After a year in rehab recovering from surgery that left her without the use of her legs, Marteen Moore wanted to be with her children and to go back to work as an interior designer. There was one catch: As a new wheelchair user, she could no longer navigate her own home. Unable to shower, she needed help to be lifted in and out of the tub. Unable to drive, she had to be chauffeured.
That was until she learned about a program called Rebuilding All Goals Efficiently. With the help of this Southern Nevada-based program, Moore modified her home and her vehicle - and got her life back.
"It is wonderful. I have a sense of independence. I can live again," says Moore, a Summerlin resident. "I can go places. I can work. Of course, I have to take my portable ramp with me to be able to go into clients' and friends' homes."
Moore considers herself lucky. Her front entrance and hallways didn't need modification, and she had a bedroom and bathroom on the ground floor.
"If I had picked any of the other three floor plans in my community," she says, "I would have had to move."
Many newly disabled persons are not so lucky, explains Reggie Bennett, executive director of Rebuilding All Goals Efficiently. "We look at a number of factors in helping families adapt a home," says Bennett, citing everything from the technical aspects to the emotional state of the family. "But not all homes can be adapted," he adds. "It is not always cost-effective. Retrofitting is not always possible. It is not always feasible to move into another home, even if we could find one."
And there aren't a lot of adaptable and accessible homes in Southern Nevada to begin with. No one tracks the data specifically, but Bennett says existing inventory of accessible and adaptable dwellings remains scarce in the Las Vegas Valley. And almost everyone agrees that as advances in medical science continue to save and lengthen the lives of people who are injured, become ill or grow older, demand for such housing will only rise.
"Babies survive birth defects and go on to live longer lives. We are fighting two wars with a number of our troops coping with post-combat disabilities. People survive accidents and illnesses more frequently. People are living longer," says Eleanor Smith, executive director of Concrete Change, an Atlanta-based nonprofit that promotes inclusive housing. "Advances in medical care and technologies have led to more people able to live well with disabilities, provided they have accommodations."
In Nevada, 6.5 percent of the population has a physical disability and is living in the community, according to 2008 figures from the Annual Disability Statistics Continuum; the national figure is 7.2 percent. However, those figures do not include people with chronic conditions who are not consistently disabled, or people who are temporarily disabled by injury or accident. And they do not include people who are institutionalized, but could be living in the community with accommodations.
But whatever the number of disabled people in the state, experts say Southern Nevada is not prepared to meet the coming wave of demand for adaptable housing.
"I wish there was some hope," says Suzanne Thomas, a local disabilities consultant, "but right now people are saying, 'There's no time to think about this because I have to worry about how to raise money.' There wasn't a lot going on [in adaptable housing] before the economic downturn, now there's nothing. The Baby Boomers will have to become vocal and until that happens, I don't think much will get done."
Ah, the Baby Boomers. 2010 marks the beginning of the much-anticipated retiring of the Baby Boomers. According to the U.S. Census Bureau, the number of people 65 and older to every 100 people of traditional working ages (20 to 64) - called the old age dependency ratio - is projected to climb rapidly from 22 in 2010 to 35 in 2030. For Clark County, whose population of people 65 and over is lower than the national average, the bump is still significant. Our ratio will go from 18 persons per 100 in 2010 to 23 persons per 100 in 2020. As people grow older, they develop disabilities that require medical and practical attention - and cost money.
The questions that confront Bennett as he seeks to help persons with disabilities will confront older adults as they seek retirement homes - or try to stay in their current homes. In short, accessible housing will become an issue that touches just about everyone.
Visitable homes, adaptable homes
The key to addressing this coming wave of demand: visitability. More than just a design buzzword, visitability describes basic features that ensure short-term access to a home for a person with mobility limitations; or it allows a person to live in a home while recovering from a temporary injury or illness. Over the long term, a visitable home presents fewer barriers to adapting the home for use by someone with more permanent limitations.
A 2008 AARP report encourages more visitable homes be built so that, as people grow older, they can age in place. "Aging in place" is a concept that recognizes both the desire of most people to remain in the community as they grow older, and the public policy advantages of avoiding institutionalization. Institutionalization requires taxpayer money. Older folks who remain in their homes cost the public far less.
The best way to increase visitable inventory is through new home builds. "Retrofitting is important," explains Smith, "but it is much more cost-effective to build from the ground up. The cost differences between retrofitting and new builds are mega-percentages."
Bill Altaffer, a civil rights attorney in Tucson, Ariz. who has muscular dystrophy, started working to pass an ordinance in the late 1990s after discovering Concrete Change and learning about visitability. He and his wife, Colette, spent several years convincing both Pima County (in 2002) and Tucson (in 2008) to pass visitability features as part of codes required on new home builds.
"Besides the legality issue," Altaffer told the AARP, "there was the other component, the builders saying this could not be done." Pima County hired a professional estimator to figure the cost of visitability in a new home. The estimator found the cost to be around $100 - including a $25 profit. That low cost for a long-term benefit convinced commissioners to pass the ordinance.
Since the ordinances passed, an estimated 17,000 homes have been built in Pima County with at least one entrance with no step, doors at least 32 inches wide, lever door handles, reinforced walls in ground-floor bathrooms for easy grab bar installation, switches no higher than 48 inches from the ground, and hallways 36 inches wide throughout the main floor.
"Local builders seem to now embrace the concept," the Altaffers told the AARP in July 2010. "They sell the idea of 'aging in place' as a key part of encouraging people to buy new homes."
Other regions have followed suit. As of December 2007, 57 state and local initiatives had been adopted, with 33 of those making visitability mandatory in some way. The AARP compared the two approaches. As of 2007, only 1,000 homes had been built under voluntary initiatives, compared to 28,600 homes built under mandatory initiatives.
A steep hill to climb
However, mandates can be a hard sell. Southern Nevadan housing industry stakeholders insist on looking to the market, not the law, as the source for change.
"I use a wheelchair," says Irene Porter, executive director of the Southern Nevada Home Builders Association. "I recently had to renovate my own home. There is no reason for all new homes to have these modifications. What the market dictates will determine how much gets built. Home builders respond to the market."
Almost any new single-family home can be built as adaptable or accessible, she says, because almost every builder offers custom home builds that include visitable and accessible features.
"If we have to make additions to the home that are not necessary or desired by an owner, the cost of the home goes up," Porter says. "For every $1,000 added to a home cost, 1,500 families are priced out of the market."
However, advocates suggest there's misunderstanding of what a visitable home entails.
"Accessible features are beneficial for everybody across the lifespan," says Darrell Christenson, director of community integration for Arizona Bridge to Independent Living in Phoenix. "Wider doorways means you can move in that 55-inch flat screen into your living room. Zero-step entrances means that you can roll in your child in his stroller after a walk in the park. Lever hardware makes it easier for a person carrying groceries into the house."
Bennett of Rebuilding All Goals Efficiently agrees. He recently sold his accessible home to someone who was not disabled but loved the features nonetheless. "He was excited about the wider spaces. He liked the idea of an easy to walk-in shower."
But modifying a home can be a double-edged sword. Jennifer Longdon was not so lucky when she considered selling her fully accessible home in Phoenix. A home inspection devalued her home by $20,000 compared to other homes in the neighborhood because some of the $70,000 in extensive modifications she made to the home would have to be "reversed," such as lower kitchen counters. Shocked, Longdon called Michael O'Donnell, Prudential Arizona, her agent when she purchased her home.
"I wanted to know how we could sell the home as the jewel that it is instead of distressed housing," she says. She discovered that the problem wasn't her home, but that the Multiple Listing Service did little to highlight her home's accessibility features among the right people.
It's a similar situation in Southern Nevada. A recent search of the Greater Las Vegas Association of Realtors' MLS yields 51 homes marked as having "handicapped" interior features. The descriptions generally lack specifics. Most of them have separate showers (though pictures confirmed these were not roll-in showers) and a master bedroom/bathroom that is somehow on ground level. Only a couple specify how they are accessible.
"That's all we had on our MLS," says O'Donnell. "It took forever to find appropriate homes to show Jennifer."
Longdon decided not to sell her home. She became a Realtor, partnering with O'Donnell. Together they petitioned the Arizona Regional MLS to create 21 searchable, mandatory fields with specific handicapped features. As of July 2010, 2,064 residentials and rentals with at least one accessibility feature are listed in the Greater Phoenix area, according to ARMLS's Wave. (By contrast, there are no current plans to change the Las Vegas MLS and no Greater Las Vegas Association of Realtors task forces addressing the issue.)
After creating searchable fields to highlight homes' visitable features, O'Donnell and Longdon faced some good news and bad news. The good news: The demand for visitability is higher than they thought. The bad news: There aren't enough homes to meet this demand.
That disconnect between supply and demand may be changing for the better. Arizona Bridge to Independent Living's Christenson believes a paradigm shift is coming in how we build homes.
"As a society, are we building homes the way we did in 1960? Of course not. We have upgraded wiring, water-efficient toilets, sprinkler systems for our lawns. In 2010, we should be building homes that are safe, energy efficient, convenient, protect us from the weather and let us age in place."
Realtor O'Donnell suggests the paradigm shift includes how people perceive disability. "Jennifer tells me that I am just 'temporarily able-bodied.' At some point, most people will more than likely experience disability."
That shift also includes how to view a house. According to a 2008 study in the Journal of the American Planning Association, the chances that in the lifetime of a house an occupant will be disabled is about 60 percent (if a person with a disability using the house temporarily is taken into consideration, it's about 91 percent).
"We do not occupy our homes forever," says Smith of Concrete Change, "and we do not occupy our homes alone. People who think that because only 20 percent of the population need this housing that means it only serves 20 percent of the population are missing that most persons with disabilities live with other people. If one person in a five-person household needs accessible features, the household needs accessible features."
Bennett is optimistic that things can change locally as well.
"Nevada has come a long way. I think it is just a matter of education. Once people see that these options give you more bang for your buck, I think you will see builders embracing the concept."