The Levers Nobody Asked For

The quote that looked right

A son who lives three states away called to ask for "the aging-in-place package" for his mother, who is 81 and lives alone in a one-story house with an attached garage. The shop had one: lever handles on every interior door, rocker light switches, two grab bars in the bathroom, a taller toilet, and plug-in night lights. The office priced it from the phone call at about two and a half days of labor for a two-person crew, emailed the quote, and the son approved it the same afternoon.

The shop's rule was that a tech does a walkthrough with the occupant before any accessibility job starts, even a pre-approved one. The tech went out expecting to confirm door counts and toilet rough-in. He came back with a different job.

What the package assumed

Every item in the package is a sound modification for somebody. Levers help a hand that cannot grip and twist a round knob, from arthritis, a weak grip or a full hand. Rockers help the same hand. Bars in a bathroom are almost always useful. A taller toilet helps someone who struggles to stand from a low seat.

What the package assumed was the person. It was built for an average older customer: some loss of grip, some trouble standing, some unsteadiness in the bathroom. The son had described his mother in those terms because they were the terms the shop's website used. Nobody had yet asked her what was hard.

What the walkthrough found

The tech asked her to walk him through an ordinary day, starting with how she gets out of the house. See related: The Accessibility Walkthrough with the Person Who Lives There, which owns how this conversation is run.

TECH:     Could you show me how you get out to the car?
CUSTOMER: Through here. I hold the door frame and sort
          of drop down onto the garage floor.
TECH:     Every time you go out?
CUSTOMER: Every time. I don't like it with groceries.
          I hold the car mirror coming back up.
TECH:     Are any of the doors in the house hard
          to open?
CUSTOMER: No. Why?
TECH:     The quote has new handles on all of them.
CUSTOMER: That was my son. I never said anything
          about doors.
TECH:     When did you last take a bath?
CUSTOMER: The spring, I think. I wash at the sink now.
          Getting over the side is the trouble.

Three findings came out of that, and none of them was on the quote.

The garage step. A single riser from the house door down to the garage floor, measured at 7 in, with no rail. She was lowering herself on the door frame on the way out and pulling herself up on the car's mirror on the way in. The IRC requires handrails on stairs with four or more risers (R311.7.8 in the 2021 edition, as adopted by your jurisdiction), so a single step at a garage door almost never has one, and nobody notices until someone cannot do it. This was the barrier she met every time she left the house.

The tub. She had stopped bathing in the tub months ago. The tub's side measured 15 in from the bathroom floor, and stepping over it and down onto a wet tub bottom was the movement she no longer trusted. She was washing at the bathroom sink. The package's two grab bars would have helped a little; they would not have got her over the side.

Her hands. She opened every door during the walkthrough without hesitating, turned on the faucets, worked the thermostat. Her grip was fine. The lever handles, the rockers and a good share of the labor on the quote solved a problem she did not have.

The toilet was a standard height and she stood from it easily with one hand on the vanity, which was solid. The taller toilet was not needed yet.

Why the phone quote got it wrong

Nobody did anything careless. The son described a parent he worries about in the words he had for it. The office took the order in the shape it had a product for. The package was coherent, and it was priced from facts the office could get on the phone: how many doors, how many switches, what toilet.

The failure was in the unit of the quote. A package is priced per house. A modification is designed per person, from what that person does, observed with them. The barriers that decide whether an older person can stay in a house are usually specific to that house and that body: a step, a tub wall, a high shelf, a dark hallway. A list of common modifications covers what most people need on average and misses what this person needs today.

What the requote became

The tech went through the findings with her and, by phone with her agreement, with her son. She chose what to do. The revised scope:

Why not a ramp at the garage. It was the first option the tech considered and the numbers ruled it out. A 7 in rise at the 1:12 slope the 2010 ADA Standards use (405.2) needs 7 times 12, which is 84 in, or 7 ft of run, plus a 60 in landing at the bottom (405.7.3), which is a reference for a private home, not a requirement there. That is 12 ft of ramp and landing out from the house door into a garage bay about 20 ft deep, and her car would no longer fit. And she did not need one: she walks without an aid and manages a low step well. A ramp would have solved a problem she might have later at the cost of the garage she uses now.

What would have changed that call. Had she used a walker, the split step would have been the wrong answer, because a walker on a platform step means lifting it up two risers with the door in the way. The options would then have been a ramp with the car parked outside, a ramp at a different entry, or a vertical platform lift, and the conversation about which would have started with where she parks. Had she used a wheelchair, the garage door would probably not have been the right exit at all.

At the garage step. The 7 in riser was split into two by building a platform step on the garage floor: a 36 in deep, 48 in wide box set against the house door, leaving two risers of 3.5 in each. Two equal risers matter as much as low ones. The IRC limits the difference between the tallest and shortest riser in a flight to 3/8 in (R311.7.5.1, as adopted), because a foot lands where the last step taught it to; a split that left a 3 in and a 4 in riser would have built a new trip into the fix. A handrail went on each side, returning to the wall at the top, and a vertical grab bar went on the house side of the door jamb, into framing, for the moment she steps through with the door in one hand. A motion-sensing light was added over the step, since she arrives home at dusk in winter.

The garage floor sloped toward the overhead door, as garage floors do, so the platform's base was shimmed to keep its top level and its riser heights equal along their whole width, which was checked at both ends with a tape before the treads went on. The platform shortens the garage bay by 36 in; her car still cleared the overhead door with the platform in place, checked before building with the car parked and the door closed.

At the tub. She did not want construction in the bathroom. So: a tub transfer bench, which straddles the tub wall so she sits outside the tub and slides across, lifting her legs over while seated; a hand-held shower on a slide bar she can reach from the bench; a vertical bar at the tub entry and a horizontal bar on the back wall, both into blocking added from the closet behind the tub wall. The shop recommended she have a home health occupational therapist check her bench transfer, because sliding across is a learned technique and the bench has to be set to her height. She agreed, and her son arranged the visit.

Dropped from the quote: all eleven lever sets, the rocker switches and the toilet. The night lights stayed; she said the hall was darker than she liked at night.

The labor. About a day and a half for the crew, against the two and a half days of the original package. The ticket was smaller and every item on it was for a barrier she had shown the tech.

How the shop checked it worked

At handover she did the movements while the tech watched. See related: The Modification Handover and Training SOP. Out to the car and back twice, with a grocery bag in one hand both times: rail on the way down, rail and the jamb bar on the way up, no grab at the car. Onto the transfer bench, legs over, hand-held on and off, back out, with the OT's bench setting already in place because the OT had visited the day before.

At the three-week follow-up she had bathed four times. She said the garage step was the change she noticed most, which was the item the original quote did not contain.

What the shop changed

Packages became a menu for the walkthrough, not a quote. The office still uses the package list, but as a set of things the tech asks about and checks, not a scope priced from a call. Phone quotes for accessibility work now give a range for the visit and nothing else.

The walkthrough starts at the door the person leaves by. Not at the front door, and not at the bathroom. Leaving and returning are the movements an older person makes daily that the house most often makes hard.

The caller is not the customer for scope. The adult child may be paying and may be the one who called, and their concern is real. The scope comes from the person who lives there. Where the two disagree, the person who lives there decides, and anything about the household that worries the tech belongs to the library's Safeguarding group, not to the estimate.

None of this means levers are a bad idea. For a customer whose grip is failing they are one of the cheapest, most useful changes in the house. See related: Lever Handles and Controls a Hand Can Work. They were the wrong idea for this house, and the only way to know was to watch her open a door.

References

• International Residential Code, sections R311.7.5.1 (riser uniformity) and R311.7.8 (handrails), in the 2021 edition as adopted and amended by your jurisdiction.
• See related: The Accessibility Walkthrough with the Person Who Lives There; Lever Handles and Controls a Hand Can Work.
• See related: Thresholds and Changes in Level; Working with the Occupational Therapist.
• See related: Grab Bar and Handrail Installation (Handyman SOP).