The Accessibility Walkthrough With the Person Who Lives There
Why this matters
Most accessibility jobs that disappoint were scoped from a list someone else made: the daughter's phone call, a printout titled "aging in place checklist," a contractor's habit of putting grab bars by every toilet. The person who lives in the house then gets a bar on the wrong side, a ramp at a door they never use, and a walk-in tub they stop using after a month. The walkthrough is how you find out what this body does in this house, and it is the one part of the job no amount of skill later can make up for.
This card owns the assessment for the accessibility group. Siblings that need it cite it.
What a walkthrough catches that a checklist cannot
A checklist asks whether the house has a feature. A walkthrough asks what the person does instead when the feature is missing, and those workarounds are the real scope:
- The door they actually use. Plenty of people never use the front door; they come in from the garage up a 7-inch step with a car door to hold.
- What they push on. A towel bar, a vanity edge, a sink, a doorframe. Each is a grab bar the house already has, installed where the body needs one, and usually not strong enough.
- Which side. A person who lost strength on one side, or had one hip replaced, transfers toward one side and pushes with one arm. A grab bar on the other wall is decoration.
- What they have stopped doing. People quietly drop the task that got hard: the tub becomes a sponge bath at the sink, the basement laundry becomes a relative's job, the top shelf becomes empty. A checklist never finds an activity that no longer happens.
The method below gets those four things in about an hour.
The steps
1. Book it for the person, at the time the hard part happens. Ask the caller when the person is home, and which part of the day is hardest. If it is the morning shower, an afternoon visit sees a rested person doing nothing difficult. Skip this and you assess someone at their best and scope for that.
2. Sit down first and ask about their day. Before anyone walks anywhere, sit at the person's eye level and ask them to walk you through a normal day from getting out of bed. Listen for pauses, "my son does that now," and anything done differently than it used to be. Address your questions to the person even when a family member answers; look back at the person and ask, "Is that how it feels to you?" Skip this and the family's version becomes the scope, and it is usually a list of what worries them rather than what is hard for the person. Conduct with a customer whose capacity is in question belongs to the Safeguarding group, not here. See related: How to Scope a Job With the User and a Family Member Present.
3. Ask directly what they have stopped doing. "Is there anything around the house you used to do and don't anymore?" Then wait. The second answer is often the important one. Skip this and you modify the rooms they still manage and leave the room they gave up on.
4. Watch them move through four places with their own aids. Entry, bathroom, kitchen, bedroom, in that order, using the cane, walker or chair they actually use, along the route they actually take. Ask them to show you how they do it, not to perform for you, and never ask for a movement they told you they avoid: do not ask someone who stopped using the tub to step into it. Stand close on their weaker side without holding them, and ask before you touch. If they lose balance, steady them at the trunk and help them sit rather than trying to hold their weight standing; if they fall, do not lift them, ask whether they are hurt, and call 911 if they struck their head, cannot get up or report new pain. Skip the watching and every workaround above stays invisible.
5. Measure what they use, not what the house has. Record their mobility aid's overall width and length, seated knee height in it, the height of the surface they push up from, the highest shelf they reach comfortably with each arm, the side they transfer toward, and the step height they manage at the entry. A tape and a level are enough. Skip this and you size the job to the 2010 ADA Standards' generic adult, which may not be this person.
6. Read the record back to the person before you leave. Say the three or four things you heard as the hardest, in their words, and ask whether you got it right. Skip this and you leave with your interpretation, and the person never had a chance to correct it.
The record this produces
The walkthrough ends in one page, filled in on site:
ACCESSIBILITY WALKTHROUGH Job 2417
Person: Mr. R., 74, lives alone, daughter nearby
Present: Mr. R., daughter (left at step 3)
Aid: 4-wheel walker, 24 in wide, 27 in long
Hardest part of day: morning, washing
Stopped doing: tub bathing (6 mo), basement laundry
Entry used: garage door, 7 in step, holds car door
Bath: pushes up off vanity edge, RIGHT hand
toilet seat 15.5 in, vanity moves when pushed
tub wall 15 in, not used
Kitchen: reaches 52 in with R arm, 44 in with L
top two shelves empty
Bedroom: bed top 19 in, sits then swings legs
Transfers toward: RIGHT
His words: "the step and the toilet, that's it"
Read back: yes, agreed
Every line is an observation or the person's own words. None is a product.
Worked example: the scope that changed
The call came from Mr. R.'s daughter: grab bars "everywhere," a walk-in tub and a ramp at the front door. On the phone it sounded like a full bathroom remodel and a ramp.
What the day told us. Mr. R. had a left hip replaced eight months earlier and an old left shoulder injury. Sitting at the kitchen table, he said the hardest part of the day was the morning. His daughter said the front steps; he said, when asked directly, that he had not used the front door since the surgery.
What he had stopped doing. He had not been in the tub in six months. He washed at the bathroom sink, standing, holding the vanity with his right hand. The basement laundry had become his daughter's job.
What the watching showed. He came in from the garage, where the step was 7 inches with nothing to hold except the open car door. In the bathroom he sat on a 15.5-inch toilet seat and stood by pushing on the vanity with his right hand, and the vanity moved when he did it. He turned toward his right every time. In the kitchen his left arm reached 44 inches and his right reached 52 inches, so the top two shelves of the upper cabinet were empty. The bed was fine.
What we measured, and what it meant. The 2010 ADA Standards use a toilet seat height of 17 to 19 inches (604.4), as a reference, not a requirement, in a private home. Raising his from 15.5 to about 17.5 inches cuts the rise he has to make by 2 inches. The grab bar goes on the right, where his push already happens, because his left shoulder will not take his weight. The garage step gets a handrail on his right going in, and the walker needs a plan: at 24 inches wide it will not fit beside the car on that side of a single-car garage, which is why he leaves it in the kitchen and holds the car door instead.
The scope that went to the daughter and to Mr. R.:
- Garage entry: a handrail at the 7-inch step on the right going in; a second step or a short platform to halve the rise, priced as an option.
- Bathroom: a comfort-height toilet; a grab bar on the right side wall, into framing; the vanity anchored to the wall so it stops moving.
- Bathing: a tub transfer bench and a handheld shower as the immediate fix; a low-threshold shower priced as a second phase.
- Kitchen: the dishes he uses moved to the lower two shelves, which needs no work at all.
What came off. The front-door ramp, because he does not use that door. The walk-in tub, because he described waiting while it fills and drains as a reason he would not use one, and a transfer bench answered the actual problem the same week. "Grab bars everywhere" became one grab bar where he pushes. The job went from a remodel to a few days' work and a phased option, and every item traces to a line on the record.
Why the daughter's list was not wrong. It was a list of what she feared: the front steps were where she had seen him struggle once in winter. The walkthrough did not dismiss it; it found the door he uses. If he starts using the front door again, the ramp comes back.
What changes the method
- A condition expected to progress. Measure for today and ask the person and their clinician what the next stage looks like, so the blocking and the clearances go in for the later need. See related: Designing for a Progressive Condition.
- Someone at risk of falling during a demonstration. If a movement could put them on the floor, do not ask for it. Ask how they do it, note it, and recommend an occupational therapist assess the transfer. See related: Working With the Occupational Therapist.
- An OT has already assessed. Read the recommendation first, then walk through to see whether the house will take it. You are checking the structure, not repeating the assessment.
How to verify you got it right
Hold the finished scope against the record and check three things. Every scope item traces to a line on the record; an item with no line came from a checklist or a family member and needs a reason. Every "stopped doing" line is either addressed or explicitly deferred with the person's agreement. And the side, the height and the width on each item match the measured figures, not a default. If the scope fails any of these, go back to the person before you order anything.
References
- 2010 ADA Standards for Accessible Design, 604.4 (toilet seat height), used as a dimensional reference in a private home
- American Occupational Therapy Association, guidance on home safety and modification assessment
- Handyman pack: Grab Bar and Handrail Installation (SOP)
- See related: Working With the Occupational Therapist; Designing for a Progressive Condition; Grab Bar Backing and Load: The Structural Rule