Community Development

ISSN: 1557-5330 (Print) 1944-7485 (Online) Journal homepage: http://www.tandfonline.com/loi/rcod20

Housing characteristics of households with

wheeled mobility device users from the American
Housing Survey: do people live in homes that
facilitate community participation?

Lillie Greiman & Craig Ravesloot

To cite this article: Lillie Greiman & Craig Ravesloot (2016) Housing characteristics of
households with wheeled mobility device users from the American Housing Survey: do people
live in homes that facilitate community participation?, Community Development, 47:1, 63-74,
DOI: 10.1080/15575330.2015.1108989

To link to this article: http://dx.doi.org/10.1080/15575330.2015.1108989

Published online: 19 Nov 2015.

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 Community Development, 2016
VOL. 47, NO. 1, 63–74
http://dx.doi.org/10.1080/15575330.2015.1108989

Housing characteristics of households with wheeled mobility

device users from the American Housing Survey: do people
live in homes that facilitate community participation?
Lillie Greiman and Craig Ravesloot
The Rural Institute for Inclusive Communities, University of Montana, Missoula, MT, USA
Downloaded by [University of California Santa Barbara] at 18:01 14 March 2016

ABSTRACT KEYWORDS
For people with mobility impairments, having an accessible and Accessibility; American
usable home environment is a critical factor in their ability to live Housing Survey; disability;
independently and participate in their communities. However, the housing
status of home accessibility in the American housing stock is largely
unknown. The purpose of this study was to examine accessibility of
the American housing stock using the American Housing Survey. We
analyzed data from the 2011 American Housing Survey to examine
the accessibility of housing units across six groups defined by home
ownership and impairment status. High levels of home inaccessibility
across all groups and all variables were evident. Developing accessible
housing stock is critical to community development in that it can
support opportunities for increased participation and employment for
people with disabilities. This study provides a basis for more specific
studies regarding housing access and the potential impact of housing
policy changes that could increase community access for people with
mobility impairments.

Environmental factors can function as either facilitators or barriers to an individual’s par-

ticipation in their community and society at large (Gray & Dashner, 2010; World Health
Organization, 2001). These factors include the natural and built environment as well as the
social and attitudinal environment. To date, there have been few systematic studies of envi-
ronmental factors (Seekins et al., 2012; Seekins, Traci, Cummings, Oreskovich, & Ravesloot,
2008). The home environment is one exception, with many studies examining home features
in relation to activities of daily living (Iwarsson & Isacsson, 1997; Stineman, Ross, Maislin, &
Gray, 2007; Stineman et al., 2011). While important, these studies have rarely used national
samples to describe the extent of the accessibility problems faced by people with disabilities.
Having an accessible and usable home environment is a critical factor in an individu-
al’s ability to live independently and participate in society (Dunn, 1990; Iwarsson & Wilson,
2006; Reid, 2004). Home, the domestic space we inhabit, is the springboard for community
participation. Home is where everything begins. In order to participate in many aspects of
community (e.g. employment, volunteering), one must be able to bathe, dress, and then
leave home (Imrie, 2004).

CONTACT  Lillie Greiman  Lillie.greiman@mso.umt.edu 

© 2015 Community Development Society
 64    L. Greiman and C. Ravesloot

In addition to direct effects on access to the community, one’s home and its accessi-
bility may have myriad additional effects. Studies link improved housing accessibility to
improved health outcomes (Heywood, 2004) and improved quality of life (Cooper & Rodman,
1994; Iwarsson & Isacsson, 1997). In addition, studies show that unmet home accessibility
needs lead to increased odds of experiencing difficulty with an activity of daily living (ADL)
(Stineman et al., 2007) and that addressing these needs through housing adaptation or acces-
sible design can improve the health and general wellbeing of both people with disabilities
and their families (Centers for Disease Control & Prevention (CDC), 2003; Heywood, 2004;
Iezzoni, 2009; Stark, 2001). Beyond accessibility, improved housing quality has been seen
to improve educational, health, and social behavior outcomes among children (Leventhal &
Newman, 2010; Mueller & Tighe, 2007). Finally, consumer choice and control over housing
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arrangements in mental health consumers proved beneficial to psychological wellbeing

and subjective quality of life ratings (Sylvestre et al., 2006; Tsai, Mares, & Rosenheck, 2012).
The status of home accessibility in the American housing stock is largely unknown. In
recent years, disability-related fair housing complaints tracked by the U.S. Department of
Housing and Urban Development (HUD) have represented the largest share of all complaints;
55.6% of the cases investigated by HUD were based on disability-related complaints (National
Fair Housing Alliance, 2013). A study of compliance with fair housing standards in public
housing facilities indicated that only 14–29% of 14 facilities examined in Kansas City were in
full compliance with the law (Froehlich-Grobe, Regan, Reese-Smith, Heinrich, & Lee, 2008).
More recently, an examination of the neighborhoods inhabited by people with and without
disabilities highlighted disparities in the quality of neighborhoods based on disability status
(Hoffman & Livermore, 2012).
The purpose of this study was to examine accessibility problems of the American housing
stock using the American Housing Survey (AHS). We hypothesized that large proportions of
households with individuals who have mobility impairments and use mobility devices (e.g.
wheelchairs and scooters) would be living in housing with substantial accessibility problems,
defined as houses that lack accessibility features queried in the American Housing Survey.
Further, we believed the accessibility of these households would be related to a variety of
demographic and housing characteristics (e.g. year housing was built).

Methods
Participants
The sampling frame for the current AHS was originally developed in 1985 and is updated
with new construction and demolitions every two years. The sample represents 394 primary
sampling units defined by the Census Bureau and covers 878 counties and independent cities
across all 50 states and the District of Columbia. On average, each housing unit has a 1 in
2148 chance of being included. The weighting procedure takes into account the likelihood
of being selected for the survey and weights households with racial minority residents and
non-metro residents accordingly. The overall weighted response rate for the survey was 88%
(U.S. Census Bureau, 2011). All analyses for this paper were weighted.
We used a sample collected for the 2011 AHS that included 65,898 households with occu-
pants between the ages of 18 and 75. Basic demographic characteristics for the households
are included in Table 1, broken out by impairment and home ownership status categories
used in this study.
 Community Development   65

Table 1. Household demographics and dwelling characteristics (2011 American Housing Survey).
No impairment Mobility Mobility & grasping
Variables Own Rent Own Rent Own Rent
Weighted n* household 37,673 18,742 380 273 252 110
 Median income ($)* 60.00 33.79 34.91 15.61 38.89 17.92
  Single occupant 31.7 52.6 20.0 47.4 13.5 44.4
 One person 65+ 25.2 8.7 52.4 33.6 54.3 35.6
Dwelling
 Median year built 1975 1970 1970 1975 1970 1970
  Single family (%) 81.0 21.4 82.4 22.2 89.7 32.4
  Rural location (%) 24.5 14.5 32.4 28.4 29.8 28.0
Notes: All values are percentages except weighted n, median income, and median year built. All differences are statistically
significant beyond p < 0.05. *in 1000s.
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Measures
The AHS is a continuous data series conducted biennially in odd numbered years
by the U.S. Census Bureau and sponsored by the Department of Housing and Urban
Development (HUD). The AHS provides information on selected housing and demo-
graphic characteristics. In 2009, the survey included the set of disability indicators from
the American Community Survey (ACS) for the first time. We used the question about
mobility impairment in this study because many of the accessibility features queried
in the AHS are problematic for people with mobility impairments (e.g. absence of grab
bars). Additionally, in 2011, the survey asked questions about access features within
housing units and the functional limitations of inhabitants. To specify functional limita-
tions of household inhabitants beyond the ACS mobility impairment questions, we used
questions from the AHS accessibility module that asked whether or not a household
occupant has difficulty grasping objects and whether or not a household occupant uses
an assistive mobility device (e.g. wheelchair).
We selected items from the 2011 AHS to examine household demographics including
income, home ownership status (i.e. owner vs. renter), number of household residents,
age of household residents (i.e. presence of residents over 65 years.), impairment sta-
tus, and use of wheeled mobility equipment. We examined structural characteristics of
the housing units including steps at entrance, type of housing unit (e.g. apartment vs.
modular home), year the unit was built, and its geographic location (i.e. metropolitan
vs. non-metropolitan). Additionally, for people living in multi-story buildings, we exam-
ined how many floors people lived above ground and whether or not the building had
a working elevator.
To explore accessibility problems within the housing unit, we used questions from the
“Home Modification Module” included in the AHS 2011 data-set. Respondents were asked
to report whether their housing units had accessibility features including: “an accessible
kitchen,” “an accessible bathroom,” “extra-wide doors or hallways,” “door handles instead
of knobs,” “handrails or grab bars in the bathroom,” and “wheelchair accessible electrical
outlets/switches/climate controls.” Households living in multi-story housing units (i.e.
the housing unit includes two or more stories) were asked about “bedroom/bathroom
on the entry level,” which indicates that these rooms can be used without navigating
stairs within the housing unit. For these analyses, we coded the data to indicate the
absence of accessibility features.
 66    L. Greiman and C. Ravesloot

Data analysis
We imported public use data files from the U.S. Department of Housing and Urban
Development into SPSS 22.0. To examine the relationship between impairment, home own-
ership, and housing accessibility, we compared the housing characteristics of six groups that
were defined by impairment and ownership status. All impairment variables are asked at
the household level and indicate whether or not someone in the household has a mobility
impairment and whether or not someone uses mobility equipment.
We constructed indicator variables by crossing two levels of ownership status, home-
owner or renter, with three impairments groups: (1) no impairment, (2) mobility impairment
and a wheeled mobility device, and (3) mobility impairment, wheeled mobility device, and
difficulty grasping objects. We selected these impairment groups because we anticipated
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they would have the greatest need of accessibility features in the home. We computed
descriptive statistics for demographic variables for each group and compared these groups
using analysis of variance (ANOVA) and chi-square test.
Finally, we used forward conditional stepwise binary logistic regression (penter = .05 and
premove = .10) to predict the likelihood that housing units have a step to enter the dwelling.
Because our predictor variables included both household demographics and structural char-
acteristics, we computed stepwise analyses to predict stepped entry using three different
predictor types: (1) membership in one of the six groups formed by impairment and own-
ership status, (2) household demographics, and (3) characteristics of the housing structure.

Findings
Household demographics across the six impairment/ownership groups are included in Table 1.
Statistically significant (p < 0.05) and substantial differences across all six groups on many
demographic variables are apparent. Overall, households with mobility impairments have
lower income than those without, and renters have lower incomes than owners.
Table 2 shows the proportion of households with accessibility problems across all six
groups. These results present the proportion of households that do not have key accessibility
features within the home. Perhaps not surprisingly, the results indicate that homes of peo-
ple without mobility impairments lack accessibility features at a higher rate than homes of
those with mobility impairments. This is likely due to the fact that the latter households have
greater need for such accessibility features. Nonetheless, a large proportion of households
with mobility impairments also lack accessibility features. Further, across all impairment
groups, renters were more likely than owners to lack accessibility features. This is particularly
notable for the home entrance, where over half of renters in all groups indicated they had
a step to negotiate at their front door.
Whether rented or owned, mobility impairment households have many inaccessible fea-
tures. Anywhere between 44 and 55.6% of households have a step or stairs, blocking entry
to the home or apartment. More striking is the significant number of housing units that are
up a flight of stairs, do not have an elevator, and have a household member with a mobility
impairment. Nearly a quarter (range 23.8–28.4%) of rental households with an individual
with a mobility impairment must navigate a flight of stairs to enter or exit the housing unit.
Within the home, a large number of households lack critical access features. For example,
a range of 49.9–64.7% of mobility impairment households report not having an accessible
 Community Development   67

Table 2. Percentage of households without accessibility features (2011 American Housing Survey).
No impairment Mobility Mobility & grasping
Variables Own Rent Own Rent Own Rent
Has a step to enter 57.4 75.0 44.0 54.2 33.8 55.6
Unit upstairs with no elevator 2.6 39.4 0.9 23.8 1.5 28.4

Does not have accessibility feature:

Entry level bedroom* 45.8 29.2 23.6 9.4 22.5 8.8
Entry level bathroom* 19.8 21.7 8.4 6.2 11.6 7.6
Accessible kitchen 68.0 73.1 64.7 49.9 53.6 55.5
Accessible bathroom 58.7 64.7 40.7 40.0 39.7 43.1
Grab bars 84.7 88.9 37.9 44.9 35.9 60.2
Extra wide hallways 91.8 95.5 77.1 72.6 63.3 70.6
Accessible outlets 33.9 42.3 23.4 24.6 29.1 33.1
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Accessible switches 32.2 41.5 16.6 19.8 23.0 27.6

Accessible climate control 49.6 57.1 33.3 32.3 44.2 40.5
Lever door handles 87.5 92.9 79.2 79.5 76.4 75.5
*Question asked only of units with more than one floor.

Table 3.  Odds ratio (OR) for having a step to enter the home by impairment status (2011 American
Housing Survey).
Variable OR 95% confidence interval
No impairment owner 1.000 –
No impairment renter 2.233 2.230, 2.236
Mobility impairment owner 0.588 0.584, 0.592
Mobility impairment renter 0.880 0.873, 0.887
Mobility/grasp owner 0.379 0.375, 0.382
Mobility/grasp renter 0.931 0.920, 0.943

kitchen, and 39.7–43.1% report not having an accessible bathroom. More specifically, a
range of 37.9–60.2% of mobility impairment households reported not having grab bars
in their bathrooms. In addition, there are serious usability concerns for housing units with
more than a single floor within the unit. In these units, a range of 6.2–24% of households
with mobility impairment do not have access to an entry-level bedroom and/or bathroom.
These rates are higher for owners than renters, with a significant number of households
across all categories experiencing this obstacle. This means that individuals in these housing
units must negotiate a flight of stairs to access a bathroom or bedroom. As with the other
variables, these rates jump when examining the no impairment group. Twenty percent of
owner households without impairment do not have an entry-level bathroom, and 45% do
not have an entry-level bedroom.

Logistic regression
The adjusted odds ratios of having an entrance with steps are listed in Tables 3 and 4.
Examining only the six impairment/owner groups (Table 3), the unadjusted odds ratio of
having a step to enter the home was lower for those with mobility impairments and mobility/
grasping impairments than for owners with no impairments (i.e. reference group). For those
without impairment, renters were much more likely to have an entrance with steps than
owners, a trend that was also evident among households with impairments.
 68    L. Greiman and C. Ravesloot

Table 4. Adjusted odds ratio (OR) for having a step to enter the home by impairment/ownership status,
household demographics, and housing unit structural characteristics (2011 American Housing Survey).
Variable OR 95% confidence interval

Impairment by ownership
No impairment owned 1.00
No impairment rented 1.00 1.000, 1.004
Mobility impairment owned 0.57 0.566, 0.574
Mobility impairment rented 0.39 0.390, 0.396
Mobility/grasp owned 0.37 0.366, 0.372
Mobility/grasp rented 0.50 0.497, 0.510
Income (log10) 1.04 1.043, 1.045

Number of household residents

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One resident 1.00

More than one resident 0.98 0.976, 0.979
Residents 65 years or older
No residents 65+ 1.00
Has at least one resident 65+ 1.07 1.066, 1.069
Housing type
Single family detached 1.00
Single family attached 1.05 1.048, 1.053
Two or more apartments 3.99 3.985, 4.001
Modular home 5.64 5.626, 5.662
Year built
Before 1920 1.00
1920–1929 0.86 0.856, 0.864
1930–1939 0.83 0.821, 0.828

1940–1949 0.63 0.627, 0.632

1950–1959 0.47 0.473, 0.476
1960–1969 0.34 0.334, 0.336
1970–1979 0.29 0.291, 0.293
1980–1989 0.29 0.284, 0.286
1990–1999 0.28 0.274, 0.276
2000–2009 0.25 0.254, 0.255
2010–2011 0.35 0.351, 0.357
Geography
Metropolitan (Urban) 1.00
Non-metropolitan (Rural) 0.86 0.859, 0.861

Table 4 includes the odds of having a stepped entrance adjusted for impairment status,
household demographics, and housing unit structural characteristics (e.g. housing unit type).
For people without impairments, the very large difference observed between renters and
owners in the likelihood of having a stepped entry is nearly erased, indicating that the
variance is mostly accounted for by demographic and structural variables in the model. For
homeowners with impairment, the adjusted odds are very similar to the unadjusted odds
for having a stepped entrance. However, for renters with mobility impairment, the adjusted
odds were substantially lower. Inspection of the stepwise entry of variables indicated that
structural characteristics (i.e. type of structure and year built) entered the equation first,
followed by impairment group, suggesting that renters with mobility impairment tend to
live in older housing of types that are more likely to have steps (e.g. multi-unit apartment
buildings).
Household demographic characteristics were predictive of homes with steps. The odds for
income, adjusted only for other demographics (not presented in Table 4), indicated a 25.6%
 Community Development   69

decrease in steps associated with each $10,000 increase in income. However, when adjusted
across all variables, higher income was associated with a slight increase in the likelihood of
having a stepped entry (i.e. 4.4% increase for each $10,000 in income). Households with more
than one resident were slightly less likely to have steps (ORadj = 0.98), while households with
residents 65–75-years old were slightly more likely to have steps (ORadj = 1.067).
Substantial differences in the likelihood of having steps to enter the home were evident
for each of the structural characteristics with odds adjusted across all variables (Table 4).
First, compared to single-family detached dwellings, those attached to another building (e.g.
duplex) were slightly more likely to have steps (ORadj = 1.051). In contrast, buildings with
two or more units and modular homes were each much more likely to have steps (OR = 3.99
and 5.64, respectively). The year built showed a steady decrease in the likelihood of having
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a stepped entrance each decade from before 1920 through 2010. Compared to housing
built before 1920, the adjusted odds that the dwelling has a stepped entrance ranged from
a decrease of 14% for housing built in the 1920s to a 74.6% reduction in stepped entry like-
lihood for housing built between 2001 and 2009. However, the two-year period from 2010
to 2011 saw a slight increase in the odds of having a stepped entry. Lastly, housing units
located in non-metropolitan areas were 14.0% less likely to have a stepped entrance than
those in metropolitan areas.

Discussion
We analyzed data from the 2011 AHS to examine accessibility of housing units across six
groups defined by home ownership and impairment status. High levels of home inaccessi-
bility across all groups and all variables were evident, as were complex interactions between
ownership and impairment status across housing age, structural characteristics, and house-
hold demographics.
Finally, we examined whether or not the housing unit could be entered without navi-
gating steps because the ability to freely enter and exit one’s home is the first step towards
participating in the community. These data indicate over 50% of rental households with
mobility impairments report having steps present at their home entrance, and approximately
25% of renters report living up a flight of stairs without an elevator. These results highlight
the scale of the problem stairs represent for people with mobility impairments. We can only
presume that many of these individuals either are carried into and out of their homes, or
they rarely leave home. The presence of stairs in the home is clearly a significant barrier to
community participation. In addition, these results may inform our recent analysis of the
American Time Use Survey that indicated 40% of people with mobility impairments spend
six or more hours a day watching television (Myers & Ravesloot, 2014).
The structure and accessibility of housing has the potential to impact not only how people
participate in the community but also individual health and wellbeing. For example, stairs
represent a considerable risk for injury, especially among those with mobility impairments
(Heywood, 2004). An additional safety risk present in nearly half of the households with
individuals using a mobility device is the lack of accessible kitchens, bathrooms, and more
specifically, grab bars in bathrooms. Bathrooms, in particular, are potentially hazardous loca-
tions for people with mobility impairments, and those aging into impairment, as slips and
falls in the bathroom present a significant risk of injury (CDC, 2011; Vladutiu et al., 2012).
 70    L. Greiman and C. Ravesloot

Reports from the field indicate that some people with mobility impairments live in the
common areas of the housing unit (e.g. using the family room as a bedroom) (Ravesloot,
Boehm, & Hargrove, 2014). Results from the entry-level bedrooms and bathroom questions
begin to illuminate the extent of this problem. If someone who uses a mobility device does
not have an entry-level bedroom or bathroom, their housing is inadequate. Case studies by
Imrie (2004) and Heywood (2004) document the effects of housing inadequacy and note
serious health and psychosocial impacts of inadequate home spaces. Individuals stuck within
their homes or forced to live in the family room with limited or no access to a bathroom face
significant health risks from unsanitary conditions, potential falls, as well as the psychological
effects of isolation, which include depression (Heywood, 2004; Imrie, 2004).
Logistic regression results on stepped entry are largely consistent with conventional
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wisdom for impairment, structural characteristics, and demographics. Adjusted odds for
people over age 65 with higher incomes indicated a greater likelihood of having a stepped
entrance. This is surprising given the positive relationship between income and year built
and the negative relationship between year built and the likelihood of having steps. This
may reflect that people are aging in places that are not accessible, at least up to age 75, the
upper boundary of this study.
When people are unable to access their community due to architectural and policy barri-
ers, they lose opportunities for participation and employment (Bricout & Gray, 2006; Clarke
& George, 2005; Dunn, 1990). Over time, they may adapt to lower levels of participation that
often translate into substantial personal and social costs. For example, the proportion of
Social Security beneficiaries who have used a “ticket to work” made available under the Work
Improvement Incentives Act remains very low (Hernandez et al., 2007). The potential for these
programs to affect the Social Security rolls depends, in part, on the target population’s ability
to access their communities. Another cost of inaccessibility may be in health care utilization.
Inaccessible housing may lead to fewer opportunities to access preventive medicine and
health promotion services. In addition, isolation is a risk factor for poor self-management that
ultimately translates into higher health care usage and costs (Ravesloot, Seekins, & White,
2005). These results may inform reports that indicate people with disabilities use a dispro-
portionate share of health care resources (Anderson, Wiener, Finkelstein, & Armour, 2011).
As noted in the introduction, a majority of fair housing complaints made to the Department
of Housing and Urban Development (HUD) are disability-related. These complaints may
fall under multiple categories pertaining to a reasonable accommodation or modification
request, or a failure to meet design and construction standards. All rental housing we ana-
lyzed for this study would be eligible for a reasonable accommodation or modification,
whereas only multi-unit housing (of four or more units) built after March 1991 must meet
federal design and construction standards. This is a relatively recent regulation in terms of
housing, particularly considering that the median year built for housing units in this study
ranged from 1970 to 1975 for all groups. An analysis of the accessibility problems respond-
ents experienced based on whether or not they lived in housing covered by design and
construction regulation is beyond the scope of this paper. However, it is clear that much of
the housing occupied by individuals with mobility impairments is inaccessible and was built
prior to 1991. As stated in the results, the older the home, the more likely it is to have an
inaccessible entrance. In light of the numerous accessibility problems identified throughout
this study for individuals with mobility impairments, it is not surprising that the highest rates
of HUD complaints are disability-related. However, age of housing units shows encouraging
 Community Development   71

trends through 2009 that indicate increased rates over time of units without steps at the
entrance. This change may reflect growing awareness of universal design principles and
social policy (e.g. Fair Housing Act Amended, 1990) and could point to a brighter, if distant,
future for accessible housing.
These results also speak to the visitability of homes in America. A visitable home is a
home containing key accessibility features, including a no-step entrance and main floor
bath, that when present, allow anyone to enter and participate in the dwelling (Maisel,
2006). As noted above, nearly 50% of owner-occupied housing with more than one floor
does not have an entry-level bathroom. In addition, over half of this same housing stock
has a stepped entrance. This means that half the housing stock in the USA is not visitable
by someone using a wheelchair. Being able to interact with and visit one’s neighbors,
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friends, and family is a critical aspect of community participation (McPhedran, 2011;

Milner & Kelly, 2009).
Interpretation of these study results is subject to the same limitations we encounter
with any large-scale self-report study. Systematic bias in these data could be the result of
poorly worded or understood survey questions. For example, the definition of “accessible”
in questions such as, “Does your home currently have any of the following features … an
accessible kitchen/an accessible bathroom?” is unclear. Without specifically defining the
characteristics which make a kitchen or bathroom “accessible,” we are left with vague ques-
tions and limited understanding of their meaning. However, cognitive testing of ACS’ home
modification module led to alterations in the instrument that may have resolved some of
these concerns (DeMaio & Freidus, 2011).
Another problem in this study results from combined use of electric or “power” wheel-
chairs and scooters in a single item. Generally, someone who uses a scooter has the ability to
move independent of the device. This is often not true of individuals dependent on a power
wheelchair for mobility. Users of these two devices tend to have different access needs and
therefore should be queried separately. Further, the mobility device variable is available
only at the household level, which complicates interpretation of these data because the
individual responding to the survey about accessibility features and impairment may not
be an individual with an impairment or a mobility device user, which increases the potential
for response error.
This study is a starting point for understanding home accessibility in America. The scope
and scale of the data collected provides a basis for more specific studies regarding accessible
housing and the potential impact of housing policy changes that could increase community
access for people with mobility impairments. Like many exploratory studies, this study raises
many questions for future research. For example, with such a high level of potential inacces-
sibility, what are the health impacts on people who have inaccessible housing? Inaccessible
features in the home and the surrounding built environment can lead to increased risk of
falls for older adults, often putting them at risk of institutionalization (Edelman & Ficorelli,
2012). Given the very high cost of health care, particularly in institutional settings, it may
be that housing policy represents an important solution to part of the health care crisis in
America. For example, United Healthcare is investing $50 million in construction of affordable
housing because the insurance company believes adequate housing is a key component of
health (Crosby, 2013). As the American population ages, and the interest in “aging in place”
grows, the need for accessible features in the home can be expected to increase as well
(Wang, Shepley, & Rodiek, 2012).
 72    L. Greiman and C. Ravesloot

Conclusion
Home is where everything begins; in order to get out into the community, one must first
be able to leave home. When people with mobility impairments live in the family rooms of
homes that have interior steps or even a flight of stairs to enter the home, full participation
in society is impossible. To support full participation, social policy must consider the home
environment. The success of many current disability policies depends on people being able
to leave their home to engage in the community and with society at large. This study high-
lights that although progress in home accessibility has been made, there is still a long way
to go before people with mobility impairments have fully accessible housing.
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Acknowledgements
The authors would like to acknowledge the Research and Training Center on Community Living at
the University of Kansas.

Disclosure statement
The authors have no conflict of interest to disclose.

Funding
This work was supported by the National Institute on Disability, Independent Living, and Rehabilitation
Research (NIDILRR) [grant number H133B110006].

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