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)