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Case study in making homes accessible: George’s story

by Caroline Pomeroy

After several visits to his GP and local A&E department, George (aged 35) was told that his severe headache would soon pass, and was assured that painkillers and rest were all he required. However, while at home he then experienced a subarachnoid hemorrhage which resulted in significant complications, including hydrocephalus and an infected shunt. It was over eighteen months, following a long stay in hospital and a programme of rehabilitation, before George returned home to his wife and two young children. In the meantime, Social Services (under a Disabled Facilities Grant) had carried out adaptations to his home to try and render it suitable for him;. As well as having cognitive difficulties, George was now wheelchair-dependent.

The several steps leading up to the front door made it inaccessible for a wheelchair, and so a permanent ramp had been installed from the rear of the property to the front. Unfortunately there was no upstand at the edge, and a gap of around 180mm between the ramp and the fence into which the wheels would roll as George maneuvered up the ramp. At the time of the first visit from an independent occupational therapist, George had a self-propelled wheelchair for both indoor and outdoor use. This limited the distance he could cover, and placed a significant strain on his upper limbs. His wife meanwhile found the chair very heavy to maneuver, and risked injury herself when trying to do so.

Inside the house, the kitchen and downstairs toilet were too small to be accessible to George. A through-floor lift now ascended from the dining area at the front of the house into his bedroom, where a ceiling track hoist had been installed. The doors to his bedroom and bathroom had also been widened, but his children’s bedrooms were now inaccessible to him. He had a hospital bed in his bedroom and, with the new through-floor lift and his wife’s bed having to be in the same room, space was severely limited. A standing hoist was used to assist all transfers. Social Services had also provided a specialist wash-dry toilet but, in the absence of sufficient space to use it, George instead had to have a wheeled commode beside his bed - which was sometimes difficult to reach in time from downstairs. The standard bath remained, with a bath-lift in place that George was able to transfer onto with the help of two carers.

An independent occupational therapist’s initial assessment determined that many needs - mental, physical and social - of both George and his family were entirely unmet by their existing accommodation. Despite the investment by Social Services in the adaptations that had already been made, his mobility at home was still severely limited, and so consequently was his ability to participate in family life as well as his own personal care. Due to their reliance on support from the wider family since George’s disability, he and his wife therefore decided that the time had come to relocate to another area altogether, in order to be closer to this network of family support.

The family themselves located a potentially suitable home, and George was accommodated in his own room on the ground floor of the property while essential alterations were made. In consultation with the occupational therapist, the downstairs shower was identified as offering insufficient space and so, liaising with equipment providers, architects and builders, the therapist arranged for the through-floor lift and wash-dry toilet from the previous property to be moved to the new one (so recovering part of Social Services original investment), while the upstairs en-suite bathroom had a wet room installed and the front path was properly ramped.

These alterations, alongside the provision of a powered wheelchair, increased George’s freedom and control over his life enormously. He now had easy and prompt access to his own bathroom, he could move on and off the toilet instead of requiring a commode, and because of the new wet room he now needed only one carer to assist him in the shower. The therapist had also sourced a double-profiling bed which he and his wife were now able to share once again. He was able to enter and use the kitchen to cook meals among his family, which he had previously always enjoyed, and was able to play a fuller all-round role as a husband and father. Not only his own quality of life, but that of his family had hugely improved.

After several months at the property, the family feel confident enough to consider improving George’s domestic circumstances even further. They plan to make the whole house accessible to him, including the ground floor toilet facilities, and are also looking at plans to have an extension built. Planning permission is currently awaited for the project, and in the meantime the occupational therapist’s involvement with family is ongoing, as they continue planning a family home in which George can once again participate fully despite his disability.

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