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Case Study

Case Study: Sarah's Bathroom Transformation

HomeAccessibility Team
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How Sarah transformed her inaccessible bathroom into a fully functional, independent space through NDIS-funded modifications, eliminating fall risks and restoring dignity in her daily routine.

# Case Study: Sarah's Bathroom Transformation

## Background

Client:

Sarah Thompson, 68 years old

Location:

Melbourne, Victoria

Property:

Single-story unit (built 1980)

Challenge:

Progressive Multiple Sclerosis with increasing mobility limitations

Timeline:

6 weeks from assessment to completion

Total Cost:

$42,500

NDIS Contribution:

$42,500 (100%)

## The Story

Sarah was diagnosed with Multiple Sclerosis fifteen years ago. For most of that time, she maintained her independence with minimal support. However, in the past two years, her condition progressed significantly. What started as occasional use of a walking stick evolved to requiring a walker full-time, and her occupational therapist suggested preparing for eventual wheelchair use.

The most challenging part of Sarah's day had become using her bathroom. The standard 1980s design featured:

  • Over-bath shower with high step (400mm)
  • Standard toilet (low at 380mm)
  • Pedestal basin with no knee space
  • Poor lighting and small mirror
  • Slippery ceramic tiles
  • No grab rails
  • Narrow doorway (760mm)
  • ## The Crisis Point

    **March 2024** - Sarah fell while attempting to exit the shower, resulting in a minor fracture to her wrist. This incident was the catalyst for change.

    *"I'd been avoiding showering because it was so difficult and frightening. That fall made me realize I couldn't keep living this way. I was sacrificing my hygiene and dignity out of fear."* - Sarah

    ## Assessment and Planning

    **April 2024** - Occupational therapist David Morrison conducted a comprehensive bathroom assessment:

    ### Current Barriers

  • **Shower access:** 400mm step impossible to navigate safely
  • **Toilet height:** Too low for safe transfers, causing strain
  • **No support:** Absence of grab rails increased fall risk
  • **Basin:** Couldn't use while seated
  • **Door width:** Would not accommodate future wheelchair use
  • **Flooring:** Slippery when wet
  • **Poor lighting:** Inadequate for someone with visual challenges
  • ### Goals Established

  • Eliminate fall risks completely
  • Enable independent showering with dignity
  • Prepare for progression to wheelchair use
  • Maintain as much of Sarah's independence as possible
  • Create a calm, spa-like environment (Sarah's request)
  • ## Design Solution

    Architect:

    Emma Richardson, Accessible Spaces Design

    ### Key Design Decisions

    **Complete Bathroom Redesign** rather than piecemeal modifications:

  • Remove bathtub entirely
  • Create 1200mm x 1200mm roll-in shower
  • Install comfort-height toilet with integrated bidet
  • Wall-hung vanity with wheelchair access
  • Widen doorway to 920mm
  • Complete retiling with slip-resistant porcelain
  • Enhanced lighting design
  • ### Design Philosophy

    *"We wanted to create a space that felt like a sanctuary, not a hospital room. Sarah deserved beauty alongside function."* - Emma Richardson

    ## Funding Process

    ### NDIS Application

    **April 2024** - David Morrison prepared comprehensive OT report:

  • Detailed current functional limitations
  • Fall history and risk assessment
  • Impact on daily living and mental health
  • Reasonable and necessary justification
  • Three quotes from registered providers
  • Quote Comparison:

  • Quote 1: $38,500 (selected)
  • Quote 2: $41,800
  • Quote 3: $45,200
  • Selected Melbourne Accessible Bathrooms for:

  • NDIS registration and experience
  • Transparent pricing breakdown
  • References from similar projects
  • Understanding of progressive conditions
  • 12-month workmanship warranty
  • Approval Timeline:

  • Report submitted: April 15
  • Additional information requested: April 22
  • Final approval: May 3
  • 18 days total - relatively quick
  • Approved Amount:

    $42,500 (adjusted quote with minor additions)

    ## Construction Process

    **May 13 - June 21, 2024** - Six weeks including planning

    ### Week 1: Demolition and Preparation

    Day 1-2:

  • Sarah temporarily relocated to sister's home
  • Bathroom fully stripped - bathtub, vanity, toilet removed
  • Tiles removed from floor and walls
  • Plumbing exposed for reconfiguration
  • Day 3-5:

  • Doorway widening (structural assessment confirmed no load-bearing issues)
  • Plumbing relocated for new layout
  • Electrical rough-in for additional lighting
  • Waterproofing preparation
  • ### Week 2-3: Core Construction

    Shower Installation:

  • 1200mm x 1200mm shower base with integrated fall to waste
  • Linear drain for optimal water flow
  • Aquaboarded walls for waterproofing
  • Grab rail blocking installed in studs
  • Flooring Work:

  • New concrete screed for level floor
  • R11-rated slip-resistant tiles installed
  • Heating cables under floor for comfort (Sarah's addition)
  • Threshold elimination - level with hallway
  • Wall Preparation:

  • Moisture-resistant plasterboard
  • Reinforced areas for grab rails and fixtures
  • Recessed shelving niches in shower
  • ### Week 4-5: Fixtures and Finishes

    Toilet Installation:

  • Wall-hung design: Geberit in-wall cistern
  • Comfort height: 480mm (customized for Sarah)
  • Integrated bidet function with warm water
  • Soft-close seat
  • Drop-down grab rails both sides (rated 150kg)
  • Vanity Installation:

  • Wall-mounted at 800mm height
  • 600mm depth with clear knee space
  • Ceramic undermount basin
  • Lever mixer tap with extended reach
  • Soft-close drawer for accessible storage
  • Shower Finishes:

  • Porcelain tile walls (easy to clean)
  • Fold-down shower seat: 450mm x 450mm
  • Height-adjustable shower head on rail
  • Hand-held shower wand with 1500mm hose
  • Thermostatic mixing valve (safety)
  • Vertical grab rail near controls
  • Horizontal grab rail on side wall
  • Built-in niches for toiletries
  • Door:

  • New door hung with offset hinges (additional clearance)
  • Lever handle at 900mm
  • D-pull on inside
  • Automatic closer adjusted for easy operation
  • ### Week 6: Final Touches

    Lighting:

  • Recessed LED downlights (3 x 6W)
  • Waterproof rating IP65
  • Warm white (3000K) for ambiance
  • Motion sensor control option
  • Separate vanity lighting above mirror
  • Night light near toilet
  • Accessories:

  • Mirror: full-width above vanity, 1800mm height
  • Toilet roll holder at optimal height
  • Towel rails at multiple heights
  • Hooks for grab-bag and towels
  • Chrome finishes throughout
  • Ventilation:

  • Upgraded exhaust fan with humidity sensor
  • Automatic operation
  • Quiet operation (<20 decibels)
  • Final Inspection:

  • Building inspector approval
  • Occupational therapist walkthrough
  • Sarah orientation and training
  • Handover with care instructions
  • ## Features in Detail

    ### Roll-In Shower

    Dimensions:

    1200mm x 1200mm

    Access:

    Zero threshold - level with bathroom floor

    Floor:

    Slip-resistant porcelain (R11 rating)

    Drainage:

    100mm linear drain with 1:100 fall

    Walls:

    Floor-to-ceiling porcelain tiles

    Shower Seat:

  • Fold-down design (space-saving)
  • 450mm x 450mm when deployed
  • 450mm height from floor
  • Weight capacity: 180kg
  • Textured surface for safety
  • Easy-clean white powder coat
  • Controls:

  • Thermostatic mixer valve
  • Anti-scald protection (38°C maximum)
  • Easy-grip lever handles
  • Positioned 900mm from floor
  • Within reach from seated position
  • Shower Heads:

  • Fixed overhead rain shower: 250mm diameter
  • Hand-held wand: multi-function
  • Height-adjustable rail: 600-1800mm
  • 1500mm flexible hose
  • Easy-clean silicone nozzles
  • Grab Rails:

  • Vertical rail near controls: 600mm length
  • Horizontal rail on side wall: 800mm length
  • 32mm diameter stainless steel
  • Knurled finish for grip
  • Rated to 150kg load
  • Positioned per AS1428.1 standards
  • ### Accessible Toilet

    Type:

    Wall-hung comfort height

    Height:

    480mm from floor to seat top

    Clearance:

    1200mm transfer space on both sides

    Cistern:

    Concealed Geberit in-wall system

    Flush:

    Dual-flush button on wall (900mm height)

    Bidet Function:

  • Integrated warm water bidet
  • Controls on side panel
  • Adjustable pressure and temperature
  • Air dryer included
  • Reduced need for toilet paper
  • Increased independence and hygiene
  • Grab Rails:

  • Drop-down rails both sides
  • 800mm length each
  • Return to vertical when not in use
  • Weight-rated to 150kg
  • Easy-grip surface
  • Lockable in down position
  • ### Accessible Vanity

    Design:

    Wall-mounted floating vanity

    Width:

    900mm

    Depth:

    600mm

    Height:

    800mm to suit Sarah

    Knee Space:

    Full depth clearance underneath

    Basin:

  • Ceramic undermount
  • Overflow protection
  • Centered in vanity
  • Rounded edges for safety
  • Tap:

  • Single lever mixer
  • Extended spout (200mm)
  • Swivel function
  • Temperature limiting valve
  • Easy one-hand operation
  • Storage:

  • Single soft-close drawer
  • Pull-out design for easy access
  • Organizer inserts included
  • Reach from seated position
  • ### Doorway Modification

    Original Width:

    760mm

    New Width:

    920mm clear opening

    Door:

    Hinged with offset hinges for additional clearance

    Hardware:

    Lever handle at 900mm height

    Swing:

    Outward-opening for emergency access

    Closer:

    Automatic with adjustable speed

    ## Life After Transformation

    **June 21, 2024** - Sarah uses her new bathroom for the first time

    *"I actually cried when I saw it. It's beautiful - but more than that, I felt safe. For the first time in years, I wasn't afraid of my own bathroom."* - Sarah

    ### Daily Impact

    Morning Routine - Before:

  • Avoided showering unless absolutely necessary
  • Anxiety about falling
  • Required sister's help 3x per week
  • Often used baby wipes instead of showering
  • Process took 45 minutes with rests
  • Exhausting and undignified
  • Morning Routine - After:

  • Showers daily with confidence
  • Independently and safely
  • Enjoys the experience (warm floor, good lighting)
  • Process takes 20 minutes
  • No exhaustion afterward
  • Dignity restored
  • ### Independence Regained

    Toilet Use:

  • Bidet function eliminates difficult reaching
  • Comfort height reduces strain on joints
  • Grab rails provide confidence
  • No longer needs sister's assistance
  • Self-Care:

  • Can do hair and makeup at accessible vanity
  • Seated while washing hands and face
  • Everything within easy reach
  • Better lighting helps with MS vision issues
  • ### Emotional Impact

    *"I underestimated how much my bathroom struggles were affecting my mental health. I was becoming isolated because I couldn't maintain my hygiene independently. Now I feel human again."* - Sarah

    Changes Noted:

  • Increased confidence
  • Resumed social activities
  • Improved mood
  • Better sleep (no longer anxious about morning)
  • Reconnected with friends
  • Overall quality of life significantly improved
  • ## Three Months Later

    **September 2024** - Follow-up occupational therapy assessment

    ### Outcomes Achieved

    Functional Improvements:

  • 100% independent bathroom use
  • Zero falls since installation
  • Daily showering resumed
  • Improved hygiene and self-care
  • Reduced reliance on family support
  • Design Success:

  • All features used as intended
  • Wheelchair-ready for future needs
  • Easy to clean and maintain
  • Beautiful aesthetic maintained
  • Exceeded Sarah's expectations
  • ### Minor Adjustments

    Added After Completion:

  • Additional hook near shower for walker
  • Shower caddy relocated to better position
  • Slight adjustment to shower seat tension
  • All minor tweaks completed under warranty
  • ### Unexpected Benefits

    Energy Efficiency:

  • LED lighting reduced electricity costs
  • Thermostatic valve reduced water waste
  • Floor heating on timer (efficient)
  • Property Value:

  • Real estate agent estimated $15,000 increase
  • Desirable feature for aging population
  • Universal design appeals to broader market
  • ## Cost Breakdown

    Demolition and Preparation:

    $3,500

  • Strip existing bathroom
  • Doorway widening
  • Plumbing relocation
  • Electrical upgrades
  • Waste removal
  • Waterproofing and Tiling:

    $8,800

  • Complete waterproofing
  • Floor and wall tiles supply and installation
  • Shower base and waste
  • Level floor construction
  • Fixtures and Fittings:

    $15,200

  • Toilet and bidet system: $2,800
  • Vanity and basin: $2,400
  • Shower fixtures: $3,200
  • Grab rails and accessories: $1,800
  • Door and hardware: $1,200
  • Mixer valves and plumbing: $2,400
  • Other fixtures: $1,400
  • Electrical and Lighting:

    $3,800

  • Lighting fixtures and installation
  • Exhaust fan upgrade
  • Floor heating cables
  • Switches and controls
  • Labor:

    $9,200

  • Project management
  • Tradesperson labor
  • Installation and finishing
  • Certification and Approval:

    $2,000

  • Building permits
  • Inspector fees
  • Final certification
  • OT assessment and report
  • Total: $42,500

    Funded:

    100% by NDIS

    ## Technical Specifications

    Compliance:

  • AS 1428.1 - Design for Access and Mobility (Clause 12: Sanitary Facilities)
  • AS 3740 - Waterproofing of domestic wet areas
  • National Construction Code (NCC) Volume 2
  • Plumbing Code of Australia
  • Products Used:

  • Tiles: Porcelain R11 slip-resistant (floor), R9 (walls)
  • Toilet: Geberit Aquaclean comfort height
  • Vanity: Custom wall-hung with caesarstone top
  • Shower fixtures: Methven Waipori range
  • Grab rails: Care Quip stainless steel
  • Lighting: Martec LED downlights IP65
  • Exhaust: Ventair Slimline Pro
  • ## Professional Team

    Occupational Therapist:

    David Morrison, OT, Enable Victoria

    Architect/Designer:

    Emma Richardson, Accessible Spaces Design

    Builder:

    Melbourne Accessible Bathrooms (NDIS registered)

    Certifier:

    Victorian Building Certifiers

    Plumber:

    Master Plumbers Association member

    Electrician:

    Licensed A-Grade electrician

    ## Lessons Learned

    ### What Worked Well

  • **Complete redesign** rather than piecemeal changes provided better outcome
  • **OT advocacy** ensured NDIS understood necessity and urgency
  • **Experienced builder** prevented delays and quality issues
  • **Temporary accommodation** with family reduced stress
  • **Focus on Sarah's goals** created space that exceeded functional requirements
  • ### Challenges Overcome

  • **Living without bathroom:** Stayed with sister (planned ahead)
  • **Dust and noise:** Unit neighbors informed in advance
  • **Product delays:** Builder had backup suppliers
  • **Minor design changes:** Builder flexible and accommodating
  • **Learning curve:** Training session with OT helped Sarah adapt
  • ## Advice for Others

    ### Sarah's Tips

    *"Don't wait until you're in crisis like I did. If you're struggling, start the conversation with your OT now. The process takes time, so begin before you absolutely need it."*

    Key Recommendations:

  • **Start early:** NDIS process can take weeks or months
  • **Be honest:** Share all your struggles with your OT
  • **Get involved:** Attend design consultations, share preferences
  • **Plan accommodation:** Have somewhere to stay during work
  • **Ask questions:** Don't hesitate to clarify anything
  • **Think ahead:** Design for future needs, not just current
  • **Document everything:** Photos, quotes, communications
  • **Trust professionals:** But also advocate for your needs
  • ### David Morrison (OT) Insights

    *"Bathrooms are often the most critical home modification. They impact dignity, health, safety, and independence. Sarah's case demonstrates that NDIS will fund comprehensive solutions when properly justified."*

    Professional Tips:

  • Falls in bathrooms are leading cause of injury in people with disabilities
  • Don't accept "standard" solutions - customize to individual needs
  • Complete renovation often more cost-effective than gradual changes
  • Focus NDIS applications on functional impact and safety
  • Progressive conditions require future-proofing
  • ## Six Months Later

    **December 2024** - Sarah reflects on her transformation

    *"This bathroom gave me back my independence and self-respect. I can invite friends over without worrying about my hygiene. I can participate in life again. It sounds dramatic, but it's truly life-changing."*

    Current Status:

  • Using walker full-time now, considering wheelchair
  • Bathroom fully accommodates both
  • No modifications needed as condition progresses
  • Maintains complete bathroom independence
  • Zero falls or close calls
  • Mental health significantly improved
  • Reconnected with community and hobbies
  • Unexpected Joy:

    *"I actually look forward to my morning shower now. The warm floor, the good lighting, the feeling of safety - it's become a peaceful start to my day instead of something I dreaded."*

    ## Conclusion

    Sarah's bathroom transformation demonstrates that relatively modest home modifications can have profound impacts on quality of life, independence, and dignity. The $42,500 investment:

  • **Eliminated fall risk** preventing potential injury and hospitalization
  • **Restored independence** reducing burden on family
  • **Improved mental health** through dignity and confidence
  • **Future-proofed** for disease progression
  • **Increased property value** as bonus outcome
  • ### The Real Value

    While the financial cost was $42,500, the value to Sarah is immeasurable:

  • Dignity restored
  • Independence maintained
  • Safety assured
  • Quality of life enhanced
  • Connections with others renewed
  • Sarah's Final Words:

    *"If you're struggling with your bathroom, don't suffer in silence. There is help available. Talk to your OT, explore your options. You deserve to feel safe and dignified in your own home. I wish I hadn't waited so long."*

    ## Resources

  • NDIS Home Modification Guidelines
  • Occupational Therapy Australia - Find an OT
  • Accessible Bathroom Design Standards
  • NDIS Registered Bathroom Builders by State
  • Progressive MS Resources and Support
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