Adaptation of living space

The first step towards eliminating structural barriers for persons with SCI is an on-site evaluation of the living space. This means that the needs of this person are determined precisely, the available building structure is evaluated, and initial suggestions for adaptations are discussed. Normally these discussions take place together with the advised person, his/her family, possibly representatives of the housing administration, occupational therapist as well as specialists from architecture and assistive equipment consulting.

On-site evaluation of living space

Individual adaptations

Each living space is different regarding the environment as well as the individual needs. A rental apartment may hold completely different solutions than a condominium or a single family home. Also social criteria play a big role: a young and single male with walking impediment has different priorities than a mother with a complete paraplegia and small children.

Aside from the available building structure, which must be considered when making adaptations to the living space, are therefore personal and disability-related aspects of the resident, e.g.:

• What is the degree of independence? Which activities will the resident really be able to perform independently?
• Do they live alone or with family?
• What are their tasks within the family (e.g. housekeeping, profession)?
• For how long will he stay in this apartment?
• Should the apartment also be suitable for old age?

These questions result in a variety of different requirements for the adaptation of living space. It is therefore important to have a detailed knowledge of the situation for the future resident. He and all necessary experts have to be involved early on in order to define the correct structural measurements. This equals the approach of a comprehensive planning and building process.

Planning and cost determination

After the on-site evaluation of the living space, the current situation and the discussed suggestions for the adaptation by the consultant for barrier-free building are written down in a protocol and documented in blueprints if necessary. In case of rental apartments, it is mandatory to get the home improvements approved by the property management or the owner.

The following step is most essential: the required costs for structural adaptations are determined with the help of bids. The work that needs to be done is discussed with the respective companies on-site. Through the offers, a detailed cost estimate is prepared. It is important that the disability-related costs (for simple and appropriate adaptations are separated from other costs (for additional requests) since in Switzerland only disability-related costs are covered by the disability insurance. This offers the clients a basis for any decision regarding the financing options for the planned home adaptations.

Frequent home adaptations

Depending on the initial situation, the following necessary adaptations may include (the list is not conclusive):

• Differences in height
• Removing door steps or installing fixed or mobile ramps
• Installing wheelchair accessible ramps, lifting platforms, ceiling lifts, stair lifts or elevators for overcoming bigger differences in height

Indoor stair lift

Outdoor stair lift

Openings

• Enlarging or exchanging doors
• Adapting types of openings or fittings
• Automating doors, windows and shutters

Kitchen

• Adapting the kitchen combination (legroom underneath furniture, accessibility)
• Adapting devices and faucets (usability)
• Adapting furniture (work surface)

Height-adjustable kitchen

Bathrooms and toilets

• Adapting bathrooms, showers and washrooms
• Replacing sanitary appliances
• Enlarging manoeuvring areas
• Installing barrier-free showers, bath lifts, ceiling lifts and height-adjustable appliances
• Mounting of holding rods and supplementary handles
• Applying various other aids (e.g. flip-up seat in the shower)

Sink with leg room

Other rooms

• Adaptation of the moving surfaces
• Changes in furniture
• Installing ceiling lifts
• Improving accessibility and handling of the wardrobes

Adapting parking spots and garages

Ceiling lift

Electrical installation

• Adaptation of switches, power plugs, power box as well as control panels for a better operability

Smart home

• Installation of electrical systems (environment control with "James" control device, tablet etc.) for controlling and remote-controlling of structural elements such as lighting, elevator, fittings, doors, intercom system but also of electrical devices such as TV, radio, computer etc.

Floor coverings

• Adapting or replacing coverings that are too soft, too uneven, or not anti-skidding

Verification of financing

A living space adaptation cannot be realized without the necessary financial means. In order to get the financing for a wheelchair-accessible adaptation, some specialized rehabilitation clinics offer financial means-testing. Occupational therapists of the clinic forward the list of disability-related costs with a written statement about the living space adaptation as well as a protocol about the financial verification to the insurance in charge. Persons affected who were not rehabilitated at a rehabilitation clinic are themselves responsible for getting their financial means tested and submitting their application to the insurance. For persons who are not able to do so, disability organizations offer support with the financial means-testing and could possibly offer financial support.

Depending on the insurance, a longer period of time may pass until a final decision is made. Therefore if an adaptation of living space is urgent (e.g., for persons with SCI who return home after first rehabilitation), the construction costs need to be pre-financed by either disability organizations, foundations or the affected persons themselves. This allows for the adaptations to be realized and the craftsmen be paid on time. After confirmation by the insurance, the expenses will certainly be reimbursed.

If an affected person is not eligible for coverage by the insurance, other financing options are investigated with the help of social counseling or disability organizations.

Center for Obstacle-free Building in Switzerland

Like any construction project, disability-related adaptations of living space for persons with SCI have to be planned and realized carefully. It is therefore highly recommended to involve architects, construction managers and contractors who are familiar with this topic. In Switzerland, the Centre for Obstacle-free Building of the Swiss Paraplegics Association (SPV) offers comprehensive advice and support with respect to all questions regarding the adaptation of living space. Further information can be found here:

• Swiss Paraplegics Association, Centre for Obstacle-free Building, CH-5037 Muhen; URL: http://www.spv.ch/en/what_we_do/center_for_obstacle-free_building/
• Manual "Hindernisfreies Bauen", Swiss Paraplegics Foundation (Hrsg.), ISBN 3-033-00378-8, CHF 50.00 (available in German and French); German URL: https://www.spv.ch/de/publikationen/handbuch_hindernisfreies_bauen/; French URL: https://www.spv.ch/fr/publications/le_manuel_construire_sans_obstacles/
• Download free of charge "Mindestanforderungen" from the manual "Hindernisfreies Bauen" (available in German and French); German URL: http://www.spv.ch/__/frontend/handler/document.php?id=756&type=42; French URL: http://www.spv.ch/__/frontend/handler/document.php?id=758&type=42

About the author:

• Felix Schärer has a degree in architecture and became the divisional director for the Centre of Obstacle-free Building at Swiss Paraplegics Association (SPV) in 2005.