How to Write an Accessibility Scope an OT Can Sign Off

Why this matters

An accessibility scope gets read by three people who want different things from it. The occupational therapist (OT, the clinician who assesses how a person functions and recommends changes) wants to know that each item matches the person's body. The funding program, if there is one, wants to know why each item is necessary and that nothing in it is a nice-to-have dressed up as a need. The building inspector wants to know which items are structural, plumbing or electrical, and what code they are built to. A scope written for only one of them comes back from the other two, usually after the start date is already set and the person is waiting.

The fix is not three documents. It is one scope where every item carries a measured dimension, the functional reason for it, and where the dimension came from. Each reader can then find their own column. How to work with the OT as a professional relationship is owned by a sibling: see related, Working With the Occupational Therapist. Funding programs themselves are covered in Funding Paths for Home Modifications. This article is the document.

Step 1: Open with the person, measured

Before any item, the scope records the person's own dimensions, because every proposed figure below is judged against them. The OT may have measured these; if so, use the OT's numbers and say so. If you measured them, say that.

What to record:

• Mobility device and its key dimension: for a wheelchair, the seat height from floor to top of the cushion, and the overall width. For a walker, its width.
• Transfer side and method: stands and pivots, slides on a transfer board, needs a caregiver's help.
• Reach band: the lowest and highest height they can work a control from where they sit or stand.
• Who measured, and when.

Why first: an OT reading "toilet seat at 18 inches" cannot tell whether that is right until she knows the chair seat is 19. Without the person's numbers at the top, she has to call you to find out, or she approves it without checking.

Step 2: Write one item per change, in the same fields every time

Every item carries the same six fields, in the same order, so a reader can run down the page and find their column without reading the prose:

1. Measured: what is there now, as a number, with what it was measured from.
2. Proposed: what it will be, as a number, measured from the same point.
3. Function: what this lets the person do that they cannot now, in one line, tied to the person's measurements at the top.
4. Reference: where the dimension came from.
5. Permit: whether it needs one, and which trade.
6. OT to confirm: what is left for the therapist to decide, or "none."

One change per item. "Bathroom accessibility upgrades" as a single line is the item every funding reviewer sends back, because they cannot approve part of it.

State the datum in the same line as the number. "Grab bar at 34 inches" means nothing without "to the top of the gripping surface, from the finished floor." Two readers measuring from different points will each think the other got it wrong.

Step 3: Cite the reference that actually set the number

The reference field is the one that lets a reader trust a figure without re-measuring it. There are four honest sources, and the scope should name which one each figure came from:

• The 2010 ADA Standards, by section. In a private home they are a reference, not a requirement; see related, What the ADA Does and Does Not Cover in a Private Home. They are still the most complete dimensional reference available and most OTs know them, so cite them as "2010 ADA 604.5 uses" rather than "ADA requires."
• The code, where a code applies: the IRC, the plumbing code or the NEC, as adopted by your jurisdiction. This is what the inspector reads.
• The manufacturer's instructions, for a product with its own installation dimensions.
• The person or the OT, where the dimension is set by their body rather than any standard: "34 inches, per OT, to suit standing height."

Where the ADA reference and the person disagree, the person wins, and the scope says so in that line.

Step 4: Mark the permit items and the code they answer to

The inspector reads only this column, so make it complete. Structural work (a widened doorway, blocking added behind a wall by opening it), plumbing (moving a fixture, a new drain), and electrical (a moved box, a new circuit) commonly need a permit, depending on your jurisdiction. Name the trade, and where the item is built to a code rather than to the ADA reference, cite the code section in the reference field.

What breaks if you skip it: the inspector sees a toilet moved 2 inches on a scope with no plumbing permit noted, and the job stops at rough-in.

Step 5: Leave the clinical calls open, on purpose

Some decisions are not yours: the exact height of a grab bar for a person with a particular balance problem, whether a vertical bar is needed for sit-to-stand, whether a shower seat should fold. Put a proposed figure in so the OT has something to react to, and mark it "OT to confirm." A scope that fills every clinical field with a confident guess gets signed by a busy therapist who trusted it, and you own the result.

Step 6: Make each item stand on its own for a funder

A funding reviewer approves or declines item by item. Each item's function line is what they read, so write it as the problem it solves for this person, not as a feature: "allows a standing transfer without pulling on the towel bar" rather than "adds grab bar." Separate what addresses a safety risk the visit observed from what improves convenience, so a program that funds only the first can approve those lines without striking the whole scope. Programs have their own forms and rules; see related, Funding Paths for Home Modifications.

Worked example: a bathroom scope for one person

The customer uses a manual wheelchair, seat height 19 inches floor to top of cushion, 25 inches wide overall. She transfers to her left with a stand-and-pivot and a hand on something solid. Her reach band, measured by her OT, is 18 to 44 inches. The toilet sits against a side wall on its left, with the open side on its right where the chair approaches.

Three of the five items as they went to the OT:

PERSON  manual chair, seat 19 in (top of cushion)
        overall width 25 in; stand-pivot transfer
        to the left; reach 18 to 44 in (OT measured)

ITEM 1  Toilet seat height
  Measured   15 in, floor to top of seat
  Proposed   18 in, floor to top of seat
  Function   transfer 1 in down to the seat, not
             4 in down, from a 19 in chair seat
  Reference  2010 ADA 604.4 uses 17 to 19 in
  Permit     plumbing, fixture replacement
  OT         confirm 18 vs her 19 in chair

ITEM 2  Toilet centerline from side wall
  Measured   15 in
  Proposed   17 in
  Function   room for her hip and the side bar
  Reference  2010 ADA 604.2 uses 16 to 18 in
  Permit     plumbing, flange relocation
  OT         none

ITEM 3  Side wall grab bar
  Proposed   42 in long, 12 in from rear wall,
             top of grip 34 in above floor,
             1-1/2 in diameter, solid blocking
  Function   pivot hand-hold; replaces the towel
             bar she pulls on now
  Reference  2010 ADA 604.5.1 and 609.4
  Permit     none if backing is reached without
             opening framing; check jurisdiction
  OT         confirm height; vertical bar?

Items 4 and 5, carried in the same fields: the 3/4 inch marble saddle at the bathroom door replaced with a beveled threshold no higher than 1/2 inch (2010 ADA 303.3 reference; no permit), and the round door knob replaced with a lever (2010 ADA 309.4 reference; no permit; flagged as convenience, not safety, for the funder).

Three things in those blocks are doing deliberate work:

• Item 1 carries its arithmetic. 19 minus 15 is a 4-inch drop to the old seat; 19 minus 18 is 1 inch to the new one. The OT can check that in her head against the chair she knows, which is why the person's measurements are at the top.
• Item 2 is the inspector's item. Moving the toilet 2 inches off the wall is a flange relocation, so the permit field says plumbing, and that line is what stopped this job from failing at rough-in.
• Item 3 leaves two clinical questions open rather than answering them. The ADA reference gives a height range of 33 to 36 inches to the top of the bar (609.4) and the scope proposes 34. Whether she also needs a vertical bar is a balance question.

What came back. The OT signed off with two changes: the side bar's top lowered to 33 inches, because she pivots low and pushes down rather than pulling, and a vertical bar added at the front end of the side bar for the moment she rises from the chair. Both went in as revisions to item 3, dated, with "per OT" in the reference field. The toilet height stayed at 18. The building department issued a plumbing permit covering items 1 and 2. The funding program's reviewer approved items 1 to 4 as safety items and left item 5 to the customer, which the scope's own flag had anticipated.

How the blocking is built behind item 3 and its vertical bar is not a scope question; see related, Grab Bar Backing and Load: The Structural Rule and the the Handyman pack SOP Grab Bar and Handrail Installation.

Step 7: Version it, and close it with signatures

Every scope that goes to more than one reader gets a revision number and a date in the header, and every change after the first issue is listed at the bottom with who asked for it. The OT's sign-off, the customer's approval and the permit number go on the final version, and that is the one the crew works from.

What breaks if you skip it: the crew installs from revision 1 while the OT approved revision 2, and the bar goes in an inch higher than the therapist asked for.

References

• 2010 ADA Standards for Accessible Design, 303, 404, 604 and 609, used as a dimensional reference only in a private home.
• IRC, the plumbing code and the NEC as adopted by your jurisdiction, for permit items.
• See related: Working With the Occupational Therapist; Funding Paths for Home Modifications; What the ADA Does and Does Not Cover in a Private Home.
• See related: Grab Bar Backing and Load: The Structural Rule; the Handyman pack SOP Grab Bar and Handrail Installation; The Accessibility Walkthrough With the Person Who Lives There.