Hi all, I am looking to see what kind of renovations or modifcations I can do to our home to help my daughter. We thought we had more time before she became immobile but it turns out that it just went fast forward. Her child size wheelchair and walker do not fit into our bathroom. We live in an older home and the doorways are just pretty small. We have a tub in our bathroom and we are wanting to see what we can do to adjust that. We dont have the budget to do a complete overhaul but I would like to attempt to make the adjustments ourselves. Her sense of independence has been taken away recently and we are all trying to adjust but Id like to leave what i can in tact for her to be able to do on her own. Any input or suggestions would be great.

I can give you lots of suggestions but many could be budget-busters. That and the fact the many houses are just not that easy to make accessible says that one option is to look for a different home. Whatever you do now needs to be for not only a child size wheelchair but also a larger one.

The basic process is simple: Exterior ramps to entry points, widen doorways, enlarge bathrooms to have more open space, replace tub and install a roll-in or full open front shower. Doing all this can be relatively simple or almost impossible, depending on your current layout. Many times enlarging a door requires new headers if the wall is load-bearing. Often the doorways in older homes are located so close together that is is not possible to enlarge both - not without other more extensive remodels. Added to that is that narrow hallways may need to be widened just to make a turn - even into a new, wider doorway. This can get into some serious and expensive remodeling.

Exterior ramps or garage entry ramps need to be a maximum slope of 1:12. If your exterior doors open to a downhill slope, it could take hundreds of feet to get to ground while still keeping the correct slope.

So the first step is to take a critical look at the house you are now in and see how feasible it is to make the needed access changes. If parts are going to prove to be almost impossible (ie - really expensive), then now is the time to look around for something else before yo pay for remodeling twice.

My father-in -law was a double leg amputee and had a similar problem for getting in our bathroom when he visited. What we did was, remove the master bath door, and when he had to use the facility, he closed the bedroom door and hung a small sign on it advising us that the bathroom was in use.
This only adressed the one problem ,but that is all you asked,(I think )

We've gone through some similar adaptations over the years as my parents aged, although they weren't on the level of remodeling. Perhaps our experience will offer some guidance and suggestions for you though.

1. Side stepping within the walker envelope to get into the bathroom is one option to provide bathroom access. This is what was recommended by my father's occupational therapist. His house is also older with a very narrow bathroom door.

Install grab bars at points where your daughter might have to turn the walker, and to access the toilet (unless you're using a commode, which is another option). A grab bar could be positioned on the wall next to the toilet, with the lower end at a level she could reach sitting down and the upper level at a comfortable reach for when she's standing.

Nursing homes typically have a long horizontal bar mounted on the wall adajacent to the toilet. They also have a long string connected to a buzzer (connected to some central monitoring area) to use if assistance is required. You could tie a whistle or bell to a string and attach/affix it to the wall or hang it with a long cord from the ceiling. She could use that if she needs assistance.

2. As Nona wrote, removing the door is another option, and one suggested to us by an occupational therapist. A heavy shower curtain could be hung outside the door to provide an element of privacy; someone could pull it back for your daughter before and after using the bathroom.

3. The ideal adaptation for a tub is a walk-in tub, but that is costly.

Regardless, there should be grab bars around the tub. Since she's a child and will be growing taller, there could be both horizonal and vertical grab bars so she has access now and in the future.

Nursing homes have either a diagonally mounted bar or horizontal and vertical bars. The diagonal bars allow someone to grab the bar while in a sitting position, slide her/his hand up the bar and use it to assist transitioning to a standing position.

4. All grab bars should be mounted in studs. I've spoke with handymen who claimed that mounting them with wall anchors is an adequate substitute. According to therapists, this is not an option; studs are the only acceptable site for mounting the grab bars.

5. There are also handles which fit on tubs to provide something to hold onto at a lower physical level than the wall mounted grab bars. Those which
are fastened by tightening nuts on either side of the tub are better than ones with suction cups (in fact I would NEVER use anything mounted with suction cups; they're not safe.) The "Tub Safety Handle" on this page is what we used.

http://www.assistivedevicesinc...om%20accessories.htm

However, this would require reaching down for stability and might not be suitable for her if it compromises her balance.

6. Shower chairs are also mandatory. There are several varieties at this site:

http://www.assistivedeviceskey.com/category/659411

Some fit completely inside a tub, and others extend out beyond the tub. This type is much safer as your daughter could sit down outside the tub, then scoot over inside the tub as someone helps her lift her legs. It takes a while to learn where the best position is for the shower curtain so that water doesn't spray outside on the floor but it can be done.

7. Suction mats inside the tub and outside are mandatory as well. And towels, clothing, everything she'll need after bathing should be at reachable levels and close enough that she doesn't have to turn around to get them.

8. Other than widening the doorways, an option would be to sidestep through the narrow openings. My aunt also had grab bars installed on the walls next to the doors.

9. If you can't afford a ramp and your exterior entrances have stairs, make sure they at least have railings. One occupational therapist recommended reconfiguring the stairs leading from the sidewalk to the porch, to make them deep and wide enough that a walker could comfortably fit on the steps.

10. Grab bars outside entrance doors are also a good idea. If there are internal stairs, even say just a few stairs from an entrance into the living area, mount the bars diagonally and parallel to the angle of the stairs so her hand can slide up as she goes up the stairs. You could also add gripper strips to the stairs for added traction.

11. Clear the rooms of as much as you can that not only could be a trip hazard but that might cause harm if she lost her balance and fell. Take out throw rugs especially. Soft furniture should be along her travel routes; move solid furniture like dressers, etc. out of the way and put them out of the travel route if possible.

12. Move things she needs on a daily basis to a level which is more accessible, i.e., waist level for toiletries, combs, clothing, etc. This could be as simple as rearranging the contents of her dressers. Also make sure her shoes don't have smooth soles.

13. Is your daughter getting physical and/or occupational therapy? There are assistive devices to aid in putting on socks and shoes; occupational therapists have catalogues for these and they are helpful.

14. Some communities have loan closets for assistive devices such as walkers, commodes and shower chairs. You might be able to get these for free, but sometimes there's a waiting list.

15. A social worker told us that the Catholic Church's St. Vincent de Paul will provide funding for different projects. I wasn't aware of that. She said their services are nondenominational. I haven't contacted them, but it's something to check out if there's one in your area.

16. Have you contacted any organizations which focus on the condition your daughter has to find out if they know of any sources for adaptive remodeling? If not, they might have recommendations on sources for funding assistance. The United Way might also have some recommendations. 211 is the UW helpline.

Hope this helps. If you need further detail on any of the suggestions, feel free to ask. And good luck!

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