Finding a construction outfit that can modify a home and make it accessible for wheelchair users can be a challenge. Bill Lusby can attest to that. But he doesn’t mind. Less competition for him, as he sees it.

Lusby owns Adaptive Access Co, a small firm in Houston specializing in retrofits of houses and apartments for the mobility-impaired.

“You could search the phone book and even the Internet all day and not find any construction companies in your area that offer home modifications for the elderly and the disabled,” he says. “One reason is that most builders don’t have experience working with people who get around by wheelchair. Another reason is that they lack the necessary familiarity with the requirements of the Americans With Disabilities Act (ADA) and their state and local accessibility standards.”

Which means there is plenty of opportunity for HMEs to provide the service themselves, possibly by putting a carpenter on the payroll or, more likely, by assigning such projects to a few delivery and setup employees with training in construction, Lusby says.

Know The Codes
Either way, intimate familiarity with the construction codes spelled out by the ADA and your state’s ADA-implementing legislation is a must, Lusby cautions.

“The ADA manual is a thick book, and not easily understood,” he says. “The guidelines and specifications can be especially confusing for inexperienced contractors. The way it is written, you have to flip back and forth from one section to another and make frequent cross-references in order to do the work in a way that is in compliance with the regulations. A wheelchair ramp is a good example. The parts about slope are easy to grasp, but builders often do not catch the parts elsewhere about having a level landing at the doorway and roll-off protection.”

Fabricating such ramps is a commonly requested job for Lusby. However, the project he is asked to handle most often is a bathroom remodel.

“The majority of bathroom modification work involves simple things, like the installation of grab bars in a shower stall or alongside a tub,” he says. “Rarely do we perform anything as radical as a bathroom expansion. Normally, people do not have the money for anything like that. And seldom does the architecture of their home permit it to begin with—the way a lot of homes in the Houston market are made, the bathroom is in the narrow middle of everything and up against an outside wall, so it is usually not possible to expand a bathroom without taking space away from adjacent rooms.”

In a typical home, especially those built more than 20 years ago, the main bathroom is cramped, made that way in part by a sink built into a counter or vanity and, on the opposite side of the room, by a tub.

“Since the elderly have a difficult time getting over the wall of the tub, the tub is the first thing to go,” Lusby says. “In its place, we install an accessible shower stall that features a small, easily surmounted curb. We also remove the vanity and install either a pedestal sink or a sink that mounts to the wall in order to free up space for maneuvering a wheelchair.”

Because most wheelchairs require more width than the average doorway allows, Adaptive Access also often widens doorways from the typical 24-inch width to 32 inches by taking out the existing doors and jambs and replacing them with wider ones that feature a special type of hinge that lets the door sit completely flush with the jamb when fully opened so as to ensure maximum available entrance width.

As Lusby sees it, the hardest part about a bathroom modification is actually the aesthetic considerations.

“When you expand the doorway, you are left without tile on one side and without carpeting on the other,” he says. “You then have to fill the gap with new floor coverings, but it can be a real challenge to closely match the new ones to what is already there. The same is true when you repaint the walls where they are mated with the new jambs. The closer the match, the better the job looks.”

Lusby has become so proficient at bathroom remodification that his company can complete a job of these dimensions in about 8 hours. “When we first got going with this company, we’d typically spend 2 days on it,” he recounts.

Accident Sparked Idea
Lusby started Adaptive Access Co in 1990. Prior to that, he had spent 20 years in construction, the latter half of that time as a superintendent for a firm involved in putting up commercial buildings.

It was a construction accident that inspired Lusby to branch into home accessibility modifications. In 1990, while overseeing a project ordered by the federal Department of Housing and Urban Development (HUD), Lusby was injured in a site mishap that left him with both legs broken and, for 2 months afterward, confined to a wheelchair. But in the course of living and working from the seat of that particular mobility aid, he discovered how very difficult it could be to get around, particularly in a nonaccommodating home.

“I was amazed at the number of obstacles I encountered—floor coverings that made propelling my chair very difficult, limited space that made maneuvering almost impossible at times, and, elsewhere, poorly conceived wheelchair ramps that were awkward if not dangerous to use,” he says. “Through this experience, I identified a need that was going unmet. So I acquired the knowledge necessary to successfully perform accessibility improvements and barrier removal.”

At about the same time, HUD came under federal order to make 20% of its Houston housing stock handicapped-accessible. As a result, Lusby had business immediately, with HUD as his initial main customer.

After the HUD work tapered off, Lusby prospected for business in a variety of ways. One that worked well for him was visiting local agencies geared to helping people with disabilities. His strategy was simple: walk in, shake hands, and start talking about Adaptive Access Co to anyone who would listen. Soon, he was receiving referrals from organizations such as the Center for Independent Living, the Texas Home-of-Your-Own Coalition, and the Cerebral Palsy Foundation. Later, he set up a Web site to serve as an electronic, 24-hour-a-day brochure touting the capabilities of his company.

Important though home accessibility modifications are to those in need of them, the work nonetheless is expensive—and getting paid for it is problematic, according to Lusby.

“Funding for home modifications can be difficult to find,” he says. “Many elderly live on fixed incomes and find it impossible to pay for larger projects such as wheelchair ramps and bathroom alterations.”

Medicare and Medi-Gap companies pick up the tab for many of the low-end projects Lusby undertakes on behalf of the elderly, while a handful of private insurance companies pay for work needed by the younger disabled. Otherwise, it is purely out-of-pocket.

Beyond the matter of reimbursement, Lusby says customers themselves represent a challenge for anyone offering home accessibility modifications. Many seniors have heard horror stories about contractors defrauding the elderly, Lusby says. “Understandably, then, many elderly are very suspicious of contractors,” he says.

To overcome this distrust of contractors, Lusby says providers better be prepared to show potential home modification customers convincing evidence that they are reputable, including satisfied customer testimonials and membership in trusted business organizations such as the Chamber of Commerce or Better Business Bureau.

Still, despite these challenges, Lusby says home accessibility modifications amount to a solid business opportunity for those who approach it seriously and with dedication.

“It’s a great niche to be in,” he assures.

Rich Smith is a contributing writer for Dealer/Provider.