In this article, I attempt to make the case for rethinking our approach to designing and building houses to make them more inclusive, visitable, and livable for everyone. I believe that with a bit of forethought at the design stage, making a truly accessible home is possible at minimal cost. You do not have to sacrifice aesthetics or luxury, nor do you have configure the home for the worst case end state. We can build a basic structure that can be affordably modified, as required, and without major renovation.
I apologize, but I am going to use the indirect approach in taking you through this discussion. I do this because I think it is important for us to have a shared understanding of what it means to live with special needs. A caution: ours is only one perspective. There are countless others.
The Current State of Single-family Home Accessibility
It was once said that a man’s home is his castle. Just as the not-politically-correct language is dated, so is the concept.
The castle was designed to protect its occupants from external attack. Often equipped with moats, great gates and massive walls, the structure was specifically designed with barriers to repel invaders and to protect the occupants from incursion.
Obviously we still want the modern home to be secure and protect its occupants, but we also want it to be easy to live in and welcoming to our guests. Still, the homes we build today continue to present barriers to a growing demographic – people with special needs. Imagine what a flight of concrete steps and a raised threshold looks like to someone in a wheelchair, or to your 90-year old grandmother with her walker. Or how about to the paramedics who have to come and get me when I’m ready to be removed from this place feet first!
Some who have accessibility needs will resort to building a custom home. This is possible for many. Those who cannot build from scratch are left to try to find an existing dwelling that meets some or most of their needs. Many resort to expensive renovations to get what they need.
This is so unnecessary. I believe that homes built to accessibility standards and best practices on speculation can be both competitively priced and saleable. I accept that such a change would take time, but I challenge the real estate development and construction industry to make this the new norm.
The Growing Need for Accessibility
Consider this. We are a population that is aging and with a life expectancy unheard of in human history. We value an independence that would be unreasonable in times past. We, as a society, also acknowledge the rights and expectations of people with disabilities to be able to live in our communities, to enjoy a life-style equivalent to their peers, and to be independent and self-reliant. This applies equally to those who have permanent disabilities, those who have temporary disabilities through injury or illness, and those (everybody else) who have potential disabilities.
Aging in Place
My wife and I are at retirement age and enjoy good health. We have worked a lifetime to find a place to live that we love and have no wish to leave. We want to enjoy the shade of the trees we have planted over the past ten years. We want to age in our chosen home and not leave it until our end has come. This is an increasingly popular concept known as “aging in place”. You will see in the following section why that is going to be a challenge for many.
Family Members with Special Needs
Louise and I have raised three girls and twin boys. The girls are adults now and live on their own, but the twins (Alex and Malcolm) who just turned 17 still live at home.
Malcolm has a disability that requires him to use assistive devices to deal with the daily demands of life. He is an intelligent, out-going, and charming young man whose social and emotional needs are no different than yours or mine. He values family, friendship, and interaction with others.
His disability impacts significantly on his mobility. Accessibility and inclusion are his major challenges. Our journey with him as a family has opened our eyes to the issue of accessibility, as participants, in a way that one cannot really appreciate without having lived it.
The Prevalence of Disability in Canada
Though he represents a small demographic whose disability originated at birth, Malcolm is not alone in having special needs. In Ontario, 15.4% of our fellow citizens have identified themselves as having a disability (source A Profile Of Persons with Disabilities Among Canadians Aged 15 Years or Older – Statistics Canada 2012 authored by Rubab Arim). Canada-wide, the rate is 13.7% and represents 3,775,910 people.
Disability is Usually Not Something You’re Born With
The study also notes that the average age at which persons with disability began to have their lives affected by their condition is 43 years old. Our son’s condition (Cerebral Palsy) was acquired at birth, but this is not the norm. The study says that roughly 13% of persons with disability of working age (15 to 64 years) reported that their disability existed at birth. This means that 87% acquired their disability later. This represents 1,870,592 individuals!
Also of note in the Statistics Canada study is the fact that, overall, nearly half of the people who reported a disability were dealing with a severe or very severe form. This accounts for 1,832,350 individuals.
Something to Think About: This Could be You
There are many ways to acquire a disability. These include illness (muscular dystrophy, multiple sclerosis, ALS, stroke), injury (sports, traffic accidents, falls at home, recreational accidents), or just plain aging. It could happen to any of us at anytime – an hour from now, next month, years down the line. You can’t know if, or when.
Next time you see someone using a wheel chair, take a moment to think about what his or her life must be like. What do you take for granted? Walking up the steps to your home and collapsing into your favorite chair after a hard day at work? What about going to the toilet, or having a shower? Going to your kitchen and whipping up your favorite meal? You’re tired so you go crawl into bed. You want to change clothes. What if you couldn’t? Some people can’t do any of these things without help.
Malcolm faces significant physical challenges, but accepts his reality, it is all he has known. He needs help to do almost everything that we would take for granted, including the most personal things in his life on a daily basis. His strength of character, resilience and positive attitude is something I admire. My goal for him and others like him is to be included in society and as independent as possible.
There is a chance that any of us could be in a similar situation in the future. How would you handle it? For most of us, the onset of a disability would be a huge adjustment. In the end, you really don’t have a choice. Your situation is what it is and you find a way to get on with life.
Keep this thought in mind as we continue this discussion. There is a lot to understand and it is best learned if we can appreciate the perspective of the person with special needs (of which there is a range of degrees). This is all about inclusiveness and respect. That is what builds strong communities.
Types of Disabilities
The Statistics Canada study identified ten types of disability shown here in order of prevalence.
Disabilities related to pain, flexibility and mobility are the most common and are often experienced together. In fact, most persons with disabilities have multiple disabilities.
The prevalence of most types of disability also increases with age. For example, in the study, disabilities related to mobility affected fewer than 1% of Canadians aged 15 to 24 years, compared to 27% of those aged 75 years or older. (Source A Profile Of Persons with Disabilities Among Canadians Aged 15 Years or Older – Statistics Canada 2012).
On August 16, 2017 Statistics Canada released another interesting and revealing report entitled Needs for mobility devices, home modifications and personal assistance among Canadians with disabilities (authored by Edward M. Giesbrecht, Emma M. Smith, W. Ben Mortenson and William C. Miller). The report is worth a read if have the time and can be found here.
In assessing home modification needs, survey participants were asked if their current residence met, or did not meet their needs in the following areas:
- Ramp/ground-level access
- Widened doorways/hallways
- Barrier-free bath/shower
- Easy-open doors
- Lift device/elevator
- Lowered kitchen counters
This is not an exhaustive list of what it would take to bring a home to a comfortable, livable standard. It does not mention room size, access routes and turning area, or operation of home systems. I would consider the scope of the Stats Can survey to be “the basics”.
Not surprisingly, the most prevalent unmet needs for residence modification were for a barrier-free bath/shower, a lift/elevator, and a ramp/ground-level access. The reason for not making these modifications was most often the cost to do so.
Aids and Assistive Devices
The Statistics Canada report identified that more than 80% of persons with disabilities use specialized aids and devices to manage their daily activities and to be able to engage in work and social activities. Many use multiple devices depending on the task, the environment and other factors.
Not surprisingly, the usage of these devices is higher among those with more severe disabilities (in the range of 89% to 95% for those with severe or very severe disabilities). The number is still significant (65% to 80%) among those reporting mild and moderate disabilities.
Types of Aids and Assistive Devices
Depending upon the type and severity of the disability, someone may use one or more of these devices. People with severe and very severe disabilities will likely use many of these. They all (with the exception of the cane) have one thing in common – they require space, both for deployment and storage.
- Manual wheelchair
- Powered wheelchair
- Pivot stander
- Standing frame
- Over-head hoist
- Bath seat
- Stair lift (platform)
- Stair lift (seated)
- Porch lift
Disability is Expensive
That is an understatement. Malcolm has owned three power wheel chairs in his life so far. I think the first cost somewhere between $7,000 and $9,000, the second around $15,000, and his current ride more than $24,000. His first manual chair, based on technology no more sophisticated than your average bicycle, cost over $4,000. We replaced that one with a used titanium chair for around $2,000, a huge saving over the cost of a new one ($8,000). You have to replace most of this gear every 3 to 5 years to account for wear and tear, and growth.
Getting In and Out and Up and Down
A porch lift (a device to lift a wheelchair and occupant from ground level to the height of the entry to a dwelling) can cost you north of $5,000 (which is probably a low estimate). The stair-lift we installed to give him access to the basement rec room cost $19,000. Some multi-storey homes may require an elevator, which will cost even more.
Transportation is also an issue that costs a lot. We needed a vehicle that could transport an adult in a wheel chair (try to find one at your local car dealer). You need to have an existing vehicle converted, and it can’t be a used one. We had to buy a brand new van (around $38,000) then send it away to be modified at a cost of around $25,000. In the process, you can say goodbye to all the little luxury features like consoles, carpets and stow-able seating along with a whole bunch of cargo space. I’m not complaining, just pointing out the facts. Welcome to the custom-everything world of disability!
A Place to Hang Your Hat
Most already-built housing on the market is not suitable for the most prevalent disabilities. Remember? Pain, mobility and flexibility? This means (depending on the specific property) renovations costing tens of thousands, up to a hundred thousand dollars or more. At the low end of that range, you are just getting the basics. This is a very big ticket item for people with special needs. The economics is simple – it is a trade-off of money and disruption for quality of life. It is also unnecessary.
The Bottom Line
Given what I have just outlined, it is little wonder why people with disabilities have a lower standard of living and unmet accommodation needs. Could you come up with $40,000 or so per year of additional disposable income to deal with all that? That’s what you may have to do if you or a family member had a severe disability. Government programs, charities, and private health care plans can help offset some costs, but there are still significant out-of-pocket expenses.
The cost for assistive devices and modified transportation will always be high because the market segment and potential economy of scale is so small. We just have to live with that for the present. There is one market where an increased awareness and some basic changes in how things are done could significantly reduce the cost related to special needs.
In my opinion, housing is an area where a simple, low-cost change would profoundly affect the quality of life and cost for people living with disabilities (and would be attractive and beneficial for everyone). Building for accessibility helps everyone. To set the stage for that discussion, I want to share our experience finding a suitable dwelling on the already-built real estate market.
Finding a Place to Live – Our Experience
We moved from Dartmouth, Nova Scotia to Ottawa, Ontario when I changed jobs ten years ago. At the time, the boys were just turning seven and we had had several years of progressive learning about Malcolm’s condition and what impact it has on his needs and our lives.
The home we bought when they were first born had once felt large and comfortable, but seven years later was cramped and awkward. When we bought it, Malcolm had not yet been diagnosed so we had no idea that we would be dealing with special needs. As he grew, we realized that this home would not be suitable over the long term, and that we would eventually be forced to move. The change of jobs afforded the opportunity to find a better space and we knew we had to get it right this time.
I had reported to my new job ahead of the move so I had plenty of time to look at the available housing market. We decided early that we would need a bungalow. I began my search in the usual way, looking at real estate listings and driving around. Eventually, I felt it was time to have a look inside some of these properties so I contacted an agent.
We looked at dozens of properties. I’m pretty sure that my agent, Jacquie, questioned her decision to take me on, but she stuck with me. We looked at many different areas, both established and recently-built, and found nothing. We saw some really nice properties, many with large open kitchens and living areas and all the amenities, but it usually came down to three show-stoppers. Bathrooms too small, bedrooms too small, and no easy way to get into the home. In retrospect, there were probably other issues such as narrow hallways and small doorways but we never got to that level of detail.
I was becoming discouraged. I knew that we did not have the time to consider a custom-built home as our relocation was imminent. To do so would mean a huge disruption in an already stressful life, but I started looking for a vacant lot to build on anyhow. In my travels, I came across one more bungalow that had just come on the market so I asked Jacquie if we could view it.
The pictures on the listing looked promising. It looked like there were large bathrooms and bedrooms, a nice big entrance, and plenty of living space. Still, I learned long ago that you can’t judge a house from the pictures.
I felt a wave of excitement once I got inside. It was sort of “this isn’t perfect but I didn’t think we were going to get this close”. The home was big and spacious. The builder had included some elements that made the home reasonably accessible. There was a barrier-free shower in the Master suite. The second bath was easily twice the size of most others we’d looked at and the hallways and doorways were large. The doorway to the second and third bedroom and second bathroom are 30″, minimum code and just wide enough for a wheelchair.
We purchased it and moved in at the end of June 2008. The house is not perfect but we could live in it comfortably. The major problem we faced, just as with every other home we looked at, was that the entry is raised and not wheel chair accessible (ironically, the entrance to the home we sold in Dartmouth was more easily accessible). We solved that problem by finding a used porch lift in really good condition on Kijiji (Louise became very adept at finding used things on line – that’s another story, for another time).
I rebuilt the steps going from the garage into the house and installed the porch lift in the garage. It provided access into a spacious mud room with plenty of room for wheelchair transfers and storage. Placing the lift in the garage has the added benefit of shelter from the elements which will ensure that the equipment lasts, but there was a cost. I had to sacrifice a bay in the two-car garage which is why you see my pick-up parked in the driveway in the picture above.
Build it Accessible
So you can see that it is possible to find a suitable property that you could either live with or eventually renovate at a relatively reasonable cost. It takes some work and a bit luck, and probably some compromise, but it is possible. But why not just build houses so that you don’t have to renovate to accommodate?
A Home for Everyone
A home built to modern accessibility standards is not just for people with disabilities, it is a more livable space for everyone. Grade-level entries, wide doorways and hallways, and a little extra space make it easier to come and go, to move furniture and appliances, and to navigate strollers and baby carriages. Larger bathrooms with barrier-free showers are a point of luxury in the home. Larger bedrooms mean that the space can be used for more than just sleeping.
Pleasing Aesthetics and Good Value
An accessible home can be just as attractive as any other style. A well-designed step-free entry is just as (if not more) attractive than one with steps. Accessible homes can be well-appointed and have high-quality finishes. Accessible homes can be beautiful.
The cost to build an accessible home should not be much more than for a standard design. You may require some extra square footage to accommodate slightly larger rooms and wider hallways and doorways. You may have to spend a few extra dollars for 34″ and 36″ doors instead of 30″ or 32″ doors. (I made a trip to a local box store and found out that the difference in price between a 30″ pre-hung door and a 36″ one is $12CDN). Whatever this extra cost is, it is a small fraction of what it would cost to redo everything in a later renovation.
The key is in planning and design of the original structure so that the basic construction has what is required should modifications need to be made later. The obvious factors are entries, room sizes and layout, hallway and staircase widths, and doorways. Adding extra reinforcement to the framing of bathroom walls (currently a requirement of the Ontario Building Code) and at the top and bottom of stairways will allow the installation of grab bars without tearing apart finished walls. These are just a few examples.
Constructing a step-free entry may be one area where cost might be a factor as this can require engineering and special construction in some cases. It can be accomplished with no or minimal additional cost (as was the case for a friend of mine) if the requirement is addressed with good planning. We will explore this and other options related to entries in a separate article.
Accessible housing is only recently getting attention in terms of standards and regulations. Most cities have universal design standards that apply to all public spaces. Most of these are very comprehensive.
The Ontario Building Code now includes specifications for newly built commercial and multi-unit residential buildings, but only limited requirements for houses, triplexes and boarding or rooming houses with fewer than eight boarders or roomers (see OBC Section 9.5.2 – Barrier-Free Design). Formal government regulation in this area is lacking.
The SAFERhome™ Standards Society
In British Columbia, a not-for-profit organization known as the SAFERhome Standards Society has established a useful standard for the construction of sustainable and accessible homes. The standard complies with existing Building Codes and the organization offers a certification service to validate the property against their standard. The standard has been adopted by the British Columbia cities of Vernon, Maple Ridge, and Armstrong.
The standards manual provides “how-to” instructions against the following 15 criteria under three headings (Structural & Design, Electrical & Telecom, Plumbing):
- Exterior thresholds
- Interior thresholds
- Doors (pinch points)
- Washroom wall reinforcements
- Wall reinforcements
- Multi-storey connection provisions (for elevator retrofit)
- Sink cabinets
- Light switch positioning
- Electrical outlet positioning
- Electrical outlet placement locations
- Four-plex outlet locations
- Bath and shower control positioning
- Waste pipes
- Pressure/temperature control valves
The SAFERhome™ Standard is a great start but falls short in one important area. It does not address factors exterior to the home like parking, approaches and entrances.
Accessibility Standards in the UK
A lot of progress is being made in the United Kingdom and countries in the European Union. In the UK, the Foundation for Lifetime Homes and Neighbourhoods established the Lifetime Homes standard which is quite comprehensive. This is an excellent and very thorough standard which we at Accessibility Advocates use as the basis for our assessments. The standard is based on the following 16 criteria:
- Parking (width, gradients, widening capability)
- Approach to dwelling from parking (distance, gradients, and width)
- Approach to all entrances
- Communal stairs and lifts (multi-unit dwellings)
- Internal doorways and hallways
- Circulation space
- Entrance level living space
- Potential for entrance level bed-space
- Entrance level bathroom and shower drainage
- Bathroom walls
- Stairs and potential through-floor lift in dwellings
- Potential for fitting of hoists and bedroom/bathroom relationship
- Glazing and window handle heights
- Location of service controls
Unfortunately, as of the publication of this article, the standard is not available on their website. This may be because in 2015 Her Majesty’s Government updated the Building Regulations and added a new section to Part M – Access to and use of buildings which appears to have been based on the Lifetime Homes standard. This is very encouraging.
A Modernized Building Code
The updated Regulations include 3 new standards: Category M4(1) – visitable dwellings (mandatory for all new builds), Category M4(2) – accessible and adaptable dwellings (optional), and Category M4(3) – wheelchair user dwellings (optional). These establish standards for the following:
- Parking and drop-off
- Circulation, internal doorways, and storage
- Habitable rooms
- Sanitary facilities
- Services and controls
- Private outdoor spaces
The need for accessible housing is real and growing, comprehensive best practices exist to provide guidance during construction, and costs are minimal if these changes are made at the time of the initial build. It just takes a little forethought and planning.
As a home buyer, I would be most willing to absorb the two or three thousand dollars extra that an accessible home might cost over standard construction. This is especially the case if I knew that I would not have to undertake extensive renovations should I or a member of my family ever become disabled.
As a home owner, I want my home to be welcoming to others. I have tried to be objective and unemotional throughout this article but I will leave you with these thoughts. As a parent of a child with a severe disability, I have watched the world become less and less accessible to him as he grew.
When he was small, he could be transported using simple and lightweight equipment that easily fit through small doorways so we could visit our friends fairly easily. As he grew, he needed progressively bigger and heavier devices. As he grew heavier, we could no longer safely carry him up flights of stairs to the guest bedroom so there eventually came a point when overnight visits to friends and family were out of the question.
I remember little things like trick-or-treating when he could not get to the door to ring the door bell. I can remember only once that we came across a home where he could reach the front door under his own power.
These may seem like small things, but they happen all the time. Let’s start to make some changes that will begin to make things better. Let’s begin with our homes. – Al McLarty, August 22, 2018