Physical access in urban public housing facilities

Methods 

These data were collected as part of another study to develop a measure for assessing environmental factors hypothesized to influence physical activity [13] and describe environmental barriers to maintaining a healthy body mass index [14]. Researchers assessed 14 of the 27 public housing developments managed by the state housing authority offices in Kansas City, Kansas and Missouri. The criteria for housing development selection were published previously [14], but factors that influenced selection included the development (1) receiving federal funding and (2) being willing to participate in a study. Although Kansas City spans 2 states, it is a seamless city visually and practically. Trained field assessors used a brief checklist to record the presence or absence of 6 general features of access at each public housing facility. Pilot testing of the environmental assessment instrument indicated good interrater reliability [13]. Because these preliminary accessibility data were collected as part of another environmental study, the accessibility checklist covered only basic access features of common areas that could be quickly evaluated rather than the array of specific regulations required for full access in any single area. For example, we assessed parking access by visually inspecting whether housing developments had at least 1 parking space designated with a vertical posted sign, rather than determining whether a sufficient number of accessible spaces were designated for the total number of available parking spaces, whether accessible spaces were located closest to the accessible entrance, or whether parking spaces and access aisles conformed to the appropriate widths. The full environmental assessment typically took 10 minutes to complete. This study focused on basic accessibility features of three common use areas: parking, entrances, and public restrooms. Table 1 lists the 6 specific features assessed and presents the frequencies and percentages of compliance with each feature. At the same time as the site assessment, qualitative interviews with property managers were conducted by trained interviewers. Managers were asked to describe the year the facility was originally built, any renovations in the last 10 years, and modifications made to enhance accessibility. All procedures were approved by the institutional review board for the protection of human participants.

Table 1. Frequencies and Percentages of Accessible Parking, Entrances, and Public Restrooms

	Area	Accessible Feature	Present	Not Present	n	%
	Parking	1. At least one parking space that is designated by a vertical sign with the international access symbol	12	2	14	85.7
	Entrances	2. Level entrance, ramp available where stairs present, or alternate entrance with signage	12	2	14	85.7
		3. Main entrance doorway ≥32 inches wide	10	4	14	71.4
	Public restrooms	4. Designated accessible public use bathroom	7	7	12	50.0
		5. All external bathroom and stall doors ≥32 inches wide	6	1	7∗	85.7
		6. At least one grab bar on a wall near the toilet	6	1	7∗	85.7

∗ Represents only those public housing facilities that had public restrooms.

Results 

Discussion 

This study documented general features of accessibility in common use areas at 14 public housing facilities in the Kansas City, Kansas and Missouri area. Most facilities (>71%) had at least one parking space designated by a vertical sign and an entrance with a level entrance, ramp, or alternate accessible entrance with signage and door widths at least 32 inches. Despite these encouraging numbers, 15% to 30% did not comply with the basic components of access we assessed, suggesting that over a decade of federal regulations has not been consistently observed by agencies that are federally funded and state managed. There is a need for better enforcement of regulations to provide access to all.

Only half of the public housing facilities had a public restroom with signage that indicated it was accessible, and this probably reflects a general lack of public restrooms, rather than a lack of accessible restrooms. Several managers reported that individual units were available with accessible bathrooms. Presumably residents would use the restrooms inside their individual units, rather than relying on the public restrooms. Unfortunately, this study did not assess individual units to determine whether accessible units complied with federal regulations.

This study assessed 6 accessibility features; however, access is more complex than simply the presence or absence of a parking space marked with a sign depicting the international access symbol. For example, entrance accessibility includes having a level entrance or a ramp with a height-to-length ratio no greater than 1:12, the ramp should be equipped with hand rails if longer than 6 feet, the exterior door handle should be no more than 48 inches high and be operable with a closed fist, there should be 18 inches of clear wall space next to the handle on the pull side of the door, the door should be at least 32 inches wide, and the entrance threshold be no greater than ¼ inch. The relatively high rates of noncompliance with only 6 features imply that there may be little knowledge of more complex accessibility issues. Some of the managers who were surveyed were not aware of improvements made to their housing facilities, and some acknowledged that they were not aware of the federal regulations mandating housing accessibility. Given the narrow scope of this preliminary study in terms of limiting assessments to common use areas and only assessing 6 features, it is likely that compliance is lower and actual access poorer than assessed by this study. Further, beyond manager reports, little is known about specific accessibility within individual housing units. National data reveal that 50% of people with limitations experience difficulties accessing areas inside their homes, including areas that can substantially impact performance of self-care activities such as reaching the bathroom or kitchen [6].

Regulations among the housing laws all stipulate that existing facilities must enhance access, including within individual housing units, and require that landlords allow tenants to make “reasonable accommodations” to their housing units to make them usable. Unfortunately, a recent HUD-commissioned report indicates that people with disabilities are frequently denied permission to make modifications [9]. When permission is granted, another important consideration is who is responsible for financing modifications. The landlord may be required to pay for the changes in federally subsidized units, such as public housing authorities, but tenants are responsible for these costs in privately owned units. National data reveal that more than 75% of people with home modifications pay for these out of pocket [15] and, thus, cost may prohibit many from making them. Although various public and private programs help finance modifications, information about these programs is confusing and there is no coordinated system for delivering home modifications [16], [17].

A more thorough assessment of housing accessibility would include assessing features inside dwellings designated as accessible such as door widths, bathrooms, kitchens, and controls such as light switches, outlets, and thermostats. Full access to the bathroom and kitchen is necessary to be able to engage in self-care activities such as toileting, bathing, grooming, and cooking. Inaccessible home environments may not only impact independence but also pose serious safety risks. Lack of grab bars near toilets and bathtubs may result in individuals not being able to perform their own transfers, or if they perform these transfers without assistance, it may greatly increase their risk of falls and injury. Although national data reveal that people with disabilities report significant problems in these areas, direct observation of individual units would provide a more thorough assessment about the scope, nature, and impact of inaccessible features. Further, the ability to easily enter and leave the housing unit is not only a safety issue but may affect tenants' community participation. For example, in a 2001 Washington Post article [18] about a federal class-action lawsuit filed against the DC Housing Authority for noncompliance with federal housing laws, the author highlighted how denial of sufficient accessible housing limited a 10-year-old girl's social opportunities. That lawsuit resulted in a 2002 court order requiring the DC Housing Authority to achieve compliance with the Fair Housing law and, among other activities, renovate or build 565 public housing units that meet the Uniform Accessibility Standards (UFAS) [19].

Conclusion 

There is urgent need to conduct more extensive research on housing access issues for residents with disabilities in public housing facilities. Accumulating evidence shows that inaccessible homes substantially impact individuals' independent functioning and health [20]; many people with disabilities reside in federally subsidized housing [7]; direct observation of home environments reveals the most common barriers are located in bathrooms, kitchens, and bedrooms [20]; and national data indicate the most common unmet need for home modifications are for handrails and grab bars, ramps, and easy-access bathrooms [6]. The recent HUD report citing various disability-based discrimination problems in housing [9] and legal suits filed by the Department of Justice against several housing authorities [10], [11], [12] indicates that home environment barriers and the need for modifications apply to the many people with disabilities residing in federally subsidized housing [7].

People with disabilities are more likely to have lower incomes or live in poverty [2]. Affordable and accessible housing for people with disabilities and low incomes is an important goal for improving health and quality of life. Accessible housing impacts individuals' ability to live and participate in their community. The findings suggest that although the majority of public housing facilities included in this study complied with the 6 features assessed in common use areas, there is room for improvement. Housing officials and residents need to be better informed about regulations and accessibility issues. Better compliance and enforcement are needed to satisfy even basic accessibility for all. Future research is needed to document education and compliance efforts. In addition, information is needed that documents general accessibility in greater depth, particularly within individual public housing units.