Adaptations in the home

A guide to the process of adapting the homes of people with disabilities from initial request to completion

In most districts of Norfolk there are two main statutory agencies involved in the process of providing adaptations to your home. They are the District Council and Norfolk County Council Social Services Department. However, in areas where the District Council transferred its housing stock you will have to consider the Housing Association and possibly the agent acting on behalf of the Housing Association.

The District Council or Housing Association: The Housing Department or Housing Association provides and maintains ‘social housing’, including adaptations for tenants with a disability.

The Environmental Health Department is responsible for the administration of the Disabled Facilities Grant for Adaptations to housing in private ownership. Occupational Therapists presently employed by Social Services are the link between Social Services, Environmental Health and the Housing Departments/ Housing Associations. These Departments are responsible for adapting properties to meet the needs of people with disabilities.

Do I qualify?

  • People must be permanently and substantially disabled and meet the Norfolk County Council’s eligibility criteria.
  • People must not be due for major surgical intervention, which will improve their mobility, and thereby solve the problem.
  • An assessment of need will be undertaken by an Occupational Therapist in consultation with the applicant. The Occupational Therapist may need to obtain information about your condition from other Health professionals, such as your GP, Consultant or Physiotherapist.
  • Only works that are necessary and appropriate will normally be recommended by the Occupational Therapist.

The person is disabled if:

  • Their hearing, sight or speech is substantially impaired.
  • They have a mental disorder or impairment, including learning disability of any kind.
  • They are permanently and substantially physically disabled by illness, injury or congenital deformity.
  • The above criteria include children.

Norfolk County Council’s Social Services Department does operate a prioritising system for all referrals to the Occupational Therapy Department. We first visit people who are considered to be in most urgent need. That is to say people with conditions which leave them at the highest risk of injury or harm. Our recommendations made to the Environmental Health Department for Disabled Facilities Grants reflect this policy, so that we all work to the same standards.

Priority Guidelines for Social Services and Housing

Priority 1

Early intervention required because:

a) Client at very high risk and cannot remain at home safely.

b) Carer is at risk.

c) Client has no access to essential facilities ie

  • Toilet
  • Sleeping facilities
  • Access to property

d) Client cannot be discharged from hospital safely.

Examples

a) Moving and handling issues i.e.
Person unable to be transferred without suitable equipment and/or adaptation.

b) Major difficulty or inability to use stairs where this provides access to the only toilet and sleeping facilities. (Where bed cannot be brought downstairs and commode used as temporary measure.)

Priority 2

The situation is putting significant pressure on client, family or carers. In all likelihood if action is not taken, physical or emotional breakdown or loss of independence will result.

Examples

a) Knowledge that the client has rapidly deteriorating condition or limited life expectancy indicates that a high risk situation likely to deteriorate i.e.
MND some cases of MS cancer.

b) Request from Housing Department requesting advice or suitability of property for disabled client on Housing transfer list being offered immediate accommodation.

c) Client has terminal illness, is managing but having difficulty with stairs to reach WC.

d) Client is unable to manage stairs, and using bed and commode in only family living room.

e) Disabled single parent unable to prepare meals for self and family without alterations to kitchen, so significant risk of losing role in family.

f) Client who is having great difficulty toileting themselves because of inability to get up from lavatory seat where provision of toilet equipment and rails would make them independent. (This would only be the case if there were no one to obtain the equipment from the Red Cross).

g) Where client’s mobility is such that they cannot access the property without adaptations being undertaken.

h) Where a child has a development delay in toileting and the additional WC has been identified as a possible solution, which will aid a toilet training programme.

Priority 3

Intervention is needed to maintain or provide reasonable level of independence. There is no immediate threat to health and safety.

Examples

a) Client having significant difficulty with Activities of Daily Living and requires advice on intervention to improve or maintain the existing level of independence and quality of life.

b) Client has significant difficulty with stairs, and WC is upstairs.

c) Client has a progressive neurological condition and is helped by formal or informal carer with washing and WC use. Could be independent with accessible facilities.

d) Accessible facilities are needed for a disabled child to maximise independence and assist parents to continue to provide care safely.

e) Bathing is always given low priority unless there is a genuine medical condition requiring daily baths (e.g. colostomy, skin ulcers etc).

f) Request is received for provision of ceiling track hoist to replace mobile hoist to reduce time on carers or make client independent.

g) Housing needs assessment requested - no suitable property yet identified.

Priority 4

Client is able to remain independent and can manage most daily living activities with difficulty using existing/alternative methods. It may be likely that higher priority needs will arise in the longer term.

Examples

To ameliorate a current low level of risk which will escalate in times as a consequence of either a progressive disability or one of, which becomes more profound with age. The client has lived with the problem for a very long time and has now heard of a possible solution.

a) Client feels apprehensive about using bath because of physical problems. Now feels they would be confident with bathing equipment.

b) Wheelchair user lives with able-bodied spouse requesting adaptations to cupboards in kitchen.

c) Having difficulty using front door step, but could be safely independent with hand rails.

What type of help is available?

A wide range of adaptations are available from the comparatively simple such as concrete ramps, over bath showers and stair lifts, to the more complex, such as level access showers, through floor lifts and ground floor extensions to provide bedrooms and bathrooms.

These are only examples of what is available. The Occupational Therapist and members of the Housing Authority (or their agent) or Environmental Health Department, in consultation with you, will advise on the most appropriate adaptation to meet your needs.

Simple adaptations, such as handrails and small timber ramps will be undertaken by the Equipment and Adaptations Service at the request of the Occupational Therapist

Who is responsible and who pays?

Funding for Adaptations depends upon the type of works needed and who owns the property.

  • Social Services under the Chronically Sick and Disabled Persons Act 1970, have a duty to provide assistance for you in arranging for works of adaptation in your home or for the provision of any additional facilities designed to secure your greater safety, comfort and convenience.
  • The Environmental Health Department is responsible for the administration of the Disabled Facilities Grant from the first recommendation through to completion of the work. All owner occupiers and private tenants who satisfy the criteria are eligible to apply for a Disabled Facilities Grant.
  • The Housing Department are responsible for arranging for adaptations to the District Council’s own properties. These adaptations are funded from a budget set aside for this purpose.
  • Housing Associations may fund some adaptations for their tenants, but they do have the option of applying for a Disabled Facilities Grant.
  • The Disabled Facilities Grant is a mandatory grant. The maximum grant is £25,000 (under review). This will be means tested and you will be awarded a grant based on your financial circumstances. If you feel that your assessed contribution is more than you can pay, Social Services may, in some instances, be able to assist, but again this will be subject to a means test. If Social Services do provide assistance they are likely to put a "charge" on the property. This means that if you sell the property, some or all of this financial assistance will be repayable.

Time Standards

Time standards have been set out between Housing Authorities, Environmental Health and Social Services for

  • Time between receipt of referral in Social Services and dispatch of recommendation to the relevant Housing Authority.
  • Time standards for Council House and Housing Association adaptations.
  • Time standards for Disabled Facilities Grants.

Some services will not be able to meet the time standards at present, because of resourcing problems.

The time standards will vary depending upon which category the referral falls into. Categories 1-3 will normally be mandatory under Disabled Facilities Grant legislation. Category 4 may not be mandatory, but could possibly be funded by a Care and Repair Grant. Environmental Health Departments will give you details of this service and the eligibility criteria.

The process

You need to make a referral, or if you prefer, you many ask someone else to do it on your behalf. Contact the Customer Services Team on 0344 800 8020

  • The Customer Services Team has access to information about available resources and will guide you to the most appropriate service for your needs. They will ask you for basic personal details and a brief summary of your particular needs.
  • The Occupational Therapist will acknowledge the referral and tell you how long it will be before they can visit to carry out an assessment.
  • In due course, the Occupational Therapist will contact you to arrange a mutually suitable time to visit you.

The First Assessment

During the first visit, the Occupational Therapist will carry out a detailed Occupational Therapy Assessment to determine what course of action would most suits your needs. You will be asked for details of your condition and how it affects your everyday life. You may be asked to show the Occupational Therapist around your home and to demonstrate the difficulties that you are having. It may be necessary for the Occupational Therapist to consult with Health Professionals involved with your care, which will not be done without your permission.

The views of you and your carers will be considered and will contribute to the decisions made.

The Occupational Therapist will check who owns the property. There are different types of assistance, depending on whether you own or rent your home.

  • Council Housing
  • Owner-Occupiers or privately rented.
  • Housing Association

You will be advised of the process for the adaptations system depending upon the type of housing that you live in.

The process for owner occupiers and tenants of privately owned properties

  • When an assessment of needs has been completed and the appropriate and necessary adaptations identified, the Occupational Therapist will send a recommendation for the proposed adaptations to the Environmental Health Department. A copy of this recommendation will be given to you. The Occupational Therapist may include a sketch plan, showing the proposed layout. This would not be to scale and the measurements would be approximate.
  • You will then be visited by the Grants Officer or the agent of the Housing Association. If the adaptations required are of a complex nature, it will be a joint visit with the Occupational Therapist.
  • When the appropriate adaptation and the best way of achieving it has been identified based upon what is reasonable and practical, appropriate and necessary, the Grants Officer or the agent of the Housing Association will draw up a schedule of works. A copy will be given to you and the Occupational Therapist.
  • For more complex adaptations, it may be necessary to employ an Architect to draw up plans and to obtain Building Regulations and Planning Approval. The Architect’s fees can be included in the total cost of the works. The Grants Officer or the agent of the Housing Association will advise you of the reasonable costs.
  • The Occupational Therapist would like to see a copy of the plans to ensure that the proposed adaptations are going to meet your needs.
  • If you are not employing an Architect to draw up plans etc, usually you will be responsible for obtaining the estimates.
  • Following the first visit from the Grants Officer or the agent of the Housing Association, you will be given a Disabled Facilities Grant Application Form, which must be completed and submitted with two estimates and where appropriate, with the plans, Building Regulation Approval and Planning Permission. The Application Form will provide the information for the means test. The Grants Officer may be able to give you an estimate of your assessed contribution early in the process before you submit your Grant Application.
  • Some of the proposed works may be VAT exempt. Contact you local Customs and Excise Office for full details.
  • When you have submitted your Grant Application, the Grants Officer or the agent of the Housing Association will check to ensure that the proposed works are both reasonable and practicable, and appropriate and necessary.
  • In due course, you will be notified in writing, to let you know if a grant has been awarded.
  • The building works must be completed within twelve months of the date of approval.
  • When the work is in progress and at completion, it will be checked by the Grants Officer or the agent of the Housing Association.
  • The Occupational Therapist will visit when works are completed, to ensure that the adaptation meets your needs. At this point the Occupational Therapist will arrange for any necessary rails and equipment to be provided.

    1. Do not start work until authorised in writing by the Grants Officer or the Agent of the Housing Association

    2. The Grants Officer or Agent of the Housing Association must check the completed work against the schedule.

    3. Completed work must be to a reasonable standard before payment of the grant money.

    4. You are responsible for the contractor and the work undertaken.

    Process for Local Authority Housing

    • When an assessment of needs has been completed, and the appropriate and necessary adaptations identified, the Occupational Therapist will send a recommendation for the proposed adaptations to the Housing Department or Housing Association and give a copy to you. Some Housing Associations have different procedures and you may have to take this into account when considering this process.
    • These requests will go to the design services of the relevant Authority. They will survey your home, prepare drawings, and obtain the necessary approvals to comply with regulations.
    • If the proposed adaptations are of a complex nature, the Occupational Therapist will do a joint visit with a representative of the design services.
    • A copy of the plans showing the proposed adaptations will be sent to you and the Occupational Therapist.
    • When the plans have been agreed by you, the Occupational Therapist and Housing, they will arrange for an appointed contractor to carry out the work.
    • The building work will be supervised and checked by a member of the design team.
    • On completion of the works, the Occupational Therapist will check that the adaptation meets your needs and will arrange the provision of any necessary equipment and rails.

    The process for Housing Associations

    The process will be very similar to that for Council Housing and privately owned properties. Some Housing Associations set aside a sum of money for adaptations to properties and will arrange for adaptations to be done following an assessment of need and recommendation from the Occupational Therapist. Some Housing Associations will use the Disabled Facilities Grant to fund all or some of the adaptations, in which case they may pay your assessed contribution.

    There are many Housing Associations in Norfolk and it is advisable to check with your own particular Housing Association as to how they assist with adaptations to their properties for tenants with a disability.