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Renovation Survival Guide


doi: 10.1097/01.NNN.0000316780.34276.19
Department: Penny Wise

How to modify a home for disability, without cutting corners—or getting an ulcer.

Adapting a home for someone with a neurological disorder can be a challenge. Here's how to do it right.

Kurt Samson is a health and business writer whose work has appeared in Entrepreneur and Opportunity magazines.

For more information on home modification, see RESOURCE CENTRAL on page 37.



You paid a hefty first installment on your renovations, but you've been without a kitchen for a month. Meanwhile the contractor breezes in for a few hours in the afternoon. Welcome to Home Improvement Hell!

Adapting a home for someone with a newly diagnosed neurological disorder doesn't have to be a nightmare. Many of the common pitfalls can be avoided with a little foresight and homework.

For starters, there's no shortage of free information and organizations whose sole mission is to make sure the job gets done right the first time. Whether it's installing a wheelchair ramp, enlarging a shower, or widening doorways, there are dozens of sources with planning information and funding assistance for disability-related renovations—even hands-on help with remodeling.

Randy Stow, a Houston-based professional renovator, has a personal stake in helping people with neurological disabilities understand how to plan projects and hire reliable contractors.

“Remodeling for people with disabilities became a reality when my mother was diagnosed with multiple sclerosis,” Stow says. “My mother went from walking, with some signs of fatigue, to being wheelchair bound and needing constant assistance in the span of about five years.”

Stow discovered that different renovations were required as her illness progressed.

“I did the more obvious changes around the house, but found many areas where my experience was lacking as the disease progressed. It would have been much more cost effective if I had taken the long view from the start, but what I learned led me to specialize in this type of remodeling.”

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Although there is no certification program for contractors specializing in disability modifications, the same industry certification standards for specialists in renovations for aging homeowners apply to most neurological disorders, Stow says. The National Association of Home Builders (NAHB) offers contractors certification in its “Certified Aging in Place Specialists” (CAPS) program, and Stow highly recommends using only CAPS-certified contractors. A list of CAPS contractors is available from the NAHB. (See Resource Central, page 37.)

But a CAPS certificate doesn't guarantee a contractor has the right experience.

“Because of the huge demand for renovations as the population ages, many contractors have gotten that certification simply to get a piece of the market. They advertise they're CAPS certified, but you need to look more carefully at their qualifications,” Stow says.

Stow recommends carefully reviewing the references submitted by potential contractors to make sure they have done jobs for clients with special needs recently, not years before. And always get a professional home evaluation by an experienced disability renovator before hiring anyone.

“We look at the patient's condition and the dynamic in the home—the spouse or caregiver's health, medication status, and other factors associated with the illness, rather than the floor plan,” Stow explains.

Planning for the future requires accepting one's condition, which can be emotionally difficult. “I've found that people tend to be in denial about the disease progression, either their own or their loved one's. If they have Parkinson's disease, for instance, they know what needs to be done in the short-term, but a professional home analysis puts things in a clearer long-term perspective,” Stow says, “and you only want to renovate once.”

This is also important when renovating a home for a child with a neurological disease such as cerebral palsy or muscular dystrophy, where their needs will change as they grow.

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On his first visit, Stow typically spends a couple of hours with the family member and the caretaker, assessing their needs, taking pictures, and collecting information about the home. He considers the client's mobility status; whether he has limited or full-time assistance; he has physical strength and vision—whether or not the client can see well and if lighting is an important issue; and what emergency exits are available or can be added or modified.

“If they are asleep and the smoke detector goes off, we need to make sure they have access to the quickest route out of the house.”

Once this information is collected, he can better determine what changes will be possible within the client's budget and whether there is any financial help available to offset the cost. For example, a ramp may cost around $2,000 and an accessible tub or roll-in shower around $6,000, but larger projects can be much more expensive. Fortunately, there are many local, state, and federal sources of funding available, as well as civic organizations that will often do the work for free.

And though it is best to “only renovate once,” Stow says many larger projects can be completed in stages. What's important is having an “accurate and realistic” evaluation of all the changes that will be needed. “Some modifications may be necessary immediately, while others can wait. It may be more affordable to make the home modifications in a progression of stages.”

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With all the scam artists out there, finding a reliable contractor sounds daunting. There are companies and individuals like Stow who specialize in disability remodeling, and most advertise this. Many hospitals have a list of contractors they recommend when patients are discharged with special needs, and the same holds true for nursing homes and home health care services.

If your budget is really tight, try calling your local high school or vacation school that teaches carpentry or home remodeling. Sometimes they will do projects for the cost of materials. Check with social services and civic organizations in your area, many of which offer help.

Above all, says Stow, try to hire a contractor who takes a personal interest in the welfare of the patient and the home dynamic when they first visit for an estimate.

“Find someone who is really interested, not just someone with a cookie cutter, one-size-fits-all approach,” says Stow. “You've really got to have a heart to do this kind of remodeling—you have to appreciate the courage these people have in facing their day-to-day challenges. And then do everything you can to lessen their burden.”

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  • ✓See at least two prospective contractors, ideally with CAPS certification from the National Association of Home Builders.
  • ✓Make sure the contractor is either licensed or registered in their state.
  • ✓Don't hire anyone who doesn't submit a plan drawing and a detailed bid.
  • ✓Get recent referrals, even if a contractor's name was selected from a screened list, and talk to all references. See if any of the remodeling projects were similar to your own.
  • ✓Get several competitive bids in writing. Never accept a verbal agreement.
  • ✓Never pay the full cost in advance and only agree to pay a reasonable down payment.
  • ✓Get a written and signed project timeline.
  • ✓Avoid “special” deals or offers from itinerant work crews.
  • ✓Always take pictures before, during, and after construction.
  • ✓If a contractor fails to meet contract obligations, complain to the Better Business Bureau; the Department of Agriculture; Trade and Consumer Protection; local Building Inspector; local Home Improvement Council; and/or Builder's Association.
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