Quick Guide: Low Costs of Visitability

Cost Information for Visitability

Eleanor Smith, Concrete Change 2012

Cost for new houses of incorporating a zero-step entrance; all passage doors (including bathrooms) with 32 inches or more clear passage space; and at least a half bath on the main floor. (The following costs assume the house plan already provides at least a half bath on the main floor, as is nearly always the case with contemporary plans.)

  • One zero-step entrance on a concrete slab: $0
  • Five doors @ $2 more per door than narrower doors: $10
  • One zero-step entrance over a basement: $250
  • TOTAL: $10 (slab) to $260 (basement or crawl space)

Why are the costs so low?

  • Figures refer to NEW construction, where the builder has the opportunity to plan, site and grade for cost-effectiveness.
  • Zero-step entrances should be omitted on sites that present unusual difficulties, so “worst case scenario” cost estimates are not relevant to typical costs.
  • The entrance may be located at the front, side, back or from an attached garage – whatever location is most advantageous.
  • Cost-effective methods have evolved in the field through direct construction experience.

Why have some building professionals estimated much higher costs? They may be unaware of best methods to incorporate basic access. Or, they may have a vested interest in claiming high costs. Estimated high costs of zero-step entrances over basements; the alleged need for extra grading for a zero-step entrance; the alleged cost or difficulty of modifying plans to accept slightly wider doors; the alleged higher cost of 2’10” doors over narrower doors – these and all other assertions of added cost have been definitively demonstrated through built experience to be inaccurate.

How are the low costs verified? By the stated experience of builders, developers and building officials who have produced thousands of houses with basic access. For example:

3,700 Houses over basements: Dan Buonamici, Building Commissioner, Bolingbrook, IL City Ordinance (PDF) (cf. 1999 to present) and Mayor Roger Claar

21,000+ Houses on concrete slabs: Pima County Official’s Letter to Congress (PDF) from Yves Khawam, Chief Building Official, Pima County, AZ Ordinance (PDF) (cf. 2002-present)

(For numerous other cost estimates, see the interviews with builders and building officials in Appendix A of Increasing Home Access: Designing for Visitability, AARP Public Policy Paper, 2008.)

Costs of No Change

What are unintended financial costs of continuing to build houses with basic barriers?

  • Costs of Moving
  • Costs of Renovations (retrofits)
  • Medical costs due to injuries resulting from barriers
  • Increased Institutionalization of when home barriers are a factor in moving to a nursing home.
  • Cost of No Change

Other sections of this site address the cost of incorporating basic access in new houses. To summarize: $100 on a concrete slab, $300-600 on a crawl space or basement. But no cost discussion is complete without considering the costs of not incorporating access.

How many houses will need access?

Conservatively, 25% to 60% of ALL NEW HOUSES, over the lifetime of the house, will have a resident with a long-term, severe mobility impairment. (See Journal of the American Planning Association, Summer 2008.) This does not include short-term disabilities such as broken limbs or healing from surgery. Nor does it include visitors with disabilities. Unfortunately, an estimated 95% of new houses are constructed with steps at all entries and/or narrow bathroom doors.

Emotional and Relational Costs

The inability to find an appropriate house to live in causes stress at the most basic level. Living in a home with major barriers adds drudgery and the stress of physical danger for a person with a disability who is already working to cope with their disability. Inability to visit in the homes of friends and extended family causes isolation, depression and loneliness. Within the home, other family members ‘ added work to help with steps and the deal with consequences of narrow doors—especially bathroom doors — strains relationships and increases helpers’ fatigue and anxiety. Being ejected from one’s familiar community into an institution, against one’s deepest wishes, can do great emotional damage.

Costs of Retrofitting

Typical cost of widening one interior door: $700 (Averaging 2007 estimates of 4 contractors from 4 states experienced in widening doors in houses of residents who have become disabled).

Typical cost of retrofitting to create an entrance without steps: $3,300 (Approximately 1,000 entrance modifications done by a publicly funded entity in Nebraska; more in most other parts of the country).

Costs of Institutionalization

60% of nursing home residents enter directly from a hospital or rehabilitation facility. Because people rarely enter hospitals solely because of dementia, deafness or blindness, it can be assumed that most enter after an accident or condition that reduces mobility: a fall, a traffic accident, a stroke, a heart attack, etc. And because the great majority of existing houses have steps at all entrances and/or narrow bathroom doors, it can be assumed that major architectural barriers are a factor preventing large numbers of people from returning home from a hospital.

No research, to our knowledge, has been carried out to assess the percent of nursing home residents for whom architectural barriers in their home was a factor in their entering the nursing home. But experience and logic point to home barriers as a major contributing factor.

  • Annual cost of nursing home residence: $122 Billion (2005)
  • Percent of this cost borne by public dollar (Medicare and Medicaid): 60%

(A cost to heirs may involve loss of the family home. Many people who begin their nursing home stay using Medicare funds deplete their savings and then use Medicaid funds. To recover these costs after nursing home residents die, Medicaid seeks funds from their assets and, unless certain specified family members still reside in the home, this often includes selling the family home.)

Compromised Safety, Increased Injuries

Steps at entries make it harder for first responders to save lives during fires and medical emergencies, and increase the likelihood of residents’ falling, particularly older people. In 2005, 1.8 million Americans age 65 and over were treated in emergency rooms for injuries from falls, and 460,000 were hospitalized. Every year, falls among older people cost the nation more than $19 billion in direct medical costs. (Centers for Disease Control, 2008)