The need for accessible housing or home modifications is faced by many of the 49 million Americans who have disabilities (24 million with severe disabilities). And the numbers are rising fast, because millions more will soon be faced with shortor long term disabilities as baby boomers reach their senior years.

While some can afford to build a house from the ground up to suit their needs, most people with disabilities must adapt their existing homes. It can be costly, but there are ways to economize.

"The average cost of home modifications nationwide for a person with quadriplegia is $35,000," says Melita Dolan, a consultant for The Dolan Group in New Jersey, who provides New Jersey residents with advice on making homes and workplaces accessible.

"Depending on your needs, of course, building for accessibility is far more cost-efficient than modifying a home," she points out.

But, by assessing your needs and planning carefully, the cost of adapting a home can be minimized. For instance, widening an exterior doorway can cost between $500 and $1,000. However, if just a little more clearance is needed, a set of special door hinges (about $32) allows the door to swing clear of the door jamb, providing an extra two inches for wheelchair passage.

BUILDING VS. MODIFYING

People who've experienced firsthand the high cost of making a home accessible, recommend selling an existing house and building a new one with special features, especially if calculations show that thousands of dollars might be needed for future adaptations.

Byron Price from Fairfax, Va., an engineer in the construction business who has a neuromuscular disease, recommends careful planning for the future. "I use a cane to get around, now, but realized the day would come when I'd need a wheelchair and that it would take a lot of money to make my old home accessible," Price says.

Price and his wife decided to sell their home and build a new one with his specific needs in mind. Their new home is one level with 36-inch doorways and wide halls; the bathrooms have reinforced mountings for grab bars as they become necessary; lower light switches were installed throughout; lower countertops in the kitchen and a stand-alone rangetop provide leg room for a wheelchair; shelves can be rolled out for easy reach; and more. The outside of their home was designed with small, shallow steps which Price can currently navigate leading to the entryway. A wheelchair ramp will be added on when it becomes necessary.

"It costs practically nothing," he says, "to take a set of house plans and make it accessible before construction begins, compared to making changes later."

TAKE THE BURDEN OUT OF MODIFYING

Many people can't build new homes because of financial constraints. Some simply prefer their current locations because of a great neighborhood or easy access to jobs, stores, etc. If that's the case, here are some suggestions to take the sting out of expensive modifications.

• For simple construction projects, friends and family with building skills are a good source for inexpensive labor.
  
  
• Make one or two adaptations at a time to spread the costs over several years. Start with modifications most essential to your needs.
  
  
• Shop around for best prices. This includes everything from appliances to contractor bids for jobs such as building ramps, widening doors, making bathroom modifications, installing lifts or elevators, etc.
  
  
• When possible, use over-thecounter appliances or equipment rather than custom building. For instance, instead of adding a complete set of costly specialty cabinets, a lazy Susan might bring kitchen utensils within reach.

TIPS FROM HOME OWNERS

Tom Walker, a retired truck lift operator at the Potlach Company in Barnum, Minn., tells about the modifications he and his wife made to a home that's been in his family many years. "I feel fortunate," says Walker, who has limb-girdle muscular dystrophy, "that my home did not need much to make it accessible to my needs."

Luckily, the doors are just wide enough and all rooms are large enough for Walker to maneuver his wheelchair. The one problem he encountered was that an 18-inch lift was needed to get him from the garage to the main house. When he priced factory-made lifts, estimates came in at $4,000 to $5,000.

Walker decided to hire a handyman/machinist to build a lift instead. "I paid $500 for the whole thing," he says. "It's sturdy and has everything I need, like a three-way switch and roll guard."

Walker is pleased with the unit and recommends finding talented builders in the community to make home adaptations at a fraction of manufacturers' costs. His one word of caution make sure you hire reputable, quality workers.

Paul Martin, 43, of Las Vegas, who recently received MDA's Nevada state Personal Achievement Award for his work to help other people with disabilities, has many useful suggestions. He plans to open a resource information service soon and is publishing a local resource book to help MDA. He recommends shopping at flea markets for some great items for the home.

"I found nice quality grab bars for $3 each that normally sell for about $40," he says. Other items he's picked up at flea markets that help him around the house are large jar openers for $2 (normally about $15), batteries for wheelchairs, crutches, long-arm extension grabbers for about $8, and shower seats "for a little of nothing."

Martin and his son also built three concrete ramps for his home for a total of about $13 (cost of the cement). In fact, he's a firm believer in finding ways to beat the high cost of making homes accessible. "I only spent a total of about $500 on my own home modifications," he says.

When he's sick in bed, Martin uses an over-the-counter intercom system he bought at Target for $20. "It was originally developed for parents to hear a baby's cry from another room. All I have to do is speak my wife's name to get assistance. I don't have to reach for a button to press."

Martin also enjoys the benefits of remote control units. He can automatically turn on and off lights, the TV, radio and other appliances. A basic model like the X-10 is about $40 and can be purchased through S Enterprises, Radio Shack or similar companies.

Mike Sweany, an Indianapolis engineer, sells remote control units through his company, S Enterprises. He understands the needs of people with disabilities because he has a neuromuscular disease and enjoys the benefits of remote controls, too. He advises customers on the best unit to buy according to their needs. "The thing I like most about the X-10 remotes," he says, "is the simple plug-in units. Wiring is not needed and costs are minimal."

For a little extra money, you can expand the X-10 to set up a home security system or a home automation system (drapery controls, sprinklers, and cooling or heating) for safety, comfort, energy savings and convenience.

"It's great for me to be able to come home from work or outings at night and turn on house lights from the driveway. You can also set up a system where you phone home ahead of time and have the heat or cooler and lights on for your arrival," Sweany says.

Hope Barrera, an educational diagnostician at the Alice (Texas) Independent School District and member of the MDA National Task Force on Public Awareness, recently finished making modifications to her home. She had an automatic door opener installed in the main entryway but, more than anything, deeply appreciates her new accessible bathroom and bedroom.

She says she's thrilled to have a large 6-foot by 6-foot roll- in shower, complete with ADA-approved, non-skid tiles -- especially since she once slipped and broke a leg as a result of slick tiles in her old bathroom. "Most builders are aware of these great non-skid tiles," she says. "And if they're not, be sure to point it out to them."

Barrera's shower contains a fold-down bath chair and a 69-inch long hand-held spray nozzle made by American Standard. The on/off water controls are on the nozzle itself to end reaching problems.

Another feature she likes is her vanity with leg room underneath the basin. It was built by the contractor at her request to "jut out slightly" and she also asked that he install the "easy-to-use winged faucet handles." People who are unable to use any type of handle should be aware that faucets with sensors are also available.

Her tips for people who want to make modifications using a builder are: 1) clip ideas from magazines, 2) find a contractor who is understanding, willing to listen to your needs and who will also make adjustments, 3) get bids from several people.

Melita Dolan, president of The Dolan Group, believes in building from scratch for accessibility. But, if it's not possible, cost-saving tips she incorporates into her own home and gives others who want to adapt include:

Remove cabinet doors and/or the whole section of cabinet to allow a wheelchair to roll underneath a kitchen or bathroom sink. Lower kitchen storage cabinets to wheelchair height.

Find a pantry with shallow shelves or with easy-pull shelves to store food and many other items. Or, use modular bins (Rubbermaid has various sizes available in most home supply/hardware stores).

"I believe in using mainstream appliances whenever possible, "Dolan says. "For instance, you can easily find a front-loading washer, an oven or range with controls on the front or a regular microwave that can be mounted or installed at wheelchair height."

The specialized equipment she does use in her home includes a Power Access door opener (about $1,500) and an Accessible Industries mini-vator ($1,500 to $1,800 for two-story homes only), which is less expensive than a regular elevator.

HELP THROUGH MDA

If you're considering home modifications, contact your nearest MDA office for help with local resources that may be available and phone numbers of nearby independent living centers (ILCs) and vocational rehab centers. ILCs are good places to inquire about recommended housing specialists.

It's also a good idea to visit homes that have been adapted for accessible living by making arrangements with consultants like those at The Dolan Group, who advise businesses and homeowners about practical modifications for people with disabilities. You may want to consider contacting the local Association of Home Builders.

Much more can be said about making homes accessible, but here's one important point to remember. It's not always practical to make home improvements on your own or with friends.

You may want to cut costs, but many financial or safety disasters can occur if you try to build a ramp, widen a door, etc., without proper knowledge of specs, tools or construction techniques. For instance, rather than building a long, unsightly(or especially unsafe) ramp to the front door, it's often best to invest in a manufactured lift. It will save you money and much frustration in the long run.

Listed below are additional resources and suppliers of items that help people with disabilities design and modify their homes.

ITEMS THAT IMPROVE HOME ACCESSIBILITY

MORE INFORMATION

Publications:

For publications on home modification and financing, call Jan Reagan at the Center for Accessible Housing, North Carolina State University, (919) 515-3082

Pamphlets are available on bathroom/kitchen modifications, home designs and more from the Paralyzed Veterans of America, (201) 416-7642.

The DoAble, Renewable Home: Making Your Home Fit Your Needs, free pamphlet from the American Association of Retired Persons (AARP), Consumer Affairs Section, (202) 728- 4355.

Tools for Independent Living, a free publication offering tips for installing and operating appliances for easier use by people with disabilities. Whirlpool Corporation, Appliance Information Services, (800) 253-1301.

Directory of Accessible Building Products ($4), and A Comprehensive Approach to Retrofitting Homes for a Lifetime ($14), National Association of Homebuilders Research Center, (301) 249-4000.

Video:

For $11.95 plus shipping, PBS offers a segment from one of its Hometime programs, "Building and Remodeling for Accessibility." It aired about a year ago with instructions for "do-it-yourselfers" on how to make some home modifications for about $800 in materials. To order, call (800) 877-6644.

Contractor referrals:

National Association of Homebuilders, 1201 Fifteenth St. NW, Washington, DC 20005, (800) 368-5242.

Design and consulting firms:

The Dolan Group Inc. in Hawthorne, N.J., (201) 427-8517.

Abilities OT Services Inc. in Baltimore, Md., (410) 358- 7269.

Barrier Free Environments Inc. in Raleigh, N.C., (919) 782-7823.

Planning Accessible Living in Amherst, Mass., (413) 665- 2059.