Beyond the Equipment: When to Call an Access Specialist

Dear Jane, I am an occupational therapist and have a patient I have been seeing who has multiple sclerosis. I […]

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Dear Jane,

I am an occupational therapist and have a patient I have been seeing who has multiple sclerosis. I have been to his home and done training with bathroom safety products for increased independence and safety using a manual wheelchair which is his main means of mobility. He is able to take a few steps when he transfers but his fatigue also impacts his functioning. At what point in this process should I refer him to an accessibility specialist to resolve access issues that a piece of equipment can not address?
Cindy Gackle
U of MN Medical Center

Fairview Outpatient Occupational Therapy, Mpls, MN

Dear Cindy,

An accessibility specialist should be contacted at the point you know the disability is permanent or the condition is diagnosed as progressing towards home access needs in the future. This is the same if they have a progressive disease such as multiple sclerosis, or a permanent injury such as a spinal cord injury.

There are three ways to resolve access and safety issues within a home. The first is to teach an alternate way to work within the existing environment (e.g., how to approach and transfer onto the toilet in a different manner); the second is to install or add a product to the equation (e.g., install grab bars or a plastic riser toilet seat); and the third is to “permanently” modify the environment (e.g., relocate the toilet and/or modify walls).

Often times we are called by individuals who are in a “panic” trying to make decisions because a loved one is due to be discharged or the need for home access modifications is immediate. Although the tendency is to wait to make arrangements the time the modification is needed, it’s best to allow as much time as possible to enable good decision making, eliminate unnecessary stress, foster collaboration between therapists and designers/access specialists, and allow time for ALL potential access solutions to be explored.

With a simple home evaluation (1 to 2 hour walk-through), major access issues can be addressed, decisions to renovate or relocate can be discussed, and a course of action and timeline established . . . essentially “fires” can be put out. The unknown is often- times the “elephant in the room” that nobody wants to talk about, yet is assumed bigger than what it is.

Remember, even the simplest modifications require some time to coordinate, design, obtain contractor bids, and then select a contractor, purchase building materials and coordinate financing. The project timeline from evaluation to project completion can vary from a few weeks to more than a year, depending on the involvement of modifications and the level of planning/design. A realistic time for most bathroom and kitchen projects is 3-6 months.

As a therapist, you are one of the first individuals who will be able to determine if a patient is going to need assistance with home access, whether now or in the future. By suggesting they contact an accessibility specialist to review their home at the same time you, the occupational therapist, are addressing home healthcare and access products, you can help them take the unknown out of the equation. Thus, allowing them to be informed regarding all their options and associated costs. Often times when trying to accept a disability, individuals are trying to process a lot of information. Their home is just one of the many issues they need to address, but one that can truly impact their independence and outlook on life.

Do you have a question for Jane and Accessibility Design? We’ll cover all of your questions in future issues of Home Access Answers. Please contact us: 952-925-0301,, [email protected].

Jane Hampton, president of Accessibility Design, founded the company in 1992 to enhance lives through design and project management. They provide design, consultation, project management, and product recommendation services specializing in home access for individuals with disabilities at all stages of life.

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