A professional’s guide to Housing
by Caroline Pomeroy
Finding a property that comes already adapted to your client’s needs can be a challenging, indeed often impossible task. Purpose-built housing can be the answer, but the needs of each client and their family, as well as their lifestyle and personal preferences, are usually too individual to be catered for by “out of the box” homes, constructed to conform to the Lifetime Homes Standards with some generic idea in mind of the needs of disabled people.
But among their strongest selling points is that they are often suitable for further adaptation. This guide is intended to describe some of the areas that a housing OT will be looking at when assisting in locating the right home for a client.
The initial assessment
Prior to making any decision to acquire or alter a property that may well last your client a lifetime, it is essential that their mobility and function are first fully assessed and understood. The role of the OT is clearly paramount in this initial stage, since identifying a client’s current and likely future functional abilities will inform the extent and nature of the adaptations, both from the outset, as well as those that may become necessary in the future. OT assessments can be carried out in the client’s own home, in hospital, in a rehab unit or wherever they happen to be living, and will include analysis of sensory, motor and cognitive abilities. Special consideration will need to be given to whether the client’s condition is stable, degenerating or fluctuating over time.
Not only the client’s needs, but those of their family or other prospective members of a household must also be considered. The broader locality may be important on account of proximity to schools, support networks, other family members, work places and so forth. Transport links and the availability of local shops are likewise significant, and perhaps the public footpaths will also need to be considered – whether they wide enough for scooters, or level enough to negotiate comfortably in a wheelchair or with a wheeled walker.
The following guidelines are considered good practice, but at the same time they should always be informed by the professional judgment of the OT who, having a detailed knowledge of their client’s requirements, will be in the best position to apply any guidelines judiciously in individual circumstances.
Considerations for outside
When looking at the outside, the presence of a garden may well influence any decision as to the suitability of a property. A holistic OT assessment should already have identified your client’s hobbies and interests and whether these depend on, or are enhanced by, a garden at their property. What will it be used for, and by whom? Can it be easily negotiated in a wheelchair? Can it be adapted to provide raised flower beds?
If your client drives or is a regular car passenger, any garage, driveway or carport requires sufficient room in which to get into and out of a car safely, possibly allowing the installation of a rain shelter as they do so. Techniques and equipment to assist getting into and out of a car are a frequent feature of OT assessments, and current and future mobility needs will influence the decision whether to purchase a given property. Many factors may determine whether or not external adaptations are practical, including the shape of the house and the materials used, the camber of the access path, the depth of existing steps and the width of the doorways.
Ramps and external doors
- Ramps should ideally have a gradient no greater than 1:20, although this depends on the type of wheelchair used and the user’s ability to maneuver it. The maximum permitted gradient is 1:12, which is the steepest slope likely to be accessible in the absence of an alternative.
- For long ramps, level areas are needed of at least the same width as the ramp and with a minimum length of 1200mm. The number of level resting places will depend on the length of the ramp, so it is essential that necessary calculations are performed to ensure there is enough space for them.
- The total rise of a ramp should be no more than 500mm, and any ramp flight should be no longer than 10 meters without a level landing.
- For wheelchair users, external door thresholds should be flush or no more than 15 mm high, and beveled.
Considerations for internal access
If your client is unable to negotiate internal steps and stairs then you will need to decide whether or not they could manage with a stair-lift or a through-floor lift. Your client’s cognitive as well as the likely progression of their motor skills will need to considered, as ill-chosen equipment may cause confusion as much as physical difficulty. In some instances a home will have to comprise of a single story throughout.
- For standard wheelchairs to turn through 360 degrees requires an area of 1500mm x 1500mm. Many wheelchairs, especially if modified, may take up more space. If there is an elevated leg rest or reclining back, for example, this will increase the space required.
- For wheelchair users the minimum clear opening for doors is 850mm, although the ideal is 900mm, with 300mm clear between the opening edge and the nearest object (or wall).
- Landings should have a clear width of 900mm for wheelchair users, while stair cases from the entrance stair should have a minimum clear width of 850mm.
- Guidance for wheelchair accessible properties is given in part two of Part M Building Regulations (2015) available from http://www.planningportal.gov.uk.
Considerations for storage
Regarding the internal layout of a prospective property, the OT will keep in mind the client’s need for storage, including for specialised mobility equipment. If they use a scooter or electric wheelchair, they will need to have a secure storage and charging-point for it. Mobility equipment may be bulky and heavy, so the width of doorways and the strength of floors may need to be considered.
- The minimum recommended size for scooter storage is 1700mm wide and 1100 mm deep, with 1200mm clear access, although this space will needs to be much larger if the client has to transfer to another chair. A powered doorway is another possibility, and all recommendations will be subject to the make and model of the wheelchair/scooter.
Considerations for the bathroom
Doorways and floors will also determine whether wet rooms or level-access showers can be safely installed. The bathroom is considered the most important room in the house by many clients, because it is here that the greatest difficulties may present themselves and where an OT’s contribution can make the most difference. Hence it is essential to consider whether rails and other necessary equipment can be accommodated in the space available. Not only floors, but wall integrity and other aspects of its construction will also need to be taken into account when making recommendations for fixed bathroom adaptations.
Considerations for the kitchen
In the kitchen, floor space – and possibly space for knee recess – will be a relevant consideration, especially if your client is going to be preparing their own meals. Activity analysis by the OT will again identify what is important for them, as well as the extent to which the needs of others in the household also need to be borne in mind. Height-adjustable work surfaces and appliances are common adaptations, and their feasibility depends not only the space available, but whether such items as boilers and windows might obstruct suitable provision.
Considerations for control and safety
Consider whether the type of heating in the property is suitable for your client, and where the controls are. Think too about the height of windows, to ensure your client can see through, open and close them, and whether environmental controls could ameliorate any difficulties.
- The solid wall or panel below a window should be no higher than 800mm, but the opening part should also be no higher than 800mm. Safety glass is required below 800 mm and fastening should be easily accessible.
Conclusion
Parking, steps and stairs, internal access and layout, door and room dimensions and so forth are all vital considerations but, ultimately, finding the right property is all about understanding the requirements and wishes of the person that’s going to be living there. OTs are ideally positioned to possess this understanding of their clients, and to ask the right questions to ensure that adaptations are both possible and practical.
Sometimes however the right home may just not be available, in which case the role of the OT will be of enormous value to the client in liaising with an architect to design the ideal new build to meet their needs.
This guide has provided an overview of the sorts of considerations that inform an occupational therapist’s assessment of a client’s housing and equipment needs. If you would like more information, please contact one of our client managers at The OT Practice via telephone (0330 024 9910) or email (enquiries@theotpractice.co.uk).
Useful Resources
- Habinteg Housing Association Ltd. (habinteg.org.uk) have information and design guidance for wheelchair accessible homes. They also developed the Lifetimes Homes Guide, which is very similar to the government’s Category 2 Housing Standards published in March 2015.
- Part M of the Building Regulations Section 2 – Accessible and Adaptable Dwellings is available from planningportal.gov.uk. The regulations have recently been amended and the new regulations have been in force since October 2015. British Standards BS8300: Design of Buildings and their Approaches to Meet the Needs of Disable People Code of Practice can be bought from The British Standards Institute for a cost of £240 from shop.bsigroup.com.
- The Center for Accessible Environments (cae.org.uk) can provide design guidance and answer many questions in relation to adaptations for disabled people. They also publish Access by Design, a quarterly magazine on inclusive design. The annual subscription is currently £21, reduced at the time of writing from the normal price of £28.
Email: info@cae.org.uk
Tel: 020 7822 8232 - The National Register of Access Consultants (nrac.org.uk) is a register of those consultants that meet defined professional standards and criteria.
Email: info@nrac.org.uk
Tel: 020 7822 8282 - The Royal Institute of British Architects (architecture.com) holds a database of 3000 architects, searchable by name, location, area of expertise or services offered.
Email: info@inst.riba.org
Tel: 020 7307 3888 - The Accessible Property Register (accessible-property.org.uk) and Prime Location (primelocation.com) list accessible homes for sale or rent, even if the term is interpreted somewhat loosely in some instances.
