Color & Control:

Accessibility and Inclusion Matter

Today, millions of Canadians worry about decreased mobility, vision and hearing not to mention frailty and the impact new limitations might have on their lives. So concluded a recent study by the Angus Reid Institute in partnership with the Rick Hansen Foundation.  Indeed 2 out of 3 people surveyed expressed concern that someone in their life will face an accessibility issue.

It’s time to change our national mindset. As I see it we need a bit of a reality check in order to make our lives safer, more comfortable and more convenient. Firstly, there’s a huge disconnect between what each of us is worrying about and what we’re prepared to do about a) prevention b) solutions for our daily lives and our futures c) finding opportunities to make things universally better for all

My friend’s daughter just renovated her house with the goal of having a basement apartment for her mother. Surprisingly she had thought nothing of accessibility when I asked her about her “forever plans” to keep her mother with her.

The supermarket down the street is less than accessible and their customer service doesn’t meet my needs now, leave alone in a few years. When I’m ready I plan to shop at a store that offers delivery, carry out to my car, personal shopping and cashiers, not machines who will help me check out.  Heads up to Mr. Weston and co.

Languages and business owners
Then there also rivers, lakes and oceans to cross between the “disability community and the aging crowd” that need to be bridged. The language and labels we continue to use are creating their own set of barriers; misunderstanding and they’re slowing down our ability to share knowledge, ideas and experiences.

Few seniors or their adult children use the word disability but, like it or not, it’s the word that human rights groups, legislators, advocacy groups and health professionals, educators and individuals themselves have used for decades.  It’s not a word I like, but its currently understandable and “actionable” across the board. When it comes to advocating for inclusion, accessibility and appropriate customer service whether it’s for an older adult that uses a walker, a child living with autism or a grandmother who has early onset dementia many of us have common needs.  And, to make the point, there’s nothing wrong with using it will pave the way.

Working together
And lastly, we need to stop tiptoeing amongst ourselves, if we want to get anything done on mass.  For years we’ve been talking about the senior tsunami, which conveniently lumps all older adults together: the fit, the frail, those living with ALS, Alzheimer’s, those who are zooming and those who are palliative.  In many circles they’re just old and whatever they’re living with is:  a) expected and inevitable b) quite possibly subject to of ageism, condescension.   Person centered care is nothing new folks. The prose maybe a little different but the disability community has been pushing down that road for year with talk of independent living and the, right to lifestyle choice rather than having decisions made for them. And, dare I say for instance that aging in place is a version of learning to live with a disability with the requisite support.

It’s all to say that building bridges between the “aging verticals” that we find ourselves in and the disability community just makes more sense. Let’s face it, people with disabilities have much of the knowledge, the experience, the tenacity and the patience to lead us into a better and more inclusive Canada. And, I’ll bet our retirement facilities and nursing homes would be that much better if they were running them.

Now back to our own situations
How many of us still live in houses and shop in stores that are not accessible? Are doors hard to open, shelves impossible to reach, stairs presenting barriers with no visible alternatives? And where’s the restaurant bathroom anyway?

Do we work for companies where customer service training doesn’t recognize the needs of people with disabilities or older adults? The need for ramps for wheelchair and walker users are just the tip of the iceberg, as by now you’ve likely started to notice as your situation changes.

You’re not the only ones
• One in four Canadians is now a family caregiver which clearly demonstrate that your family is not alone when it comes to needing support and assistance for physical and mental health related concerns. The numbers are quite staggering when you look at them all together:
• 1 in 5 of the Canadian population ages 15 or older or 6.2 million individuals have one or more disabilities. (Stats Canada –2017)
• 24% of Canadians have a mobility, vision or hearing disability or challenge (Angus Reid Institute –January 2019) – 1/3 of Aboriginal Canadians has a disability (CCCD)
• 47% has a relationship with someone who has a physical disability or challenge (Angus Reid Institute – January 2019)
• Every year 50,000 people have a stroke- that’s one every 10 minutes (March of Dimes)
• In any given year, 1 in 5 people in Canada will personally experience a mental health problem or illness. (CMHA)
• There are over half a million Canadians living with dementia – plus about 25,000 new cases diagnosed every year. (Alzheimer Society of Canada)
• One in 4 of Canadians is now a family caregiver (Stats Canada)
• Two-thirds of Canadian adults with disabilities lack one or more of the educational, workplace, aids, home modification or other supports they need

Changing our national mindset
A number of organizations, including the Canadian Abilities Foundation, The Rick Hansen Foundation, Canadian Council for Canadians with Disabilities and Canadian Associate or Retired Persons are working hard in their own ways to encourage a more inclusive and accessible country for everyone. It’s a Canada where anyone with a disability – children, youth, working-age adults, and seniors – has the necessary personal supports, aids and devices, medications and environmental accommodations and funds that make social, economic, cultural, and political citizenship to fully access and benefit from all that our country has to offer. It is vision for a Canada that’s the most accessible country anywhere.

Legislation without teeth
Change is needed in order for all of us to live comfortably and safely in our homes and communities.  But, large-scale change takes time. Federally with Bill C-81 the Accessible Canada Act, improving human rights polices and expanding the understanding of meaningful access has finally moved forward. Some provincial, politicians have passed accessibility legislation have made strides to pass implement standards that, if followed, would remove critical barriers. However, there is still no carrot, or stick to encourage best practice or enforcement and there are a lot of common misconceptions.

The Honourable David C Onley once reviewed the Accessibility for Ontarians with Disabilities Act, “the glacial pace of change over the past 14 years ” continues to leave residents with disabilities, and older adults facing daily soul-crushing barriers.

What we need to know
I’ve chosen to use some definitions that have been considered best practice in Ontario to help all of us understand some of the important terms that are being used in this space:

Accessibility: Accessibility refers to the design of products, devices, services, or environments for people who experience disabilities. Ontario has laws to improve accessibility for people with disabilities, including the Accessibility for Ontarians with Disabilities Act (AODA), the Ontario Human Rights Code, and the Ontario Building Code.

Legislation: AODA: The Accessibility for Ontarians with Disabilities Act (AODA)is an example it seeks to ensure that all Ontarians have fair and equitable access to programs and services and to improve opportunities for persons with disabilities. The Act address barriers in Customer Service; Information and Communication; Employment; Transportation; and the Design of Public Spaces.

Barrier: A barrier is a circumstance or obstacle that keeps people apart. For people with disabilities, barriers can take many forms including attitudinal, communication, physical, policy, programmatic, social, and transportation.

Disability: According to the human rights code, disability is a physical or mental condition that limits a person’s movements, senses, or activities.

IASR: There are five Standards included in the Integrated Accessibility Standards (IASR). These include the Customer Service Standard; Employment Standard; Information and Communication Standard; Design of Public Spaces Standard; the Transportation Standard as well as some general requirements.

BC: The Building Code Act is the legislative framework governing the construction, renovation and change-of-use of a building. The Ontario Building Code (OBC) is a regulation under the Act that establishes detailed technical and administrative requirements as well as minimum standards for building construction. The Act was amended on January 1, 2015 to include requirements that enhance accessibility in newly constructed buildings and existing buildings that are to be extensively renovated.

Standard: The Act operates by bringing accessibility standards into regulation. Accessibility standards are laws that individuals, government, businesses, nonprofits, and public sector organizations must follow in order to become more accessible. The accessibility standards contain timelines for the implementation of required measures and help organizations identify, remove, and prevent barriers in order to improve accessibility


Adapting Your Home

Imagine this scenario.  Your mum has been discharged from the hospital with a manual wheelchair, a bath seat, and toilet rails. However, she can’t get in and out of the front door, let alone the bathroom!   How do you make your home more accessible?  Depending on your situation, there is a range of no-cost and low-cost solutions, as well as more expensive alternatives.

Start with the basics
If someone is using a wheelchair, living at home can be challenging.  Answer “yes” to three basic questions and you’ll be home free.
1) Can you get into the house using a wheelchair?
2) Can you get through the doorways?
2) Can you get into and manoeuvre within the bathroom?

If you answered “no” to any of these questions, please read on.  Simply put, you’ve got to consider your options.  Is it possible to move to a more accessible home?  Is it possible to renovate or remodel? To help you decide whether it’s better to remodel, move or build, think carefully about your loved one’s situation today and in the near future.

Go through this list together

Yes No Questions
Is their medical situation stable, or do you expect improvement or decline?


Will housing changes be required in the future if your parent’s abilities decline?


What are their goals for independent living and how can you help them achieve what they’d like
What housing modifications are needed? 1.___ 2. ____ 3. ____ 4.___


Will daily assistance be needed from a family member or outside caregiver? Does space need to be planned for helpers to work or live in the home?
Would it help to postpone housing decisions until a caregiving routine has been tried in the existing home?
What is the structural condition of the home? Is it safe?  Is it worth the investment?
Can modifications be made without destroying the architectural appearance or resale value of your home?
Does you parent have enough money or funding to live independently and safely?
Would a care home/facility be easier/safer/less expensive/offer better quality of life?


Be creative

Before you go all-out, hit the panic button, and call the mover or the contractor for additional remodelling, consider no-cost or low-cost ways to relocate activities.

If your parent lives in a two-story or split-level house, activities for eating, sleeping, bathing, and living can be confined to one floor. If some of the household tasks your older used to do are no longer accessible, think about eliminating these tasks or having someone else do them. For example, other members of the household could get the mail, or do the laundry. Finally, less “stuff” means more space. A wheelchair or walker will take up more space to manoeuvre in the home. Large pieces of furniture may block access to rooms or make it difficult to get around. Rearrange furnishings and decrease clutter and create straight, easy-to-follow “traffic lanes” will make things safer.

Relocate activities within the home: Two-story or split-level houses can be practical if you’re prepared for the elderly or frail person to relocate activities for eating, sleeping, bathing, and living on one floor.

Restructure tasks:  If some of the household tasks your elder used to do are no longer accessible, think about eliminating these tasks or having someone else do them.  For example, other members of the household could get the mail or do the laundry, and the elder could assume some of their responsibilities in turn.

Rearrange furnishings: Less “stuff” means more space. A wheelchair or walker will take up more space to manoeuvre in the home. Large pieces of furniture may block access to rooms or make it difficult to get around. Rearrange furnishings to create straight “traffic lanes.” Consider making modifications to their home to allow more independence and a greater sense of security. In reviewing home improvement projects to accomplish easier mobility, remember that everything should be done to meet building codes and regulations as well as to also keep in mind that there are a number of temporary or low-cost solutions. to fit the needs of the occupants, with an eye for accessibility, comfort and safety.
Entrance: Look to have at least one accessible entrance with no steps, or a suitable way to navigate around existing steps. A barrier-free entrance is one that will accommodate people in wheelchairs and walkers. To do this, a level or gently sloping pathway is needed, or ramp without steps. Wise advice: Get professional help, but there are some of the things that need to cross your “caregiving” radar:
•  Use portable ramps as a temporary solution.
• Build a more permanent ramp with no more than 1-inch rise for every 12 inches in length (check with ramp manufacturer for specific guidelines).
• Re-grade the site to make a ground level entrance without steps. Make sure this does not compromise the foundation by allowing water build-up against the house.
• Build a “bridge” to connect the house and yard on a sloping site.
• Think about unloading from the wheelchair lift in the van directly onto a deck, porch, or landing pad.
• Install a weather-resistant lift or elevator (or provide a protective structure over it).

Go wide! Doorways need at least a 32-inch clear opening to roll a wheelchair through a doorway under your own power. Here are some ways to make an existing doorway wider:
• Take the door off temporarily.
• Install swing-away hinges or change the swing of door to allow it to open wider.
• Remove woodwork from around door.
• Remodel to create a wider doorway.


Expert’s advice

If you decide to renovate relocate, think about finding a builder realtor or property manager who can help you locate to a condo or a flat or house that much better meets your current needs. Whether you decide to look for a new place, remodel or build your own home, this next section of the book will provide you with some practical guidelines.

Bedroom safety tips
Not surprisingly, falling out of bed or tripping over clothes or other bedroom obstacles in the dark is high on the list of unnecessary mishaps. Aside from getting help and getting a better night sleep these tips will give you new perspective on senior’s bedrooms.

Keep a charged flashlight handy in the bedroom. A mini flashlight within easy reach of the bed will help safely guide one to the bathroom or kitchen during the night.
• Non-slip mats and, if needed, grab bars or a transfer pole with an adjustable grip beside the bed.
• For increased comfort and safety, look into a special home care lift and tilt bed. It can be one of the best investments that you make.
• A small humidifier or air-filtration system can enhance nighttime breathing.
• Personal items such as a magnifier (to make reading easier), long-handled reachers, and specially designed dressing aids can be very convenient.
• Depending on the patient, side rails on both sides of the bed may increase safety and prevent accidents for “tossers and turners.” And avoid soiled beds.
• Use a night light and make sure bedside lamps are easily reachable and have easy-to-operate switches. Many falls occur when someone gets up in the night for a midnight snack or a trip to the bathroom.
• Use a firm mattress for added support. Even consider a specialty pressure relief mattress for someone who is spending considerable time in bed.

Hallways and lighting
• When it comes to lighting, you can’t have too much.
• Add rocker switches, which can be turned on and off using an elbow, in place of wall switches in hallways, near the bed and outside the bathroom.
• Line hallways and stairwells with motion-activated night-lights and install motion-sensitive lights to front and rear entryways.
• Also, light-coloured carpeting is easier to see, as are light-coloured handrails in stairways.
• Remove scatter rugs and end tables with ornaments.

21 ways to make a kitchen safer
In the morning, at mealtimes and during a midnight snack, the kitchen is often a hub of activity. Combine this action with electrical appliances, water and tiles, and there’s quite a potential for accidents. If the kitchen is used by an older family member living alone or at risk, you’d best do a pre-emptive safety check and stop accidents before they start by following these proactive steps to accident proofing the kitchen:

• Make appliances more accessible – by lowering or raising them to a height more suitable for the chef. For instance, by lowering a section of countertop and leaving the space beneath it clear, you can make it easier for a person who uses a walker or a wheelchair to use the counter as a work surface. Installing a dishwasher about 6 inches off the floor also makes it easier for everyone to load and unload.
• Add roll-out shelving – also called pull out racks or drawers, these can be added to kitchen cabinets.
• Turn pot handles away – from the edge of the stove, counter-top or table to avoid hot spills ad burns. And never leave cooking unattended. Purchase a simple timer and use it as a reminder.
• Kettles and toasters – look for easy use, automatic shut off features for more versatile and easy use.
• Keep the oven and stove top clean – residue grease and food can easily catch fire.
• Secure electrical cords – behind cupboards and appliances. Avoid extension cords because they are a tripping hazard and can overload circuits causing a fire hazard.
• Discourage older family members from wearing especially loose clothing – while cooking or working near the stove. You can buy special flame-resistant aprons from many cooking supply stores for extra safety.
• Set the hot water temperature – heater at 120 degrees to avoid unnecessary hot water burns.
• Don’t stack plates or dishes – in the fridge and keep frequently used items – like butter and milk – near the front.
• Respect the microwave – Check for non-metal items. Also, people are frequently burned because they don’t expect microwave heated items to present the same risk as items from the stove or oven.
• Watch for glasses – cans and mugs left near the edge of counters, tables and shelves. Place “everyday” dishes on lower shelves, especially if your loved one frequently uses the kitchen on their own. Remove any items that can break easily.
• Don’t leave sharp objects unattended – and load utensils “points down” into the dishwasher.
• Store sharp knives somewhere safe – or even out-of-reach of family members who may be easily confused.
• Move cleaning supplies – from below the kitchen sink to upper shelves or into the garage or workshop.
• Be sure to remove medications from the kitchen – confusion over dosages and timing may increase with visibility, and humidity can reduce effectiveness.
• Don’t use high gloss – (and slippery) floor waxes or finishes on the kitchen floor.
• Consider putting a non-slip mat – in front of the sink. Clean up spills quickly.
• Look for useful items like ‘reachers’ – designed to take light items down from higher shelves, and ‘grippers’ to help open tight jars or bottles.
• Keep a fire extinguisher – in the kitchen and learn how to use it. Add overhead sprinklers if needed.
• Install smoke detectors – Replace smoke detectors that are older than nine years, and check the batteries once a month.
• Buy a sturdy rubber stool – with rubber feet, and a long handled reacher. Discourage unnecessary climbing and reaching for out-of-the-way items.
• Post a list of emergency telephone numbers – on the fridge. In case of an accident, you need to be able to reach help fast!

The Living Room
As the social centre of the house, just being in the living room can help improve a loved one’s outlook and well-being.  Comfort is key, as well as safety and positioning:
• Attractive lift-chairs sometimes come with heat/massage options and have options to help the user stand up and sit down. Back rests and neck rolls make sitting more comfortable.
• Transfer poles set up beside the couch can also help make sitting/standing easier.
• Remove throw rugs and secure all other rugs with tacks or two-sided tape.
• Secure all telephone and cable cords, wires, etc.
• Mark transitions from one room surface to another (for example from a carpet to tiles) with coloured tape for increased visibility, especially if they are similar in colour.
• Consider volume levels when using electronics like radios, TVs, and computers to avoid discomfort and confusion from too much noise.

Remember that noise and activity can be overwhelming.  Plan activities but be mindful of sudden tiredness, confusion or extra noise that may be too much.  Also, be mindful that many seniors wear hearing aids which may amplify even normal background noise. Sometimes the comfort, peace and quiet of the living room is a welcome solace and simply a change of scenery for someone who is frail or unwell. At other times, a visit to the “active” part of the house can provide much needed stimulation and an opportunity to share in family activities.

Bathroom Safety
As a caregiver, the bathroom is my number one enemy. I’ve learned to cope by using some of the following tips regarding basic bathroom setup, tub and shower safety, toileting, and accessibility.
And before we start, a word to the wise: Never leave a frail family member alone in the bathroom — not even for a second – even for something as practical as fetching toilet paper or other supplies from a nearby closet.

Basic Bathroom Setup 101
• Grab bars or safety bars are important. Install a grab bar on the sidewall and another on the back of the shower or tub as well as next to the toilet. Both ends should be mounted to wall studs, and not merely screwed into drywall.
• Install lever-type faucets which require little pressure at the sink and tub or shower. Pre-set water heater thermostat controls to prevent scalding. Clearly mark hot and cold-water handles.
• Remove or adapt the door lock to prevent accidental locking and permit easy entry in case of emergency.
• Make sure that any cane or walker that might be used in the bathroom has a wide rubber tip, and that it’s kept dry.
• Ensure that the area is well lit
• Remove area rugs. If the bathroom is carpeted, make sure they are glued down.

Showers vs Baths
A stall shower may make all the difference in the world to someone who has no easy way to climb into a tub. It may cost a few dollars more, but adding a seat makes showering safer for older bathers. Non-skid rubber mats or self-adhesive strips on the bottom of the tub or shower stall reduce chances of slips and falls, as do rails and grab bars. If showering is too difficult, consider sponge baths instead of tub baths or showers and do bathing in the bedroom.

Hand held showers with flexible hoses make washing easier for both the elder and the caregiver. They easily attach to your existing shower arm, or can be attached with a diverter valve and used in conjunction with the existing shower head. They provide features including: Extra-long reinforced hoses and convenient wall-mounting brackets and on/off valve built into the handle to allow control of water flow.

• Bath and Shower Seats are available in blow-molded plastic for sturdier, safer seating or padded vinyl for added comfort; available with height adjustments and slip-resistant rubber feet. Keep rubber feet clean from oil or talc.
• Transfer Tub benches extend beyond the edge of the tub for non-ambulatory patients who have difficulty stepping over the side of the tub safely. Leg extensions are available to fit bath/shower seats and transfer benches to accommodate old-style bathtubs.
• Consider purchasing a bath chair or a bath lift for additional comfort and safety. You may also be able to use a commode as a shower chair in a pinch.

Toilet Tales
If being on the throne is no longer a simple matter, here are some helpful suggestions, depending on your requirements:
• Raise the toilet seat. A few extra inches of height may make sitting down safer especially for someone with a recent hip fracture or anyone who has difficulty getting up from a low seat.
• Consider adult diapers at night time or a bedside commode


What is a Bedside Commode?

People who have difficulty getting to the bathroom are helped by these bedside toilet facilities. A commode is a movable toilet which is usually placed on wheels. Basically, a chair with a toilet seat, they are made out of metal or plastic and equipped with a removable container under the toilet seat which can be cleaned after use. Generally, a commode can be rolled away when not in use and its wheels can be locked to prevent moving while it’s being used.

Anyone who is too weak to get to a bathroom, particularly those who are in bed most of the time, could benefit from a commode. A commode should also be considered for people who cannot use bedpans or in cases where transferring the person to a bathroom would be too difficult for the caregiver. Always ensure that the container is securely under the seat and be sure to lock the wheels before use.

Depending on the physical limitations of the patient, you can choose from a number of different models. For example:

Basic: with fixed arms: this is for people who can walk, stand, and sit down safely, but may have trouble accessing a bathroom because of stairs or distance.

Drop-Arm: this model is for non-walkers who need help sliding into the commode from a wheelchair or bed.

Over Toilet: in addition to bedside use, this model can also be placed over a regular bathroom toilet with the container removed.

Toileting risk assessment
When is a patient at risk for independent toileting?  Each case and level of care required is different.  Ask these questions:
• When seated, can your elder reach down to pick up objects from the floor without falling? Does the patient have satisfactory sitting balance, i.e. with one hand holding on for support
• Is your elder able to stand independently without holding onto any furniture or are they only able to stand with a walking aid or if there is something to hold on to?
• Is mum or dad able to walk independently or do they require a walking aid or helper?
• Can they get up and go – eat, dress, groom, dress, shower and toilet independently or do they use assistive devices (e.g., long handle brush) for certain tasks? Would he/she be able to stand and transfer to a bed-side commode chair or would standby supervision or help for feeding, grooming, dressing, showering and toileting be required?


More things to consider

Here are some additional issues that you may encounter in the bathroom, particularly when caring for someone with Alzheimer’s disease or a related condition:

Shortened Attention Span: People with cognition issues can forget they are sitting on the toilet and begin to stand up and leave or they can become distracted by the slightest noise and become startled or upset.
Refusal to Bathe: Resistance to bathing is one of the more frustrating behaviors that caregivers face.  A bathtub full of water can be terrifying. A person may be concerned about getting their hair or bandages wet or soap in their eyes. The water may appear too deep. Being forced to bathe against their will may prompt an attempt to escape or resist. Soft, protective edges on counters and corners, and using shower curtains (instead of shower doors) are all bathroom modifications which can minimize injury or avert a fall when agitation or frustration occurs.
Bath Mats: Try a coloured bath mat to make the bottom of the tub easier to see and the water appear shallower.  Face a person living with Alzheimer’s away from the visible exit and involve them in the showering process by installing a grab bar on the wall opposite the door and asking them to help by holding onto it with both hands.
Cues to finding the bathroom:  Pathways on the floor (made with colored electrical tape) or wall railings can guide and direct a person to the bathroom or back to their bedroom. Negative guides, or modifications to discourage going the wrong ways are also helpful. Consider putting up “Stop” signs on doors other than the one leading to the bathroom.  If the only room with a light on or open door is the bathroom, it could attract your loved one’s attention and guide them there.  Make the most important rooms stand out and the hardest to miss.  Try a bright, colored doorway.
Comfort: What makes a bathroom pleasant, comfy and homelike? Add soft and colourful towels, carpeting, curtains, shades, potpourri, pictures on the wall (framed with non-reflective plastic, not glass), colourful wallpaper borders, etc. Perhaps even a warm blanket in the closet would be welcome on those cold nights when sitting on the john may not be too pleasant.
Reduce Anxiety: Water rushing out of the faucet, the flushing toilet or the exhaust fan may cause too much noise and discomfort. Close the window, wait until later to flush the toilet and turn off the fan if your family member becomes agitated easily or resistant.

Accessible bathrooms 

Most important, make sure the wheelchair can get through the door. To accommodate a wheelchair, you will need a 60-inch diameter circle of manoeuvring space in the bathroom area so that the person will be able to reach fixtures. To achieve more usable floor space:
• Arrange for the door to swing out instead of into the bathroom.
• Replace the existing door with a folding door.
• Use a curtain for privacy instead of the door.
• Remove under sink cabinets to provide knee space.
• Change fixture locations to create more floor space.
• Replace the tub with an easy-to-access shower unit.
• Relocate toilet or shower to a corner of the bedroom.

Consider how you will transfer your family member from a wheelchair to a toilet, shower or tub. You’ll need room to move the chair close enough to the sink to wash your loved one or brush their teeth.

 Don’t overlook the threshold at the bathroom door. These small “bumps” are high enough to stop even the most modern wheelchair. Normally 3/4-inch high, they can be replaced with “handicapped” thresholds which are only 1/4-inch to 1/2-inch high and tapered. Add the thickness of the tile or carpeting, and you barely have a bump at all.
Clear space to the side of and in front the toilet. Transferring to and from a wheelchair can take place from in front of the toilet or from one side. Helping a family member stand from a sitting position requires plenty of space in front of the toilet. This allows room for the caregiver to grasp the person’s arms or hands and lean backward, lifting them up.
“Accessible” also means “close by.” A second-floor bathroom may require the caregiver to go up and down the stairs several times a day or it may simply be too far for your loved one to get to. Stairs can be a silent cause for incontinence — if you can’t get to the bathroom, you can’t use the bathroom!


The joy of stairlifts

While stairs can be barriers and hazardous, moving into a bungalow or limiting access to one floor of your home may not be options.  If you find yourself in this situation, you’ll probably want to look into installing some sort of stair lift or elevator.

When looking for a stair lift, you may find yourself confused by technical jargon and the wide range of models available. You should be able to get informed advice from an occupational therapist or other home care pro in your area. Read on for some basic info about what’s available and what you should consider when buying a lift. Here are three basic stairlift types:

1) Conventional stairlifts
This is the most common type of lift and it’s generally used by people who can walk, but who have trouble with stairs. Fixed to a straight or curved track, these lifts can usually be mounted on either side of the staircase. While most lifts come with a chair, there are models for people who prefer to stand or perch on the lift. Here are two options to think about:

• Folding armrests and footplates – Many lifts block off quite a bit of the stair area, so you may need to fold away footplates, armrests, and the seat while the lift is not being used. If you’re going to need to fold the footplates, make sure that this can be done safely and easily as it may need to be done several times each day and it can be a very tricky task!
• Swivel seats – When getting off the lift, the person using it needs to turn themselves around so that they’re facing away from the stairs. A swivel seat can make this much easier. Check for models that can be operated either manually or electrically depending on your needs.
• Wheelchair Access – Think about:
– How will the person get their wheelchair on and off of the lift?
– Is there enough room at the top and bottom of the stairs to get the wheelchair on the lift?
– Will you need two wheelchairs? One at the top and one at the bottom?
– Make sure there is enough room on the lift for the person, their wheelchair, and a helper if necessary?

2) Wheelchair platform lifts
These lifts, specially designed to handle wheelchairs, are often the most practical option for someone who needs to get up and down the stairs without leaving their wheelchair. If you’re considering this option, note that you may need to lower the area at the bottom of the stairs to provide level access for the wheelchair over the platform. Also make sure that there’s enough space at the top and the bottom of the stairs for wheelchair to turn around when the person’s getting off.  Think about how other people may be inconvenienced by the lift.

3) Vertical or through-floor lifts
Check out this option if there’s not enough room around the stairs for a regular lift or a wheelchair platform lift. This lift will carry the person from a place like the living room on the lower floor, up to a bedroom or landing.  The lift car can be either fully or partially enclosed and the lift can be constructed with or without a shaft depending on your needs. Do note that this option can be quite expensive as renovations are often required!

Family Considerations
In most cases, families are able to adjust quickly and easily to stair lift additions, however its vital that safety functions that lock or stop the lift in emergencies are working to protect in case of falls, pets or young children.

Think about space – Stairlifts run on tracks and generally take up quite a bit of room on the stairs. Be sure to ask sales representatives how much room the lift will take up on the stairs and whether any parts can be folded away easily to make more room.

Safety first – Stairlifts will stop if they encounter any object or person obstructing the stairs. Through-floor lifts and wheelchair platform lifts also have mechanisms to prevent anyone being crushed by them. Lifts also generally have guards to prevent fingers from moving parts.


Stairlift purchasing tips

Seek advice – Ask an occupational therapist to advise you on the best choice of lift for your home. When purchasing, be sure to ask as many questions as you need to about the lifts as installing a lift can have a significant impact on your home configuration and lifestyle.

Try before you buy – Purchasing and installing a lift can be a significant investment. Be sure to try out any model before buying to make sure that it suits your needs.

Ask for a home demonstration – A sales representative may be able to arrange a visit for you to someone’s home so that you can see first hand what a stairlift or through-floor lift is like. Take this opportunity if you have it!

Consider funding options – Lifts and structural adaptations are expensive. Think about funding options before you decide to make a purchase. Some benefits or insurance packages cover home modifications and lifts but often only if labor costs and equipment purchases are pre-approved.


Room by room overview

Here’s my “heads up” guide to 6 key areas of the house where there are usually issues of accessibility and/or safety

Getting Inside
• Problem: Steps are difficult to climb.
• Solution: Rebuild or replace steps if too narrow or too steep, add non-slip surfaces, repair broken or loose steps, build a ramp to create an alternate route and add sturdy handrails on both sides (should extend beyond the first and last step)
• Problem: Ramp is unsafe or slippery.
• Solution: Install handrails on both sides extend porch to provide weather protection, reduce the slope of the ramp, add level platforms for landing spots at top and bottom of ramp, add edge protection to keep wheelchair, crutches, cane, or walker from slipping off edge

• Problem: Counters are too high to be able to work comfortably from a seated position.
• Solution: Use pull-out cutting board as lowered work surface, place board across top of open drawer, use lap tray for food preparation area, pull kitchen table/card table near existing kitchen to create seated work area, remove base cabinet(s) and install lower counter or table for seated work area; lower upper cabinet(s) above work area to create reachable storage, install power elevating cabinets and counters.
• Problem: Sink faucets are hard to reach from wheelchair.
• Solution: Replace separate hot and cold faucets with single-lever control, add extension arm to single-lever faucet, remove floor of sink cabinet and centre doorstop to create knee access (attach doorstop to back side of door to keep cabinet appearance) and insulate pipes to prevent burns
• Problem: Can’t reach items stored in refrigerator or freezer.
• Solution: Use lazy Susan to make items accessible, use a reacher, purchase a side-by-side refrigerator/freezer for easier access, select a refrigerator that has a water and ice dispenser in the door, purchase a small refrigerator for supplementary storage next to the seated work area, ask someone else to transfer items from a chest freezer to the freezer section of refrigerator once a week.
• Problem: The existing kitchen is too large for the wheelchair user.
• Solution: Create “mini-kitchen” that allows the wheelchair user to reach everything from one spot, include microwave oven, portable appliances, and essential supplies and utensils; store small items on countertop shelf unit or rolling cart.

Living Areas
• Problem: Windows and window coverings are hard to open and operate.
• Solution:
Clear floor space in front of window so controls are easier to reach, install auxiliary handle on bottom sash of double hung windows, replace double-hung windows with casement style windows, select mini-blinds with long wand, install power operated windows and draperies.
• Problem: Your elder has trouble getting out of a chair or sofa.
• Solution: Place a pneumatic seat lifter in chair, use chair that has sturdy arms, raise chair or sofa on wood blocks.
• Problem: Good furniture, walls, and woodwork get damaged by the wheelchair.
• Solution: Move fragile or valuable furniture to protected location, staple carpet remnants around doorframes, make “sleeves” from carpet remnants to protect chair legs, select durable furniture, use corner guards, carpet (wanes coating) and Plexiglass sheets to protect walls, add rubber bumpers to footplates.

• Problem: Bedroom on the upper floor is not accessible.
• Solution: Relocate the bedroom on an accessible floor, place the bed in one end of large room on accessible floor and use bookcases or screens to create privacy “walls,” use a daybed in the living room to create a sofa by day and a bed by night, install a stair-lift to another floor (requires a transfer to and from the lift), install a chair-lift to another floor (lifts both wheelchair and person), install residential elevator; elevator shaft can be located outside house by converting windows to access doors.

• Problem: You or your elder are worried about the prospect of them falling in the bathroom especially when taking a bath or shower.
• Solution: Install grab bars near the tub and shower (be sure grab bars are securely fastened into wall studs), replace existing shower head with a hand-held shower to bathe while seated, purchase bath bench that straddles tub (two legs inside, two legs outside), use hydraulic seat or boom lift to transfer in and out of tub, Install transfer shower with built in seat, install roll-in shower (requires transfer to shower chair), build combination shower/toilet compartment so toilet can be used as shower seat.

• Problem: Your parent or friend can’t use stairs to reach laundry in basement.
• Solution: Move existing laundry equipment to accessible floor, replace existing equipment with stacked washer dryer unit located on accessible floor.
• Problem: Can’t reach controls on laundry equipment
• Solution: Use “reacher” to operate controls, purchase laundry equipment that has touch controls or front controls, purchase front-loading washer and dryer for easier access, raise laundry machines on platforms.

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