NR Times Articles - 02 April 2024 - 10 minutes

Housing adaptations – how to secure best outcomes for clients

Housing adaptations – how to secure best outcomes for clients

Enabling a property to be adapted or designed to suit the bespoke needs of a client can have a life-changing positive impact. Here, ILS Professional Mentor Sarah-Jane Davies offers some insight. 

The quest for improved function and increased independence lies at the heart of any client’s rehabilitation. There is nowhere more important for this to be achieved than in the home environment, but independence can be hampered in any number of ways.

Depending on the complexity and enduring nature of the injury, there are a number of issues that may crop up, mainly in the area of accessibility.

Factors to consider

Outside, clients need to be able to enter and leave the house, having transferred from a vehicle ideally protected from the weather by a car port or covered area close to the house. Gardens and pathway surfaces need careful consideration to ensure safe and easy access.

Indoors, clients need to be able to move about freely to communicate with their families where possible – sometimes this can be impeded due to narrow doorways, uneven thresholds or positioning of interior doors. Clients also need space and privacy for comfortable personal care to take place with effectiveness and dignity.

Family leisure and mealtimes mean that layout and space in the kitchen and living areas should encourage inclusion. Families also thrive on having separate areas for both socialisation and privacy and the need for any bathroom, kitchen and living space adaptations should impact the balance of the family unit as little as possible.

Clients may have a team of support workers and accommodation for carers, needing separate bathroom, office or sleeping area for overnight care, can present challenges. If the design and layout is sensitive, any perception of intrusion by their presence in the home can be significantly reduced.

‘Careful assessment is key’

Understanding the client’s everyday functioning and more importantly their personal choice enables the most sensitive and flexible response.

Careful assessment is key to this process and can often reveal small nuances of prior habit, preference, ability or need that ‘change the game’. This is where the recommendations of an experienced housing OT come in so handy and as case managers we are in the position to promote this input at the earliest stage of the process.

Situated as they are at the very centre of the process. the case manager can be asked to perform as coordinator between the demands of the litigation case, the expectations of the family, the practicalities of delivering a realistic response to the architect’s imaginings and the pragmatic issues of what really works for the client.

Solutions to the difficulties presented by narrow doorways, high thresholds, unsuitable interior staircases, lack of storage etc. can easily be found by building extensions to the footprint of the building, installation of through floor lifts, levelling of floors and widening of doors, extra storage in garden buildings, pre-supposing that the property is owned freehold, the structure will allow it and planning permission for adaptations will be forthcoming.

More substantial re-designs because of the complexity of the client’s needs, such as installing track hoisting systems, may require finding a rental property for temporary accommodation pending the works being completed.

This temporary housing will also require adapting, there are several mobile hoisting systems that would work, and it is rare that a landlord, notwithstanding any reinstatement agreement, will not agree that an open plan living space and a bedroom with ‘wet room’ ensuite once installed, will offer a valuable upgrade to the property on departure.

Here are some examples from our clients…

Protecting Ben’s independence

Client Ben with a spinal injury was living in a single storey privately-rented bedsit on discharge from hospital as his wheelchair would not fit through the garden gate of his family home, let alone allow him to move about in the Grade II listed thatched cottage that he had lived in for the last 18 years.

We were able to find a four-bedroom detached rental property nearby on a new estate, built to modern part M standards with wide doorways, flat access thresholds and LVT flooring throughout, and open plan kitchen/diner that nearly fitted the bill. There was no downstairs bathroom however, and no option to install a through floor lift.

An astute Occupational Therapist, alongside a very clever project manager (who was an engineer/builder), offered the solution of turning the small existing study into a ground floor wet room, taking into consideration the plumbing runs from the upstairs bathroom.

With the blessing of the landlord, they turned this into a large flat access bathroom, en-suite to the dining room which was turned into a ground floor bedroom.

Ben then had his own self-contained suite where he could use his standing frame, shower comfortably supported by his carer and get ready for the day without any disturbance to the rest of the family.

Flat access throughout enabled him to join in barbecues in the garden, transfer by board to watch TV in an adapted chair in the sitting room and chat to his wife while she prepared family meals by rolling his wheelchair under the side of the kitchen island that the cupboard was removed to allow.

He was able to help with homework and play computer games with his teenage son, following installation of a gaming suite on one wall of the kitchen/diner.

Physiotherapy took place in the well-equipped studio conversion in the attached garage. Ben accessed this independently crossing the lawn via an existing concrete, fairy-lit path.

At the end of the rental period and on settlement of the case, the client purchased the property outright.

Suzy – finding happiness in new surroundings

Client Suzy, a student with an ischaemic injury to her lower left limb was left with the agonising challenge of regulating the pain and temperature in her left leg, while struggling with an ugly and uncomfortable orthosis and raised shoe.

She had a constantly cold lower limb which made sitting to watch TV or sleeping at night debilitating and miserable. On cold winter nights, she said she felt ‘like she was sleeping in a tomb’ as the rest of her body’s temperature decreased to match that of her affected limb.

Remedies she tried included taking several hot baths a day, wearing cashmere leggings (difficult with an orthosis) and carrying hot water bottles around with her. She always had an underlying feeling of dissociation and revulsion which severely impacted her mental health.

Her family were keen to move from their old draughty home and found a family home with one small living room to the rear which could be made into a ground floor bedroom and the next door room into a snug/study for Suzy to use exclusively.

Uneven thresholds and floor levels were used to advantage, as it was possible to install retrofitted underfloor heating to just Suzy’s area, meaning that the floor temperature could be regulated to suit her needs even through winter.

The upstairs bathroom was enhanced by a jacuzzi bath and steam cabinet offering intense stimulation and heat, more than enough to boost her overall body temperature/circulation to comfortable levels without the need for any further external heat source.

When visiting on completion it was a delight to see Suzy’s happiness in her new surroundings.

Throughout the communal areas of the home, the carpets had been removed to prevent her orthosis from constantly catching and tripping, replaced by smooth wood flooring.

The cosy study where she was able to invite friends without having to wrap up in a duvet, now has doubled as a media suite, to enable Suzy to video game and pursue her career as a website/media designer. Her garden studio, with static bike and treadmill is now being used much more regularly as her motivation and energy improves.

A place for Lindy to enjoy her childhood

Client Lindy, aged 6, had retinopathy of prematurity, was registered blind, being able to differentiate only light and dark.

Gregarious and energetic, clutter and noise were the two overriding considerations for the family when it came to improvements to their existing traditional two-up two-down semi-detached rental property. The steep stairs also presented a formidable risk.

Once funding was agreed, with the case manager acting as property finder, the family were able to secure the tenancy on a single storey barn conversion, coincidentally closer to her primary school.

Any mobility issues that Lindy experienced were entirely around proximity, safety and reassurance. She needed to be able to hear people at all times so that she felt able to move around safely. This meant constant verbal feedback from family members to help her navigate. Clutter in a busy family was always going to be a risk factor too.

The large double-height living space included the TV and sofa area, dining area and the large well-appointed island kitchen. The kitchen designers had fortuitously installed runway-type lighting in the floor to delineate the kitchen zone, meaning that Lindy could immediately tell where not to go if hot pots and pans were being used. Laundry room and storage areas to the side of the entrance meant that stray shoes, bags and clutter could all be put away and decrease the risk of a trip or fall.

With the help of contractors, the in-floor lighting scheme was extended throughout the property, giving Lindy an easy path to follow which increased her ability to move freely, which in turn reduced her anxiety.

She could run along the corridor to and from the main living space. Outside, she could run along lit runway style decking paths installed in the garden.

Situating her bedroom closest to the sitting room meant that parents could have time together in the evenings while also providing easy reassurance to enable her to relax and go to sleep.

Lindy was increasing her skills with the iPad and then was introduced to a digital voice assistant by the case manager in liaison with the local authority visual impairment advisor. This means that she now has access to an intercom system, connecting her to her parents anywhere there are speakers in the house.

She can also play her chosen radio stations, DJ and stream music and have karaoke sessions with her siblings and playmates.

She can independently access podcasts and books, set timers and alarms, ask questions on school topics, control the curtains and lighting in her room, make calls to her friends and family members and play relaxing sleep music when it is time to go to bed in her own room.

With this device, and parental controls in place, Lindy can access all the information and reassurance she requires.

Getting the home environment right for everybody is a challenge, but one to which we case managers are committed. When client-led home adaptations are sensitively implemented, it empowers the client, their carers and family, supports rehabilitation and can significantly improve lives.


This article was also published on on 23rd August 2022