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Home Modifications: What to Change First and What It Costs

Do the bathroom first, because that is where people get hurt. Then fix the lighting and the floor between the bed and the bathroom, because it is the cheapest change that works. Doorways, ramps and a ground floor bed come next. A full shower conversion comes last, because it costs the most and can wait. Measure everything before you buy anything.

Why the bathroom comes first

The Centers for Disease Control and Prevention, the US federal public health agency, looked at emergency department records to test whether bathrooms really are as dangerous as people assume. Using 2008 national injury surveillance data, the CDC estimated 234,094 nonfatal bathroom injuries treated in US emergency departments among people aged 15 and older. Most of them, 81.1 percent, were caused by falls, and injury rates rose with age.

That is the whole argument for the ordering on this page. The bathroom is where the wet floor, the hard surfaces, the standing up and the sitting down all happen in the same three feet of space. A ramp at the front door matters, but nobody falls at the front door six times a day.

Within the bathroom, work outward from the two transfers that happen most: the toilet and the shower. Our guides on toilet transfer techniques and using a shower transfer bench will tell you which fixtures the technique actually needs, which is a better shopping list than a catalog.

The order to work in, and what each step costs

This table is ordered cheapest first. That is deliberate. Families routinely spend on the shower conversion before they have spent twenty dollars on lighting, and the lighting would have prevented more falls.

We do not publish dollar figures for contractor work. They swing by region, by what is behind your wall, and by whether your floor joists run the helpful way. A number here would be a guess, and you would find out it was wrong on the day the quote arrived. Get three written quotes and ask each one what they found when they opened the wall.

Doorways: 32 inches clear is the number that matters

The Americans with Disabilities Act sets design standards written by the US Access Board, the federal agency responsible for them. Those standards require a door opening to give a clear width of 32 inches minimum, and they say how to measure it: with the door open 90 degrees, from the stop to the face of the door.

That measuring method is the part people miss. A 32 inch door is not a 32 inch opening. The door leaf, the stop and the hinge side all eat into it, and a tape measure held across the frame with the door swinging free will tell you a number you cannot actually roll through.

Before you pay anyone to move framing, measure the real clear opening. If you are within an inch or two, ask a carpenter about swing clear hinges, which move the door leaf out of the opening, and about taking the door off entirely on a bathroom where a curtain would do. Moving a stud wall is the answer of last resort, not the first quote you should accept.

Ramps: threshold, portable, or built

The ADA standards put ramp running slope at 1:12 maximum. In plain terms that is 12 inches of ramp for every 1 inch you have to climb. A 6 inch step wants 6 feet of ramp. A 24 inch porch wants 24 feet, which is why real ramps switch back.

The same standards limit a single ramp run to 30 inches of rise before a landing, require level landings top and bottom, set intermediate landings at 60 inches by 60 inches clear where the ramp changes direction, ask for 36 inches clear width, and require handrails on both sides once the rise is more than 6 inches, mounted 34 to 38 inches high.

Those standards govern public buildings, not private homes. Your house is covered by building code and, for housing discrimination, by the Fair Housing Act rather than the ADA. But 1:12 is still the number to build to. It is the slope a person can be pushed up without the helper losing the chair, and the slope you can control coming down. Steeper is where people get hurt.

Three tiers, in order of commitment. A threshold ramp is a wedge that sits on the floor and takes a chair over a raised sill or a door track. A portable folding ramp is carried out, laid on one or two steps, and taken back in. A modular or built ramp is permanent, needs a permit in most places, and is the only answer for a real flight of steps.

On thresholds specifically, the ADA standards cap a new threshold at half an inch, and require the edge to be beveled 1:2 above the first quarter inch. Anything in your house taller than that, and a chair will stall on it. Measure the sill, not the door.

Grab bars go into structure, not into drywall

The ADA standards require a grab bar assembly to withstand a vertical or horizontal force of 250 pounds at any point, and they apply that requirement to four things: the bar, the fastener, the mounting device, and the supporting structure. Read that list again. Three of the four are your wall.

So a bar rated for hundreds of pounds means nothing if it is held by plastic anchors in half inch drywall. Fix into a stud, or have blocking added behind the tile before the wall closes up. If the wall is already tiled, a fitter can set the bar to reach studs, or mount a backing plate. Say the word blocking to whoever quotes the job.

The same standards mount bars 33 to 36 inches high to the top of the gripping surface, use a 1.25 to 2 inch diameter, and set the gap to the wall at exactly 1.5 inches. That gap is an absolute figure, not a minimum, because a wider gap can trap a forearm. Copy the dimensions, and let an OT set the position.

A suction bar is not a grab bar

Suction cup bars are sold on the same shelf as screw fixed ones, at a fraction of the price, and they look identical on a shelf. They are a different product. They are held on by a seal against smooth tile, and that seal is affected by soap film, by grout lines, by a textured surface and by temperature.

Check the packaging on any suction model you already own, and read what the manufacturer says it is for. If it is described as a balance or positioning aid rather than a weight bearing support, believe that. Do not put it anywhere a person would grab it while falling. Where someone will put real weight through a bar, use a screw fixed bar into structure.

Bathroom fixes short of a full wet room

A curbless roll in shower is the best bathroom, and it is also a demolition project with a permit, a plumber and a week without a bathroom. Most families need something on Tuesday. In rough order of cost, here is what buys you most of the benefit.

• A transfer bench that spans the tub wall, so nobody has to step over it
• A handheld shower on a slide bar, so the water comes to the person sitting down
• A raised toilet seat or a toilet frame, so the sit and the stand are shorter
• Two screw fixed grab bars, one at the toilet, one at the tub entry
• A non slip mat inside the tub, which the National Health Service, Britain’s public health system, also lists in its falls advice

If the downstairs bathroom is a half bath with no shower at all, that is worth knowing early. A bed sponge bath routine, or a shower at a family member’s accessible bathroom twice a week, is a legitimate plan while you price the real work.

Moving the bed downstairs

This is the modification with the best ratio of benefit to money, and the one people resist longest, because the dining room becoming a bedroom feels like a defeat. It is not. Stairs are the single feature of a house that no equipment fully solves, and a bed on the same floor as a bathroom removes the hardest trip of the day.

Pick the ground floor room closest to a bathroom, not the biggest one. Check that the route from bed to toilet has a clear opening the chair fits through, and that you can get to both sides of the bed. Leave three feet on the transfer side if you can. If a lift is likely later, check the ceiling and the floor now.

Lighting and trip hazards, the cheapest thing that works

Most bathroom falls happen on a trip to the bathroom, and a large share of those happen at night, in the dark, by someone who did not want to wake anyone. Light the whole route: bedside, hallway, bathroom door, and inside the bathroom. Motion sensor lights do this without anybody finding a switch.

Then take the floor apart. NHS falls guidance is blunt about this: do not have too much clutter at home, or things you could trip on such as loose wires or rugs, and use a non slip mat in the bath or shower. That advice is British, and Britain’s funding and assessment routes do not map onto American ones, but a loose rug is a loose rug in any country.

Throw rugs are the worst offender because they are also the thing people most want to keep. There is no safe way to tape one down for a wheelchair or a walker. Roll them up and put them away, and revisit the decision if mobility improves.

Three things worth buying before you call anyone

These are the items that do the most for the least money, and none of them needs a contractor to arrive first. Everything else on the list can wait for a quote.

Before you buy the larger items, check what you can get without paying. Loan closets, state assistive technology programs and equipment reuse schemes cover a lot of this. Start with our list of free medical equipment for seniors and the wider financial resources page.

Common questions

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