Making Changes to Structures to Accommodate Limitations

Over time, medical conditions cause physical changes that result in new limits. Since the limitations interfer with how tasks are performed, accommodations help adapat a process or procedure so that the person with the disability can successfully perform the task.  The same holds true with making changes around the house. Changes to buildings and rooms may be necessary to adjust the surface spaces, height, width, etc. so that equipment can be used or gain entrance into an area.

 Home Owner Responsibile for Cost of Making Accommodation   

 For the most part, private property or non-federally owned businesses require the person receiving the accommodation to pay the cost.  They may also require them to pay the cost to get the place back to its original state if the person later moves.  Two federa 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 structure of the building to accommodate your disability depending on the State and that State’s laws.. 

Public Accommodations Required

     Though the law may not require changes to the rental unit, you may be able to ask for accommodations in the parking area or accessible 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. The building’s age plays a factor in the application however, because older buildings  are exempt from compliance under Section 504 if built after 1991.  

Accommodating a FAmily Member Moving Into Your Home

Where Is Dad Going to Move?  

      Living arrangements present a challenge for many families. As the need arises for someone to monitor care for Mom or Dad, siblings debate who should be responsible for looking after their parents as they get older. Is it the one who lives closest? The one who has already retired? Or the one with the medical background and the nurturing personality? As the children debate where the parents should live, Mom and Dad, stubbornly dig their heels and refuse to consider moving. Just as teenagers can’t wait to leave home for freedom, grandpa and grandma want to stay in their own homes during their golden years after achieving that same freedom decades before retirement.  So, what is the solution to “where do the Grandparents go?”

Dad may feel depressed about having to give up his home to come live with a child

     Moving Mom and Dad into a Room in Your Home

      You may decide to move Mom and Dad into your home. Consider their current and long term needs as you plan any remodeling or home repair projects. Think about how well they are 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 one can’t get out of bed, they need to have their head elevated to eat. A bed that allows the head to raise and lower would be helpful and a knee elevation to keep him/her from sliding down.
  • If he/she becomes immobile, are the doors to the room they use wide enough for a wheelchair?
  • Can the bathroom accommodate a wheelchair for a transfer to the toilet?
  • Can a shower chair fit into the shower?

Walk-in; roll-in shower with handrails

  • Do we need a ramp to get into the house? Front door? Anywhere else?
  • What type of privacy concerns do you need to address?
  • Do you need to install more cable or satellite viewing options? What about 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 if there is a 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.

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?

public toilet facility adapted for the disabled. Mandatory regulations for people with motor handicapped

  • 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 so that he can 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? Type of tracking device for them to wear?

rescue alert system

  • Do you need alarm systems for the home or GPS tracking device in case he wanders away?
  • What safety devices do you need in the home?

Accommodations Needed to Gain Access to Public Areas

Accommodations Needed to Gain Access


   If you use a mobility device, you may have difficulty gaining access to facilities due to doorway obstructions, stairways, and unpaved access routes with or without slopes or obstacles. Depending on the device you use, obstructions can prevent you from gaining access to facilities.


     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, it’s always good to call ahead and ask, “How do you access the facility?”


Access Issues Vary Depending on Device


     My husband currently uses a powerchair. In the past, he has used a cane, rollator, and manual wheelchair. Each produced a different challenge. With the cane, we found a need for handrails and rest areas if walking any great distance.  Also, obstacles that were in the way posed a significant challenge to get around and keep his balance. The rollator and manual wheelchair both faced challenges with areas needing 2-3-inch ramps for smooth transitions between levels. Narrow doorways, especially for bathrooms and limited space to maneuver, also created difficulties if not impossibilities. While items placed out of reach were frustrating, we could at least request assistance to obtain those things. However, structural barriers made using the facility an impossibility.   

“Handicap Accessible” Means Handrails Available


     Travelers need to know that the only requirement for calling a room “handicap accessible” is that it has handrails in the restrooms. While handrails help, they provide limited usefulness for someone in a wheelchair who needs assistance with the transfer. Therefore, if you are attempting to book a reservation somewhere and need a specific accommodation, ask to speak to a manager. Ask specific questions about what you need and what can be available. Request your accommodations in writing and confirm them in writing so that you can take the confirmation with you. Check the status before you leave to start your trip to confirm that nothing has changed, and the equipment remains available. Unfortunately, communication between shifts regarding accommodation requests is not the best. Do not be surprised if nothing is as you have requested when you arrive.


Challenges of Public Access

     When attempting to use public facilities, we encounter the following challenges.

  • Aisles between tables in restaurants are narrow. 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, they push his arm and interfere 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 could not enter or leave without assistance. Once inside, he had no way as a person with quadriplegia to transfer to the toilet seat because I could not accompany him into a male restroom. Most public areas have gender-specific bathrooms that do not allow both sexes to enter.  I must accompany Lynn to the toilet to perform a catheterization for him. He either must go with me into the women’s bathroom or go into the men’s restroom while someone blocks the door for us. The alternative requires us to go to our vehicle and cath there.
  • Storm drains usually empty below the 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 handicap entrance.” You arrive at the front of the building, and there’s a sign with a picture that reads “handicap 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 is not all-inclusive of the many challenges encountered. Still, it gives you an idea of the difficulties you may face if you attempt to take someone out in public who cannot function independently. 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 frustrations of access issues.

Installing a Ramp Needed as an Accommodation

You might be able to avoid going out in public, but you must be able to access your home. Once you start using a mobility device to assist you in moving around, you may find that you need an 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 extra weight of the chair so that it would 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 American 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. Example: a 30-inch rise requires a 30-foot ramp.
    • At the end of each 30-feet of the ramp, you must install a 5-foot x 5-foot platform for a rest area or turn-around space.
    • The width of the ramp must be 36-inches, and the ramp must have handrails that are 34-38 inches in height.

31cMgHiVi8L._AC_telescoping access ramp

Rotating Living Spaces As an Accommodation

Rotating Between Homes

     For some families, the perfect solution is to have Dad visit between all the children. By rotating houses, Dad 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 Dad 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 Dad getting lost or hurt as he moves around at night in unfamiliar spaces.  Alternating homes also require a lot of moving “things” from place to place each time Dad moves, too, unless duplicate belongings exist in each location.

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