For people who are mobility-limited, there are many instances where a small step up or the slightest of inclines becomes an unsafe obstacle, resulting in the need for assistance to perform even the most basic of functions. The ADA has provided information that should eliminate these barriers. There is a seemingly endless misinterpretation of what people believe accessibility is. This has led to an industry of bathroom remodeling products that intend to address the accessibility problem. The most mainstream of these are shower conversion products. These products allow people to remove their tub system and install a walk-in shower. These products and the companies that install them are advertised everywhere as a quick and low-cost solution. However, the limitations of the product are, as would be expected, not advertised to potential customers.
The primary problem with these walk-in shower areas is that they still require a step up into the shower area. This problem is even worse with “walk-in tubs.” This only satisfies short-term issues, and the tub will need to be removed at some point if a person expects to live their final years in their own home. The reasons include worsening health as we age can limit our ability to perform standing activities and people who rely on wheelchairs for mobility cannot access these areas when there is a step up. Updating bathrooms and other areas is something that many people do, but the personal reasons for these updates and potential limitations that may exist are numerous.
Cost, time, and overall effort are reasons people remodel a home only sporadically in their lifetime. McCullagh (2006) found that people may not address barriers in their homes due to fear and other psychological factors. She stated that finances were not the common reason stated as reason for reluctance in making home modifications to prevent falls. As a physical therapist who specializes in home PT services and accessible design, I often wonder why a patient holds back from a needed remodeling project and whether they realize the consequences of not having a safe and accessible space before falls start to occur or the frequency of falls increases.
Choi (1996) describes that poor health and insufficient amenities are reasons people move out of their homes. It is not often that a person will perceive a bathroom remodeling project as a health improvement process. The cost of bathroom remodeling can be in the tens of thousands of dollars for even the most basic projects. Based on a recent online review, I found the cost of a quick conversion by just replacing the standard tub with a “Walk-in” shower or tub is $1,000-$8,000. This difference in cost is a primary factor that people will accept as their solution for accessibility. Of course, this is reinforced by salespeople for the many companies out there who will portray their products as a long-term solution. Anything for a profit, right? How would a salesperson know their prognosis? For people who want to avoid moving out of their homes, there will likely be a time when a barrier-free shower area and accessible toileting area will be required for continued independence and safety function.
So, why do so many people accept their bathroom semi-remodeling with short-sightedness? Again, along with psychological factors, one’s perception of safety is fine with the status quo. That is, until a pop-up ad, social media post, or an actual human salesperson convinces them otherwise. In addition, when you have a spokesperson like Christina Hall or promotion of syndicated TV shows like “The Doctors,” there will be those who act on these recommendations rather than solicit those of healthcare professionals.
While I have worked with thousands of people who would benefit from accessible bathing spaces, the most common reason that people have told me is the cost of the project, and they were not sure how long they would be staying in their current homes. For these patients or their families, they did not consider the future costs of moving to another home (which also would need to have accessible spaces), moving to an ‘independent living’ facility, costs needed to hire aides or the cost of family members needing to stay home to assist with bathroom functions.
For people who have a desire to live in their own homes for all their living years, utilizing the services of “Aging-In-Place” professionals is essential. This includes occupational therapy and physical therapy professionals, social service professionals as well as builders and designers who have extended knowledge in their fields. In general, resources for people to learn about the process for best remodeling a bathroom is lacking. With an internet search, you can find a great deal of information, but having a local resource and professional to assist is not as easy. One credential, amongst several out there, to be aware of is the Certified Aging-In-Place Specialist (CAPS), which is earned by healthcare professionals who as associated with the National Association of Home Builders.
It is my hope that products that are limited in scope to help people with mobility limitations with their home bathing needs will need to declare those limitations to potential buyers. Furthermore, I hope that patients and their families will receive more customized education from their healthcare team, from quality media outlets, and possibly even ethical businesses. In time, I believe these hopes can be realized.
Most conversions from a tub to a walk-in shower include a shower base that can be installed with existing plumbing. Although it is quick, easy, and low in cost, the height being a few inches can be a mountain for someone with leg weakness or balance impairments.
A beautiful new shower with more expensive features, but still not close to being fully accessible (which includes the concepts in “barrier-free design”). Along with the height of the shower base, there is a glass barrier that makes it nearly impossible for a person who is a wheelchair user to access without significant assistance.
An example of what was promoted as a successful project on social media. Although the aesthetics are undoubtedly better, and the removal of the tub may be helpful for the client at that time, the utility of the beautiful new space may be limited. Depending on the client’s mobility status, this remodeling may still be unsafe and require assistance from another person.
References:
Choi, N. G. (1996). Older Persons Who Move: Reasons and Health Consequences. Journal of Applied Gerontology, 15(3), 325-344.
McCullagh, M. C. (2006). Home Modification: How to help patients make their homes safer and more accessible as their abilities change. AJN The American Journal of Nursing, 106(10), 54-63.
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