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QUEST Volume 11, Number 5, SEPTEMBER/OCTOBER 2004

Staying Put

Remodeling Can Keep You Safe and Comfortable in the Home You Love

by Jan Blaustone

Remodeling is a daunting process always disruptive and often intimidating down to the last detail.

That said, perhaps you've been thinking about making changes to your home to accommodate your changing physical abilities.

A list of the "Top Ten Reasons for Wanting to Remodel" could include:

10. Water runs down your armpits every time you wash your hands because the sink and counters are too high.

9. Your seasonal clothes and hobby supplies simply disappear in the black hole of your attic because you have no accessible storage space.

8. There's not enough putty compound in the world to fill in the gashes in your hallways and doorways.

7. In case of fire, common sense says you need more than one accessible exit from your home.

6. You can't remember what the back yard looks like but they tell you it's nice.

5. Who really knows what secrets lurk on the upper level of your home? You've only seen it on video.

4. Your carpeting has enough embedded tracks in it for a railroad.

3. You're home alone. The blinds are shut; the lights are off; the heat needs adjusting; the TV remote was left on the floor. And you can't reach any of it.

2. Grab bars what a concept!

And the #1 reason to remodel

1. You're tired of peeing in a cup and bathing with wet wipes.

Move or Improve?

Build, buy new or remodel? It's a common question and the answer is frequently the third choice.

Why? First and foremost, people remodel because they love their homes. You also may enjoy your neighborhood and its stable property value, proximity to work, public transportation, good schools or recreational opportunities.

Second, home improvements are a sound investment, up to a point. A 2002 report in Remodeling Magazine comparing remodeling costs and values indicated that the national average return rate is 88 percent on bathroom remodels.

The rule of thumb is: Don't spend more than 5 percent of your home's value on remodeling a room. But most families affected by neuromuscular disease care less about resale value than about being safe and comfortable in their own homes.

Third, wheelchair-accessible homes are few and far between. Not only do they rarely exist, but when they do, they're not advertised as such. Realtors often recoil in horror from the term because of the outdated, "institutional" stereotype that comes to clients' minds even though today's "universal designs" left that image behind long ago.

Consulting the Experts


The wraparound porch was the first thing that attracted Daniel Creger's wife, Mary, to their 104-year-old Gaffney, S.C. home. The Cregers redid the porch and back deck and added ramps, all in "virtually indestructible" PakkaWood, which is nonslippery and resists moisture. Photos by Doug Jordan

Once you've decided to remodel, the next challenge is getting it done. Architects and contractors are part of this process.

You may wonder if an architect is really necessary.

"Architects can offer more ideas about design, space and what's available," says Nicholas Johnson, a senior engineer in the field of heating, ventilation and air conditioning (HVAC) and the 2004 recipient of MDA's National Personal Achievement Award.

Johnson notes that relying on a "design-build" house (a contractor's predesigned floor plan) is cheaper than hiring an architect to create a plan for you. But the expertise an architect brings to the table is well worth the extra expense and results in fewer mistakes along the way.

"The architect designs plans for the contractor to build. After that the contractor does everything," explains Johnson, of Waltham, Mass.

Additionally, an architect interprets your wishes in technical terms for the contractor to follow. For example, you may tell your contractor that you want a roll-in shower but it's the architect who explains its dimensions and how you want it to look and function.

Alan Garlitz of Oklahoma City admits his biggest mistake in building his 500-square-foot master bedroom and bath addition was not hiring an architect "to assist with the materials and avoid the price wars." Garlitz, who has limb-girdle muscular dystrophy (LGMD), says, "An architect would have drawn up a plan and we'd all agree on the costs up front."

Once you're ready to hire a contractor, Johnson suggests these guidelines:

Consult with at least three contractors about your plans. Check their licensing, insurance and credentials online, with your states registrar of contractors or the Better Business Bureau. (See "Remodeling Resources" for information on finding and contracting with builders.)

Get bids and detailed breakdowns from all three contractors in writing. Typically, the mid-range bid is your best bet.

Be wary of contractors who supply only out-of-town references, present tight time pressures or promise completions that seem unrealistic.

Pay in stages. Never give 100 percent up front (or even a hefty deposit (deposits are typically 10 percent). Always hold back money based on the stage of completion, because it's your only leverage for getting things done.

Both you and the contractor should sign and date a written contract. In addition to work details, specify materials (with substitutions requiring your written approval), payments and dates thereof, and a completion date. Don't sign a completion statement or make a final payment until the job has passed final inspection, either by yourself or the appropriate city/county building authorities.

Be aware that suppliers or subcontractors who are owed money by your contractor can place a lien against your property. To protect yourself, add a release-of-lien clause to your contract or ask for proof of payment by your contractor.

Ramp It Up

Logically, the first thing most people with neuromuscular diseases do to existing homes is install ramps. For safety's sake, every home should have at least two accessible entryways/exits.

Ramps don't need to be elaborate, just functional. The correct slope on a ramp is a 1-inch drop for every 1 foot of travel, and 2-inch side curbs for safety are essential.

Modular aluminum ramps are a quick, easy solution for many situations. One caution: They can have inadequate traction if the slope is greater than recommended.

A more attractive choice for the front of the house is treated hardwood, which isn't terribly expensive, especially if you purchase the wood from a lumber liquidator. (See "Remodeling Resources" and "What's It Going to Cost?," for more on specific products.)

Plywood works, too, but it should be coated with a mixture of outdoor paint and sand for traction. (Sandpaper adhesive strips won't hold up under the weight of a power wheelchair.)

Handrails should be added, with vertical bars every 2 feet. Products such as Quikrete are convenient for short concrete ramps or thresholds. These can be "acid-etched" for better traction and colored for aesthetics.

A higher-dollar material often used for decks, ramps and walkways is a virtually indestructible product called PakkaWood, manufactured by Fibron. It consists of hardwood veneers impregnated with phenolic thermosetting resins that are fused under intense heat and pressure, forming a solid, homogeneous block of material.

It's a mouthful to say but ingenious in functionality, says Daniel Creger of Gaffney, S.C., who has LGMD. He liked the Fibron product so much for his ramps that he also used it for his large deck, wraparound porch and garden walkways.

"It's nonslippery because it resists moisture," Creger says. "I don't have to do anything to it and it's so solid that it will be here longer than any of us. It costs about twice as much as premium grade lumber but it's well worth the money."

If cost is an issue, your local Chamber of Commerce may have a list of programs that can assist with residential ramp installation and costs.

Wider Doorways

In a 30-year-old home, a typical front door is 35 inches wide; bedroom doorways with trim average 30 inches wide; hallway closets and bathroom doorways with trim are only 24 inches wide; and linen closets are a dreadful 18 inches.

And the average power wheelchair is 28 inches wide.

Usually the first door you'll want to widen is the most essential the bathroom doorway.

Sometimes you can simply replace door hinges with offset ones that bring the door out beyond the trim, allowing another 2 inches for passage. That may be enough to squeak by, but chances are good your doors and trim will acquire some dents and scars unless the opening is at least 36 inches.

Elsewhere in the house, many people prefer double doors. If French doors aren't in the budget, contractors recommend 4-foot-wide bi-hinge doors. A lightweight pocket door (one that slides into a cavity in the wall) also works well unless the house shifts and the door becomes stuck.

Ceiling Lifts


Ruth Ann McDowell's SureHands lift features a hub in the bathroom ceiling. "I position myself under it and turn myself toward either the bathtub, toliet, bed or scooter,"she says.

Garlitz gets to his bathroom amenities via his Barrier-Free electric lift, which runs on a single ceiling track over his bed, down the hallway and over the whirlpool bath, around a corner and past the bathroom sink and toilet, and then directly into his roll-in shower.

"It's very streamlined and nonobtrusive," he says, "one track that allows me to function independently on a day-to-day basis."

Garlitz recommends being very involved in planning ceiling lift installation. He drew out the entire track diagram prior to construction because "I've seen installations that look like railroad tracks and I didn't want that."

Garlitz notes that ceiling reinforcement joists are more expensive to add to an existing structure than to one being built. For an addition, he advises, "it makes a lot more sense to spend the $50 to $75 and be prepared."

Another design issue to consider: Vaulted or cathedral ceilings aren't practical for ceiling lifts, because "the installation isn't as neat," Garlitz says. Tracks must hang down from vaulted ceilings in order to run a level course.

"It's important that you know what works for you and not get talked into something that you don't need," he says. "Builders are going to build according to their usual practices, or ADA guidelines, but neither one may work for you."

Don't Wait Too Long

Remodeling came slowly for Sam and Alice Shannon of Nashville, Tenn.

They began by widening the bathroom doorway in their 1956 ranch-style home, and ended up converting their single-car garage into a larger master bath with a custom-tiled, roll-in shower and roll-under sink. The garage was replaced with a custom-sized carport to accommodate Sam's full-size van. (Sam, who had facioscapulohumeral muscular dystrophy, died last year.)

Because Sam was able to use transfer boards, he only installed about 5 feet of ceiling track over the bed. After getting contradictory opinions from three installers about the need for ceiling reinforcement, the Shannons ultimately chose the installer who said reinforcement wasn't necessary, and ended up happy with the results.

"Sam could go from the bed, up in the air in his sling, and drop down into his power wheelchair or shower chair," Alice Shannon says. "Because his shower chair had wheels and our floors were hardwood and tile, I could then push Sam right into the roll-in shower."

Shannon, who recently learned she has multiple sclerosis, knows firsthand the value of her homes modifications. She has only one regret.

"We should have done things sooner," she says. "We should have moved into this house sooner; got Sam's power chair sooner; installed the ceiling lift sooner. [We] got smarter about things through the years but we just didn't get around to doing things until we were almost past the point of needing them. It's costly stuff, but in the meantime, we were living with unsafe things."

Floors That Take a Lickin'

Anyone who uses a wheelchair knows what it can do to floors.

Most folks with hardwood flooring swear by it. If you're lucky enough to find a home with it already installed, you'll save a bundle, as opposed to paying the rising cost of hardwood these days. The maintenance factor is a consideration, however.

By contrast, a high-quality wood-replica product will never splinter, warp, fade, stain or swell. It's quieter, water-resistant, unaffected by humidity and requires no polishing. But even so, there are special considerations for heavy wheelchair use.

The weight and possible torque created by a power chair "places exceptional forces on any flooring," explains Oliver Stanchfield, senior technical specialist for flooring company Pergo. For power wheelchair use, he recommends a 3/8-inch-thick wood laminate such as Pergo Vintage Home or Pergo Select, rather than the standard 5/16-inch thickness.

Thicker wood laminates have a very dense core material for additional joint strength, says Stanchfield, adding that other Pergo glueless and preglued products are designed for foot traffic, not wheelchairs. In tile, he recommends a -inch thickness.

Stanchfield makes three additional recommendations to ensure floors hold up under power chairs.

First, be sure the subfloor is extremely flat. Unevenness puts added pressure on the joints and can lead to the planks separating.

Second, glue down laminate flooring, even if the product is preglued. It's like using wallpaper paste for a stronger bond on prepasted wallpaper.

Third, hire an installation professional who can assure the best possible fit for the type of traffic the floor will experience.

Creger learned how important product quality and installation are when he had ceramic tile flooring added in his home.

"Halfway through the job," he says, "I drove across it and pop, pop, pop I broke almost every tile!

"I've gone on other tile floors and there's not been a problem. It depends on the give. I think if it had been a better grade, a thicker tile, and if it had been laid on a concrete slab then it would have been OK."

Keep in mind that tile adds weight, not strength, so the subflooring has to be strong enough to support it. If the structure underneath is flexible or uneven, the tile will crack.

For those reasons, some people choose vinyl flooring. Unlike ceramic flooring, high-quality vinyl won't chip, crack or fade. There's no grout to seal and reseal; its lightweight, easy to install anywhere in your home, and generally costs less than -inch ceramic tile or wood laminate.

The Cohen family of Brooklyn, N.Y., whose 8-year-old son Aaron has Duchenne muscular dystrophy, selected maintenance-free Amtico flooring for their entire addition. This high-quality product can look like wood or marble.

Working with an architect, Aaron's mom, Esther, chose several styles.

"The family room will be parquet, the kitchen and bathrooms will be ceramic, and it's all plastic," she enthuses. "This product can imitate anything! I even fooled my husband with the samples."

The Cohens, who also are installing a small elevator in their three-level, 85-year-old home, aren't too concerned about recouping their remodeling investment.

Says Esther, "We're working very hard to ensure that were creating a home and not a hospital. For now I worry about the quality of life for our family. Resale value is not on the top of my list of worries."

Cabinets to Dream About


Cabinet hardware shaped like a "D" makes doors and drawers easier to open.

Ruth Ann McDowell of Orange, Texas, was feeling lucky when she and her husband, Cliff, discovered a 3-year-old home with an open floor plan and very little that needed modifying. Besides the usual changes, McDowell, who has LGMD, installed ceiling tracking for her SureHands lift, added a screened-in sunroom and widened the doorways to her walk-in closets.

Yet, one of the original features of the home just may be her favorite.

"I have a big linen closet with double doors," she brags. "Plus, there's even more storage space in the utility room, which is lined with cabinets!"

Because reaching items is especially challenging for McDowell, all she needs now are wire baskets on tracks that pull out from her shelving, so nothing is out of reach.

Your best bets in cabinetry, especially in the kitchen, are cupboards that feature pull-out or pull-down shelving, corner lazy-Susans, and D-shaped hardware instead of knobs for easier opening.

Dave Geter, who works for Home Depot in Albuquerque and has Emery-Dreifuss muscular dystrophy, recommends the Passport Series by KraftMaid Cabinetry.

Geter advises finding a cabinet vendor who offers free computerized planning services, allowing you to see a mock-up of your virtual cabinets in your virtual kitchen before you pay your actual money.

To Infinity and Beyond

Engineer Nick Johnson, who's knowledgeable about automated temperature control or "direct digital control," says that in the near future most new homes dubbed smart homes will offer this perk. Smart home technology also will be available to add to existing homes.

"You will be able to do anything adjust the room temperature; control the lights, blinds and electronics; lock your doors and windows. Any control point you desire can be adjusted and all with one or two keystrokes," he says. "The technology is already there. You can do anything you want. You're only limited by your checkbook."

Until then, Daniel Creger advises delighting in whatever simple modifications you can make to increase your homes accessibility, comfort and safety.

"This is my dream house, even though the remodeling is never-ending," he says. "It's the simple things, like good kitchen knives, that make life so much nicer."

And so much safer, too!

Ka-ching! Whats It All Going to Cost?

Here are some national average costs for various remodeling projects. Your actual cost will depend on where you live in the United States; the age, condition and layout of your home; and the quirks of the individual project.

Door widening: From $300 to $1,000 per doorway, not including the price of a door. The cost depends on whether its a load-bearing wall, if electrical outlets need to be relocated, and the expense of replacing fancy door molding.

Before hammering a bigger hole, see if offset hinges (see "Remodeling Resources") will make the entry wide enough. Another way to gain width is to rehinge the door on the outside of the frame, and remove the doorstop trim below the door lock.

Installing a roll-in shower: From $600 to $2,500 in labor/construction costs, not including the cost of the shower unit. This includes taking out the old tub and tile and installing a prefabricated unit in the existing space. Plumbing modifications and floor/wall prep, patching and finishing greatly influence cost.

Adding grab bars: From $100 to $600 a bar on unreinforced bathroom walls, not including the cost of the bar. The cost varies according to the wall (interior or exterior) and the finish that needs to be removed and replaced.

Lowering a kitchen sink: $400 to $800. The countertop is one of the greatest expenses in this remodel. Costs are lower if you reuse the existing sink.

Installing overhead track lift system: The average cost runs from $5,000 to $15,000 for the system and installation of ceiling tracks. Variables include the extent of track coverage in the house, how much ceiling joist reinforcement is needed, and whether track is suspended from the ceiling.

Newer homes built with prefabricated trusses often require joist reinforcement. In general, reinforcement isnt needed if the ceiling is made from 2-by-6-inch lumber thats 16 to 19 inches measured from the center of each board, says Brian Hudson, owner of Image Management of Raleigh, N.C., who has installed about 500 Barrier Free lift systems.

Major bathroom remodel: Midrange cost is $10,088; high-end cost is $23,457.

Major kitchen remodel: For a 200-square-foot kitchen, including cabinets, countertops, appliances, and flooring, the midrange cost is $43,804; upscale cost: $68,962.

Master suite addition: To add a 24-foot-by-16-foot area over a crawl space, including walk-in closet, whirlpool tub and shower, midrange cost is $70,760; upscale cost: $133,993.

Flooring installation: Labor costs vary widely based on regional prices, subfloor preparation, moving furniture and appliances, taking up and replacing commodes, disposal of old flooring, trim, etc.

In a quick survey of prices across the country, installation costs for wood laminate flooring ran from $3 to $4.50 a square foot; for -inch ceramic tile from $3 to $12 a square foot; and for high-grade vinyl from 78 cents to $1.65 a square foot. These figures are for installation only, not materials.

Note: These costs are based on Remodeling Magazines 2003 "Cost vs. Value" report and interviews with contractors and retailers.

REMODELING RESOURCES

Unique features like the fireplace in the bedroom of Daniel Creger's house are what convince some owners to remodel rather than build.

General Information

Center for Universal Design, College of Design, North Carolina State University
www.design.ncsu.edu/cud/
(800) 647-6777 or (919) 515-3082
Links to a wide variety of information on technology, housing, funding, floor plans and more

Charles Schwab Architects
www.universaldesignonline.com
(563) 359-7524
Book of 83 fully accessible home plans

Kansas State University Dept. of Apparel, Textiles and Interior Design
www.ksu.edu/humec/atid/UDF
(785) 532-6993
Universal design information for bath/kitchen

New Horizons Un-limited
www.new-horizons.org/gdbhac.html
Guide to Buying a Home for People with Disabilities: Accessible Homes and Accessible Home Modifications

REMODELING Online
www.remodeling.hw.net
(202) 452-0800
Product and design trends in remodeling, how-to information, "Cost vs. Value" report, detailed product specifications and ideas for sharing with fellow remodelers

Thomas Register Online
www.thomasregister.com
(212) 290-7277
A tremendous resource for locating manufacturers and suppliers of all kinds of products, including out-of-date products

Toolbase Services
www.toolbase.org
(800) 898-2842
Home building industrys technical information resource. Click on "Seniors Housing" in the left-hand menu.

Finding Contractors

Home Improvement Specialists
www.handymanconnection.com
(800) 466-5530 or (513) 771-3003

National Association of Remodeling Industry
www.nari.org
(800) 611-6274 or (847) 298-9200
Valuable tips on interviewing and working with contractors

Prescreened Home Improvement Contractors
www.servicemagic.com
(800) 474-1596

Kitchen Products

Elkay
www.elkayusa.com
(630) 572-3192
Kitchen and bath products

Kohler
www.us.kohler.com
(800) 456-4537
Kitchen, bath, touchless faucets

KraftMaid Cabinetry
www.kraftmaid.com
(440) 632-5333

Smart House Products

Direct-Digital-Control.com
www.direct-digital-control.com
(973) 815-9909
Home automation

Quartet Technology
www.qtiusa.com
(978) 649-4328
Voice- and switch-activated environmental control units

Assistive Products and Equipment

Adaptive Access
www.adaptiveaccess.com
(281) 856-9332
Offset door hinges, ramps, grab bars, shower seats

Architectural Products for Barrier Free Living
www.barrierfree.org
(877) 717-7027
Grab bars, ramp kits, kitchen and bath items

Directory of Accessible Building Products
National Association of Homebuilders
www.nahbrc.org
(800) 638-8556

DSI
www.wavegrip.com
(818) 782-6793
Grab bars with better handholds

Fibron Products
www.fibronproducts.com
(800) 516-0285
Ramping materials

Guldmann
www.guldmann.net
(800) 664-8834
Manufacturer of ceiling lifts and the Stepless Excellent Ramp System

Horcher Lifting Systems
www.horcherusa.com
(866) 378-3316
Manufacturer of Barrier Free lifts

Liko
www.liko.com
(888) 545-6671
Ceiling lifts

Lindustries
www.arcat.com
(781) 237-8177
Manufacturer of Leveron doorknobs

Maddak Ableware
www.maddak.com
(973) 628-7600
Devices for dressing, bathing, grooming

Open Sesame
www.opensesamedoor.com
(800) 673-6911 or (510) 638-0770
Wheelchair-mounted door opener

Rand-Scot
www.rand-scot.com
(800) 467-7967
EasyPivot lifts

Roll-a-Ramp
www.rollaramp.com
(866) 883-4722
Portable ramp system

SureHands Lift & Care Systems
www.surehands.com
(800) 724-5305
Ceiling lifts

WingIts
www.wingits.com
(877) 894-6448
Fastening system for grab bars no blocking or studs needed

Funding Information

Low Income
Government assistance for home modifications may be found through:
Your states Medicaid waiver program, vocational rehabilitation agency, or health and family services department
Veterans Administration

National Resource Center on Supportive Housing and Home Modification
www.homemods.org
(213) 740-1364 (Los Angeles)

Rebuilding Together
www.rebuildingtogether.org
(800) 4-REHAB9
A volunteer-based organization that helps low-income people with home repairs and accessibility modifications

Tax Breaks
Accessibility remodeling costs may be deducted as medical expenses, or as "impairment-related work expenses." See "Take It All Off," Quest, March-April 2004, and IRS Publication 502, "Medical and Dental Expenses."

U.S. Department of Housing and Urban Development
www.hud.gov
(800) 569-4287

Information on reverse mortgages www.hud.gov/offices/hsg/sfh/hecm/rmtopten.aspx

Home loan financing for accessibility modifications is available through the Section 203(k) mortgage program www.hud.gov/offices/hsg/sfh/203k/203kabou.aspx