By Marney Walker

(On behalf of The OT Service) 

Independent OT specialising in design of housing for older people


All too often when reviewing a completed adaptation, OTs are dismayed to find that their recommendations have not been implemented. Whether an adaptation or new build, once work is completed it is difficult and costly to change. It’s not just about making recommendations, it’s about being able explain why they are needed. As advocates for our clients, how can we be more effective in getting our message across?

OTs are rarely in direct contact with the person who is fitting the rail, installing the shower, building the housing. By the time of installation, will the builder understand the impact of fixing a shower seat at the wrong height? Will they have seen the reasoning in your recommendations?

There is a fine line between understanding user requirements and the technical knowledge required. Knowledge exchange between OTs and architects, surveyors and contractors is crucial to successful outcomes.

Ask the OT questions:

OTs are experienced in the various challenges our clients face on a daily basis.

First-hand experience of clients, families and carers provide invaluable insights that ensure that an adaptation or new build is fit for purpose.

The issues may seem obvious to us, but always ask the questions. How will a person with a walking frame open that door? How will someone with arthritic shoulders be able to reach up into that cupboard? Will the position of that light cast a shadow on the task area? Could you reach the shower if you are seated? How easy is it to see and operate shower controls?


Must do and could do

Referencing regulations and access guidance gives reports more authority. Part M(1), familiar to all involved, is the minimum, ‘must do’ standard and needs to be signed off by Building Inspectors. To make a case for more generous space requirements use BS8300(2) and HBN 00-02(3). Although not mandatory, it’s worth referring to the excellent OT guidelines(4) for both new build and housing adaptations.

Learning the language: Version Control: Charts, Plans, Checklists, and Acronyms

It’s impossible to learn all the jargon used in build projects. But it’s well worth familiarising yourself with some key terms and documents commonly used: GIFA (Gross Internal Floor Area) first fix , second fix, GA (General Arrangements) , RFI (Request for Information), RDS (Room Data Sheets) Employers Requirements (ERs). And if you don’t know what these are don’t be afraid to ask. I have found that when auditing large schemes using tables and checklists that reference units, and prioritise requirements, alongside reasoning, is better understood.

Understanding priorities and developing negotiation skills

It helps to understand the viewpoint of our partners in these projects. Housing Providers will see maintenance costs as a priority. If rails in corridors are seen as institutional, their value for people with sight loss, may be less convincing than potential marks on walls. Equally we need to understand the real technical challenge for contractors in creating flush thresholds when they will have insurance liability for weather protection.

It’s never too early and it’s always too late

I have been told in the past that it’s too early to visit the site because it’s still very muddy. Emphasising the value of OT input at an early stage is essential. Once foundations are laid the next step is drainage. Position of WCs will be set, and almost impossible to change. OTs are always trying to avoid being too late to influence decisions about space, layout and positioning of key items: sanitary ware, switches, sockets and controls. In new build an OT is unlikely to have an agreed sign off role will need to respond at short notice. I have developed checklists lists of key dimensions ready to hand so I can check plans and specifications quickly.

ot_housing-2Every picture tells a story

Written or verbal descriptions of specialist needs can be misunderstood. Using images in reports, meetings, or on site, can be more immediate, accessible and persuasive. Products with technical specifications are readily available on websites. Good design solutions that are functional but less clinical in appearance can change attitudes of commissioners. People in spaces: turning circles are useful but drawings showing space taken up by users and cares is more convincing. CAD software, I pads and smartphones are making this much easier.

Act it out

If you get the chance, act it out. I’ve met ingenious project managers who have bound the shoulders of contractors to demonstrate inability to reach high shelves. I have slid down walls to show how a radiator could be a hazard in the event of falls. Or bring equipment with you walking frames, wheelchairs and so on.

Knowledge Exchange Forum for OTs Contractors, Surveyors and Architects

In the long term I believe it’s about raising awareness. I am really keen to explore the possibility of setting up knowledge exchange forums across the building trades so that we can learn from each other and develop better outcomes.

Above all, in any communication, written or verbal, be positive, constructive and realistic. Everyone involved wants to achieve the best result.

To find out more please contact Marney Walker (Associate of The OT Service) on 07796181305, email or follow her on @marneywalker.


1 Approved Document M Access to and Use of Buildings: Volume 1: Dwellings (2015 Edition)

2 BS8300 2009 + A1 2010 Design of Buildings and their approaches to meet the needs of disabled people

3 Health Building Note 00-02 Sanitary spaces Department of Health, 2016

4 For example the Greenwich Wheelchair Site Brief (2012) and Adaptations Design Communications Toolkit (2014) DHSSPSNI and DSDNI