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Housing adaptations following brain injury

One of the biggest capital outlays any of us are likely to make during our lifetime is the purchase of a home. After a traumatic brain injury or other catastrophic or personal injury, many clients present with very different clinical and functional needs. They may rely on large specialist mobility and therapy equipment and a large care package, all of which requires considerable space. Clients and their families then face the dilemma of deciding what to do about accommodation and how best to meet the altered needs of the individual in the community.

It is often the case that the injured person cannot move back to their previous family home by virtue of inherent design features that pose access barriers such as differences in internal floor levels, multiple steps at entry points that cannot be easily or reasonably overcome with ramps/lifts, or is too rural in location with inadequate amenities such as shops, healthcare and public transport. Most frequently though, is the fact the home simply is no longer big enough to meet the client/family’s needs. Whilst extending the property might be an option in some cases, issues such as the original size of the property, location, conservation/heritage caveats can dictate and limit what can be added. The client/family and professional Deputy might then make the decision to purchase a more suitable property for the client that has the potential to be adapted for the client’s needs while factoring in the needs of the wider family, providing carers facilities and proximity to community amenities and resources.

Already adapted properties for complex physical disabilities

It is widely recognised that finding domestic properties that have already been adapted that meet the requirements of clients with complex physical disabilities can be extremely difficult; some degree of adaptation will inevitably be required. It’s not a case of ‘one size fits all’ with adaptations; each client has their unique set of needs and abilities which means that any changes must be designed to meet their specific requirements. When a home requires adaptations the cost of those adaptions can also be significant.

It is often the Court of Protection Deputy or the Professional Trustee of a Personal Injury Trust who will have overall responsibility for this expenditure. They are likely to have purchased many properties during their professional careers and for clients with a variety of needs. Their experience will often allow them to see potential in a property that at first sight may seem unsuitable but the professional Deputy or Trustee will form only part of the professional team which is needed to ensure that the project is a success.

A key member of the professional team will be an Architectural Consultant specialising in disability related housing adaptations. The Architectural Consultant’s role is to design, specify, tender and manage the adaptation process from start to finish but they will also provide useful input in the preparation for these stages.

Planning to adapt a property after brain injury

When a property requires an extension needing planning permission to make it suitable for a disabled occupant, the Consultant can submit a pre-planning advice request to the local authority to gain feedback on whether the proposal is likely to receive their support. In addition cost estimates for the necessary adaptation works can also be provided with the Consultant drawing on figures from similar projects they have overseen. Utilising these services during the early stages of the acquisition process, will assist the Deputy or Trustee to make an informed decision on whether the property is a viable and suitable option and prior to committing to a purchase.

The consultant will usually convene a briefing meeting, allowing the various stakeholders in the project to share their respective opinions and expertise thereby ensuring that the property will meet the individual’s needs and be fit for purpose. To assist with this the Deputy or Trustee will usually supply the Consultant with as much relevant information as possible including reports from any other professionals who have assessed or are working with the injured person. Having involvement and input from the right people at the right time is a key factor in making sure that the home purchase and adaptation project is a success.

Housing Occupational Therapist visit

The other key person at this early stage will be a specialist Housing Occupational Therapist who will arrange to visit the client and their family to carry out a focused assessment of their housing needs. This will involve evaluating the individual’s performance abilities, liaising with the family, Case Manager and treating therapists and taking thorough measurements of the person and their equipment; a step not usually undertaken by design and construction professionals. The needs of the wider family and care team are also factored in.

Working through these steps with these professionals will allow the Deputy/Trustee to then proceed with their purchase confident in the knowledge that they are expending their clients money wisely and that the project will have a successful outcome.

Once the property is purchased the Housing Occupational Therapist will make detailed recommendations based on sound clinical reasoning, for specialist equipment and assistive technology as well as the major adaptations. Their recommendations will be designed to promote inclusion and to maximise a person’s potential to carry out activities of daily living.

Having knowledge of current legislation, industry best practice guidelines and latest innovations in mobility, care, assistive technology, moving & handling equipment and accessible design are paramount when there is a need to ensure that the recommended options do not resemble a hospital or rehabilitation facility and that they combine both functionality and aesthetics as well as coming within budget.

In instances where a client’s cognitive or communication difficulties hinder their ability to express their wishes verbally, the Occupational Therapist may arrange a joint session/s with the client, clinical Psychologist and/or Speech and Language Therapist to find alternative ways of presenting the information and eliciting their views, wishes and preferences.

Adapting the family home for a brain injured person

Whilst the input of professionals is very important, it is also the individuals and their families that know best the day-to-day difficulties that they face, so they will also play an important role in helping to shape design features that can eliminate or reduce these as far as possible. It is therefore important to involve the individual and their family at an early stage and throughout the process. When a home needs to accommodate an individual’s specific disability related needs and their care team but also function as a family home, careful consideration must be given to the layout of the property so that appropriate privacy and separation can be given to those at home and those at their place of work.

Planning application

Following this careful consultation process the Architectural Consultant will need to produce drawings for the planning application and building regulation submissions and once planning permission is obtained a detailed specification of works from which competitive tenders will be obtained from suitable building contractors. The Consultant will take account of the Occupational Therapist’s recommendations at the very early stages of the design process so that these can be incorporated into the scheme design drawings and they will then work collaboratively to review all tender documents ahead of dissemination, to ensure that the proposals will meet the injured person’s current and future clinical needs.

The consultant will also assist the Deputy/Trustee by using their construction knowledge and experience to carry out a thorough due diligence process on the tendering contractors before a final choice is made and then procure an appropriate construction contract. Again, this expertise plays an important part of ensuring the project is successful and will help avoid the pitfalls so often associated with building projects which are not managed effectively.

The Housing Occupational Therapist will remain involved for the duration of the project, on hand to advise on product specification, arrange for equipment demonstrations and quotes, advise on furniture, optimal layout and deal with unforeseen issues from a clinical perspective and provide necessary training to the client, family and carers upon completion of the project. The Consultant will also seek the input and approval of all the various other stakeholders during each stage of the project to ensure the design stays on track and that the initial brief is met. Good communication throughout this time is vital.

Discussion over adaptation proposals

There are, occasions where a family member may be keen for the adaptation proposals to progress in a certain direction that may not be considered to have a direct benefit for the client or contradicts what the client’s wants. If matters cannot be resolved directly or with support of the MDT, the Architectural Consultant and Occupational Therapist will look to the Deputy to help resolve such issues on a best interest’s basis.

Although smaller scale projects can be realised more quickly, a substantial home adaptation project requiring reconfiguration and extension of a property does take time and it may be in the region of twelve months before the property is ready for occupation.

Top Tips:

  • Establish the client’s and family goals and priorities
  • Appoint/instruct a Housing Occupational Therapist as early as possible in the process.
  • Ensure that the appointed Occupational Therapist’s main clinical area of specialism are housing and adaptations
  • Arrange an architectural feasibility visit, report and cost estimation prior to purchase
  • Put in a pre-planning advice request for any proposed extensions prior to purchase
  • Consult with the client, family and MDT at all stages and make sure there are good channels of communication throughout the project

With thanks to the contributors to this article

Christine Bunting – Professional Deputy at Hyphen Law a specialist law firm dealing with all aspects of property and affairs work in the Court of Protection and Personal Injury Trusts.

David Goodheart – Architectural Consultant & Tess Whitehead – specialist Housing Occupational Therapist both of Adaptation Design Limited a surveying and architectural practice specialising in disability related property adaptations.

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