Section 3: Modifying Your Home, Farm or Ranch

Learning Objectives

1. Consider the benefits of assessing your home.
2. Use a simple checklist for assessing your home.
3. Be familiar with different modifications for your home.

Glen's Story

Glen, a wheat and soybean farmer from Southwestern Oklahoma had a stroke at the age of 64, which caused partial paralysis of his right arm and leg. While he could walk short distances with a cane and the assistance of a physical therapist at the hospital, he realized he was going to have to make some changes to his one-level home to be able to live there. He was amazed that some of the standard features of a home could become such large barriers. Suddenly things like a four-inch stoop became like Mount Everest. If he couldn’t get into his home, how was he going to get back to farming?

Home is Where the Heart Is

It was important that Glen regain control of moving safely around in his environment: the place that for many is considered “home.” A lot of memories dwell in homes, especially when the home has been in the family for generations. It seems true that homes reflect who we are, what we value, and what we do. Right down to the furnishings, family photos, and heirlooms decorating the home. A strong bond often develops with a home and the people living there. It’s a special feeling to have a sense of connection to home, farm/ranch, family, and community. Contemplating making changes to the home or perhaps even moving from the home can create stress and stir up emotions. Especially as the need to make tough choices become apparent.

Making changes are often hard, but sometimes making changes that foster independence, enjoyment of one’s home, and safety may increase quality of life in very positive ways. Everyone deserves to live where they can use all of the spaces within the home, get in and out freely, and feel safe. Unfortunately, sometimes a home just doesn’t work for us anymore and puts us at risk, or worse, makes us a prisoner because of structural barriers.

The Situation

In 2013, over 20,000 Americans die every year after accidents in their homes. A large number of these accidents are falls that occur within the home. Falls are the leading cause of injury, disability, nursing home placement, and death in adults over the age of 65 years. Some of these accidents could have been prevented by making changes in lifestyle, health behaviors, and making home safety modifications.

This section addresses the types of modifications that can promote a safe and healthy environment for you and your family members to live in. Every home represents a different challenge depending on the structure, materials, and layout. You will find resources that can help with problem-solving and planning for changes.

Common Problems in a Rural Home

There are numerous farmers or ranchers with disabilities who would benefit from having modifications made to their homes. Most of the houses in rural areas are made up of older homes. Some old houses are multi-story, have basements, narrow doorways, and very small bathrooms. Try to look beyond the “home” to see the house underneath. Look at how the house is built, the layout, and objectively consider whether it is meeting your needs to “be in place.”

Look at Your Home Critically

There are several parts of your home that need to be looked at when deciding if your home can accommodate your disability. The following section will go in-depth for what you need to look at to make that decision.

Approach: You might spot several potential hazards as you approach your house. The approach is usually the space between where you get out of your vehicle and the front door. Start with the surface you have to walk or wheel on. Is it sandy, muddy, graveled, or paved?
Is the surface even or full of potholes?

Are sidewalks too narrow or buckling from tree roots? Usually maintenance or repairs can improve the approach to the home to remove trip hazards or physical barriers. Make sure to consider how the approach changes depending on weather. For example, homes that face north are notorious for being icy in winter because they lie in the shadows during the day and don’t get enough solar action from the sun to melt ice or snow. A northern approach could make getting in and out difficult or freeze up equipment like stair lifts. Adding coverings over walkways and stairs may be a potential solution. Making sure steps are free of ice and snow, and using traction mats, are also good ideas.

Now move on to the front door area of the home. Does your house have stairs? Are there railings on each side of the stairs? How tall are the steps? What kind of lighting is available to guide you at night? Can you reach to change the bulb 

in the porch light? Is everything in good repair? If you have to wheel up to the home, then stairs and thresholds of doors are going to be a barrier. A sturdy ramp may be needed. A general rule of thumb is: for every inch of rise, there needs to be one foot of ramp. So if the rise from ground level to the top of the stairway is 12 inches, there will need to be 12 feet of ramp. Thresholds can often be replaced so they are flat, allowing you to wheel in and out.

If you are walking up steps that are steep and it is difficult or painful, you may want to consider having new stairs built and installed. It will be easier to walk up a six-inch step than an eight-inch step.

You may have noticed around town that newly constructed public buildings have shorter six-inch steps, railings on both sides, a slightly deeper stair tread that allows your full foot to step, and a bullnose edge on each step to minimize catching your toe. These are features that make climbing steps easier and safer. Sometimes there will even be non-slip treads on the stairs. These are ideas that you might want to use if deciding to re-design the entrance to your home.

Home Interior: Once inside your home, take a look at the floor surfaces. There may be several potential hazards to the layout and flooring of your house. Think about whether there are slippery surfaces, uneven carpeting or flooring, or carpeting or linoleum torn in places. Are there clear pathways through the home or is there too much clutter? How about lighting? Do you have a good balance of overhead lighting, task lighting by your comfortable chair, and lighting in hallways? Can you reach the light switches on walls and turn the switches on lamps? Can you reach wall outlets for plugging in appliances? If you answered “no” to any of these questions, you may want to make some changes: repair flooring or replace carpeting for something easier to wheel on, remove clutter, clear pathways, increase lighting, and install adapted knobs on lamps if switches are hard to turn.

Bathroom: Let’s move on to the bathroom. There may be several potential hazards in this room that can be taken care of on a small budget. Swing-away door hinges (also known as two-inch offset hinges) can enable precious width to a narrow door, just enough to allow a standard wheelchair or walker. These hinges are available at most home improvement stores. Non-slip strips can be added to the bottom of tubs to decrease the chance of slipping, and grab bars can be put in the areas of the tub, shower, or toilet area where you need them. Bath rugs near the tub, toilet, or sink need to have non-slip rubber on the bottom or even consider permanently removing.

If fatigue or balance is an issue, a proper bath chair or bench will allow sitting down while bathing. A long shower hose is a great addition to the bathing area, as well as long handled sponges to increase reaching feet and back. Lastly, properly venting the bathroom can improve room temperature and removal of humidity that makes surfaces slippery and the air chilly. Many home improvement stores now carry a line of bathroom safety products that can be installed by a family member with common tools.

More extensive remodels to the bathroom can be a deal breaker when it comes to making reasonable modifications. The bathroom may have the narrowest doorways in the house or be too small for a wheelchair to turn around. Inaccessible bathrooms will often force an unwanted living change to occur if the room cannot be remodeled for access in a reasonable way and with a modest budget. Many people living in homes who hope to grow old there can start early to make bathrooms accessible for wheelchairs or walkers, as well as more usable to the aging body. In general, an accessible bathroom should have a 36-inch wide doorway, enough space to turn 360 degrees in a standard wheelchair, a large walk-in shower or walk-in tub, a higher commode, grab bars, and sinks that can be wheeled underneath. Such a bathroom may require stealing space from other parts of the house, or bumping out the floor plan with a new structure. These are the kinds of renovations that require skilled and licensed carpentry, plumbing, and electrical contractors. We will talk about how to find skilled services later in this section.

Interior Stairs: There may be several potential hazards with the stairs in your house. Are there sturdy railings on either side of the stairs? Are the steps too steep for climbing? Are the treads too narrow? Is there poor lighting in the stairwell? If improving the safety around the stairway is not enough to assist you in getting up/down stairs, it may be possible to have a stair lift installed. If space is available and plumbing feasible, moving laundry facilities out of a basement is a good idea.

Bedrooms: Survey your bedroom and remove any trip hazards created by electrical cords, throw rugs, or comforters and quilts that are too large for the bed. Many individuals fall because they trip on a piece of bedding draped on the floor or over an extension cord. Also remember, the cords’ rating should match the appliance or fixture it is powering. Repair the flooring if needed and remove carpet if you wheel for mobility. If you need throw rugs, make sure they are secured to the floor with carpet tape. Think about reconfiguring the closets so that clothing and items can be reached easily. Adjust the height of the bed if it is too high or low. Bed risers are available at many bed and bath stores or a low- profile mattress can replace a tall mattress if the bed needs to be lowered. Half rails are frequently available to assist with coming to a sitting position or turning in bed. Again, consider adding more lighting if needed.

Kitchen: Does the kitchen have enough space for moving around? Can you get into the refrigerator and operate the stove and oven? Can you get into the cupboards and pantry? Is there a sturdy chair you can sit on while doing food prep? Can you turn on the faucets and reach the bottom of the sink? Many changes can be made to increase safety and ease in using the kitchen. Big grip kitchen knives and cooking utensils make gripping easier for someone with arthritis or weak grasp. Changing to a lever faucet and shallower sink makes rinsing and washing dishes easier for someone in a wheelchair. Exchanging a gas stove for an electric stove reduces risk of fire. Having a small handheld ABC extinguisher is essential to have in the kitchen. Be sure to familiarize yourself on how to use it. Lowering cabinets or rearranging how food goods are stored in the refrigerator may make it possible for someone to reach from a wheelchair with less effort.

Do I Have to Follow the ADA?

The Americans with Disabilities Act of 1990 (ADA) established guidelines for wheelchair users and individuals with disabilities in the community for public access. ADA guidelines are designed to meet the needs of the majority of users, no matter their ability or disability level. Although it does not specifically apply to residential homes, it can be useful to keep the ADA guidelines in mind when modifying homes for an individual’s need. However, following the ADA is not required.

Most Commonly Needed Modifications

• Ramps
• Bathroom grab bars near the toilet and in the shower or the tub
• Railings on both sides of a stairway
• Widening of door frames for greater access to common areas such as bathrooms, kitchens, and bedrooms
• Repair and removal of structural barriers such as inadequate flooring, uneven transitions between flooring surface, and other non-structural barriers such as furniture

Most Common Structural Issues and Barriers to Meeting Accessibility Guidelines

• Limited floor space.
• Limited wall space for installing grab bars.
• No wall stud where one is needed (example: grab bars).
• Unknown barriers within walls.
• Financial limitations.

Hiring a Contractor

Some modifications should be made by a skilled contractor. You need to be careful and do research before hiring a contractor.

• First, get a prescription of medical necessity or a recommendation from a doctor or occupational therapist describing what modifications you need. You may be able to reduce some of the expense on your taxes.
• Find an established local contractor.
• Make sure that the contractor has insurance and is licensed to do the work required. Ask for verification.
• Ask yourself: Does your contractor have experience with disability retrofits? Does your contractor have design certification? (Universal Design Certified Re-modeler)
• Do they have references? Contractors with a good reputation can generally be counted on to do a good job.
• Comparisons: Get three bids and use the same language when explaining the type of work needed. (i.e. ramps, lifts, etc.)
• Ask if your contractor offers discounts or will work on a sliding scale basis.
• Make sure the contractor can stay within your budget. Get the quote in writing and be sure it spells out any change order costs.
• Ask for a written agreement that includes only a small down payment and specifies exactly what work will be done and how much it will cost (with the balance of payment to be made when the job is finished). Never pay all the money up front!
• Check with your local Better Business and Chamber of Commerce to see if any complaints have been filed against the contractor.
• Although ADA laws do not apply to private homeowners, be sure your contractor is well versed in them. This is especially true for instances where wheelchairs are involved.
• Does your contractor know the ADA specifications for turning radius in bathrooms and elsewhere?

What Should Contract Bids Include

• Specifics of your job, such as the brand name of supplies, type and quantity of materials to be installed, etc.
• Cleanup of debris and hazardous waste removal and safety clearance of the job site.
• Any warranties provided under the contract.
• Securing of any necessary building permits with your local city or town.
• Details should be outlined in the bid if the  contractor plans to use any sub-contractors.

Make sure your contractor has a Home Improvement License and liability insurance. Ask to see a copy of their workers’ compensation policy. Otherwise, you may be liable if a worker is injured on your property.

Be sure to ask questions for anything you don’t understand. Following these guidelines for hiring a contractor can help you avoid unnecessary frustration, expenses, or delays in construction.

Adapted from http://activeinhometherapy.com, used with permission.

Financial Resources for Home Modifications

While some home modification and repair programs charge for alterations, many programs provide services free of charge or at reduced rates for eligible older individuals. For more information about financial assistance, contact your local branch at the following offices:

• Farmers Home Administration: Various grants and loans are available for rural, low-income elders.
• Local Community Development Department: Many cities and towns use Community Development Block Grants to help citizens maintain and upgrade their homes.
• Local Housing/Energy Department: Two programs from the Low-Income Home Energy Assistance Program (LIHEAP) and the Weatherization Assistance Program (WAP) of the U.S. Department of Energy provide funds to weatherize the homes of low-income persons.
• Physician or Healthcare Provider: Funds from Medicare and Medicaid are available for durable medical equipment with a doctor’s prescription.
• Local Office on Aging: Funds from the Older Americans Act Title III often can be used to modify and repair qualified homes.
• Local Lenders and Banks: Some lenders offer Home Equity Conversion Mortgages (HECM’s) that allow homeowners to turn the value of their home into cash, without having to move or make regular loan payments.

Adapted from The Center of Excellence for Fall Prevention at: www.homemods.org

Oklahoma Home Modification Resources

Rural Housing Repair and Rehabilitation Loans

These loans are funded directly by the government and are available to qualified low-income, rural residents who own and occupy a house in need of repairs. Funds are available for repairs to improve or modernize a home or to remove health and safety hazards. This is a 1% loan that may be repaid over a 20-year period.
Purpose: The Very Low-Income Housing Repair program provides loans and grants to very low-income homeowners to repair, improve, or modernize their house or to remove health and safety hazards.

Eligibility: To obtain a loan, homeowner-occupants must be unable to obtain affordable credit elsewhere and have very low incomes (defined as below 50% of the area median income). They need to make repairs and improvements to make the house more safe and sanitary or to remove health and safety hazards. Grants are only available to homeowners who are 62 years old and older and cannot repay a Section 504 loan.

Terms: Loans of up to $20,000 and grants of up to $7,500 may be available. Loans are for up to 20 years at a 1% interest. A real estate mortgage and full title services are required for loans of $7,500 or more. Grants may be recaptured if the property is sold in less than three years. Grant funds may be used only to pay for repairs and improvements resulting in the removal of health and safety hazards. A grant/loan combination is made if the applicant can repay part of the cost. Loans and grants can be combined for up to $27,500 in assistance.

Standards: Repaired properties do not need to meet the U.S. Department of Agriculture (USDA) Housing and Community Facilities Program (HCFP) code requirements, but the installation of water and waste systems and related fixtures must meet local health department requirements. Water supply and sewage disposal systems should meet HCFP requirements. Not all the health and safety hazards in a home must be removed with Section 504 funds, provided that major health and safety hazards are removed. All work must meet local codes and standards.

Approval: Rural Development should make a decision on a complete application within 30 to 60 days after receipt.

Contact Information:

Central Oklahoma
100 USDA, Ste. 108, Stillwater, OK
(405) 742-1000
201 N. Sandy Ln., Ste. B, Chandler, OK
(405) 258-1405

Central Oklahoma
100 USDA, Ste. 108, Stillwater, OK
(405) 742-1000
201 N. Sandy Ln., Ste. B, Chandler, OK
(405) 258-1405

Northwest Oklahoma
300 Oklahoma Ave. Ste. 100, Woodward,OK
(580) 256-3375
1216 W. Willow Rd. Ste. B, Enid, OK
(580) 237-4321

Southwest Oklahoma
800 W. 11th St., Hobart, OK
(580) 726-3347
3901 W. Beech, Duncan, OK
(580) 255-7676

Northeast Oklahoma
3001 Azalea Park Dr., Ste. 3, Muskogee,OK
(918) 682-8831
235 W. Hope Ave., Vinita,OK
(918) 256-7863

Southeast Oklahoma
1328 Cradduck Rd., Ada, OK
(580) 332-3070
102 W. Ruth Ave., Atoka, OK
(580) 889-2554

Website: http://www.rurdev.usda.gov/

Oklahoma ABLE Tech Bank Loans

Oklahoma ABLE Tech bank loans help individuals with disabilities obtain needed assistive technology devices and services to help them live, work, and learn independently. Loans can help individuals finance home modifications and purchase other assistive technology.

Unsecured loan terms:

• 6% interest rate
• Repayment term of 3 years
• Borrowed funds paid directly to the vendor
• Documentation fees apply

Secured loan terms (with collateral or guaranty*):

• 5% interest rate
• Repayment term of 5 years
• Vendor payment and documentation fees apply

*Guaranty loan with flexible underwriting guidelines is available for applicants who don’t meet unsecured loan criteria due to credit/income inssues from disability-related expenses.

For more information or to download your application, visit Oklahoma ABLE Tech:
www.okabletech.okstate.edu

Durable Medical Equipment Reuse Programs

Oklahoma ABLE Tech’s Durable Medical Equipment Reuse Program

OK ABLE Tech and the Oklahoma Health Care Authority (OHCA) partner to provide the Oklahoma Durable Medical Equipment Reuse Program (OKDMERP).

The program is designed to reuse valuable durable medical equipment (DME) that is no longer needed, and reassign it to Oklahoma residents in need.

Program highlights include:  

• Retrieve donated equipment.
• Sanitize and refurbish devices returning DME to peak performance.
• DME vendors repair equipment if needed to ensure quality.
• Reassign DME to the best matched eligible client and deliver it free of charge.

Who can benefit? Pickup and delivery services are limited to central Oklahoma residents. Any Oklahoma resident can drop off or pickup equipment at the OKDMERP office in Oklahoma City.

Types of DME offered include:

• CPAPs
• Blood pressure monitors
• Gait trainers  
• Knee walkers
• Nebulizers
• Quad canes
• Shower chairs
• Walkers
• Bath benches
• Commodes
• Hospital beds (electric and semi-electric)
• Patient lifts
• Scooters
• Standers
• Wheelchairs (manual and power)

How do I apply for the program? An application is required to begin the process for matching equipment with an eligible central Oklahoma resident.

Contact:
3325 N. Lincoln Blvd., Oklahoma City, OK
Phone: (405) 523-4810
Website: http://okabletech.okstate.edu

Oklahoma Equipment Exchange

The Oklahoma Equipment Exchange is manged by Oklahoma ABLE Tech. The goal is to put equipment that is not currently being used into the hands of someone who can benefit. The Equipment Exchange is primarily for Oklahomans, although they do accept entries from neighboring states. The program is designed to facilitate equipment exchange between individuals and is not for the use of vendors or distributors.

Types of equipment include:

• Computers and related
• Daily living
• Environmental adaptations
• Hearing
• Learning, cognitive, and developmental
• Mobility, seating, and positioning
• Recreation, sports, and leisure
• Speech communication
• Vehicle transportation
• Vision

Visit their website: http://oec.okstate.edu