The Costs of Not Modifying - For Stroke Survivors

Updated:Feb 12,2014

Supplemental information for the article "The Bathroom: Modifying the Room to Match Your Abilities" by Carol Siebert, MS, OTR/L, FAOTA in the September/October 2007 issue of Stroke Connection.

Home modifications are usually not considered a medical expense, which means they are usually not covered by health insurance either. So it’s no surprise that people often forgo home modifications and seek less expensive alternatives. But while this option costs less up front, other unforeseen costs may present themselves later on. That’s why it’s important to consider all the ways not modifying may cost you.  

If you’re unable to perform personal care tasks in the bathroom independently, and choose not to make modifications, your choices are typically limited to:

  1. recruiting or hiring the assistance of another person,
  2. performing the task in an alternate location, or
  3. giving up the activity. 

Choice no. 1 often means you’ll need to call on a family member or significant other, who then must agree to accept a certain level of responsibility for your care. This could alter or strain your relationship with that person. With time, the person may be unable or unwilling to continue. If significant physical effort is involved, there is a risk of injury to you and to the person assisting you. And even “free” help has a financial cost if the person has to reduce their work hours or give up a job in order to help you. 

If you decide to hire someone, paid assistance costs are typically $8–10 per hour, and most agencies require a minimum of two to four hours per day. This can quickly become a significant financial burden in and of itself.

Regardless of whether the assistance is volunteer or paid, having to depend on a caregiver for bathing, toileting or grooming may also limit your ability to engage in activities outside the home, including education, vocational training or employed work. 

In all cases, if you require assistance with the intimate, personal activities performed in the bathroom, there will be considerations of privacy and personal autonomy.

Choice no. 2—using the bathroom at another location—could also mean surrendering a certain level of personal privacy, and can clash with your sense of home aesthetics By sponge bathing at a sink or from a basin, you will most likely use your kitchen sink or   a basin placed at the bedside. A bedside commode may enable you to toilet independently, but it is seldom aesthetically acceptable, and you may need assistance to empty the commode receptacle. Even less desirable, the commode may have to be placed in other living areas to be accessible. 

Grooming activities such as shaving, makeup and brushing your teeth may be relocated to a bedroom or other area, but this may also come at the cost of privacy (and sometimes, a mirror).

Choice no. 3—giving up the activity—usually means performing sponge baths instead of using a tub or shower. This option involves a compromise in terms of personal preferences and hygiene. It also often means “giving up” applying makeup or shaving. Again, these costs are not obvious and do not involve dollars, but over time they may have enormous impact in terms of self-image and quality of life.

Choice no. 3 may also require an inordinate investment of time, and can be tiring and even require you to rest afterward. If you feel unsafe performing the activity, there may be associated anxiety, fear and stress, as well as the potential for injuries that can be prevented with appropriate safety modifications.

Read more about home modifications.

This content was last reviewed on 03/18/2013.

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