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Visitability: A Way of Thinking About Aging and Design

As the population ages and more people are living with physical disabilities, housing and community development must be re-examined. Inaccessible homes impede the daily lives of people who are mobility impaired due to illness, accident or age. Visitors to inaccessible homes face the danger of falling on the entry steps, the worry of not fitting into a bathroom and the embarrassment of being carried up the stairs. An affordable, sustainable and inclusive design approach for integrating basic accessibility features into all newly built homes is a movement known as Visitability.

In 1988, The Fair Housing Amendments Act created accessible units in all new multi-family housing apartments and condos with four or more units. In 1990, the Americans with Disabilities Act greatly increased accessibility to all government and public buildings. But detached single-family houses and town homes, where the majority of the population lives, are the last part of the built environment that is not covered by federal law. No accessibility codes exist. To date, private houses and town homes continue to be built with the same basic accessibility barriers: steps at all entrances and narrow doors to bathrooms.

In an effort to pass legislation for accessibility in new single-home construction, Eleanor Smith, the founder of Concrete Change, started the Visitability Movement in the US. The movement asks that three basic accessibility needs be met:

* One zero-step entrance on an accessible route from a driveway or public sidewalk.

* Doorways with a 32″ minimum clear passage space.

* A half bathroom on the main floor to accommodate a wheelchair.

If these three requirements are met in the construction of every new home, future adaptations for specialized needs can occur as needed. Visitability features make it easier for the mobility impaired to visit friends and family and to remain active in their communities..

COST OF VISITABILITY

Over the lifetime of a home, 25-60% of all new homes will have a resident who becomes mobility impaired. This may be muscle weakness, lack of balance, arthritic stiffness or wheelchair confinement. 95% of all new homes are constructed with steps at every entry and narrow doorways to the bathroom. Because of architectural barriers, the risk of falling for the homeowner is greatly increased and the success rate of first responders may be compromised during medical emergencies.

In 2005, 1.8 million Americans age 65 and over were treated in emergency rooms for injuries from falls, and 460,000 were hospitalized. 60% of all nursing home residents enter these facilities directly from hospitals after a fall, a stroke or heart attack. With the majority of homes having steps at all entries and narrow doors to bathrooms, one can only surmise that large numbers of people are not returning to their homes after accidents because of no accessibility.

Below is a cost comparison of Visitability built into a new home versus Visitability retrofitted into an existing home. The nursing home cost reflects the extreme expense of “doing nothing”. (Maisel, Smith and Steinfeld, 2008, “Increasing Home Access: Designing for Visitability”)

New Home Visitability Construction

* Zero-step entrance on concrete slab-add $100

* Entrance over crawl space or basement -add $300-$600

* 34″ door-add $2 to the cost of a 32″ door

* Average cost for visitability features, depending on region-add $98 to $573

* Average cost for Universal Design features-add 1% to total project cost

Existing Home Visitability Retrofit

* Zero-step entrance -add $3,300

* Widen interior doorway-add $700 per doorway ($22 for a swing-away hinge)

* Home elevator-add $15,000-$25,000

Nursing Home Costs

* Nursing home for individual-$85,000 per year

* Nursing home for US-$122 Billion in 2005 (60% of cost borne by public through Medicare & Medicaid)

* Cost of falls among older people for US-$19 billion in direct medical costs (Maisel, Smith and Steinfeld, 2008)

LEGISLATION

Cities and towns across the country are preparing to assist their ever-growing senior populations. With a short supply of affordable senior housing and the desire of most seniors to remain in their homes, home-based programs are in the forefront: meals-on-wheels, home healthcare, hospice-at-home, physical therapy at home, senior transportation from home. But for home-based programs to succeed, basic accessibility in the home must be provided. Visitability in private homes is crucial for the safety and social sustainability of older adults who are mobility impaired. Without the independence to enter or leave their home or to use the bathroom when needed, older adults can become isolated, depressed and sick. Visitable homes are needed for the safety and independence of everyone: older adults, the physically impaired, visitors, caregivers and first responders.

In the late 1980s, Eleanor Smith of Concrete Change began pushing Atlanta homebuilders to incorporate Visitable features into their new homes, but was met with great opposition. Habitat for Humanity listened and today there are more than 800 Visitable Habitat homes in the Atlanta area.

1992- Atlanta Visitability Ordinance

Atlanta became the first city to adopt a Visitability ordinance that mandates all builders of new single-family dwellings, duplexes or triplexes, who receive any financial benefit from or through the city, must meet several basic access requirements, including at least one zero-step entrance and adequate interior door widths.

2002- Pima County Inclusive Home Design Ordinance, Tucson, AZ

Pima County adopted the first ordinance in the nation to require a zero-step entry into single-family homes with door openings at least 34″wide, lever door handles, reinforced walls in bathrooms for grab bars, switches no higher than 48 inches and hallways 36″ wide throughout the main floor.

In 2003, the Southern Arizona Home Builders Association sued Pima County over the legality of the Visitability Ordinance. In a unanimous decision, the Arizona Court put to rest efforts by Tucson builders to void Pima County’s law requiring minimal access in newly constructed single-family homes. By 2008, Tucson, AZ had built 15,000 Visitable homes.

2004- Visitability Code, Bolingbrook, IL

Bolingbrook initially approved a voluntary Visitability ordinance that was unsuccessful among homebuilders. In order to make homebuilders comply, Bolingbrook enforced the ordinance requiring that all new homes be built with Visitability standards:

* A minimum of one zero-step entrance

* Doorways with 32″ clear passage space

* One bathroom on the main floor that will accommodate a wheelchair

Today Bolingbrook has 3,600 single-family Visit-able homes.

2009-Inclusive Home Design Act

US Representative Jan Schakowsky (D-ILL) introduced legislation that would apply Visitability standards to all new single-family homes and town houses receiving federal funds. Currently, 95 % of new single-family homes and town houses built with federal assistance fail to incorporate accessibility features, making it impossible for many people with disabilities to live in or visit homes. Representative Schakowsky reintroduced the bill in 2010.

Since the induction of the Atlanta City Ordinance of 1992, more than 50 ordinances of varying quality have been passed nationwide. Legislation has resulted in more than 30,000 Visitable homes built for the open market, regardless of whether the first occupant has a disability or not. States whose cities are adopting visitability ordinances or voluntary programs are: GA, FL, TX, VA, VT, MN, NM, KN, IL, OR, KY, NJ, MI, PA, OH.

ICC/ANSI A117.1, the standard for accessibility referenced by most building codes in the US, is currently developing a Type C section that includes technical design criteria for visitability. This will provide an accessibility model that can be adopted to new single-family homes and clarify the design of a zero-step entry, an accessible bathroom and accessible doorways. The standard can be referenced by visitability laws and programs, thus promoting uniformity in applications and aiding in their interpretation. Please note, the IBC will not require Type C dwelling units. If a jurisdiction or state chooses to require visitability in single family homes, the Type C unit criteria will be available for adoption as a baseline. The 2010 edition of ANSI A117.1 will contain the Type C (visit-able) dwelling unit specifications. (Maisel, Smith and Steinfeld, 2008, “Increasing Home Access: Designing for Visitability”)

References:

Jordana Maisel & Edward Steinfeld, Buffalo, NY, IDEA Center and Eleanor Smith, Concrete Change, Atlanta, GA, “Increasing Home Access: Designing for Visitability”

Related Links

IDeA Center: http://www.udeworld.com

Concrete Change: http://www.concretechange.org

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