Rural Facts: Visitability

Visitability

Montana Disability and Health Program, Research and Training Center on Disability in Rural Communities, September 2004

Description of photograph (Photo taken by Lisa Brennan.)

Visitability means:

A friend or family member with a physical disability can easily visit you in your home.

Basic accessibility features are integrated into all newly built, single-family housing in an affordable, sustainable way.

Emphasis is on the most essential access features, such as exterior entries and interior doors.

Widespread construction change can happen more quickly.

Visitability does not require including a long list of desirable access features or adhering to a comprehensive full-accessibility construction standard.

What makes a home visitable? A visitable home has three features:

1. One zero step entrance on an accessible path of travel from the street, sidewalk or driveway. A "zero step" entrance has no step or threshold to block a wheelchair or trip a person with limited mobility. An "accessible path of travel" is a walkway or ramp, 36 inches wide or wider and without steps. Walkways should be no steeper than one foot of rise per 20 feet of length (1:20/5% grade). Ramps should be no steeper than one foot of rise per 12 feet of length (1:12/8.3% grade).

2. Doorways that provide 32 inches clear space throughout the home's main floor and hallways that provide 36 inches of clear width.

3. Basic access to a half or (preferably) full bath on the main floor. A bathroom with "basic access" has sufficient length and width for a person using a wheelchair to enter and close the door.

The visitability movement grew from Eleanor Smith's conviction that basic architectural access to all new homes is a civil and human right and improves livability for everyone. Smith founded the Concrete Change organization in 1986 and by 2003, she and her colleagues had worked with Habitat for Humanity to make 300 Atlanta, Georgia, homes visitable. Thanks to Smith's vision, visitability was designed into all 67 homes in the Decatur, Georgia, housing development where she lives.

How many homes are visitable in your state or community? Unfortunately, no one knows. In Montana, we've begun an effort to calculate our state's number of visitable homes. The Montana Department of Public Health and Human Services, in conjunction with the Centers for Disease Control and Prevention http://www.cdc.gov/brfss/ , conducts Montana's annual Behavioral Risk Factor Survey (BRFS). In 2004, a question on visitability was added and four thousand Montanans are being asked "If a person who uses special equipment such as a wheelchair came to visit you, could they get into your house without being carried up steps or over other obstacles?". From respondents' answers, we will be able to estimate the number of visitable homes in the state and use this number as a baseline for measuring progress toward making Montana's communities visitable. Future survey data may demonstrate a link between increased numbers of visitable homes and improved health and safety for all Montanans.

How can visitability increase safety? Falls are the most common cause of injuries to older adults. More than a third of adults aged 65 or older fall each year, and of those who fall, 20-30% suffer moderate to severe injuries that decrease their mobility and independence. Because seniors spend so much of their time at home, one-half to two-thirds of all falls occur there. Injury prevention strategies are effective in keeping older adults healthy and safe; removing household hazards that might cause tripping is a simple way to reduce falls and fractures in older Americans. National model building codes currently require a zero-step entrance in all new buildings except private homes. In order to promote this feature in private homes, the American Public Health Association encourages the National Fire Protection Association and other organizations to create codes and standards that will promote safety from falls in residences and improve their general utility "for the largest range of people, including elderly persons or those of any age with disabilities" (Public Policy 2000019, 2001). The policy specifically names the zero-step entrance as a desirable component of any home building codes and standards.

How does visitability relate to the health of persons with disabilities? Many Americans with disabilities experience depression. It is a significant "secondary condition" that limits their participation in enjoyable activities. Older adults with disabilities are particularly vulnerable to depression, anxiety, and social isolation. The disability supplement to Washington state's 2001 BRFS included sixteen questions on common secondary conditions. Compared to respondents without disabilities, nearly three times as many people with disabilities reported periods of depression and feelings of isolation. The daily barriers to social support and companionship which they encounter may contribute to this health disparity. Visitable homes might eliminate some of these barriers and reduce the rates of depression and sense of isolation experienced by individuals with disabilities.

Is visitability required by law? People often assume that the Americans with Disabilities Act (ADA) and/or other laws mandate that all newly-constructed U.S. housing be accessible to people with disabilities. Although laws mandate accessibility for some construction, most newly-constructed single-family housing is exempt. Federal Fair Housing Act Accessibility Guidelines include seven basic access requirements for multi-family dwelling units in elevator-equipped apartment buildings and ground floor units in walk-up apartment buildings, but these requirements don't apply to single-family detached homes and townhouses. The Architectural Barriers Act (Section 504 of the Rehabilitation Act of 1973, as amended, 29 USC sec 794), Title II of the ADA, and many state laws require that housing built with public funding be accessible. However, this usually only applies to a minimum of five percent of the units in a building or project. Accessibility laws do not apply to dwelling units financed by federally-insured mortgage programs. However, mandated visitability is possible the United Kingdom instituted national building regulations (Part M) in 1999 requiring new homes to be visitable. In the U.S., the proposed "Inclusive Homes Design Act" would require 95 percent of homes built with federal dollars to be visitable.

Could a visitable home have more value than a non-visitable home? "Aging in place" means continuing to live in your own home or other non-institutional setting as you age. Products, services and conveniences are available to allow or enable you to function in changing circumstances (http://www.seniorresource.com/ageinpl.htm). A home constructed with visitable or accessible features adapts as family members age and/or acquire a disability. A visitable home accommodates common age-related conditions (such as poor balance) as well as more severe disabilities that require using a motorized scooter or wheelchair. Any person with an acquired mobility impairment will have greater sense of well-being if he or she can continue to live at home. Visitable homes may be more desirable to the growing number of Americans moving into retirement and seeking single-family homes suitable for aging in place. Future real estate market research should explore the desirability and value of visitable homes.

Are there financial incentives for making a home visitable? There are federal income tax deductions for making an existing home visitable. Costs of certain home improvements made to accommodate a taxpayer, spouse or dependent with a disability and allow that person to continue living at home are deductible as a medical expense. Improvements include, but are not limited to, grading the home site to improve access, constructing ramps, modifying entrance areas, widening exterior doorways, widening/modifying interior doorways, installing railings and support bars, and modifying bathrooms. Each of these improvements is an element of a visitable home. Details of allowable expenses are published in the Internal Revenue Service Publication 502: Medical and Dental Expenses. Only the amount of medical expenses that exceeds 7.5% of adjusted gross income is allowable. For example, if adjusted gross income is $20,000, the allowable amount is $1,500 (.075 x $20,000). If medical expenses for home modifications are $800, the expense is not deductible. If adjusted gross income is $20,000 and the homeowner makes $2,000 in medically necessary modifications for self, spouse or a dependent, the deductible expense is $500 ($2,000 - $1,500 = $500, IRS, 2003).

States may also offer tax incentives, such as the Kansas Disabled Tax Credit and the Illinois Accessible Housing Demonstration Grant Program.

References:

American Public Health Association. (2001). 200019: Public health role of the National Fire Protection Association in setting codes and standards for the built environment. American Journal of Public Health, 91, 28.

Baker, N. & Spas, D. (1999, Updated 2004). RuralFacts: Accessible Rural Housing. Missoula: The University of Montana Rural Institute.

Centers for Disease Control and Prevention. (2004). Falls and hip fractures among older adults. Retrieved June 2, 2004 from http://www.cdc.gov/ncipc/factsheets/falls.htm .

Hausdorff, J. M., Rios, D. A., & Edelber, H. K. (2001). Gait variability and fall risk in community- living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation, 82, 1050 6.

Hornbrook, M. C., Stevens, V. J., Wingfield, D. J., Hollis, J. F., Greenlick, M. R., & Ory, M. G. (1994). Preventing falls among community-dwelling older persons: Results from a randomized trial. The Gerontologist. 34, 16 23.

Internal Revenue Service. (2003). Publication 502: Medical expenses. Washington, DC: Author. Retrieved July 15, 2004, from http://www.irs.gov/publications/p502/ar02.html .

Kinne, S., Patrick, D. L., & Doyle, D. L. (2004). Prevalence of secondary conditions among people with disabilities. American Journal of Public Health, 94, 443-445.

Nevitt, M. C., Cumming, S. R., Kidd, S., & Black, D. (1989). Risk factors for recurrent nonsyncopal falls: a prospective study. Journal of the American Medical Association, 261(18), 2663 8.

Pauls, J. (2003). Visit-ability: Advocating this public health goal through improved building codes. Poster presented at the American Public Health Association annual meeting, Atlanta, GA.

Rehabilitation Research and Training Center on Independent Living Management and the Rehabilitation Engineering and Research Center on Universal Design at Buffalo. (2003). Visit-ability: Making universal access to community life a reality: computer based tutorial. [CD] Buffalo: RRTC-ILM.

Seekins, T., Clay, J., & Ravesloot, C. (1994). A descriptive study of secondary conditions reported by a population of adults with physical disabilities served by three independent living centers in a rural state. Journal of Rehabilitation, April, 47-51.

Sterling, D. A., O'Connor, J. A., & Bonadies, J. (2001). Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma-Injury Infection and Critical Care, 50, 116 9.

Traci, M. A., Seekins, T., Szalda-Petree, A., & Ravesloot, C. (2002). Assessing secondary conditions among adults with developmental disabilities: A preliminary study. Mental Retardation, 40, 119-131.

Truesdale, S. & Steinfeld, E. (n.d.). Visit-Ability: An approach to universal design in housing. Buffalo, NY: Rehabilitation Engineering Research Center on Universal Design at Buffalo.

Wilkins, K. (1999). Health care consequences of falls for seniors. Health Reports, 10, 47 55.

Resources:

AARP: http://www.aarp.org/life/homedesign/

Accessible Housing Specialists: http://www.accessiblehousing.net

Center for Universal Design: http://www.design.ncsu.edu/cud/

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

Inclusive Home Design Act of 2004

Kansas Dept. of Revenue: http://www.ksrevenue.org/taxcredits-disabled.htm

Montana Fair Housing
2522 South Third West, Missoula, MT 59804
406-542-2611 406-542-2235 (fax)

Rehabilitation Engineering and Research Center on Universal Design: http://www.ap.buffalo.edu/rercud

For more information, contact: Meg Ann Traci, Ph.D., Director
Living Well under the Big Sky: Montana Disability and Health Program

MTDH logo: Silhouette of Montana with title "Living Well under the Big Sky" Research and Training Center on Disability in Rural Communities, The University of Montana Rural Institute: A Center of Excellence in Disability Education, Research and Services, 52 Corbin Hall, Missoula, MT 59812-7056
(888) 268-2743 toll-free; (406) 243-4956;
406) 243-4200 TTY; (406) 243-2349 (fax)
rural@ruralinstitute.umt.edu | http://rtc.ruralinstitute.umt.edu | http://mtdh.ruralinstitute.umt.edu

The information provided in this report was supported by grant #R04/CCR818822-02 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. This factsheet was prepared by Lisa Brennan RTC: Rural 2004. It is available in standard print, large print, Braille, and as an ASCII DOS text file on disk. The RuralFacts Series is edited by Diana Spas.