays, Stephanie Hayes, Gina Ligori, Darcie Mang, Leslie Pottorf, Amanda Terstriep, Kristen

Thompson

Housing Laws:The Fair Housing Amendment

Disability Rights in Private and Public Housing

Prohibits discrimination against persons with disabilities. It is unlawful for a housing provider to refuse to

rent or sell to a person because of a disability. Housing providers must allow persons with

disabilities make reasonable modifications. A reasonable modification is a structural

modification that is made to allow persons with disabilities the full enjoyment of the housing and related facilities.

Reasonable modifications are usually made at the resident's expense.

Disability Rights in Private and Public Housing (cont’d)

Housing providers must make reasonable accommodations for persons with disabilities. Housing providers should do everything

they can do to assist and is not required to make changes that would alter or create an undue financial and administrative burden.

However, resident may be required to remove the modification if they leave the rented space.

Examples of Reasonable & Unreasonable Accommodations

A housing provider may not refuse to rent to an otherwise qualified individual with a mental disability because s/he is uncomfortable with the individual's disability. Such an act would violate the Fair Housing Act because it denies a person housing solely on the basis of their disability.

New Multi-Family Housing

New apartment buildings and condominiums (occupied after March 1991) with 4 or more units must have basic access in every ground floor unit, and in all units that have an elevator.

Townhouses are exempt

Requirements under the Fair Housing Act

Accessible entrance on an accessible route Accessible public and common-use areas Usable doors Accessible route into and through the

dwelling unit Accessible light switches, electrical outlets,

thermostats, and environmental control Reinforced walls in bathroom Usable kitchens and bathrooms

Renovated Multi-Family Housing

If a builder receives money from the Dept. of Housing and Urban Development (HUD) or other federal agencies to renovate a multi-family dwelling, a small percentage of the units must have access.

HOWEVER, once the small percentage has been reached the remaining units can legally remain inaccessible.

What to do if your client has been discriminated?

The client has one year from the date of the alleged act to file his/her complaint.

HUD provides a form to fill out: The Housing Discrimination Information Form, or the client may call his/her local HUD office.

Complaints will be investigated by the Office of Fair Housing and Equal Opportunity (FHEO).

Evidence-Home Modification

Current Studies V Pardessus (2002)

Benefits of home visits for falls and autonomy in elderly: a randomized trial study

After recommendations are made, client compliance varies. It is important to stress home modifications can prevent falls.

BR Connell (1997) Environmental and Behavioral Circumstances Associated With Falls at

Home Among Healthy Elderly Individuals Successful elimination of environmental and behavioral risk factors

are likely to be closely related to an individual's perception that an environmental or environmental use problem is correctable, motivation to undertake changes in the environment, and a desire to integrate changes into daily activities

Robert Cummings (1999/2001) Home visits by OT for assessment and modification of environmental

hazards: a randomized trial of falls prevention. Adherence to OT’s recommendations for home modifications for falls

prevention. Randomized trials have shown home visits and modifications by

occupational therapists can help prevent falls among the elderly who have previously fallen.

Continued Catherine Lysack (2003)

Occupational Therapist Home Evaluations: Inequalities, But Doing the Best We Can?

OT home recommendations for equipment or modifications were unfairly influenced by patient health insurance. Health policies deeply effect clinical decision making. It is important to address OT’s ethical obligations in the management of health care.

Susan Stark (2004) Removing environmental barriers in the homes of older adults

with disabilities improves occupational performance “The removal of environmental barriers from the homes of

older adults who have functional limitations can significantly improve their occupational performance and their satisfaction with their ability to perform everyday activities.”

H.V. Sorensen (2003) Stroke rehabilitation: assistive technology devices and

environmental modifications following primary rehabilitation in hospital - a therapeutic perspective

Home visits by therapists are needed in order to discover stroke survivors' changing needs for AT devices and environmental modifications

Continued MA Corcoran and LN Gitlin

(2001) Dementia management: an

occupational therapy home-based intervention for caregivers

“This paper describes an occupational therapy intervention designed for family caregivers of persons with dementia. The intervention, based on a framework of a competence-environmental press model and the principle of collaboration, was implemented during 5 home visits.”

Home Environmental Modifications for Individuals with Alzheimer's Disease

“Participants will be introduced to the concept of excess disability in dementia as one focus for environmental modifications and caregiver teaching. In addition, methods for establishing a collaborative relationship with caregivers as the basis for deriving relevant and effective environmental solutions will be presented.”

Need for Further Research

Further research is recommended! Limited information about specific

assessments. Funding is a key component of both research

and modifications within the homes. Information is limited to select populations

and disabilities. Majority- fall prevention and elderly individuals i.e. Pediatric population, patients with spinal cord

injuries, etc. Specific modifications are not addressed.

i.e. “How to…” Such as, grab bar placement- vertical vs. horizontal

Funding for Home Modifications

Depends on who is doing the modification Do it yourself, or have a friend or family member help Hire a contractor Contact a home modification and repair program

Depends on location Contact the local Center for Independent Living or

local area agency on aging National Council on Independent Living Center (703)

525-3406 (V) or (703) 524-3407 (TDD) State and local government programs Local organizations and charities

Federal and State Programs

Medicare- contact local Social Security office to see if needed equipment is covered

Medicaid- depending on state, may cover modifications under Medicaid Home and Community-Based Services Waiver, contact the county welfare office for Medicaid eligibility

VA- for disabled veterans and their spouses, contact VA to see if funding is available for certain home modifications (Dept. of Veterans Affairs- 800-827-1000, or call a local office)

Federal and State Programs

Vocational Rehabilitation- when the home modification are “needed for being on the job”

Technology Related Assistance to Individuals with Disabilities Act of 1988- programs differ by state, contact local independent living center for information

Housing Agency- contact public housing authority to see if there is low income assistance for housing modifications

The Accessible Customized Environments Program (ACE)- locates, purchases, rehabilitates or modifies homes that have been pre-sold to qualified families with a member who has a physical disability. Contact at Extended Home Services at (847) 215-9490.

Foundations Check for local foundations St. Louis Examples:

Paraquad of St. Louis Programs that fund home or apartment

modifications for people with disabilities to prevent homelessness

Funded through the Missouri Housing Development Commission and The St. Louis City Affordable Housing Trust Fund

Muscular Dystrophy Association, offers some grants for modifications

United Cerebral Palsy Association provides information on funding for equipping homes with technical support through the Assistive Technology Funding and Systems Changes Project

Charities and Organizations Differs depending on location, check for local charities

and organizations Example of how they can help

community projects to repair projects for elderly persons or persons with disabilities done by neighborhood association or community groups, churches, synagogues, Agency on Aging, senior centers, building trade unions, Boy or Girl Scouts of America, sororities, fraternities, YMCA, or 4H Clubs.

Christmas in April, a volunteer project around the country. Volunteers organize painting parties or make repairs for low income, elderly, and disabled homeowners.

Some local contractors will provide labor for free if you purchase the supplies

Some stores will donate supplies

Private Sources Savings Loans, home mortgages, life estates, etc

Contact local FannieMae office for programs Banks offer Home Modification Loans for

Homeowners under Access Loans in CA, IL, TX, NM Access Home Modification Program- provides

mortgage loans (up to $10,000) to assist persons with disabilities to make accessibility modifications.

The Guaranteed Rural Housing Loan Program and The Direct Rural Housing Loan Program provide assistance to households with low or moderate incomes to buy, build, improve, repair or rehabilitate rural homes.

Private Sources Medical tax deductions

Internal Revenue Service (IRS): deductions are allowed for certain modifications such as installation of ramps, widening doorways, modifying kitchen cabinets and equipment, moving or modifying electrical outlets and fixtures, fire alarms, and smoke detectors.

If a work-related injury, then as an Impairment Related Work Expense on taxes, also possible under Workman’s Compensation

Private insurance (not common) With a doctors prescription

If you are going to rent or buy a place, negotiate with the builder or seller to have the needed modifications specified in the lease or purchase agreement.

Home Occupation-Environment Assessment

(HOEA)

Purpose

Assess home environment Can be used in adolescence through

adulthood Checklist for activities based on

observation Includes area for personal and

environmental strengths and weaknesses and plan for action

Addresses: PEO factors

Subscales

Accessibility within the home Sanitation Food Safety Observable Behaviors Other (leaves space for additional

difficulties that were observed)

PEO

P Factors: Does ct feel safe in

home Does ct want to

stay in home Feelings on AT

E Factors: Type of Home Who lives with ct, Caregiver,

O Factors: Activities done on

a daily and weekly basis

ADL and IADL difficulties

Home Observation Measurement of the Environment

(HOME)

Purpose

Screening tool Assess the stimulation potential of

the home environment of young children

Early Childhood Form (Infant form is available but does not include the physical environment)

Subscales

Learning Materials Language stimulation Physical environment Responsibility Academic stimulation Modeling Variety Acceptance

Limitations

Does not assess specific physical barriers to the child’s independent living within the home

Does not address specific areas of concerns from the child or caregiver

Is focused more on an intellectually stimulating environment than an accessible one

In-Home Assessment

(Stark and Ellert, 2002)

Occupational Profile

Interview outlined in assessment protocol Information to acquire:

Demographic Information Home Description Current service utilization Medical History Current Accommodations Fall History

Record pertinent comments made by participant

“P”-Screening Vision:

Use of visual aide Near Visual Acuity Functional Vision

Hearing: Use of aide Audition Screening

Ambulation: Observe timed

ambulation of 30ft

Functional UE Performance ROM Strength Grip

Sensation Interview, screen if

applicable Balance

Sitting and Standing Functional Observation

Depression Interview

“P”-Short Blessed Memory Test

Orientation Year, Month, Time of Day

Short Term Memory Phrase Repetition

Concentration and Sequencing Counting backward 20 to 1 Months of the year in reverse order

“O”- Activity Card Sort (ACS)

Pictures of common activities done in and around the home (adapted from ACS)

Sort into Four Categories: Do not do/Don’t want to do Do now with no problem Do now with difficulty Do not do but wish to do

Discuss reason for difficulty: C = client competency E = environmental barrier AT = need for equipment

Record on In-Home Activity Checklist

“O”-Canadian Occupational Performance Measure (COPM)

Identify 5 current occupational performance problems from ACS

Participant rates ability to perform activities

Participant rates satisfaction with performance of these activities

Record initial answer in “Pre” column

“E”-Environmental Barrier Inventory/E-FIM

Address 5 occupational performance problems identified in COPM

Conduct walk-through evaluation of home while participant indicates barriers to performance

Record description of barrier and location in the home (measurements, photographs)

Observe performance of 5 identified activities, record E-FIM score (“pre” column)

Contact, Household, and Child Information- CHAMP

Contact: General information (address and phone numbers) regarding the client, a contact person, health care professionals, and CHAMP evaluator

Household: Name, age, disability info., relationship, gender, and bedroom info. of all family members at home

Child: General information about the child as well as a current medical history, medical equipment, mobility aids, AT, vehicle info., and functional movement ability information

Recognizing Problems in the Home and Family Goals

Problems in the home: Parent/ guardian is asked about the child’s ability to function independently. The parent chooses whether the task is a problem (child cannot complete it), help (if the child needs help completing the task, not now (if the child should not be doing the task at this time), or not later (if the child should not do it in 5 years). This section explores areas within the home, socializing, and care giving.

Family Goals: Parent/ guardian reports their concerns and ideas for change about a specific activity area; the test provides specific activity areas, thus leaving little room for flexibility in activity options

Used for measurements to modify the home

6.1 Getting in & out of the house

6.2 Going up & down interior stairs

6.3 Moving around the house

6.4 Using the bathroom

CH5 Using the bedroom

CH6 Socialization, Play, & Activity areas

CH7 Using the kitchen

CH8 Other Child activity spaces

CG1 Vehicle Parking

CG2 Caregiving space

CG3 Caregiver private spaces

6.0 Description of the Home

Recommendations

The last section of the CHAMP allows the health care professional to provide recommendations for home modifications within the goal areas

Also additional comments and other health care services provided are written here

Jeopardy

Cook Top

• $800

Step Flow Water System

•$195.00

Ovens •$550

•$375Cabinets

Kitchen Incorporation

Incorporation

• $2,900Aquatic Access

•$18.50

Door Hinge

$1,200

Smart HouseRaised Fire Place

                                                                                                                                  

GrabbarsOnline.com

www.airdelights.com

TV Remotes

Voice Activated

Adjustable Beds

www.adjustablebeds.com

http://www.dynamic-living.com

Ms. P

Stephanie Hayes, Paige Hays, and Kristen Thompson

P factors

• 43 y/o, African American, single female• Outgoing, lively, intelligent woman• Previous medical history

– Cerebral palsy• Recently had heel cord lengthening surgery

– Visual impairments • Progressive and varies day to day

– Previous wheelchair user for 10 years • Does not climb stairs independently• Does not currently drive• Short stature• Current AT: Quad cane and AFO braces, occasional

wheelchair use

E factors

• Lives in an older two-story house with a basement– All entrances require stairs to enter house– Basement is where she does her laundry– Currently, she is renting the house (supportive

landlord) but is only a few payments away from owning it

– Has existing modifications in the bathroom and bedroom

– Clean, but slightly cluttered• Receives assistance from children, neighbors,

church members, and supportive services from Willow’s Way

O factors

• Mother of two children and a cat– 15y/o daughter and 20y/o son

• Home maker• Previously employed in social services, but is

not currently looking for work (income from SSI-SSD)

• Active church member• Volunteer with Salvation Army• Active social life• Participates in many programs, such as exercise

programs

Goals in COPM

• To increase safety and independence in the following:– Climbing and descending stairs– Exiting and entering doorways– Doing laundry downstairs– Getting the mail– Taking out the trash– Reaching high or low items

Existing Accessible Features

• Bathroom– Raised toilet seat– Shower bench– Hand held shower– Portable grab bar– Rocker light switch

Existing Accessible Features

• Bedroom– Raised bed

• Dots on thermostat and washer and dryer

• Chair in kitchen to sit on or use as a stool

A view of the front entrance and lawn to Mrs. P’s house

Barrier: Entrances with Stairs

• Main entrance for the home.

• Front entrance has uneven sidewalks and steps up a steep incline.

• Weather creates dangerous situations with slick surfaces and railings.

Barrier: Entrances with Stairs

• Requires many steps to enter and path to back door is grass and gravel up an incline.

• Steps are wooden and unstable.

Back entrance to Mrs. P’s house*Possible place for ramp

Solution: Accessible Home Entrance

• Build a ramp to her back door– Requires hiring a contractor and buying supplies and

labor: Cost: $7,000-8,000

– Considerations: • Lowest slope possible• Largest flat landing

possible at turns, doorways, and resting points

• Handrail specifications• Made out of treated

wood, with non-slip surfacing

Solution: Increase Safety in Existing Entrances

• Add non-slip surfaces to railing– Paint the railing with paint

mixed with sand• Add non-slip surfaces to

stairs– Non-slip safety tread (from

Home Depot, $9.99 for 60ft of 1 inch wide tape)

– Paint or aerosol spray non-slip coating (paint additive from Home Depot, $2.99 for 1 quart)

• Add a second railing on front steps– Contractor (4 hours at $50-

75/hr) and supplies ($100)• Repair or replace current

cement steps and walkway

http://www.homedepot.com/prel80/HDUS/EN_US/diy_main/pg_diy.jsp?CNTTYPE=PROD_META&CNTKEY=misc%2fsearchResults.jsp&BV_SessionID=@@@@0592889749.1113351761@@@@&BV_EngineID=ccecaddegfmjghkcgelceffdfgidgjj.0&MID=9876

http://www.reedbrothers.com/22nd_Stair_Rail.htm

Barrier: Low and Deep Cabinets • Low cabinets in kitchen too deep

– Need to bend down and reach

Solutions: Alternative Cabinets

• Solution 1: Sliding shelves– Do not have to reach into

cabinet– Cost $29.95– Custom made, various widths

• Solution 2: Lazy Susan– Pulls out as you open the door– Can put multiple shelves in one

cabinet– Multiple shapes for different

cabinet sizes– Cost $37.14 to $147.42

http://shelvesthatslide.com/lazy_susan.htm

http://shelvesthatslide.com/sliding_shelves.htm

Barrier: Height of Storage

• Storage in the kitchen is often too high for her to reach.

Solution: Storage Shelves

http://www.walmart.com/catalog/product.gsp?product_id=1757088

• Inexpensive additional storage shelves (Walmart, $20.00)

Barrier: Height of Mailbox

• Tall mailbox– Mailbox is 67 inches off the ground– Mounted into the brick siding of the house

Solutions: Change Mailbox

• Solution 1: Add mail slot in door– Do not need to go outside to get mail– Beneficial for people of all heights– Approximant price: $25 plus labor to install

• Solution 2: Remount Mailbox in brick wall– Need very specific tools so best to hire a

handyman– Some handymen give SSI/SSD Discounts– Contractor/ handyman (1-2 hours at $50-75/hr)

http://sweets.construction.com/index/profile.htm?ad_commun=0&id=2473&pid=30412

http://www.hgtv.com/hgtv/cda/article_print/0,1983,HGTV_3659_1427190_ARTICLE-DETAIL-PRINT,00.html

Barrier: Cord in Doorway

• Loose cord running across front doorway– Could trip and fall– Safety concern

Solutions: Secure Cord

• Solution 1: Tape down cord– An economical way to secure

cord– Price: $4.89 for a 60 yard roll

• Solution 2: Put cord cover over the top– A more permanent way to hold

cord in place– Price: $11.27 for a 60 inch cover

http://www.homedepot.com/prel80/HDUS/EN_US/diy_main/pg_diy.jsp?CNTTYPE=PROD_META&CNTKEY=misc%2fsearchResults.jsp&BV_SessionID=@@@@0059872792.1113354576@@@@&BV_EngineID=cccladdegfmjffdcgelceffdfgidgmj.0&MID=9876

http://www.lowes.com/lkn?action=productDetail&productId=219679-35681-CD1200-5GR&lpage=none

Barrier: Unsafe Stairwell to Basement

• Basement stairway– Steep– Only one side of stairs has railing– Dim lighting– Mrs. P feels unsafe going up and

down the stairs

Solution: Add a Second Handrail

• Stairway– Install railing to

other side of stairs to provide safety.

– Round railing with good grips

– Contractor (2 hrs at $50-75/hr) and supplies $75)

http://prestigestairs.com

Solution: Add Lighting

• Install Lighting– Utility Light– Automatic mode illuminates

with door movement– Manual mode with a pull cord– $14.99 – Self-installation wall mount

• Alternative is to hire an electrician to install more lighting

http://www.securityworld.com/lighting/entryutilitylight.html

Funding Options

• Insurance will not cover home modifications• Landlord has interest in helping, but is not

required to finance modifications• Requested funding through Great Things, a local

church, with help of landlord• Possible funding sources include the following:

– Organizations she is part of, such as Paraquad, her church, United Cerebral Palsy Foundation, and Adaptability

– Landlord– Other local charities or foundations– Self-pay