George Braddock is the founder of Creative Housing Solutions www.gbcchs.com a leading housing consultant and general contractor with a 25 year proven track record in pioneering the implementation of person-centered planning principles to more than 1,500 projects and homes for people with autism and other disabilities. He is also an ARCHway Consortium member.
This blog article is a first of many articles ARCHway will be posting that George Braddock has written in order to show you the many examples of housing adaptations and modifications for improving the quality of homes for people with autism.
ANNA’S STORY: Severe Autism
Topics Covered:
• Windows
• Backyards
• Water play/Indoors and Outside
• Fencing
• Pica: Eating Hedge Plants
• Lights
• Bathroom
• Kitchen
• Entertainment Center
• Flooring
• Privacy vs. Monitoring
• Scald Prevention
Vigilance and Duct Tape Aren’t Enough Anymore
In 1997 Anna’s parents wrote to us in desperation. Anna was “getting bigger, stronger and quicker, doing things she couldn’t do before”. She was breaking the windows. “Anna has an intense interest in moving water and her powerful need for constant access to water to calm herself is creating serious health and safety issues. She turns on faucets full blast and plays in the water damaging the building and stressing her family.”It is important to access the whole-person in the context of their environment before you design.
What the professionals told us:
• Anna experiences Autism at a severe level further complicated by enormous sensory processing problems making Anna one of the most challenging children they have encountered.
• Anna is constantly bombarded by sights, sounds, sensations and information that her brain cannot process. The filters and sorters in her brain just don’t work properly.
• Ordinary activities such as eating, sleeping and sitting down are a constant struggle for Anna.
We learned from Anna:
• She needs a home where she can do the things she likes to do without negative consequences.
• She needs a home that makes sense to her and where she is safe.
• Her home must be durable and withstand her “testing the strength of its materials”.
• She wants/needs a home where she can be in control and make choices.
• She needs a home where there are interesting things to do outside and inside that support her love of water and movement.
• Change and surprises are very difficult for Anna/
Anna’s Family Needs a Home:
• Where we can really enjoy Anna without constant intervention and re-direction.
• That will enable our family to remain together in our family home.
• That will keep everyone safe.
• That will allow Anna to safely use the bathroom the way she wants without harm or damage.
• That will provide Anna choices in preferred activities inside and outside the home.
• That is easily modified and adaptable to our family’s changing interests, abilities, needs and lifestyle.
PROJECT GOAL: A safe and sound family home where supports can be always aware of Anna’s activities and whereabouts to help her stay safe. The home needs to be a place where she can do the things she enjoys and learn new skills without hurting herself or others or damaging the building.
Disability is a consequence of the wrong environment.
Windows
Our work began with the most pressing health and safety concerns. Anna was banging on the large single-glazed picture window in the living room and kicking the window next to her bed. Anna had already broken other windows. The family had put up plexi-glass but it made their home “feel like a battle zone”.
New 3/8 inch tempered glass Lexan installed over the existing window
Plexi-glass, Lexan or other poly-carbonate materials will protect glass from breakage. However, it scratches easily and discolors over time. More importantly, it makes the home “feel like a war zone”.
The sliding glass door and other targeted windows in the house were replaced with tempered glass.
Tempered glass is extremely strong. If it is broken it disintegrates into hundreds of small harmless pieces. Typically ¼ inch glass is placed on the inside and 1/8 inch glass laminated to the outside; this will withstand most heavy abuse. If a person uses tools or has significant head banging or kicking behaviors, 3/8 inch glass can be installed which will withstand extreme testing.
A window was added in the dining room to provide a view to the back yard. It is critical that Anna’s whereabouts and activities are known so that she can remain safe.
It is important to support the needs of the individual and their caregivers.
Backyard
Anna loves to be active in her backyard. She particularly loves running water and the stimulation of swinging. At first a standard backyard swing was adequate. But over time she out-grew it but not her love for the vestibular stimulation it provides. A new appropriate swing was required.
Anna’s fascination with running water was damaging the backyard and undermining the foundation of the house. The watering “square” and a drainage system were installed to collect and route water away from the house. Anna could do the things she loved to do without harming anyone or damaging the house.
The needs and lifestyle of a person with disabilities changes over time.
Fencing
A large Arborvitae provides protection and privacy in the backyard. Unfortunately it is poisonous and can cause seizures if ingested. By installing a coloured wire fence inside the hedge line the privacy afforded by the hedge was preserved.
Anna is all wrapped up in the fabric the family had installed to keep her from eating the hedge.
Safeguarding the reputation of a person with disability is paramount.
Lights
Standard glass ceiling globes were easily broken by balls and other flying objects. These were replaced with wire protected lenses or recessed cans.
Health and safety is improved for everyone in this simple, cost effective modification.
The Bathroom
“Anna’s water play, incontinence and perpetual motion is destroying our bathroom and creating constant stress.”
• Because Anna likes to take 5-10 baths each day, the bathroom floor is always wet and slippery. We use 25-30 towels to mop up excessive water each day.
• Anna pounds on the window and the mirror.
• “Anna is bigger, stronger and quicker. She turns the faucet on full-blast. She gets upset when we run out of hot water.
• “We are afraid Anna will get scalded. We are afraid to leave her alone in the bathroom.”
• Standing water is unsanitary and a slip-hazard.
• “Anna jumps vigorously in and out of the tub.”
• “We have no place to store wet items or bath toys. The existing two-sink vanity is impractical.”
Anna spends many hours each day in the bathroom in intense water play, a source of tremendous stress on her family and damaging to the physical structure of the house. Based on an evaluation of the space, Anna’s desires and her family’s needs, a remodel plan was developed to improve the layout and technical performance of the bathroom. Grab bars, impervious materials, heated surfaces, improved lighting, durable fixtures and other elements were introduced.
New Vanity and Tub/ Shower
Radiant heat mat under the tile keeps the floor warm and helps it to dry faster.Floor drain eliminates need for 25-30 towels to mop up excessive water after every bath
•Old toilet area is now a place to store wet items
•Tempered glass mirror
Basket provides place to store wet toys. Window with 3/8” tempered glass
Anna will not use the existing toilet.
The space is cramped making it difficult to assist.
There needs to be additional room around the toilet.
It needs to support a toileting ritual that makes sense for her.
The space needs to be inviting and comfortable for Anna.
The new toilet location provides adequate room to assist.
It is bright and inviting.
The area is warmed by the floor heat.
Tile surfaces are easily cleaned and sanitized.
Shelves support use of picture schedules.
The evaluation of the completed project and its effect on Anna’s life shows that she can now do what she clearly enjoys without negative consequences. Safety is improved, damage to the building is minimized and her family experiences significantly less stress and more freedom because they spend less time doing intensive supervision and clean-up. Anna has exhibited a reduction in behavioral episodes because she experiences more choice, control and independence in her life.
The Kitchen
The kitchen in Anna’s home has always been the center of activity. When she was little she had to have the water running near-by in order to eat her food. When she was not in the bathroom or outside playing with water, she was at the kitchen sink.
“Anna’s water activities at the sink have caused significant damage to wood, walls, sheetrock, countertops and cabinets.” Dry rot has and will continue to occur.
Plastic installed to protect walls and countertops detracted from the feeling of home.
A supportive physical environment promotes individual independence and empowerment.
Entertainment Center
Anna needs a water proof entertainment center because she will fill her mouth with water and will spit on the TV when she is upset. There were six water-logged televisions in the garage.
Anna’s bedroom is her ‘safe place’. The TV and VCR are her favorite ‘comforting things’. Her large photo albums, favorite tapes, story books and beads need to be in her bedroom.
Over time Anna gained more experience and developed the capacity to use her TV without assistance. With more control came more opportunities. She no longer needs a locked cabinet in her room and freely uses the entertainment center in the family room.
Flooring
Although carpeting is ‘home like’, even the best of it is difficult to keep clean or sanitize. Anna “has toileting accidents, food spills and then there is always the water”. The biggest issue is in the bedroom, her sleeping and leisure space. We need to be able to clean and deodorize this environment easily.
The carpet was replaced with a commercial grade vinyl. The material was coved up the walls to protect the edges from water. Throw rugs that can be simply picked up and laundered as needed help to soften the look of the vinyl floor coverings.
Privacy Versus Peace of Mind
When Anna was in her safe place, her family needed to know if she was okay or needed their help to stay safe. When they opened the door to check on her, the interruption would trigger an immediate change in whatever she was doing often for the worse.
After much discussion of privacy versus peace of mind a wide angle door viewer was installed that enabled the family to look in on Anna without disturbing her.
Scald Prevention
Because Anna was able to turn the faucets on “full blast” by herself scald prevention became a concern. We installed a whole house tempering valve on the hot water heater that prevents hot water from being delivered at a dangerous temperature.
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