I was very happy to contribute to the PI Focus journal in My 2017. My article looked at why accommodation expert witnesses often have to look beyond the physical fabric of a building. The following is the full article.
“The number of cases involving complex injuries and rehabilitative needs is undoubtedly on the rise. Many PI claimants can no longer live safely in their own homes, and while some do move to new properties, this isn’t an option in every case. Adapting the victim’s existing home is often the only way forward.
As an expert accommodation witness I have worked with many PI claimants. The needs of these claimants are often complex, including cognitive and sensory impairments as well as physical ones. Adding to the complexity are less tangible issues, such as parental responsibility, or tenure situation.
As I will show below, these cases often require radical and creative solutions to maintain the claimant’s quality of life.
Visual impairment case:
A 43-year-old mother of two was left with life changing impairments after an RTA. At the time of the accident the claimant and her family lived and worked on a remote farm. The property was set on a steep hillside and offered a far from ideal living environment. Moving to a new house was not an option and structural issues made additional building work difficult.
The injuries the victim sustained included complete loss of her left visual field, double vision and poor sight in her right eye. The accident also left her suffering from epilepsy and with difficulties in cognitive functioning and spatial awareness.
The layout and condition of her property presented many challenges, particularly in relation to visual capacity. Split-level flooring, poor lighting and unstable staircases all made for a hazardous environment.
The farmhouse bathroom facilities – which were situated on the first floor and lacked a shower – were also a major issue, as the claimant’s epilepsy made it dangerous for her to bathe alone.
As the claimant was no longer able to care for the livestock, cooking and serving food for her family and the farm workers became particularly significant for her. However, the farmhouse kitchen was arranged over three separate rooms with steps in-between, and the complex layout was very difficult to navigate. This made it difficult to prepare and serve food.
The most important recommendation was to bring the separate kitchen facilities into one room. Knowledge of specific fixtures and fittings, tailor-made for visual impairment, enabled me to advise on a new design which included suitable kitchen units, a smart oven, specialist talking appliances and a safe hot water dispenser. Another significant element of the kitchen design included advice on light sources, use of natural light and colour contrast. Effective colour-contrast has been shown to significantly help visual field problems, enabling sufferers to identify objects and execute better spatial awareness.
To address the problems with the existing bathroom I recommended replacing the bath with a level access shower. As with the kitchen, I suggested a simple new colour scheme to help counter the claimant’s visual impairment.
I further recommended changing the layout of the staircase and eliminating the large number of oddly-shaped steps throughout the house. I have found that there is a general lack of understanding around how people with visual impairment negotiate stairs – curved staircases and uneven steps are particularly hazardous for those with a reduced visual field and impaired 3D vision.
In this case my accommodation recommendations went far beyond the physical fabric of the building and included a whole range of simple non-structural measures to enable the claimant to stay in her own home. Expert reports that concentrate purely on structure can miss a whole range of alterations which are significant to the claim. Cognitive disability case:
The claimant in this case suffered significant brain injuries and partial sight loss after a serious motorcycle accident. At the time of the accident the claimant lived in a rented small first floor flat, which he shared with his partner. The children from his previous marriage also stayed regularly. While not affected by an obvious physical disability, he was left with a range of cognitive impairments, including an intolerance to noise, irritability, fatigue, a shortened attention span and aphasia (difficulty understanding speech and communicating). He required intensive rehabilitation and regular therapy sessions. As a Housing Occupational Therapist I was able to fully understand the impact of his condition on his housing needs.
One of the first issues I identified was lack of space and privacy. His therapy sessions took place in the lounge which lacked privacy. The kitchen and bathroom were too small to allow the required distant supervision and verbal prompting the claimant needed whilst preparing meals and completing personal care tasks. To further compound his problems the layout of the kitchen was unsuitable and increased his levels of frustration. In addition, inadequate guest bedroom facilities for the claimant’s children meant that it was difficult for him to maintain family life.
Access to the property was another area of concern. The claimant’s aphasia had left him unable to recognise voices or understand speech, and the flat’s standard intercom system proved something of a challenge.
Since the flat could not be sufficiently adapted, I recommended that a new home be sought.
My recommendations included the provision of a dedicated therapy room to enable the claimant to concentrate during private treatment; a specific kitchen layout; the necessary number of rooms (including minimum size guidelines) to enable remote supervision; and a visual intercom system. All of these changes would support the claimant’s continued rehabilitation, whilst maintaining his parental role.
Limited life expectancy case
This case involved a man with an extremely serious brain injury, sustained after being hit by a car. The 45-year-old father of four was diagnosed with a persisting disorder of consciousness and had just 5 years to live.
The claimant lived in a local authority house, which was over-occupied and had limited space on the ground floor. He slept in the dining area while his wife took the sofa to provide care throughout the night. There was little or no space for medical equipment and supplies, and the lack of a downstairs bathroom meant that simple daily hygiene tasks were inhibited. Overall, the property was highly unsuitable for this claimant.
The first two options I examined were quickly ruled out. The local housing association would not allocate a larger house because the claimant had received an interim care payment and was considered too ‘wealthy’. In addition, he was unable to purchase his own property as his limited life expectancy meant he would have insufficient funds once the claim settled.
It seemed that the most straightforward option was to move the claimant to a privately rented property. However, this would have left the family homeless once the claimant died, and was obviously an option they refused to consider.
This left only one option – staying put to ensure the family maintained their secured tenancy agreement. I had to consider the quickest and least disruptive way to adapt the ground floor, and so I recommended that a specially designed pod, with a bathroom and bedroom, be attached to the rear of the house. This would enable the claimant to continue living at home with his family, maintain his dignity and receive the best possible care. My knowledge of local authority housing rules, gained from working as a housing occupational therapist in local authorities, was vital in this case. I was very familiar with points-based allocation systems, and I knew whom to approach in order to obtain the information I needed.
The Bigger Picture
The claimants in these cases had very different medical conditions, but the holistic approach to assessing their accommodation needs was the same – to ensure the size, layout and design of their accommodation would support the claimant’s new roles in life, and by so doing enhance their independence and assist in overcoming their impairments.
The most appropriate solutions can only be determined when the expert understands how different medical conditions affect our ability to function. Difficulty negotiating stairs, for example, can result from visual, cognitive or physical impairment, but the solutions offered will be different in each case.
In addition, when the claimant lives in a social housing property, the housing expert must understand the provision and allocation of such properties before recommending suitable accommodation solutions.
Warren Collins, Senior Partner at Penningtons Matches LLP and lead solicitor in all three cases explains:
“The accommodation needs arising from PI cases are often multi-faceted and complex. Expert accommodation witnesses are increasingly required to adopt a holistic approach and to offer advice on more than just the physical fabric of a building. Issues such as accessibility to local services, positioning of equipment, space for medical supplies and carers are all important, and can be integral to a claimant’s new accommodation needs. Occupational therapists are well placed to advise on all of these issues, with the objective of securing the best outcome for our claimants.”
Anava Baruch, is an accommodation, equipment and accessible design expert. She is also Clinical Lead and MD of Design for Independence Ltd, a Housing OT Service. : www.designforindependence.co.uk