6 Reasons I can’t get URGENT Complex Home Modifications

As an occupational therapy service that focuses on assessing for complex home modifications through funding schemes including NDIS and icare we are often asked by people to ‘get my bathroom fixed by Christmas’. We would love to say that if someone asked us in September that they may get a new bathroom by December, however the reality is that this won’t occur.

Here are 6 essential steps that lead to delays for complex home modifications and the reason that a complex home modification can’t occur in a couple of months.

1. Low-cost options need to be excluded first

Occupational Therapists should be confident knowing and applying the policies, procedures and legislations of the funding bodies that we request funding through. All the funding bodies that we approach to request funding on your behalf require a rigorous process to be followed before considering high cost complex home modifications. We need to trial or consider all reasonable low cost, non- structural modifications and assistive technology prior to considering stripping a whole bathroom out or doing other major work to people’s homes.

For example, in a bathroom we start with using equipment (assistive technology) like bath boards, shower chairs, transfer benches; and installing minor modifications like grabrails, removal of shower screens, handheld shower hoses, and threshold wedges. When lower cost options don’t work effectively, we have the proven evidence requires to progress our request to considering higher cost interventions.

For people who are palliative or have end-stage conditions we often provide creative solutions that are not high cost, so that we can improve someone’s quality of life now while it counts most. Complex home modifications are rarely installed in these situations. Trialling and installing low-cost solutions is the start of the process for complex home modifications and this step can only be skipped if there has been a catastrophic accident that has dramatically changed someone’s function permanently- such as a spinal cord injury.

2. Builder Visits

It can take some time to coordinate the funding and appointment for a joint Occupational therapy and builder visit. This joint visit is essential when considering complex home modifications.

While occupational therapists are the experts in function, the builders are experts in buildings. They have the knowledge of requirements to meet the Australian Standards, Building Code of Australia, National Construction Code, plumbing and electrical requirements, management of asbestos and many other critical elements that are essential when considering modifications to bathrooms, kitchens, access and other areas in the home.

Two builders will need to visit to quote on the job once the design is finalised, to meet funding body requirements. We’ve experienced a waiting time of 2-3 months for some builders to quote on the jobs before we can submit our reports for requesting funding.

3. Due diligence with the design process

Our modifications are designed to assist you to function long-term, are based on Australian Standards AS1428.1 and are solutions designed to help you with your long-term independence and safety. We take into consideration the progression of change of function of various conditions and the possible need for wheelchair accessibility and/ or hoist access long-term. Our plan is that no matter what happens in your life, the modifications will remain suitable or adaptable to meet your changing needs.

We understand that most funding bodies allow for one opportunity for complex home modifications, so we need to make sure that we get the design correct for your long-term needs. You will be asked to review and sign off on the reports, design and scope of works, following the builder visit, to provide your consent for the modifications to be completed. We have worked with many people whose circumstances change unexpectedly and in unplanned ways. For example, selling their home and relocating before modifications have been completed or moving interstate for work. For others we have seen people’s condition rapidly deteriorate, and they were not able to enjoy the modifications requested as they may have moved into a nursing home, or even may have passed away.

The process should not be rushed to ensure that the modifications are not installed unless you’re 100% confident that this is your forever home and that the modifications are requested to meet a long-term need.

4. Completing the reports

It can take months to complete the reports for complex home modifications, as the report requirements are rigorous and each report may be many pages long.

There are also other situations that may impact the report requirements to request high level funding. For example, many people through NDIS who request complex home modifications will also need a current functional capacity assessment to go in with this request, which also takes more time to complete.

Once the lengthy reports are written you will need to sign off on these reports and the design, which will take another home visit to confirm design elements with you. We then need to wait for many weeks for the quotes to arrive to go with the reports.

5. Waiting for approval

Once the many, lengthy reports have been submitted, we wait for funding body approvals. In NDIS this may mean waiting until you have your next plan review or waiting for the availability of the complex home modifications delegates to review the reports.

Delegates may then call the occupational therapists for further detail regarding their reports or to clarify issues before giving approvals. They may ask for additional evidence in relation to your circumstances that will require further assessments and feedback before they can make their decision on the request.

If they decline the request, it will take many months longer to go through the appeals process.

6. Builders waiting lists

Once the funding is finally approved, it is still likely to take several months from date of funding to final completion of the work.

Many of the reputable builders who provide quality workmanship according to disability standards have a waiting list of many months until they can complete a job. The job cannot be scheduled until the funds have been released, so we then must wait for a date given by the builder as to when this can be scheduled.

You will also have to negotiate with the builders any upcharges and items that are not funded as the basic level in the modifications, as upgrades are at the owner’s expense. When the builders are working on the major home modifications it is recommended that you leave your property while the work is being done. You may be able to go to respite, or other accessible accommodation while you wait for the work to be completed, as there will be a lot of dust and noise, and no access to the toilet/ bathroom while work is being done (unless a portable option is possible, affordable and meets your circumstances).

Summary

As the steps above outline, there are many essential steps in the process for complex home modifications that require months of planning and designing and collaboration, before funding can be released from major funding bodies. Generally, you can expect a complex home modification through NDIS to take 1-2 years, or longer for appeals if they decline aspects of the request.

One of the main ways that you can speed up the process is to install the modifications privately without seeking funding from other sources. Most people do not have this option available to them though.

If funding your own modifications is not possible in your situation, then we recommend you start the process with your occupational therapist as soon as major modifications are identified as essential to manage your long-term needs. We will then work on the steps together as required from our major funding bodies to give you the best chance of success with your complex home modifications request.