Show Notes:
Stats Mentioned in the Episode:
- CDC – 28.7% or 1 in 4 people have a disability in the US.
- HUD – 19% of households include 1 member with accessibility needs.
- American Housing Survey – Less than .15% of homes in the housing stock are usable by someone in a wheelchair
- NAHB – Average age of a home = 42 years, but greater in the northeastern states.
Transcript:
Sarah: [00:00:00] You’re listening to Good Fit Poor Fit. Our podcast is part of The UD Project, a small business rooted in occupational therapy that looks at how the design of a home environment impacts how well people of different ages and abilities perform everyday activities. We chat about this unique perspective to boost your knowledge and help you consider what can be changed in communities like yours.
Learn more about our work at universaldesign.org.
This episode is part of an ongoing series here on Good Fit Poor Fit. We’re going deep on residential universal design specifications, walking through every major area of the home with an occupational therapy lens. Along the way, you’ll hear stories about real people. Whose lives are shaped by the design choices we discuss.
Whether you are a rehab therapist, a designer, a builder, or someone thinking [00:01:00] ahead about your own home, this series is built for you. Start with episode 107 for the full picture. A good fit doesn’t happen by accident. Let’s get into it.
Sarah: Hello, Good Fit Poor Fit listeners. We are in our final prep episode of the new series we’ve been talking about the past few weeks. Today, we are going to be discussing why homes in our housing stock fail to meet the needs of people in our community based on the ability of people to do their daily tasks with ease and convenience.
Of course, there are other factors, including finances, major clutter or disorganization, unsanitary living conditions, homes being in disrepair, and others you may have in your brain as well. But today we’re gonna be focusing on the limited supply of thoughtfully designed homes and how most homes fall short on making it functional for those who currently have an illness, injury, or disability, or will have change in function in the future.
Rebecca: Which basically means all of us, because changes in [00:02:00] function are actually universal across pretty much all living beings. See what I did there, listeners? Universal, trying to tie it in. But anyway, Sarah’s right. If we think about what we discussed in last week’s episode, all the tiny aspects of environments that can support or inhibit us from doing the things we want and need to, we can imagine how most homes are not built with accessibility in mind. For example, listeners, have you ever gone to a home that has a no-step entrance? I honestly don’t know that I have. So you can imagine how there are not a ton of houses out there in the United States that have that particular accessibility feature built in, and we can extrapolate that to apply to lots of different accessibility features. And we’ll be getting into the stats about that later on in this episode.
Sarah: So imagine you’ve been hired to design a product that roughly a third of your customers cannot fully use, and when that’s pointed out to you, the answer is, “Well, they can hire someone to modify it after they buy it.” [00:03:00] That’s kind of where we are in the housing industry right now in the United States. And what makes this particularly interesting to me is the gap isn’t completely a knowledge gap.
There’s a lot of information out there for people to utilize on learning how to build out and design in accessible features. The technology exists. The specifications exist. Yet I’m also seeing a priorities gap, and in some ways, a market gap. Accessibility got categorized as a specialty, and specialties cost extra, and so here we are.
I want to spend this episode on the numbers behind that problem, because I think when you look at the numbers, the scale of the mismatch between what the housing stock offers and what people actually need becomes very hard to ignore.
Rebecca: For sure. And like as Sarah said, as OTs, we see this mismatch pretty clearly. Again, as we mentioned last week, we see how environments, in this case homes and the actual people that live in them, both disabled and non-disabled, are often not working sychronously. And this is similar to what we talked about in the first episode. This is the kind of thing that’s often invsible… until it isn’t. Someone who has lived in their home for decades who then develops Parkinson’s for example may never have noticed how difficult their deep entry-way step was until they could no longer traverse it. A family who lives in a home where the kitchen is on the 3rd floor may never have realized how inconvenient that is until they want to invite their friend who uses a wheelchair over for dinner. When we are faced with these mismatches between design and human functioning, it can be surprising and also really frustrating.
So let’s actually look at the numbers, because I think a lot of people hear “housing accessibility” and they think we’re talking about a relatively small population with specific, significant disabilities and design needs. And the numbers tell a very different story.
Sarah: [00:04:00] Yeah, they really do. The CDC puts the number of US [00:05:00] adults with some type of disability at 28.7%. That is one in four adults, and HUD’s research puts the share of households that include at least one person with an accessibility need at 19%. So nearly one in five households right now, today, has someone in it who needs something from their home that most homes don’t offer.
Rebecca: And those numbers don’t even include temporary situations. They don’t include someone who just had a knee replacement and is navigating their home on crutches for six weeks, or someone who’s navigating their home after a pickleball injury. They don’t include the parent carrying a toddler who can’t open a door that requires two hands. In many people’s perspectives, temporary situations don’t need a workaround because they can compromise a bit and then ultimately get back to their baseline.
Sarah: Right. It’s like thinking it’s a little blip in the radar. But honestly, why not make life a little easier even in the short term? So if [00:06:00] you’re sitting with these numbers and you ask the next question, what percentage of the housing stock is actually universally accessible? The answer is less than 0.15%.
Like, that’s less than 1%.
Rebecca: Which is staggering. This stat is from the American Housing Survey, and the survey analyzes the accessibility of America’s housing stock. When you look further at the actual features that it represents, you realize they’re very basic ones. A stepless entry from the exterior, bedroom and bathroom on the entry level, or presence of an elevator in the unit, no steps between rooms, rails and grab bars along the steps, an accessible bathroom with a grab bar, and door handles and sink handles that are levers.
Sarah: Now, don’t get me wrong, those are wonderful features to have, but I do have a question, and maybe you thought about it, too. What do they mean by an accessible bathroom? What do [00:07:00] you think about when those words are mentioned? I know I have my perception of what that should be from all of the details surrounding the toilet, the sink, the shower setup.
But as we know, not everyone is on the same page with that. I did dig into this article a little bit more, and it said that in future iterations of the survey, they plan to include a short explanation of this category to include things like turning radius and width and height requirements, because there was a lot of subjectivity and limited respondent knowledge of those things.
If you haven’t heard of a turning radius before, it’s basically the amount of clear floor and wall space in a room that gives people using mobility equipment the opportunity and ability to turn in a circle without running into any barriers. It’s basically like being able to turn around like everyone else and not have to stay in one spot because the layout is small.
Then for width and height requirements, hopefully, they’d be looking at sink and [00:08:00] countertop heights, the height of storage or sink hardware for towels, for example. There’s probably more as well. But all that to say, considering those very basic features alone, with less than .15% of housing units even having those in place for basic accessibility, that’s a really limited amount of homes in our housing market.
So we have roughly 19% of households with at least one person who has an accessibility need and less than 1% of homes that are designed to meet that need in a very basic sense.
Rebecca: And the thing I keep coming back to when I think about the majority of our population living in their homes is that this isn’t a new problem. These homes weren’t accessible when they were built, nothing has happened to make them more accessible since, in most cases. There’s a mismatch between what a person needs and what the home has to offer. These homes have just stayed the way that they were, more or less, and this isn’t something that’s gonna self-correct [00:09:00] quickly.
Sarah: Exactly. Which brings in another number that I find really clarifying. The median age of a home will change year to year, but in the United States right now, based on the data found in the National Association of Home Builders website, gathered at the time of this podcast, homes are on average around forty-two years old.
I’ll link the article in the show notes, but the map is really interesting, as most of the oldest homes in the US are found in the Northeast. Which means, on average, half of all homes in this country were built before the late 1970s and early 1980s, well before universal design principles were common, let alone practiced.
So we’re not talking about a few older homes with some dated features.
We’re talking about the majority of the housing stock being designed under assumptions like people never aged or had health-related problems that would impact the way they use the home.
Rebecca: And like Sarah said, those homes are still out there. They’re still being sold. They’re still being rented. They’re still [00:10:00] being bought. They’re still being passed down and renovated. The decision someone made in 1959 when they built my house about whether to put a step at the front door is still affecting us and our friends today when they’re trying to get into our home.
Sarah: Can you imagine this with cars? What if we kept doing maintenance on cars from the 1950s and before? Granted, we do see some older models on the road, and we’re often surprised when we see them on the road. But as technology has evolved, our cars have too, and we’ve changed them to meet the needs and desires of the tasks people do and upgraded the technology as well.
That’s exactly the compounding problem you were saying, Rebecca. A home built with a step at the front entrance and 28 to 30-inch interior doors doesn’t just fail the person who buys it next year. It fails every household that occupies that home for the next several decades. Each inaccessible home that gets built or sold without modification [00:11:00] is locking in that inaccessibility for the lifetime of the structure.
That’s not an individual problem. That is a systems problem.
Rebecca: Definitely. And from a clinical standpoint, the response can’t just be when someone needs accessibility features, they just retrofit them into place as they need them. Because retrofitting is expensive and it’s disruptive, and in a lot of cases, it’s structurally complicated in ways that mean you can’t actually replicate the outcome that you could have gotten if you had built it right to begin with.
Sarah: Additionally, these changes aren’t that easy. If someone is slowly losing function, and they aren’t sure why, when they finally get that diagnosis, they’re in crisis mode, and then having to adjust their home on top of that, it pushes people overboard mentally and emotionally. There’s just too much to learn and manage from all of those life events.
That’s the piece I want to spend real time on as we move through this episode because I think [00:12:00] it changes the conversation in a really useful way. If you understand the cost and mental load difference between designing something now versus adding it later, the math and weight of the situation look very different.
But let’s get there through a specific example first. We want to take you to someone’s home. Actually, two people, Matthew and Katie. They’re thirty-four and thirty-three. They’ve been together for nine years, and they’re building a home on a lot Katie’s family owns. Matthew works in construction management.
Katie is a landscape architect, and they have spent the last eighteen months making thoughtful, careful decisions about every element of this build. They’ve researched and chosen low VOC materials, which is a dedicated decision to use products like paints, cleaners, or adhesives that put out less harmful chemicals into the air.
You know how people have said things like how they, quote-unquote, “notice the new car smell” or the new house smell? Well, those are the [00:13:00] materials that put more odors into the air and can cause headaches and nausea in some people. They’ve oriented their house on the lot for passive solar.
They’ve specified double-pane windows and high efficiency HVAC and a metal roof with a fifty-year lifespan. They are the kind of people who read product reviews before they buy a shower head. They’re also expecting their first child in about five months, which has added a useful urgency to getting the design locked down.
They have not thought much about accessibility. There’s no particular reason they would have. Neither of them have a disability. Neither of their parents are currently in that situation in which they would have a conversation about this. It just hasn’t come up, and the builder they’re working with has not brought it up either because the builder’s job is to deliver what the client asks for, and this is not something Matthew and Katie have asked for.
Matthew is the one who started reading. A client of his had done a renovation on a twenty-year-old home, [00:14:00] and the project got complicated in ways that involved pulling walls apart to do things, as he put it, “Really shouldn’t have required pulling the walls apart.” He started asking questions and ended up somewhere he hadn’t expected to be.
He was trying to understand why the renovation went wrong, and what he kept running into was the same pattern over and over. The things that are hardest and most expensive to change later are the things that cost almost nothing in the beginning. And a lot of that research he ran into came about in conversations regarding accessible homes, which got his mind thinking about what could be done for his family home.
Rebecca: So this kind of situation isn’t something that we as OTs see too often, right? This family doesn’t have healthcare needs right now that impact the accessibility of their home.
They’re not receiving clinical care, so there’s no reason for any of the accessibility stuff to necessarily be on their radar yet. But the thing is, most people we do encounter as [00:15:00] OTs who are navigating inaccessible homes were Matthew and Katie at one point, 10 years ago maybe. But they didn’t act on those thoughts. Maybe they didn’t even have those thoughts, because why would they? But what happens when you do take this into consideration before the design decisions are made? What happens if you’re thinking about accessibility from the get-go? This is such a rare, discreet, and valuable window in which you can choose to make your home work better for you now and for years to come.
Sarah: So here’s a really concrete example, a zero-threshold shower, one where the floor of the shower is flush with the bathroom floor. No curb, no step. Requires the drain to sit a little lower in the floor, and then installation, which means the subfloor has to be framed down to accommodate the depth of that drain.
At the design stage, that is a conversation between the architect and the framing crew. It adds essentially nothing to the cost of the build. But if you [00:16:00] want that same shower in a finished home, you’re not just pulling out the old unit and retiling a new one. You’re cutting into the subfloor, potentially reconstructing what’s underneath it, relocating the drain, redoing waterproofing, and retiling the entire floor.
And the complications don’t stop at the bathroom floor. If the home is on a slab, you may not be able to recess that drain at all without breaking into the concrete of the foundation. If the bathroom is on the second floor, lowering the subfloor affects the ceiling height of the room below it, and now you’re coordinating two rooms, not one.
What was a decision at the design stage becomes a project that touches the whole house, and depending on what’s underneath the floor, you may not be able to achieve it at any price.
Rebecca: And that same pattern pretty much shows up everywhere. Wider doorways. At the design stage, specifying a 36-inch interior door instead of a standard 30-inch door, costs the difference in door [00:17:00] materials, which in most cases, is really modest. As a retrofit, a wider doorway may require structural work if the door sits in a load-bearing wall.
It may require new framing, new trim, a new door, undoing and then fixing the floor beneath it. So you’re looking at an order of magnitude difference in both cost and disruption.
Sarah: Electrical outlets are another one. Electrical outlets are placed before drywall goes up. Specifying them at 16 to 20 inches from the floor instead of the standard 12 inches, high enough that you don’t have to crouch or kneel to reach them, costs essentially nothing if done during the design stage.
It’s a conversation with your electrician before the walls are closed. But if you want to move outlets in a finished home, you’re cutting into drywall, running new wire, patching, priming, and repainting, and that’s not one outlet. That’s every room in the house. A decision that takes five minutes at the rough electrical stage becomes a [00:18:00] whole house project if you try to address it later.
Rebecca: That’s right. So getting back to the example that Sarah started earlier with Matthew and Katie… Matthew works in construction. He knows this pattern because he lives it every time a client asks for something after the framing is up. It’s gonna cost more money.
Considering making changes now to avoid costing more money later, doing this with accessibility features only adds value and usability to the home.
Sarah: Matthew and Katie are in the best possible position.
The window is open, the decisions haven’t been made or finalized, and by Matthew happening on these conversations about modifying existing homes for accessibility, he now has the vocabulary to ask for what he wants. In addition to considering a walk-in shower, door widths, and electrical outlets at higher heights, I also mention something for them to consider as well: blocking in the bathroom walls for future grab bars, locating the breaker box in a location without having to go [00:19:00] up or down stairs, and providing an easy transition from indoor spaces to any backyard or outside space without steps.
Really, I could keep going on, but those things are much harder to change later. If you keep listening to our future episodes, we will give you a lot more ideas just like those.
Rebecca: That’s right, now, most people listening to this are not in this ideal world situation that these theoretical people Matthew and Katie are in where they’re building new from scratch. Most people are already in a home that’s already built, and the design-stage window is way past closed, for most of us, many years ago. And I don’t want to spend this whole episode on new construction and leave everybody else without anything actionable to do.
The good news is that the same knowledge that makes Matthew and Katie’s situation clear makes the existing-home situation clearer too. When you understand which features matter and why, you can look at any home and start to see where the friction [00:20:00] points are. Not all of them require structural work to address. Replacing round doorknobs with lever handles throughout a home costs somewhere in the range of $200 to $500 in hardware and a couple hours of labor, and it removes a friction point from every interior door in the house. Installing grab bars in an existing bathroom where blocking is already in the wall or the studs are in a good spot is a $50 to $200 project. Same result as having planned for it, very different cost than opening a wall without that blocking.
Sarah: And for the situations that are more involved, the sooner you address something, the more options you have. A modification made before there’s a crisis, before a fall, before someone comes home from the hospital, and the house just doesn’t work, it’s almost always less expensive, less rushed, and better executed than one made under pressure.
Rebecca: That’s right. And the starting point for all of it is just knowing what you’re looking at, and that’s [00:21:00] genuinely something that takes some education because most of us weren’t taught to see homes this way. It’s not intuitive, And you don’t recognize it until you start learning about it.
Sarah: That is exactly why I’m excited about this series, because we get to talk about exercising those muscles of understanding the why behind these features so that any of our listeners may be building new, like Matthew and Katie, or someone like Margaret, who we mentioned in our last episode, who has been in her house for twenty years, can look at their home and know what they’re seeing and what options are available.
The thing I want to leave you with from this episode is something about Matthew’s situation that I find genuinely compelling. He didn’t come to this as someone worried about his own future needs or as someone navigating a disability in a household. He came to it as a construction professional who started pulling on a thread from a client project and found himself looking at his own industry differently.
And what strikes me about this, he already knew how to build those features. That [00:22:00] knowledge was never the gap. The gap was that nobody had framed it as a standard, as something that belongs in every project, rather than something you add when a client specifically asks for it.
He saw it that way, and he couldn’t unsee it.
Rebecca: That’s actually where the supply problem gets solved, if it gets solved. Not just in Matthew And Katie’s house, but in every project Matthew touches going forward. Every conversation he has with a client where he says, “Here’s what it costs to do this now versus later.” Every time he puts wider doorways and a zero-threshold shower and outlets at the right height into a bid package as a baseline rather than an upgrade. That’s how the point one five percent number starts to move.
Sarah: And that’s really the invitation this series is making to anyone who builds, designs, or works with clients in their homes. The features we’re going to walk through episode by episode aren’t specialty items. They’re just good decisions that happen to require knowing what they are [00:23:00] and when in the process they have to be made.
Rebecca: That’s right. So next episode, we’re gonna start with where every trip into and out of a home begins: parking. Which sounds mundane, and it turns out to be genuinely important in ways that most people haven’t considered. And we’ll introduce that when we get there, and we’re looking forward to seeing you there, listeners. Thanks for listening, and we’ll be back soon!
Thanks for listening to Good Fit Poor Fit. If you want to learn more… first, find more episodes with transcripts and show notes at goodfitpoorfit.com. Don’t forget to subscribe! Second, check out our courses at universaldesign.org.
We cover housing topics like advocacy, collaboration, home modification, universal design and task adaptations. Lastly, if you have questions or topics you’d like us to discuss, email us at [email protected]. Thanks for fitting us into your day. [00:24:00]
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