Practice Resources: Home Accessibility Resources
Todd Mayer, LCSW
As a clinical social worker on a spinal cord injury rehabilitation unit, I repeatedly hear the same questions from newly injured patients: Who will provide care for me? What will my income now consist of? How is my home going to meet my accessibility needs? In past articles, I have provided some education on financial and caregiving resources. For this issue I have done some research on home accessibility resources.
I remember as a child helping my grandmother open her heavy garage door. She would comment to me about how garage door openers were for rich people and that you only saw them on television. Times have changed; now every home in America has a garage door opener. They are easy to install and are very affordable. I went into my research for this article believing that things like elevators and stair lifts were only for the wealthy. I learned that these devices are not only affordable, but not very difficult for the experienced contractor to install, particularly during new construction. Parts of my investigation lead me to meet with Casey P. Dyon, Senior Operations Manager for Access Solutions Center and Nationwide Lifts (www.nwlifts.com). Mr. Dyon has been in the business for over six years and has assisted a number of persons with spinal cord injury with home accessibility issues.
Some persons with spinal cord injury require assistance getting in and out of their chair and bed. This process can be very difficult physically for a caregiver. A typical hoyer lift is a large piece of equipment that can be difficult to operate. It also takes up a lot of floor space. An in-ceiling, track lift system is another option. There are basically two types of in-home track lift systems. There is a continuous track system with a metal rail running along the ceiling of every room in the home. The sling seat is connected to the track system, and with the touch of a button, the person can be transported to any spot in the home.
There is also a two-stick portable track system that can transfer the person from a chair to a bed and back and can also move the person around the bedroom as needed. The tracks of both of these devices are installed into the ceiling and operate on electricity. The equipment eases the physical burden on the caregiver, thereby reducing injuries, and removes the need for large pieces of floor equipment in the home. A patient that has hand function can operate either system completely independently. An important aspect of the two-stick portable system is that you can have the tracks installed in any home for a reasonable price. This enables the use of the system in a relative’s home or a vacation retreat. It can be installed in any home, including trailers and modular homes. The cost of a continuous track system, one that runs throughout your entire home, is between $9,000 and $20,000. The cost of a two-stick system that runs in the bedroom alone is about $5,000. If you wanted to install the tracks in a second home the cost is about $1,400. This is only slightly higher than the average price of a hoyer lift at $4,500. For almost the same cost, the ceiling track system saves the caregiver from hard physical work and eliminates a large piece of equipment from your bedroom floor.
There is also a completely portable track system that can be folded up and taken anywhere. It consists of a short piece of track between two standing A-frames. It is long enough to go over any bed, uses a sling, and is very sturdy. It folds up into a carry bag and fits easily into any automobile trunk. I have heard a lot of complaints over the years from consumers that the lower support section of a hoyer lift often does not fit under hotel room beds. This system eliminates that problem since it can be erected over any bed. The system is easily constructed by one person within minutes, is portable, and can go anywhere. The average cost of the completely portable system is about $3,000.
Stair lifts or glides are another in home accessibility piece of equipment. There are basically two types of stair glides, custom curved or straight. Any home with more than one level can have a stair glide. According to Mr. Dyon, the only limitation that would prohibit the use of one in a home is a staircase that is less than 26 inches wide. A custom curved stair glide costs between $9,000 and $20,000. The straight stair glide runs between $2,800 and $3,500. The straight stair glide can be installed and made operational in three hours. I have seen photographs on the Nationwide Lifts website and it is amazing how easily these fit into staircases without blocking them. The carrying capacity is 300 pounds.
Another, grander, option is an elevator. A major requirement, however, is that there must be room in your home for the elevator shaft. But I was surprised at the relatively low cost of installing an elevator, particularly in new construction. A two-stop elevator costs, on average, about $18,500. According to Mr. Dyon, the cost of an oak staircase in new construction is about $20,000, making the cost of an elevator cheaper than a nice staircase. He also said that through his business contacts, he has learned that over 80% of newly constructed homes in Europe include elevators.
A vertical platform lift is a piece of equipment installed outside of the home to allow access into an outside door. The wheelchair is wheeled onto the platform from street level. The platform then raises the person to the porch or entry level or from the entry level back to the street. The average cost of an outdoor vertical platform lift is between $6,000 and $10,000. If the device is located outside of a multiple unit building then it must be a commercial lift. This requires a “commercial package” due to the fact that commercial codes are different than residential codes. Again, photographs and information are available on the Nationwide Lifts website.
Ramps are another, more traditional, option for making an entrance accessible, but the ADA requires that for every inch of rise in the ramp, there must be one foot of length. If a home has an unusually high entry point, the ramp can become very lengthy. For example, if the entrance is four feet (48 inches) above the ground, the ramp must be 48 feet long, an impressive undertaking. It can also be costly as the average permanent ramp costs about $100 per foot to construct: in our example, about $4,800. This makes a vertical platform lift a cost effective option for entryways that are at the level of an average porch. Adding to the cost of ramp construction is each city’s permit and code requirements.
I also learned that there are wheelchair lifts that will hoist the wheelchair directly into the trunk of a car and close it. There are lifts that will lift a wheelchair directly into and out of the back seat of a car. I also learned about car seats that will come out of the car, set on the ground, and then when you are ready, will lift you right into the driving position! Even though not physically challenged, I would like one of those, too!All of the items described above are not particularly inexpensive, especially for someone who might be on a fixed income and I certainly expected them to cost much more than they actually do. If you would like more information on these accessibility options you can obtain two outstanding resources on the Spinal Cord Injury Association website (www.sci-illinois.org). Under resources/accessibility, link to Accessibility Equipment Manufacturers Association (1-800-514-1100) (www.aema.com) . You can also link to Beyond Barriers (www.beyondbarriers.com). Both of these fine websites have extensive information on accessibility equipment. Access Solutions Center and Nationwide Lifts are not on the Spinal Cord Association website, but are certainly worth exploring. You can reach them at 630-742-2721, and view the equipment they offer by accessing their website. Another excellent site for researching assistive technology options is United Spinal Association’s USA-TechGuide (www.usatechguide.org). In addition to providing a wealth of information on available devices, the Guide also provides candid performance reviews of equipment by people who actually use it. USA-TechGuide also offers information on “lemon” laws across the country and lively, opinionated articles on a variety of topics affecting people with disabilities.
If you have a resource you would like to write about, contact Todd Mayer, LCSW at Hines VA Hospital, 708-202-2082.
Todd Mayer, LCSW is a licensed clinical social worker on the Spinal Cord Injury unit at Edward Hines Jr. VA Hospital, Hines, Illinois.