The Modification Handover and Training SOP

Purpose

An accessibility modification is not finished when it is installed. It is finished when the person it was built for has used it, the way they will actually use it, with the shop watching, and the things that can be adjusted have been adjusted to fit them. A bar 2 in out of their reach, a hand-held shower they cannot lift off its hook from the seat, a ramp they do not know how to clear of ice: each of those looks complete on a punch list and fails in the first week, usually when nobody from the shop is there.

This procedure guarantees that every modification is tested by its user before the crew leaves, that adjustable items are set to that person, that fixed items found wrong are recorded and scheduled rather than improvised, that the person has written instructions they can read, and that the shop comes back to check.

Scope

Covers the handover visit at the end of any accessibility job or phase: grab bars, rails, ramps, showers and bath fittings, toilets, controls, lighting, door hardware.

Not covered here:

• The installation itself, including load testing of fasteners, which belongs to the install procedure. See related: Grab Bar and Handrail Installation (Handyman SOP).
• Powered lifts and stairlifts, which hand over under their manufacturer's and installer's requirements and, in many states, under elevator-licensing rules. See related: Stairlifts, Platform Lifts and Who May Install Them.
• Connected devices and alerts, which have their own setup procedure. See related: How to Set Up Smart Devices with a Disabled User.

Roles and responsibilities

The procedure

1. Schedule the handover for the time of day the user does the task, with the right people present. A morning shower gets a morning handover. Book the caregiver who helps with transfers, and the OT if one specified the work. Acceptance: the user present and rested, the helper present if the user has one, the visit at the time they named. Wrong looks like a 4 p.m. handover with an adult child present and the user tired after an appointment. Stop rule: if the user is unwell or exhausted on arrival, do the walkthrough of features and reschedule the use tests; do not push someone through transfers on a bad day. Hazard: none physical at this step, it is a booking decision.

2. Have the user perform every movement the modification exists for, while the helper spots. Transfer onto and off the toilet using the bar; enter and sit in the shower; roll or walk the ramp both ways with their own aid; reach each relocated control from where they will actually be. Acceptance: each movement completed by the user, and recorded as "done unaided", "done with helper" or "not done" with the reason. Wrong looks like the tech demonstrating the bar on themselves and calling that the test. Stop rule: any movement the user cannot complete as designed goes to step 3 if the item is adjustable and to the fixed-item list if it is not. Hazard: a transfer is where a fall happens. The helper or OT stands close on the user's weaker side and spots; the tech does not lift, steady or try to catch the user from a poor position, and if the user starts to go down, guide them toward the floor rather than holding them up. If the user falls and is hurt or cannot get up, do not move them; call 911.

3. Adjust what is adjustable to the user, on the spot. Hand-held shower slide bar height and holder position, shower seat height on adjustable legs, toilet safety frame height, closet rod and shelf positions on standards, lever orientation, the anti-scald limit stop. Acceptance: each adjustable item set and re-tested by the user in the same movement, with the new setting written down ("slide bar holder at 42 in above floor"). Wrong looks like an item adjusted and not re-tested. Stop rule: a FIXED item that is wrong (a grab bar, a rail bracket, a ramp landing) is not moved today unless the new position lands entirely in blocking already mapped on the install record; otherwise it is written on the fixed-item list with the measurement the user needs, and scheduled. Hazard: a wet shower floor under the tech's own feet; work from a dry mat or from outside the wet area, with the user seated out of the way, and any adjustment needing a drill goes to the fixed-item list.

4. Restore and check the hot water before the user's skin meets it. Where the job touched a shower or tub valve, set or confirm the high-temperature limit stop, then run the shower at full hot for two minutes and read the water temperature at the outlet with a thermometer. Acceptance: outlet temperature at or below 120 F, the limit most plumbing codes set for a shower or tub valve through ASSE-listed devices, as adopted by your jurisdiction; a lower setting the user or OT asks for is fine. Wrong looks like the user testing the water with their hand. Stop rule: above 120 F, re-set the limit stop and re-read; if it cannot be brought down, the shower is not handed over and the user is told not to use it until it is fixed. Hazard: this is the step that returns hot water to an older user, and some users cannot feel heat reliably or move away quickly; the tech's hand and the thermometer go into the stream first, the user's never does until the reading passes. See related: Anti-Scald Protection for an Older or Disabled User.

5. Show how each item works, then have the user show it back. Fold and lock a shower seat, use the hand-held's on and off, operate the lever, clear the ramp surface, find the night light switch. Acceptance: the user, or the helper for items the user will not operate, demonstrates each item back without prompting. Wrong looks like a nod after an explanation. Stop rule: an item nobody in the house can operate after two demonstrations gets an adjustment (step 3) or goes on the fixed-item list as a design problem. Hazard: none beyond step 2's, with the helper spotting any demonstration that involves a transfer.

6. Leave written notes in large print, and read them through with the user. One sheet, printed at 18 point or larger (the size large-print guidance commonly sets), high contrast, matte paper, one item per block, plus the shop's phone number. Acceptance: the user reads it in their usual light and confirms they can; a copy is attached to the job record. Wrong looks like the manufacturer's leaflets left in a pile. Stop rule: if the user cannot read it, read it to them and ask who will keep it; for a user with low vision, record the instructions in whatever format they use. Hazard: none at this step.

YOUR BATHROOM - THE SHOP - CALL 555-0100

GRAB BARS
  Hold the bars, not the towel bar or soap dish.
  A loose bar: stop using it, call us.

SHOWER
  Hot is limited to a safe setting.
  Water too hot or too cold: call us. Do not adjust.

SEAT
  Lift to fold. Push down until it clicks to use.

NIGHT LIGHT
  Comes on by itself when the hall is dark.

WE COME BACK: Tuesday, 3 weeks from today.

1. Leave the house in its use state. Remove floor protection, temporary rails, tools, packaging and the old fixtures; put back furniture the user relies on for support; check that nothing moved during the job is now in the user's path. Acceptance: the user's route through the room walked once more, with their aid, after cleanup, with nothing on the floor and nothing moved. Wrong looks like a chair the user steadies themselves on left in the hall. Stop rule: anything the user leaned on that was removed and cannot go back is discussed before the crew leaves. Hazard: carry old fixtures out on a clear path; a toilet removed and set in a hallway is a trip hazard to a user walking with a cane, so it leaves the house first.

2. Book a follow-up check three weeks out, with what to check. Three weeks is the shop default: long enough for real use, short enough to catch a problem before it causes a fall. Tune it to the job. Acceptance: a dated visit on the job, with the checklist attached: fasteners and flanges for movement, caulk and grout at wet-wall penetrations, the user's account of what is hard, and anything from the fixed-item list. Wrong looks like "call us if anything comes up." Stop rule: a user who declines a visit gets a call at three weeks instead, logged. Hazard: none at this step, it is a booking.

The record this produces

On the job, completed before the crew leaves and read by the office, the follow-up tech and anyone reviewing the job later:

• Who attended and the time.
• Each movement from step 2 with its result.
• Each adjustment from step 3 with its new setting.
• The fixed-item list, with the measurement the user needs and the scheduled date.
• Hot-water outlet reading and limit-stop setting.
• The large-print sheet, attached.
• Follow-up date and checklist.

Worked pass: curbless shower and two bars, Tuesday 8:30 a.m.

Step 1. User, a woman in her seventies, present and rested; her husband, who helps her into the shower, present; OT not attending. Pass.

Step 2. Toilet transfer using the side bar: done unaided. Shower entry and sit on the fold-down seat: done with helper. Reaching the hand-held from the seat: not done; she could reach the holder only by leaning forward off the seat. Vertical bar at the shower entry: she used it to stand from the seat, but pushed down on it from seated rather than pulling, and said it was too high to push on.

Step 3. The hand-held holder is adjustable on its slide bar: moved down from 54 in to 42 in above the floor, re-tested, she lifted it off and replaced it from the seat. Pass. The vertical bar is fixed. Its bottom flange sits at 36 in; she wanted to push at about 30 in. The install record showed blocking from 24 in to 48 in on that wall, so a second, horizontal bar could land entirely in mapped blocking, but not today: the bar was not on the truck. Step 3's stop rule applied: no improvised fix. On the fixed-item list: "horizontal bar, top of gripping surface 30 in, centered on seat, blocking mapped, scheduled Thursday."

Step 4. Limit stop confirmed; full hot for two minutes; thermometer at the outlet read 118 F. Pass, at or below 120 F.

Step 5. She folded and unfolded the seat, operated the hand-held's diverter. Her husband showed the seat lock. Pass.

Step 6. Sheet read in the bathroom light; she read it without glasses. Pass.

Step 7. Old tub surround panels and the floor protection removed first, then a walk of the route from bedroom to shower with her cane. Pass.

Step 8. Follow-up booked for three weeks out; the Thursday bar install also on the schedule.

References

• ASSE 1016 and ASSE 1070, temperature-limiting and pressure-balancing valve performance standards, binding where your plumbing code as adopted requires listed devices; the 120 F shower and tub outlet limit is set by that adopted code.
• 2010 ADA Standards for Accessible Design, section 609 (grab bars): a dimensional reference for a private home, not a requirement there.
• See related: The Accessibility Walkthrough with the Person Who Lives There; Anti-Scald Protection for an Older or Disabled User.
• See related: How to Improve Lighting for a Customer with Low Vision; Grab Bar and Handrail Installation (Handyman SOP).