When someone suffers a traumatic injury or illness that affects their ability to walk or bear their own weight, a wheelchair may be required to help with mobility.
For permanent wheelchair users, their home would need to be modified to improve accessibility and support their ability to engage in daily living tasks such as bathing or dressing.
These are some of the common home modifications and safety equipment needed for wheelchair users to be more independent with their own care and living.
Bathroom Modifications For Wheelchair Users
Most bathrooms are poorly equipped for wheelchairs. With some changes, bathrooms can be made more accessible for disabled and elderly individuals requiring wheelchairs.
These are some common bathroom equipment and modifications that can help support a wheelchair user to be more independent.
1. Transfer pole or super pole with horizontal bar
A transfer pole or floor to ceiling pole is a great assistive tool useful for wheelchair users that continue to have some ability to stand for short periods of time, and good upper body strength.
The pole can be grabbed along any portion of the vertical shaft and pulled on for support to help with standing up out of a wheelchair. This transfer device needs to be placed in a strategic spot near the surface where the movement will occur.
Most commonly, a transfer pole will be located near the toilet to facilitate easier movement onto and off the toilet, but can also be found near the bathtub or shower.
This equipment is usually made of metal to ensure it is a sturdy support, so it may be susceptible to rusting if exposed to water. As a result, proper maintenance of this safety device recommends that the base and shaft of the pole be wiped regularly of any moisture or water.
2. Tub transfer bench
Some wheelchair users can move onto a tub transfer bench or can be assisted onto the seat by a caregiver. This bench sits within the bathtub, but also partially outside of it to allow for easier transfer onto the bench.
From the edge of the bench, its user can then push down onto the seat to shift their body into a more central position within the shower or be assisted with this process if needed.
This equipment allows someone to have a shower from a seated position and more easily exit the shower once they are done.
3. Bath lift
For many disabled people and elderly individuals, being able to soak in warm water offers some benefits, especially those that may have dry skin or muscle pain. However, getting up from a lower position in the bathtub is difficult, especially if one does not have the necessary upper and lower body strength.
With a bathtub lift, someone can sit or be placed onto the platform and gently lowered to the floor of the bathtub by pushing the down button on a remote control. Because the lift itself is waterproof, a person can sit with their body partially submerged in the water and engage in bathing or simply soak in the water as needed.
When ready, they can push the up button on the remote control to get raised out of the tub to more easily get back into their wheelchair. Most modern bath lifts have an included safety feature that would prevent the platform from lowering if it did not have sufficient backup battery power to raise up should the electricity go out.
NOTE: Because of the electrical motor required to make this device operate, a bathlift tends to be expensive to purchase. As a result of the cost, it tends to be seen in few homes, however it is one of the only ways to allow someone to safely enjoy a bath while being able to get out of it with great ease. As a result of these factors, bath lifts tend to be quite common in settings where the elderly and disabled congregate such as a retirement home or nursing care home.
4. Roll in shower
If there is any difficulty with getting out of a wheelchair, it may be helpful to reduce the amount of transfers from one surface to another. Within the bathroom, this can be achieved with the addition of a roll in shower.
Roll in showers typically have a level surface with the exterior, but a slight incline for the water to drain at a central spot. A small Collapsible Shower Threshold Water Dam can be added to the shower’s entrance to prevent the water from splashing outside, and remains easy enough for a wheeled shower chair or wheeled commode to roll over to enter the shower.
For a roll in shower to be installed in the home, renovations are required to demolish existing bathroom structures or walls that may act as a barrier for wheelchairs. This is one of the more expensive modifications that can be done to a home, so alternative options can first be considered for those on a more limited budget.
5. Ceiling lift or patient lift
A ceiling lift or mechanical patient lift is a device commonly found in the bathroom as it can be used to move someone from a wheelchair into the bathtub or onto another surface in preparation for personal hygiene.
This type of device is typically used for people that have difficulty with bearing weight on their lower extremities related to a lack of strength or inability to sustain a standing position for any period of time. It can also be used for patients that have balance or gait instability.
A ceiling or portable patient lift is used in conjunction with a body sling to lift someone out of a wheelchair. Some slings have been specially designed to be used within the shower and can get wet or soapy without affecting the material.
A patient lift is a useful tool for protecting caregivers and reducing their risk of back injuries often sustained during unassisted transfer attempts of patients that require moderate to maximum support.
NOTE: A ceiling lift needs to be installed onto a track on the ceiling and is limited to where the wheelchair user can be moved by where the track is located. Ceiling lifts take up minimal room in the bathroom, but they tend to be more expensive compared to floor based portable patient lifts when factoring in the installation costs.
6. Hand held shower head
A hand held shower head is a great bathing device to have for wheelchair users. As a result of being attached to a long flexible cord, the shower head can be easily manipulated to wash all parts of the body from a seated position.
This helps to get hard to reach areas that an overhead shower head would not be able to easily wash or clean. They are easy and inexpensive to install, and can be used by a caregiver assisting with personal hygiene or by the wheelchair user themselves.
7. Grab bars
Grab bars are usually placed in the bathroom to allow wheelchair users additional support for weight shifting or with transfers from one surface to another. Grab bars that are drilled into studs are optimal as they tend to be more secure compared to suction based grab handles.
Common locations for grab bar installation include near the toilet, shower and bathtub. For bathrooms with narrow doorways that prevent the wheelchair from entering, grab bars are sometimes placed along the walls.
This can act as a support for a wheelchair user as they walk the short distance to the toilet or a shower seat. That said, a caregiver is usually recommended to be nearby should any assistance be needed during the short walk.
When installing grab bars near the bathtub, one should be placed on the wall nearest the faucet to allow one to safely navigate the step over the bathtub wall. Another grab handle should be placed on the adjacent wall to allow someone to readjust their body position while seated on a bath bench.
Beyond these two basic locations, additional grab bars can be installed near the bathtub based on the preference of their user. Of course, grab handle placement should be approved by a trained home safety expert like a physical therapist or occupational therapist as bathroom layouts vary between homes and this can affect their position.
8. Wheeled shower chair or Wheeled Commode
A wheeled shower chair or commode can be rolled into the shower by a caregiver to position someone for washing and cleaning. Given the fact that this equipment’s frame sits on wheels, a heavier individual can easily be pushed around and positioned within the bathroom.
Most shower chairs come with a hole in the seat that also allows it to be used as a commode for voiding urine or feces. This opening also allows for easier access for peri-care and cleaning of the genital area.
The use of these devices is often coupled with a roll in shower given the fact that they have wheels. The biggest benefit to using this type of equipment with elderly individuals or disabled persons is that it can be used for both showering and toileting. With this in mind, it minimizes the physical transfers one must perform and one can shower immediately after voiding into the removable pale.
9. Transfer board
A transfer board is a plank often made of wood that can help someone move from one surface to another.
The board acts as a bridge between the wheelchair and another surface of equivalent seat height as one slides across to get to the other end. This is commonly used by individuals that cannot bear weight through their legs, but have sufficient control of their sitting balance and upper body strength.
A caregiver can also assist someone with sliding across the board and is considered a safer transfer method compared to unassisted transfers where the caregiver provides the majority of the physical movement help.
Living Room Modifications For Wheelchair Users
The living room is usually a main area where individuals in wheelchairs relax, watch television or interact with their family members or caregivers. Ideally, this room should also be altered to allow a disabled wheelchair user greater comfort and safety with transfers.
The following products are often found in living rooms of wheelchair users:
1. Lift Chair Recliners
Sitting too long on the same part of one’s body increases friction and moisture at that area and overtime, the pressure on that point due to one’s body weight can lead to skin breakdown or more commonly known as a pressure ulcer.
If left untreated, pressure sores can progress into deep wounds that penetrate to the bone and are very difficult to treat and resolve. For this reason, wheelchair users at high risk of developing pressure injuries are often recommended to have more advanced wheelchairs with a tilt ability where the wheelchair can lock into an inclined position to help relieve some of the pressure temporarily from a specific body part.
TIP: Wheelchair users are often recommended to change body positions approximately every two hours to minimize risk of developing pressure ulcers. They are also recommended to weight shift and hold a different position for a short period of time approximately every 30 minutes.
When a tilt adjustable wheelchair is prohibitively expensive, a lift chair recliner can be utilized throughout the day to help minimize concerns of pressure sores. Most lift chair recliners are generally remote controlled and recline fully backwards to allow its user to be placed into a lying down position.
This helps to distribute one’s weight over a larger surface area rather than focusing all the weight onto one’s buttocks or coccyx. More importantly, a lift chair can be raised and inclined forward to help its user get into the appropriate transfer position to move away from the chair when they wish to return to the wheelchair. This involves the lift chair being raised slightly off the ground with the backrest tilting forward to give its user the necessary height and momentum to transfer back to their awaiting wheelchair.
2. Patient lift or Ceiling Lift
It is a little less common to find a mechanical patient lift or ceiling lift within the living room because the majority of patient transfers occur in the bedroom and bathroom.
Having said that, this transfer device can sometimes exist in the living room to help someone with minimal trunk control, leg strength, poor balance, etc, move from the wheelchair to another sitting surface like a reclining chair.
3. Floor to ceiling pole
In some situations, a floor to ceiling pole can be placed in the living room to help a wheelchair user transfer from their wheelchair into a nearby chair, couch or electric lift chair recliner.
This equipment is often placed within close proximity of the surface one wishes to transfer to as it must be within grasping length for the device to be useful.
Bedroom Modifications for Wheelchair Users
1. Hospital bed
A hospital bed is one of the most commonly used pieces of safety equipment within the bedroom for a wheelchair user. Hospital beds have a distinctive advantage over traditional beds in that they can be height adjusted as needed to help its user easily move from bed to wheelchair or vice versa.
It is also useful for those with less trunk control or strength as the elevating headrest of a hospital bed can be used to assist someone to move from a lying down position to a sitting up position at the edge of the bed.
Most hospital beds can also have attachable partial bed railings that can be used to grab onto for support with repositioning while lying in bed or with getting out of bed.
CAUTION: Hospital beds with a half railings can be used to help facilitate any transfer, whereas full railings that run the length of the hospital bed can act as a barrier and discourage transfers. As a result, full railings are considered restraints and are seldom used.
2. Bed rail
Bed rails are a popular safety product used to help with weight shifting within the bed, changing body positioning and any attempts to get up from bed. Bed rails come in multiple different securement methods that range from being mounted onto a nearby wall, secured to the floor or held against the bed mattress.
Bed rails are normally positioned near one’s pillow at the head of the bed and are pulled on to sit up at the edge of the bed. If the bed rail is mounted to the wall, it can be pulled on to also stand. If the bed rail is secured to the bed frame or mattress, it can be pushed down on the grab handle to help someone with standing.
Bed rails have some risk of getting an arm, shoulder or other body part stuck between the mattress and the railing. This entrapment risk can be dangerous and in some situations lead to death, so it is important that only a cognitively intact individual with good insight uses a bed rail.
A physical therapist or occupational therapist are just some of the home care experts that may help decide if a bed rail is a safe option. A discussion with one’s physician can help initiate this type of care or arrange any additional social services as needed.
3. Floor to ceiling pole
A floor to ceiling transfer pole can be positioned near the bed to help facilitate getting up out of bed or weight shifting within the bed. A superpole is especially helpful as an added horizontal bar can be rotated to be placed overtop of the bed where someone is lying down and pulled to adjust one’s body position.
From seated, the main shaft of the transfer pole can be pulled to help get into standing. Overall, this equipment helps take advantage of one’s upper body strength to make getting up or adjusting one’s weight within the bed a little easier.
4. Patient lift or ceiling lift
Similar to other rooms, a patient lift can be utilized in the bedroom to safely move a wheelchair user from bed to the wheelchair and back as needed. Some special slings exist that can minimize friction and reduce the risk of skin tears for those with sensitive skin.
5. Bed Wedge
A bed wedge is often made of a squishy foam that provides some support and comfort with positioning. This item can be positioned underneath one’s knees or feet to provide some elevation to help with peripheral edema or swelling of the feet.
When used as a backrest to offer increased comfort, a bed wedge also pushes an individual slightly forward. Sometimes this slight angle change in one’s upper body can be sufficient enough to assist someone with getting out of bed.
Moreover, the bed wedge can be placed on the edge of the bed and be used to slightly guide someone more towards the center of the bed to prevent falling out of bed.
6. Dressing Aids
An individual that has difficulty with dressing, but wishes to remain independent can utilize dressing aids to be more self sufficient.
With the use of a reacher, one is able to grasp items that are further away on the floor or hung up higher in the closet. Reachers can also be a useful tool when trying to put one’s pants on.
Other assistive devices such as a sock aid can be used to put on socks if one is unable due to challenges with bending over or raising their foot up. A dressing stick can also be used to help with putting on pants, sweaters, jackets or other clothing.
Kitchen Modifications for Wheelchair Users
To live independently, a wheelchair user’s kitchen may need to be changed in order to make things more accessible for them. Some common changes and recommendations to make kitchens more easy to use for a wheelchair user includes:
1. Lowering shelves and kitchen countertops
Wheelchairs tend to have a low base of gravity, a feature that is necessary to ensure that the chair does not tip over easily. However, this affects a wheelchair user’s ability to engage in other activities that may be slightly out of their reach. For instance, meal preparation can be difficult for a wheelchair user because most counterspaces are too high to use easily.
Some wheelchairs have an ability to elevate the entire seat base higher for its user to be able to access the counter space or high cupboards. Unfortunately, this added feature is highly expensive and the mechanical requirements usually prohibits it from being added onto existing wheelchairs.
Rather, this feature needs to be considered from the beginning when purchasing a wheelchair as only very specific wheelchair frames are able to accommodate the technical components required to make this work.
For most people, it may be more practical to remodel or have a kitchen redesign to have the counter spaces and shelfs lowered. While this may be costly, it can be a great addition for homes especially if one wishes to remain in their home for as long as possible to age in place.
This type of home modification offers many benefits for disabled or elderly individuals in wheelchairs as it may reduce their need to rely on others and can help them avoid an admission into a retirement home or nursing care home.
2. Rearranging ingredients and kitchen utensils so they can easily be reached
Having ingredients and utensils stored high up in a cupboard, they may be out of reach for a wheelchair user. In order to maximize one’s ability to live independently, everyday items must be within reach. Consider relocating frequently used items to lower shelves or onto the kitchen’s counter space as appropriate.
By having these items more readily available, a wheelchair user does not have to rely on the support of a caregiver to reach the tools and ingredients to cook a meal. This is one simple lifestyle change that can be completed without investing any money and may allow a wheelchair user to live more independently.
3. Using a reacher to grab things from the floor or higher up
Within the kitchen, a reacher can be used to grab small cans and food items from shelves that might be slightly out of grasping range for someone sitting in a wheelchair.
Reachers come in various lengths to be able to grab objects at varying distances away, however their use requires good hand eye coordination, sufficient hand grasping and arm strength.
Home Entrance Modifications for Wheelchair Users
The exterior of many homes may pose different challenges for wheelchair users. If the home is situated on an elevated terrain, some steps may be required to lead to the front door. This next section will discuss ways to help change the exterior of one’s home to make entering or exiting the home more easy for a wheelchair user.
1. Exterior Ramp
One of the biggest challenges wheelchair users have is accessing their own home, especially if their residence is sitting on elevated terrain. When the front entrance has steps to enter the home, an alternate entrance or setup may need to be considered to be able to enter or safely exit one’s home.
If a suitable alternate entrance through the garage or rear of the home does not exist, an exterior ramp may be needed to help a wheelchair user with entering or leaving their home.
As a general rule of thumb, for every foot in height to the doorway, the ramp must be 12 feet out in length to allow a wheelchair user the ability to safely propel up the incline or to roll slowly down the ramp in controlled fashion to descend the incline. As a result of this, high staircases may require a more elaborate ramp with multiple landings in order to safely use the ramp.
Ramps can either be temporary and easy to relocate or a permanent addition to the home. Depending on one’s local municipality, a permit may be required for a permanent ramp leading to the home. Medical equipment vendors and ramp distributors are usually able to answer any questions that one may have regarding rules that must be followed when installing a ramp.
2. Outdoor elevator
In situations where an exterior ramp is not feasible, an outdoor elevator may need to be considered. This is one of the most expensive options when the cost of installing the elevator unit, and removal of any existing structures that may impede installation are factored into the calculation.
Most modern elevator systems have safety features where they utilize backup power to move up or down a floor in case there is an electrical blackout.
3. Grab bars
A simple, yet effective means of allowing someone to climb or descend a few small steps or threshold is to install grab bars on a nearby wall.
That said, there are a lot of things to take into consideration in order to successfully use a grab bar to support a wheelchair user with entering or exiting the home.
The wheelchair user must have sufficient upper body strength, balance and lower body endurance to sustain a standing position while a caregiver moves the wheelchair from one level to another for the user to sit again.
Most often, the physical abilities required to successfully use grab bars to navigate a few steps is found in someone who does not utilize a wheelchair for everyday mobility within the home. Rather, these individuals usually only need to use a transport wheelchair to get to medical appointments and back to their car.
Grab bars that support wheelchair users are frequently found in the garage to help traverse over one or two steps to access their vehicle.
Installing a grab bar can be a good alternative when installing a ramp or elevator is not feasible or within one’s budget. However, it is important to consider whether this device would allow a wheelchair user to safely enter or exit the home.
Ideally a physiotherapist or occupational therapist should complete a home safety audit to ensure that one has the physical capabilities to safely use grab bars, suggest appropriate locations for any grab bars or recommend other assistive devices if needed.
Accessing Different Floors of a Multistory Home
For most homes, it is usually 12-14 steps to get from one floor to another. Some wheelchair users may not be able to climb a full flight of stairs to access the different parts of their multistory home.
If setting all of one’s living arrangements on one floor is not possible, equipment that helps move someone between the different levels may be required. Helping a wheelchair user move from one floor to another can be achieved with the use of these:
1. Indoor Elevator
Depending on the home layout, indoor elevators can help someone to access higher floors or the basement level of their home. Of course this addition to one’s home is very expensive when including the need for building permits, materials and labor.
It is also important to consider that elevators tend to require a lot of maintenance and repair to ensure that they are always ready to use and function safely. Furthermore, the structural design and foundation of one’s home may prevent an elevator from being installed. Given these factors, many people consider alternate options.
2. Stair lift
A more common support method of moving someone from one floor to another is to use a stair lift, also known as a stair glide. This equipment has a chair that runs along a track installed on the stairs to move someone up or down a floor.
The cost of stair lifts vary depending on the configuration of one’s stairs. Usually, any staircase that has a curve tends to be more expensive while a straight staircase tends to be less costly.
General Home Modifications for Wheelchair Users
1. Widen narrow doorways
It is important to consider the width of a wheelchair when looking at whether someone can pass through a doorway. Enough room should be given on both sides of the wheels, especially for those that propel the wheels with their arms as scraping along the door or its frame can lead to skin tears or other wounds.
For this reason, several additional inches on each side is required to ensure that one’s arm or hand does not get clipped by the door while passing through.
Narrow doorways are especially common in older homes when building codes did not consider accessibility as seriously. In this setting, it may be impossible for a standard width wheelchair to enter different rooms.
Sometimes the narrow doorway is as a result of the door itself being in the way and prevent someone from passing through. The doorway can be made more open and clear by having a clear away offset door hinge installed that would push the door entirely out of the way.
In situations where the narrow door frame is the issue, it may need to be removed to convert the home into an open concept environment. However, this may not be possible with all rooms such as the bathroom or bedroom where some privacy is required.
2. Remove and replace carpeted surfaces
Caregivers and wheelchair users often struggle to move a wheelchair on carpeted surfaces. Because of the weight of the wheelchair and the person sitting in it, greater force is required to move a wheelchair from one spot to another.
When on top of a carpeted surface, moving a wheelchair can be difficult because the wheels dig in and sit in groves that prevent the wheels from turning and climbing out of.
For permanent wheelchair users, surfaces must be flat and non-slippery to allow for enough traction to be generated to move easily. Some of the best surfaces for wheelchair users within the home include:
- Hardwood floors
- Ceramic tiles
- Certain laminate flooring
3. Remove obstacles and make clear pathways
For a wheelchair user to safely maneuver around the home, pathways need to be clear of any obstacles.
Clearing pathways within the home allows a wheelchair user to access more parts of the home and prevents the wheels from getting caught or entangled.
Decluttering the house can also minimize a wheelchair user from accidentally knocking items over onto the floor or sustaining any wounds to their hands or arms as they move around.
4. Improve lighting to see one’s surroundings
Finally, having more lighting within the home can help a wheelchair user see where they are going and prevent them from bumping into objects or walls.
Motion, noise or voice activated lighting can be installed if light switches are in locations inaccessible by wheelchair, or just slightly out of reach when sitting.