True home safety should take into account not only current functional level, but enhance independence as aging and disease processes continue to make independent living more difficult. Those things should be weighed along with the most cost-effective way to actually affect safety and ultimately independence in the home.
Check out before and afters of some of my recent projects.
AFTER
BEFORE
Bathroom
Remodel
Accessibility increases safety and decreases falls. The tub was removed and replaced with a barrier-free tiled shower surround. An elevated toilet was installed and grab bar placed at the proper height. This client was very tall so these modifications made a huge difference. New lighting always makes things better. Also not seen in this picture is the door. The in-swing door was removed and replaced with a barn door, which provides much more accessibility to the bathroom.
Toilets are often in narrow spaces and inaccessible. This space was encumbered by the door which hit against the tub. The grab bar was too far away and too high for the client to safely be able to use it to transfer onto the toilet. The toilet itself was too low. Unfortunately, the shelf behind the toilet, though necessary for storage at the time is a safety hazard, in this case for a client with a spinal cord injury and limited core / trunk control.
AFTER
BEFORE
Bathroom
Remodel
Accessibility provides independence. The door was removed, the entire tub was removed and the surround was replaced with tile and an in-floor drain installed. The wheelchair pictured allows the client to be able to transfer to it, wheel themselves into the bathroom, use the toilet and complete hygiene and then go straight into the barrier-free shower for bathing.
Tubs often restrict access and are significant fall risks unless properly modified, In this case, the tub does not allow the bathroom door to open all the way and impeded the client from being able to get her wheelchair into the bathroom to access both the toilet and the tub.
AFTER
BEFORE
Doorway Accessibility
Remodel
The bathroom door was too narrow to allow access to the bathroom. The decision was made to widen the door and remove the hallway closet to allow a barndoor to be installed to provide wider and easier access to the bathroom.
Accessibility provides opportunity. With the hallway closet removed, the bathroom door could be widened from 29 inches to 36 inches and provide full access to the bathroom. Not pictured, a small closet was built on the other side of this wall to store towels and toiletries with easier access to the client to promote her safety and independence.
AFTER
BEFORE
Bathroom
Remodel
Accessibility decreases dependence. The vanity was removed and replaced with a wall-mounted sink. A tilting mirror was installed to allow the client to see themself. The toilet was able to remain as a ShowerBuddy chair was recommended for bathing and toileting and allowing access for caregivers to complete bowel hygiene.
This client is dependent with all aspects of self care and the home, including the doorways did not allow the caregivers the space needed to provide care to the client. This modification required opening the bathroom, making the bedroom larger and making a new opening to the bathroom from the bedroom to allow privacy to the client since this was a shared bathroom off the living room.
AFTER
BEFORE
Bathroom
Remodel
Accessibility provides convenience. The vanity was placed at the appropriate height for the wheelchair to be able to roll under. The wheelchair pictured allows the client to be able to transfer to it, wheel themselves into the bathroom, use the toilet and complete hygiene and then go straight into the barrier-free shower for bathing and finish up at the sink and be able to see themselves in the mirror and easily access the sink and storage to the side.
This vanity does not allow access for the client in their wheelchair to be able to reach the sink and they cannot see themselves in the mirror in a seated position.
AFTER
BEFORE
Bathroom
Remodel
Accessibility provides independence. The shower enclosure was removed and a 1 inch step-in shower was installed due to slab concerns. A comfort height toilet was installed with a folding grab bar which would provide a stable surface for getting on and off the toilet but also a reliable hand hold for getting in and out of the shower. The spouse had a vanity they wanted to refinish and use in the bathroom with the sink on top.
Doorways frequently limit access to bathrooms, especially when client’s are using ambulatory devices like rolling walkers. In this case, the client could not get the walker through the 26 inch doorway and swing-clear hinges would not widen the door frame to make it accessible with corners on both sides of the frame. Likewise, the step in shower was unsafe and needed to be modified. Because the client was tall, the toilet needed to be replaced with a comfort height toilet but we did not have a way to install a grab bar for them to steady themselves while getting on and off the toilet.
