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Wheelchairs often encounter obstacles limiting the passenger's accessibility to areas beyond that barrier.

Accessibility

Stairways with no elevator limit accessibility to upper levels of the building.
Unable to access next landing due to wheelchair and no elevator.

Gaining Accessibility to Public Areas

Accommodations Needed to Gain Access

   People who use mobility devices find public area accessibility challenging even though there are many “disability” accessible signs posted around.  If you use a mobility device,  doorways, stairways, and unpaved access routes (with or without slopes or obstacles) may obstruct your access into buildings and other structures. In addition, external obstructions like trash bins may bar entranceways or prevent access to areas above ground level. With newer construction codes, that is no longer the case. 

     Public facilities built after March 13, 1991, must provide accommodations under the Americans with Disabilities Act, Section 504, and Fair Housing Act.  If you are not sure how to access an area, it’s always good to call ahead and ask. It’s surprising how often the people who work in the building responsible for assisting customers do not know the answer to that question and must call you back.

Accessibility Issues Vary Depending on Device

     My husband currently uses a powerchair. In the past, he has used a cane, rollator, and manual wheelchair. Each device came with a different set of challenges.

     With the cane, we found a need for handrails and rest areas if walking any great distance.  Obstacles that were in the way posed a significant challenge to maneuver about and keep his balance.

    The rollator and manual wheelchair both provided challenges related to entryways. Many doorways had elevated entryways or steps requiring the use of a 2-3-inch ramp to have a smooth transition between levels. Narrow doorways, especially bathrooms, had limited space to maneuver, complicating the use of a joystick that usually sets slightly apart from the chair and making it difficult for all “parts” to come through together. Often his elbows develop battle scars in the process. 

While items placed out of reach are frustrating, requesting assistance from a store assistant is usually an option that allows us to overcome the barrier. I wish it were as easy to find a way to fix the structural barriers that make using a facility nearly impossible.   

A portable ramp is a useful accessibility resources to carry in the car just in case you arrive somewhere and the curb is too high to go over.
A portable ramp is a useful accessibility resources to carry in the car just in case you arrive somewhere and the curb is too high to go over.
“Disability Accessible” Means Handrails Available

     Caregiver travelers beware: If a hotel advertises that a room is disability accessible, they probably mean that it has handrails in the bathroom. Now, handrails are very useful, but they are limited in much help they provide someone who needs assistance with transferring from a wheelchair to a toilet.  Therefore, if you attempt to book a reservation somewhere and need a specific accommodation, ask to speak to a person rather than completing an automated reservation. Once you book the accommodation, follow up directly with the hotel to confirm they receive your specific request.  Confirm your arrangements in writing with the specific hotel talking to guest services. Get a name! If something is wrong with the arrangement upon arrival, you want to know who knows the details and help resolve the issue. Communication among staff in reservations for large hotel chains is not always stellar. I also recommend that you check the status of your arrangement a day or two before you leave to leave for your trip to confirm that nothing has changed and the equipment arrangements remain available. Be prepared to start over in making your arrangements happen – that’s where the letter confirming the prior agreement comes in handy.

The Accessibility of Public Areas Can be Challenging

Challenges of Public Access

     In our personal experience with using public facilities, the following challenges made our enjoyment of time out less than we hoped.

  • Restaurant aisles between tables are narrow. Booths may have a step up for seating. Seating “levels” to access salad bars or other self-service arrangements do not have ramps and are not low enough for access by wheelchair. 
  • If a wheelchair sits at the end of a table (it can’t be parked in the booth, obviously), patrons cannot easily pass. Each time they attempt to go by, they push my husband’s arm interfering with his eating or drinking.
  • Wheelchairs and powerchairs do not fit well under tables making access to dinnerware and dishes difficult.  
  • Many bathroom doors did not have electronic access devices. Therefore, my husband cannot enter or leave those areas without assistance. Once inside, his quadriplegia prevents him from having a way to get back outside again unless someone else comes in to assist him.   
  • Most public areas have multi-seat restrooms that are gender-specific. Therefore, we cannot use either gender’s bathroom to catheterize him due to the presence of “watching eyes.”  Since I must accompany Lynn to the toilet to perform a catheterization for him, he must go with me, or I go with him into the opposite gender’s bathroom while someone blocks the door for us. The alternative requires us to go to our vehicle and cath there.
  • Crossing the street during the rain is another fun experience. Storm drains usually empty below curb access ramps.   During any rainstorm, the curb access is inaccessible for a power chair. For efficient access to occur, street curbs should be located directly across from one another. If they were, the person could effectively and safely cross the street quickly.  All too often, unfortunately, the access ramps do not line up.
  • Perhaps one of the greatest frustrations is playing, “find the disability entrance.” You arrive at the front of the building, and there’s a sign with a picture that reads “disability entrance.” The arrow points toward the back of the building.

    No handicap accessible entrance way

Disability entrances are frequently tricky to find. Signs notifying the public of their location often do not exist. When found, doorways repeatedly are blocked by garbage trucks or storage devices, preventing easy access. 

      The above list gives you an idea of some of the many challenges those who use wheelchairs to get around every day must face. Most of them are frustrating though usable. I guess that’s my point.  Accommodations are available but be prepared that they are not easy to use. Most companies provide only what is required and not a dollar more. The accommodation is placed in a difficult-to-find location, and most of the time, once installed, it’s rarely upgraded. We decided that take-out orders worked best, and internet shopping was a gift from God. Both provide access to all the resources we need while reducing the risk of infection and the frustration of dealing with accessibility.

Bathroom fixtures adapted for use by someone with mobility limitations help make the room accessible.
Bathroom fixtures adapted for use by someone with mobility limitations help make the room accessible.

Providing Accessibility through Structural changes

Making Changes to Structures to Accommodate Limitations

Over time, medical conditions cause physical changes that result in building accessibility difficulty and other structures. Since the limitations interfere with how tasks are performed and freedom of movement, accommodations help adapt a process or procedure so that the person with the disability can successfully perform the task or travel at-will. 

     The same holds true when facing accessibility challenges if bringing home someone from the hospital who is immobile for the first time.  Changes to buildings and rooms may be necessary resulting in adjustments to surface spaces including their height or width as you attempt to overcome accessibility barriers for new equipment.

 Home Owner Responsible for Cost of   

 For the most part, private property (i.e., rental homes) or non-federally owned businesses (i.e., apartments) require the person receiving the benefit from making a place accessible for them to bear of cost for that privilege.  They may also require them to pay the cost to get the place back to its original state if the person later moves.  Two federal laws, The Americans with Disabilities Act, Section 504 of the Rehabilitation Act of 1973 as amended, and the Fair Housing Act mandate that public or federally funded properties make changes to their buildings that allow people with disabilities to use them. However, the federal law does not apply in the same manner to private, residential properties. Therefore, if you live in an apartment, your landlord may not be required to make permanent changes to the building’s structure to accommodate your disability, depending on the State and that State’s laws. 

Public Accommodations Required

     Though the law may not require a particular change that you need for a disability, you may ask for a particular accommodation to aid in the accessibility of the parking area or public spaces. Therefore, if you need a wheelchair ramp to gain access to the building, your request might fall under the ADA or Section 504 requirements because outside areas are often considered public access. However, the building’s age plays a factor in the application because older buildings are exempt from compliance under Section 504 if built after 1991.  

As a caregiver, it is often hard to know how to handle difficult situations such as depression in a loved one.
In deciding where Grandpa should go, consider whose home better accommodates his accessibility needs.

Where Should Grandpa Go?

What to do about Grandpa?  

      Living arrangements present a challenge for many families. Siblings debate who should be responsible for parents who can no longer live alone. Is it the one who lives closest or the one who is retired? As the children debate where the parents should live, Dad stubbornly digs his heels and refuses to consider moving. Just as teenagers can’t wait to leave home for freedom, grandpa wants to stay in his own home during his golden years. After all, he achieved the right to have that freedom after so many years of being responsible for children and work, right?   So, what is the solution to “where should Grandpa go?” Many times the decision comes down to whose home is more accessible.    

Rotating Living Spaces As an Accommodation

Rotating Between Homes

     For some families, the perfect solution is to have Grandpa visit all the children. By rotating houses, Grandpa has an opportunity to visit with everyone for a while and not overstay his welcome anywhere.  Such a solution works well for someone who likes to travel and doesn’t mind living out of a suitcase. However, for many, it has its drawbacks. If the parent has a house that needs care or pets at home, someone has to tend to those. If Grandpa has confusion or other signs of dementia, changing locations frequently can make disorientation worse.  When wandering is a risk, there is a significant danger of Grandpa getting lost or hurt as he moves around at night in unfamiliar spaces.  Alternating homes also require moving “things” from place to place each time Grandpa moves, too, unless duplicate belongings exist in each location. Each time a move occurs, there is an increased risk something will be lost,  broken, or forgotten.

Making Your Home Accessible

     Moving Grandpa  into Your Home

  Before moving Grandpa into your home, consider his current and long-term care needs as you plan any remodeling or home repair projects. Think about how well he is moving around and how accessible your home is for someone with mobility challenges. Will you need to make structural changes as well as move furniture around in the long run? Would this only work as a temporary fix, or could it be a long-term solution? Consider some of the following as possible accommodation needs:

  • If Grandpa can’t get out of bed, he needs to have his head elevated to eat. A bed that allows the headWalk-in; roll-in shower with handrails to raise and lower would be helpful, and a knee elevation to keep him from sliding down. Alternative:  Stacked pillows or a bed wedge.
  • If he becomes immobile, are the doors to the rooms wide enough for a wheelchair to comfortably move through?
  • Can the bathroom accommodate a wheelchair for a transfer to the toilet?
  • Can a shower chair fit into the shower? Can it also be used as a toilet?
  • Do you need a ramp to get into the house? Front door? Anywhere else inside or outside?
  • What type of privacy concerns do you need to address? 
  • Do you need to install more cable TV or satellite viewing options? What about wireless telephones?
  • Consider emergency egress and 9-11 access. How can a stretcher get to the location you will be using? In an emergency, can you help them exit safely?
  • Are there any special considerations related to temperature regulations, need for refrigeration, water temperature for showers, safety measures for locking doors or windows?
  • Is the height of the bed safe? Will bladder or bowel control be an issue for mattress protection and sanitation?
  • Are carpets or rugs on the floor a risk for falls?
  • Do young children or animals live with you and pose a potential fall hazard either for rapid movement or leaving things lying around?
  • Evaluate access into and out of each room if using any assistive devices or fall risk.
  • Painting doors in different colors is an excellent way to help people with dementia remember how to find their way around the house.
  • Painting a door and surrounding walls the same color helps to camouflage the exit to decrease the risk of dementia family members leaving through external doors.

Ramps Help with Accessibility into Buildings and Rooms

You might be able to avoid going out in public, but you must access your home. Once you start using a mobility device to help you move around, you may find that you need accommodation for accessing your entrance or other parts of your home. There are many types of ramps that can help with that problem. We have both a permanent and a portable ramp in use. If you go to the Mobility pages under Caregiver Marketplace, you’ll see several ramp options to consider. We have used several of them successfully.

6120CSutAlL._AC_UL320_ML3_ EX-access transition entry ramp

 Portable Ramps

     We used a portable ramp for Lynn’s rollator and continued to use it when he began using a manual wheelchair. The portal ramp also worked well with the powerchair, but we decided to buy a sturdier model to accommodate the chair’s extra weight to last longer. If you are considering purchasing a ramp, here are some pointers to consider first.

Tips for Buying a Ramp

Before buying or building a portable ramp, think about why you need one.  If you only need it periodically, a portable may be all you’ll need, but if you use it every day in one location, you might want to go with a permanent model. Once you decide, you’ll need both width and height measurements.

  • Which doors do you need to access?
    • Measure each for the height of the threshold and get a ramp long enough to elevate one foot per inch of elevation.
    • Measure the inside width of the door frame at the narrowest point. Does anything obstruct opening the door to its broadest potential?  If so, consider that limitation in your measurement.
    • Your ramp needs a “lip” on both sides for a smooth entrance and exit of the wheels.
  • The Americans with Disabilities Act requires that public facilities must install a ramp for a 4.8 degrees slope.
    • There must be a foot of ramp for each inch of incline. For example, a 30-inch rise requires a 30-foot ramp.
    • At the end of each 30-feet ramp, you must install a 5-foot x 5-foot platform for a rest area or turn-around space.
    • The ramp’s width must be 36-inches, and the ramp must have handrails that are 34-38 inches in height.

31cMgHiVi8L._AC_telescoping access ramp

Accommodations Due to Immobility or Dementia

If your family member is transferring home from the hospital and is immobile, consider the following concerns.

  • With immobility, you need to consider frequent turning.  In such cases, an abundance of foam wedges and extra pillows for positioning and comfort become necessary. Do we have enough or need to order more?
  • If he’s incontinent (loses control of bowels or bladder), adult diapers and additional sheets may be needed, and incontinence pads.
  • What type of equipment is needed to help with the bed to chair transfers, toileting, showering?
  • If you have a two-story home, will rooms need to be rearranged?
  • How are you going to handle bathroom accommodations?
  • What type of bathing arrangements are needed?
  • Do items need to be moved to a lower shelf to reach them from his wheelchair?  If so, which ones and where do the misplaced items go?
  • Is there a risk of him wandering away? Does he need a GPS alarm button to wear? 
  • Do you need alarm systems for the home or a GPS-type tracking device in case he wanders away?
  • What safety devices do you need in the home?