NSW Home Modifications and Maintenance Services State Council Kym Linsday DOB 22/06/1959

OCCUPATIONAL THERAPY WRITTEN SPECIFICATIONSMAJOR BATHROOM MODIFICATIONS

A joint site visit with the builder nominated by the HMMS must be undertaken before finalising the OT diagrammatical and written specifications.

This form is a template for the OT written specifications.

How to complete this form:

1. Retain headings and delete points, as appropriate

2. Client identification (i.e. client name and date of birth) to be included on top right hand corner of page 2 and on all subsequent pages

3. Complete Appendix A- Bath and/or Appendix B-Bidet only if applicable

4. Refer to the NSW HMMS State Council Fact Sheet 17 “Major Home Modifications: Minimum requirements for Occupational Therapy referrals to HMMS”

Date: 21/10/16

Occupational Therapist Client

Name: Kirsten Deutschmann Full Name: Kym Lindsay

Organisation: NSW Health Address: 13 Rigoni Cres Coffs Harbour

OT Address: Coffs Harbour Base Hospital

Phone: 02 6656 7604 Phone: 0448 138 444

Email: Kirsten.deutschmann@ncahs.health.nsw.gov.au DOB: 22/06/1959

Days Available: M-F Contact Person: Kim Lindsay

General description of modification required (eg wheelchair accessible bathroom):

Wheelchair accessible bathroom in ensuite.

WEIGHT OF CLIENT: Please specify if over 100kg ................88.....................kg

NSW Home Modifications and Maintenance Services State Council Kym Linsday DOB 22/06/1959

1. Approach and Entry to Bathroom

1.1. Widen existing doorway to Wall C with distance from corner of Wall D to be 1000mm (as per diagram 1) and change cavity slider to other side of doorway.

1.2. Specify for widening existing doorwayClear door opening to be 900mmInstall cavity sliding door to other side of doorway (inadequate room left on other side after widening doorway.)

1.3. Provide level install a wedge within the door jambs (maximum lip of 25mm) or threshold ramp(as appropriate). It is not possible to provide level access as bathroom floor has not been recessed into the concrete slab. The family is replacing the carpet in the bedroom with lino and will attempt to lay on sheeting to reduce the height difference between the bedroom and the bathroom. Exist size of wedge/threshold ramp will not be known until the new floor is laid.

2. Floor Surface

2.1. Floor surface of bathroom and shower recess to be continuous

2.2. Tile bathroom floor with slip resistant tiles - R10 rating (size 100mm x 100mm maximum)

3. Window

3.1. Retain existing window

4. Shower Recess

4.1. Install a level access shower recess (as per position on diagram 1)No lip or nosing tile at entry Length 1450 mm x Width 900mm Grade to a single floor waste in the shower recess

PLUS

Grated drainage system at outer edge of recess as discussed with home mods builder to limit risk of water overflow into bedroom.

4.2 Walls of shower recess to be tiled full height to the ceiling.

4.3 Taps to be Lever taps mounted on wall

Specify Type (if applicable) Standard turn (both taps turn on/off in the same direction) Yes

NSW Home Modifications and Maintenance Services State Council Kym Linsday DOB 22/06/1959

Position of taps to be either: Horizontally aligned with height above finished floor surface 1000mm

4.4. Shower Head

Install a 2000mm length hand held shower hose (HHSH) mounted on Wall A:

Hook/peg to be located 1700mm above finished floor surface (for other standing users including Kym’s wife)Distance from corner of walls A and D to be 450mm

2nd hook/peg to be located 1400mm above finished floor surface (above seated head height to allow Kym to wash his hair without holding up the hose).Distance from corner of walls A and D to be 450mm.

3rd hook/peg to be located 1000mm above finished floor surface (below seated head height to allow Kim to wash without holding the hose and access to the hose when he needs it without stressing his shoulders).Distance from corner of walls A and D to be 450mm.

4.5. Install a soap holder wall mounted corner basket on corner of Walls A and D

Height of base of soap holder to be 1000mm above the finished floor surface

4.6. Grab rail requirements- See Point 10

4.7. Install a straight shower curtain rail at a height to facilitate weighted shower curtain meeting finished floor surface.

Height of top of shower curtain rail to be 2000mm above finished floor surface

5. Toilet:

5.1. Install new toilet with bidet seat(see Appendix B)

5.2. Install a new disabled toilet pan:Locate toilet cistern on Wall ADistance from Wall B to centre line of toilet to be 450 mm

Distance from back wall to front of toilet pan 690 mm Seat height above finished floor surface 435mm to ceramic. Bidet seat to go on top.Standard flush control location.

5.3. Grab rail requirements- See Point 10

5.4. Install toilet paper dispenser on Wall BHeight above finished floor surface 750mmDistance from corner of back wall 700mm

NSW Home Modifications and Maintenance Services State Council Kym Linsday DOB 22/06/1959

5.5. Other remote control for bidet on Wall B

6. Basin/Vanity:

6.1. Install a new wall hand basin on Wall A between toilet and shower as per diagram

Width of basin to be 450mm and length to be 720mmHeight of rim of basin above finished floor surface to be 800mm Specify type: suggest Opal Caroma with left hand shelf

6.2. Taps: Flick mixer.

7. Storage

7.1. Provide a mirrored shaving cabinet located on Wall A above the basin.Dimensions of cupboard Height ……mm x Width 750mm x Depth ……...mmHeight of base above finished floor surface to be 1000mm approx., allowing for tap.Wall mounted

9. Grab rails:

10.1 Grab rails in Shower recess

Install a horizontal grabrail(s) 900mm length on wall A and 1200mm length on wall DDiameter 32mm

Height above finished floor surface to be 800 mm

10.2 Grabrails outside shower recess

Wall C should be sheeted to allow future installation of grabrail on wall containing cavity slider.

10.3 Grab rails next to toilet Install a grabrail, on the left hand side when seated on toilet

Horizontal rail on wall B Diameter 32mm Length of straight grabrail 750mm

Height above finished floor surface to be 800mm Distance from back wall A to be 700mm

10. Water Temperature: Discussed with builder. Temperature able to be set on existing water system.

11. Lighting/General Power Outlet (GPO)/Fans/Heating:

12.1 Install new light switch. Needs to be relocated onto other side of doorway after installing cavity slider.

12.2 New light switch to be located on bedroom side of wall C, adjacent to doorway.Height above finished bathroom floor surface 1000mm.

Type of switch Standard

12.3 New GPO to be located within mirrored cabinet. Height above finished floor surface 1100mm

NSW Home Modifications and Maintenance Services State Council Kym Linsday DOB 22/06/1959

12.4 Install three-in-one light, heating and exhaust fan Yes

12. Additional Information:

NSW Home Modifications and Maintenance Services State Council Kym Linsday DOB 22/06/1959

Appendix B -BIDET (if applicable) Discuss requirements with Builder nominated by HMMS

B.1 Specify for bidet seat on toilet

Type....BA13 Conway bidet Supplier (if applicable) The bidet shopWeight capacity.............................kgShape of bidet seat - round/elongated/large/other (specify)Height of top of Bidet seat above finished floor surface approx. 460mm

Controls:Wall mounted remote control YesLocate on wall B. Height above finished floor surface 750mm Distance from back wall A 800mm

General Power Outlet (GPO)

Install new GPO on right or left side of seated client (opposite to water tap preferred, within 1500 mm of toilet)

NOTE: If prescribing a bidet seat on toilet, include specifications for grab rails in point 10.

Disclaimer: The recommendations contained in this form are made after consultation with the client and an investigation of the client’s circumstances and needs. Their purpose is to outline steps required to be taken for the benefit of the client, having regard for his or her disabilities. They do not purport to reflect other than limited knowledge on the part of the Occupational Therapist of structural considerations and building codes. Any queries, concerns or alterations considered necessary for compliance with current building regulations must be discussed with the Occupational Therapist before quoting for the cost of the work and before the work proceeds. The Occupational Therapist accepts no responsibility for supervision of the work or for the quality of the workmanship.

NSW Home Modifications and Maintenance Services State Council Kym Linsday DOB 22/06/1959

NOTE: Attached to these written specifications are: 1. The following diagrammatical specifications (please tick):

NB: All diagrams must be to scale

□ Existing bathroom floor plan (Mandatory)

□ Proposed bathroom floor plan (Mandatory) □ Changes to spaces adjacent to bathroom eg hallway, bedroom, doorways (Mandatory)

Also elevations (full or partial) of any wall that requires modification, as appropriate(please tick)

□ Elevation Wall A

□ Elevation Wall B

□ Elevation Wall C

□ Elevation Wall D

2. Photographs of existing bathroom and other areas relevant to the modification requested, (eg hallway adjacent to bathroom doorway), if available (please tick)

□ Photographs

Forward these completed written specifications to your Level 1 HMMS with the following: 1) CIARR or equivalent information2) OT Report and Checklist for Major Home Modifications and3) Diagrammatical specifications

The level 1 HMMS will forward all documentation to the level 2 HMS.

The OT Report and Checklist for Major Home Modifications is available for download as a word document from State Councils website www.nswhmms.org