When I came home from the hospital after becoming paralyzed one of the first things my parents and I had to take care of was modifying their house to make it accessible. My family added a portable ramp so I could get over the one small step at the back door. Luckily our house was a ranch style with all rooms on one level. My parents removed many of the area rugs to make rolling around the house easier. We did have to widen the doors in the bathroom, and the configuration of the room was narrow and difficult for me to turn my wheelchair to face the front of the bathtub. My parents were able to add on to their house and make an accessible entrance, large bedroom and a large fully accessible bathroom. Not everyone can move or add a new accessible section to their house. Over the years, I have worked as a medical social worker and discharge planner helping people make arrangements to discharge home after a catastrophic illness or accident. I have given people suggestions on getting their houses ready to get their newly disabled family member home. There are several things you can do to modify your existing home to be more wheelchair friendly if you don’t have time for big renovations before you are discharged home. I have included suggestions for both renovations and temporary changes that can make your home more accessible.



Accessible Entrance
One of the first things that needs to be done is to create an accessible entrance from the outside of the house. If you have several steps to enter the house you will need to add an electric wheelchair lift. These wheelchair lifts for the exterior of your home can cost anywhere from $3000 to $5000, and that does not include the modifications that would be required for the porch. If you only have a few steps to slope you can add a ramp. You can find a variety of ramps and with many configurations, and can look for a portable ramp when you are first discharging home. There are companies that will allow you to rent a ramp until you can have a permanent ramp added. ADA ramp specifications require a 1:12 ratio which equals 4.8 degrees of slope. If you need specific instructions to build a ramp click here.

Doorways
Doorways are also critical for getting around a house in a wheelchair. ADA says the minimum width for a doorway is 32 inches and a maximum of 48 inches. The doors should be lightweight and easy to open. The hardware on a door in a public space should not require more than five pounds of force to open it. If you only need a little bit of space to get the wheelchair through the doorway try installing an offset hinge or a “Z” hinge. A “Z” hinge enables the door to swing clear of the doorway and can add about an inch of clearance with minimal cost or effort. You can also remove the door itself and the molding to make more space for the wheelchair to pass through the doorways.

Doors require a certain amount of space around them to allow individuals using wheelchairs to approach the door and reach the door knob. It can also be difficult in a small space to open the door while remaining outside of the swing of the door. The space requirement varies depending on the direction of the approach. Click here to find the space requirement. These are the ADA requirements, but can be used as a helpful guide when making modification to your home.

• Hardware on the door must not require more than 5 pounds of force to operate.
• Door handle must be operable with one hand and without tight grasp, pinching or twisting of the wrist. Lever handles and a few others comply with this requirement, while traditional door knobs don’t.
• Threshold can’t be higher than half an inch at accessible entrances according to ADA guidelines

Bathrooms
There needs to be at least one full bathroom on the ground level. There are several things you can do to make an existing bathroom more wheelchair accessible - depending on the amount of space you have. One thing I have noticed in smaller bathrooms is that if the door swings in towards the room it sometimes blocks the bathtub or the sink. A door that swings in can make it impossible to get the wheelchair all the way in the bathroom and clear the wheelchair to close the door. Sometimes it’s possible to move the hinge and have the door open out, enabling a wheelchair user to get in and close the door.

• Grab bars will need to be installed on the sidewall closest to the toilet, in the shower and in the tub. The wall will need to be reinforced because it should be able to hold at least 250 lbs. A large plate will need to be installed behind the sheetrock for proper reinforcement.
• Taller toilets are easier to transfer to, so the ADA requires toilet height to be 17 to 19 inches above the floor.
• Sinks should be 34 inches off of the ground with clearance for your knees according to the ADA.
• ADA requires 60 inches of diameter of clear floor space in a bathroom to accommodate the turning radius of most wheelchairs.
• Removing cabinets under a sink can make it easier for a wheelchair user to access the sink. Make sure the water pipes under the sink are well insulated to prevent burns.
• Light switches and outlets should be within easy reach.
• Make sure you have extra storage space for medical supplies. I have several drawers near the toilet to keep catheters.
• Install slap handles or motion sensors for the sink. This is helpful for people with limited hand dexterity.

Roll-in-Showers
There are very specific ADA guidelines for roll-in-showers in hotels. I really like the guidelines, and I plan to use them for my roll-in-shower at home. I like that they require the bench to be attached to the wall with supports built into the wall or a tile bench. Built in benches are much safer than portable benches because they don’t slide when you are trying to transfer. Recently, I was in a hotel using a portable bench that collapsed under me, which caused some bruising on my hip. Check the bench thoroughly before transferring to it. Put a non-slip mat under the bench and the wheelchair to keep them from sliding during the transfer. One way to make a roll-in-shower in an existing home is to remove one of the bathtubs and have a roll-in-shower installed. Here are a few of the important requirements that can be used in a home or commercial roll-in-shower.

• Must be 60 inches X 30 inches from the center points to opposing walls.
• The handheld shower spray unit and water controls must be adjacent to the bench, as well as a grab bar.
• 60” minimum opening from the top to the bottom.
• ANSI (American National Standards Institute) requires a seat to be provided, optional for the ADA
• Folding seat should be placed on the side wall no more than three inches from the front entry
• It’s important to have a small shelf within reach of the bench for soap and shampoo. It is not a requirement, but it should be.

Kitchen
The kitchen is often the heart of the home and the center for activity. Meal preparation and eating are part of key activities of daily living. However, kitchen renovations can be expensive. Some of these suggestions could be costly, others are minor adjustments.

• Remove cabinet door under the kitchen sink so a wheelchair user can face forward and have easier access to the sink.
• It helps to have a variety of counter heights, so the kitchen is functional for wheelchair users and able-bodied people.
• If you can’t change the counter height use a cushioned lap desk as a preparation surface. You can put a cutting board on top of that for chopping.
• Place frequently used dishes and glasses in the lower cabinets.
• If you have money for a larger renovation consider the adjustable height systems that electronically lower and raise the entire cabinet.
• Get a side-by-side refrigerator/freezer that allows easier access for someone in the seated position.
• Find a stove with controls on the front. They are easy to reach and you are less likely to burn yourself.
• If you can’t reach your microwave, get a countertop unit and place it close to the edge of the counter for easy access.
• Counter top air fryers are an inexpensive addition to a kitchen that’s easy for many wheelchair users to access.

Getting Upstairs
Getting upstairs might be necessary in a house where the main room of the house is on the second story. The less expensive option is to have a stair lift installed. I have one in my house where there is a game room and guest bedroom and bathroom. I don’t need to get upstairs often, but when I do I transfer from my wheelchair to the stair lift and get to the top of the stairs. I keep my old wheelchair at the top of the steps and then transfer into it. If you don’t have an extra wheelchair you will need someone to carry your wheelchair upstairs. Another downside to the stair lift is that it takes up space in the stairwell leaving less space for able-bodied people to access the stairs.

Another option is a home elevator, which offers several benefits over other means of changing floors. You can stay in your wheelchair, which is much easier. You can put an elevator inside of a closet, which is out of the way and more aesthetically pleasing. A home elevator can add value to a home, while a stair lift doesn’t. However, a stair lift is easy to remove for resale of a home. It all depends on your budget and the amount of assistance you need with transfers. One other factor to consider is how long you plan to stay in the home. 

Temporary Solutions for Accessibility
If you can’t modify your home to get upstairs I have provided a few suggestions for making accessible accommodations downstairs. Here are some of the creative solutions I have learned about that can help you be comfortable downstairs, at least temporarily.

• Create a bedroom on the downstairs level by using a Day Bed that can be a sofa by day and a bed by night.
• Get a mini refrigerator, microwave or portable oven and put them in a place you can access if you can’t get into the kitchen.

If you are unable to have bathroom renovations or an addition done immediately here are some tips.

• Use a bedpan or a bedside commode.
• A sponge bath can be done near any sink.
• Your local fitness center may have an accessible shower you can use if you buy a membership.
• Use a portable shower system to shower in rooms other than a bathroom, like a laundry room.

Making your home wheelchair accessible or at least wheelchair friendly can be an expensive endeavor. There are many changes that can be made that are fairly easy. The beginning is making one exterior entrance accessible and one bathroom needs to be wheelchair accessible. There are some minor adjustments that can be made in the kitchen to make preparing food possible. Many people make a bedroom downstairs if getting upstairs is not possible. There are many solutions that can work temporarily while you decide if you need to move and add on to your existing home. Hopefully you can use some of these solutions if you are about to discharge home with a newly acquired mobility impairment. If you would like to review the 2010 ADA Standards for accessible design click here. If you are considering a full renovation the ADA guidelines can be very helpful.