Advice & Guidance

External Access

Points to consider before recommending a change to the approach.

• Can the person safely enter and leave their home independently?
• Are steps, gradients, thresholds or uneven surfaces creating barriers?
• Does the person use a wheelchair, walking frame, rollator or other mobility aid?
• Is access required for carers or emergency services?
• Is there a safe route from the highway, parking space or garden to the entrance?

Internal Access

• Can the person move safely between essential rooms?
• Are doorways wide enough for a wheelchair or specialist equipment?
• Is there adequate turning space?
• Are flooring surfaces suitable for mobility aids?
• Does the furniture layout affect access?

Access To Outdoor Space

Access to a garden or outdoor area can promote wellbeing and mental health, support social participation, encourage physical activity, and reduce isolation.

Focus on a safe and usable area, rather than unrestricted access to the entire garden.

Bathing arrangements should be safe for the person and anyone assisting them, promote dignity and privacy, reduce manual-handling risks, and support independence where possible.

Assessment Considerations

• Can the person get into and out of the bath safely?
• Are carers undertaking unsafe manual handling?
• Has bathing equipment already been tried?
• Does the person need assisted bathing, or independent showering?
• Is a shower more appropriate than a bath?
• Is there a foreseeable deterioration in functional ability?

Showers

A level-access or low-level shower may be appropriate where the person can no longer use a bath safely, transfers are significantly difficult, carer support is becoming unsafe, or existing bathing equipment is ineffective.

• Transfer method
• Shower seating
• Space for carers
• Safe access to controls
• Slip risks
• Future needs

Specialist Baths

A specialist bath is normally considered only where the clinical need cannot be met by showering, where the condition requires bathing for health or therapeutic reasons, or where alternative equipment is unsuitable.

Assessment Considerations

• Can the person reach the toilet safely and in time?
• Is there severe incontinence?
• Are stairs creating a barrier to the existing WC?
• Is overnight access needed?
• Can the existing facilities be adapted before an additional WC is considered?

Specialist Toilets And Bidet Systems

These may be appropriate when functional limitations prevent adequate personal hygiene, other equipment has been explored, and the person cannot safely manage toileting independently.

Hoists

Consider a fixed hoist where the person cannot transfer safely, existing moving-and-handling equipment is unsuitable, there is a significant risk to carers, or hoisting would reduce care needs or improve safety.

• Transfer routes
• How often a transfer is needed
• The number of carers
• Ceiling structure and whether a track is feasible
• Likely future progression

Stairlifts

Consider a stairlift when essential facilities remain upstairs, the person can transfer on and off safely, they can sit safely throughout the travel, and the need is likely to last.

Assess balance, cognition, transfer ability, progressive conditions and falls risk with particular care.

Through-Floor And Vertical Lifts

Consider a through-floor or vertical lift when a stairlift is unsuitable, the person relies on a wheelchair, facilities on an upper floor need to stay accessible, and alternative housing or ground-floor living is not appropriate.

• Wheelchair dimensions
• Space for the lift and its parked position
• Emergency procedures
• Future needs

Ground-Floor Living

Before structural alterations or an extension, ask whether an existing room can be used differently, whether living and sleeping can be arranged another way, whether a stairlift or vertical lift would meet the need, and whether that arrangement is sustainable.

Additional Bedroom Space

Extra bedroom space is for situations where the existing accommodation genuinely cannot meet the need, privacy, dignity or manual handling cannot be achieved in the current layout, and the alternatives have been fully explored.

The aim is to let the person prepare food and drink safely and as independently as possible.

• Wheelchair access
• Worktop height and reach
• Appliances
• Food storage
• Turning space
• Windows and controls

• What level of meal preparation is realistic?
• Which tasks matter most?
• Can a smaller adaptation still meet the need?

Consider parking or vehicle access where getting to the vehicle is essential to independence, the walking distance is a significant barrier, or wheelchair transfers are unsafe. The question is functional need, not convenience.

Flooring has to support safe movement. It is often critical to whether an adaptation works in daily use.

• Trip hazards
• Wheelchair use
• Hoists and other moving-and-handling equipment
• Wet areas
• Slip risks

Lighting

Lighting supports safe navigation, fewer falls, independence, and people with a visual impairment.

• Task lighting
• Glare
• Contrast
• Where the controls can be reached

Heating

Consider whether the person is vulnerable to cold, whether adapted spaces will be warm enough, and whether further heating is needed once the adaptation is in place.

Where it is reasonable, look beyond the day of the assessment: progressive conditions, anticipated changes in mobility, equipment that may be needed later, care arrangements, and whether the solution can be sustained.

Address the needs that are present now and, where it is reasonable, those that can already be foreseen.