Home Modifications for ALS: Build for the Wheelchair Now
How to Make a Home Safer for Someone With ALS
The build-ahead sequence: step-free entry, doorway widths, the roll-in shower, ceiling lift preparation, what order the work happens in, and who pays, including the VA.
A home is made safer for someone with ALS by building for the mobility that is coming, not the mobility of the week of diagnosis: a step-free entry, doorways with 32 inches of clear width, a curbless roll-in shower with turning room, living arranged on one floor, and blocking and wiring placed inside the walls for the equipment of later stages. ALS is progressive, so the design target from the first day is the power wheelchair and the assisted transfer, and one build planned to that target costs less and disrupts less than two builds a year apart. The ALS Association's own guidance runs the same direction: have the home evaluated by the clinic's therapy team, make the changes proactively, and plan the modifications for needs now and in the future. Every scope decision follows the person's ALS clinic team, occupational therapist, and physical therapist; the house's job is to be ready before the equipment arrives. The funding picture is also different from every other condition: for veterans, the VA presumes ALS is connected to military service, which opens home modification grants covered later in this guide.
Where do you start with home modifications for ALS?
You start with a home evaluation through the ALS clinic's occupational and physical therapists, and then with the two priorities the ALS Association names first: getting in and out of the home, and the bathroom. Those two zones decide whether the person can live in the house at all once a mobility device is part of daily life, so the entry and the bathroom are scoped before anything else, and everything in them is sized to the wheelchair stage even while the person is still walking. The third early decision is the floor plan: a bedroom moved to the first floor is usually more practical than remodeling a second story, which is also the Association's guidance, and settling that question early keeps the rest of the scope honest. The contractor's measurements matter, but the plan's inputs come from the therapy team and the person, because the adaptations have to fit needs now and the needs that are coming.
- The design target is the power wheelchair, not the cane or the transport chair of this month.
- The entry and the bathroom come first, because they decide whether the house works at all.
- First-floor living usually beats a second-story remodel, so settle the floor plan early.
- Any time a wall is open, the blocking goes in for the bars, rails, and ceiling lift of later stages.
- The work starts earlier than feels necessary, because equipment and construction run on their own clocks.
How does someone with ALS get in and out of the house?
Through one entry made step-free and kept that way: thresholds brought to 1/2 inch or less, a ramp where the rise is small enough, and a vertical platform lift where it is not. The ramp math is fixed by the ADA reference slope of 1:12, which means every inch of rise needs a foot of ramp: a single 6-inch step needs about 6 feet, and a 30-inch porch needs about 30 feet of ramp with landings, which many yards cannot give. That run requirement, not preference, is what decides between a modular ramp and a vertical platform lift, and it is why the entry is measured and decided early rather than the week the wheelchair arrives. The entry door itself gets the same treatment as the interior doorways below, plus lever hardware and a landing large enough to sit on wheels while the door swings.
How wide do doorways need to be for a wheelchair?
The ADA reference is 32 inches of clear width, and clear width is not the size printed on the door: a door slab loses opening to its own thickness and hardware when it swings, so a nominal 32-inch door delivers roughly 30 inches of clear passage. The fixes run from cheap to structural: swing-clear offset hinges buy back about the thickness of the door, removing a door and casing buys a little more, and widening the frame is the durable answer on the daily path. The second number is turning room, with a 60-inch circle as the reference for a full turn, which is why hallway-to-door turns fail before straight runs do. Both numbers are checked against the actual chair, and with ALS that means the chair that is coming: power wheelchairs, often with tilt and recline seating, run wider and longer than the lightweight chair of the early months, so the house is measured for the chair the clinic is specifying, not the one in the garage today. The full room-by-room reference table lives in the wheelchair accessible bathroom guide.
What does an ALS bathroom need?
A curbless roll-in shower a shower wheelchair can enter, turning room to reach it, a handheld showerhead reachable from the seated position, and walls that are already reinforced for the supports of every stage. The roll-in conversion replaces the tub or curbed stall with a level, waterproofed floor that drains correctly, and because the wet work opens the walls, this is the moment the blocking goes in everywhere a bar, a rail, or a fold-down seat could ever land, at any height a therapist might later name. A wall-hung or open-front vanity preserves knee space for seated use, the toilet gets clear space on the transfer side the therapist names, and a thermostatic anti-scald valve takes over temperature judgment for hands that may lose sensation and speed. The reference dimensions, layouts that fit a real 5 by 8 bathroom, and the conversion details are covered in the wheelchair accessible bathroom guide, and the installed work is on bathroom safety.
When does a stairlift, ceiling lift, or home elevator come in?
Each one serves a stage, and naming the stages keeps families from buying the wrong one. A standard stairlift serves the window while sitting balance and trunk control allow an unassisted ride, which with ALS can be a limited window, and that is a strong case for renting one rather than buying, covered in the stairlift rental guide. When transfers begin to need a second person or a device, a ceiling lift carries the person between bed, chair, and bathroom, and its track loads into structure, which is why the blocking and the electrical rough-in go into the ceiling during any earlier wall-open work: opening the finished ceiling twice is the expensive version of the same job. For a two-story home where first-floor living cannot cover everything, a vertical platform lift or a through-floor home elevator moves the wheelchair itself between levels; Ace plans the structural preparation and coordinates licensed elevator specialty contractors for the lift equipment. The right sequence is set with the clinic team, because the equipment decisions and the construction decisions have to land in the same order.
What hardware works as grip changes?
Hardware that works with a weak grip, one hand, or no grip at all: lever door handles and lever faucets that run off a forearm, D-pulls and loop pulls on cabinets that take a hooked hand, rocker light switches that take an elbow, and a single-handle thermostatic valve at the shower. Door closers are adjusted or removed so doors do not fight the person, and the daily-path doors can be left latched open once a wheelchair is in use. Voice and smart-home controls for lights, locks, and doors sit on the equipment side of the list and are genuinely useful with ALS; the clinic's assistive technology team guides those choices, and the house's side of that job is power and mounting where the devices will live.
What order should the work happen in?
Earlier than feels necessary, in stages set by function rather than the calendar, because ALS progresses on its own schedule and construction, permits, and equipment approvals run on theirs. The working sequence: now, while walking, the entry is made step-free, thresholds drop, the first-floor plan is settled, and the bathroom conversion is designed; before the power wheelchair arrives, the doorways, the ramp or lift, and the roll-in shower are finished, because the chair cannot wait outside while the house catches up; and whenever any wall or ceiling is open along the way, the blocking and wiring for the ceiling lift and future supports go in, whether or not that equipment has been ordered. The ALS Association's guidance is to make these changes proactively, and the practical reason is arithmetic: a custom power wheelchair, a lift, and a bathroom conversion each have their own approval and build clocks, and none of them pause. Planning the whole arc once, with the clinic team's input, is what lets the home stay one step ahead instead of one step behind.
What does not work with ALS?
- Building for this month's mobility. A scope sized to the cane means a second construction project at the hardest possible time. The design target is the wheelchair stage from the first day.
- Ordering the ramp when the chair arrives. Equipment lead times and construction schedules do not compress because the need became urgent. The entry is solved while the person is still walking.
- Measuring for the transport chair. The power wheelchair the clinic specifies is wider, longer, and heavier. Doorways, turns, and the shower are sized to that chair's dimensions.
- Remodeling the upstairs bathroom when the first floor can take a bedroom. Moving life downstairs is usually the more practical build, which is also the ALS Association's guidance.
- A step-in conversion when the trajectory ends at roll-in. A low curb that works with a walker still blocks a shower wheelchair. The conversion is built curbless once.
- Closing a wall without blocking. Every opened wall and ceiling is a one-time chance to reinforce for bars, rails, and the ceiling lift track. Blocking costs little open and a great deal closed.
- Treating grab bars as the end state. With ALS, bars serve the early transfers; the plan has to already contain the lift stage that follows them.
Who pays for ALS home modifications?
For veterans, the VA comes first, and the facts are unusually strong: since 2008 the VA has presumed ALS to be connected to military service for veterans who develop the disease at any time after separation, since 2012 service-connected ALS has carried a 100 percent disability rating, and under the VA's own rule change, veterans and service members with service-connected ALS are determined medically eligible for the maximum Specially Adapted Housing grant without waiting for mobility to decline. The Home Improvements and Structural Alterations benefit is a separate, smaller VA path for medically prescribed home changes. A veteran with an ALS diagnosis should bring it to the VA before paying cash for anything; the routes are outlined on veterans. Outside the VA, the ALS Association is plain that home renovations are typically not covered by insurance, and the exceptions are specific: in California some Medi-Cal managed care plans fund home modifications as a CalAIM Community Support for members who qualify, workers' compensation funds home access when ALS is accepted as work-related, some long-term care policies reimburse, and ALS Association and ALS Network chapters run equipment loan programs that cover gear, though not construction. The power wheelchair itself is equipment, commonly covered through Medicare with the clinic's documentation. The full set of routes is on all payment options.
The ALS home checklist
Walk the house with the clinic team's recommendations in hand. The groups below follow the build-ahead sequence.
Answer standing in each spot, with a tape measure.
Now
- One entry is step-free or has a signed plan for a ramp or vertical platform lift, with the rise measured.
- Interior thresholds are at 1/2 inch or less and throw rugs are gone.
- A first-floor bedroom and full bathroom plan exists on paper, even if it is not needed yet.
- The home evaluation with the ALS clinic's occupational or physical therapist is done or scheduled.
Before the power wheelchair arrives
- Doorways on the daily path measure 32 inches clear, checked against the chair the clinic specified.
- The bathroom is converted to a curbless roll-in shower with turning room and a handheld showerhead.
- The ramp or lift at the entry is installed and tested with the actual equipment.
- Furniture is arranged to leave the turning circles clear.
Whenever a wall or ceiling is open
- Blocking is installed for grab bars, rails, and fold-down supports at any height a therapist might name.
- Ceiling structure and electrical rough-in for a future ceiling lift track are in before the wall closes.
- Photos of the open walls are taken so the blocking can be found again.
Frequently asked questions
What home modifications does someone with ALS need?
A step-free entry by ramp or vertical platform lift, doorways at 32 inches of clear width, a curbless roll-in shower with turning room, first-floor living, lever and loop hardware, and blocking inside the walls for grab bars and a future ceiling lift. The scope is set with the ALS clinic's occupational and physical therapists, and the design target is the power wheelchair stage, installed ahead of the need rather than after it.
How wide do doorways need to be for a wheelchair?
The ADA reference is 32 inches of clear width, measured with the door open, and a nominal 32-inch door delivers only about 30 inches because the slab and hardware eat the opening. Swing-clear offset hinges buy back roughly the thickness of the door, and widening the frame is the durable fix on the daily path. With ALS the measurement is checked against the power wheelchair the clinic specifies, which is wider than an early transport chair.
How long does a wheelchair ramp need to be?
At the ADA reference slope of 1:12, every inch of rise needs a foot of ramp, so a 6-inch step needs about 6 feet and a 30-inch porch needs about 30 feet plus landings. When the yard cannot give that run, a vertical platform lift carries the chair straight up the rise in a few feet of footprint, which is why the entry gets measured before the ramp-or-lift decision is made.
Does the VA pay for home modifications for ALS?
For eligible veterans, yes, more directly than for any other condition. The VA has presumed ALS to be service-connected since 2008 for veterans who develop it at any time after separation, rates service-connected ALS at 100 percent, and determines those veterans medically eligible for the maximum Specially Adapted Housing grant without waiting for mobility to decline. The smaller Home Improvements and Structural Alterations benefit is a separate path. Eligibility details are the VA's call, so the diagnosis goes to the VA before the family pays cash.
When should you modify the home after an ALS diagnosis?
Earlier than feels necessary. The entry, thresholds, and the first-floor plan are handled while the person is still walking, the doorways, ramp or lift, and roll-in shower are finished before the power wheelchair arrives, and blocking for the ceiling lift goes in whenever a wall or ceiling is open. ALS progresses on its own schedule, and permits, construction, and equipment approvals run on theirs, so the home is built one step ahead.
Should you remodel the upstairs bathroom or move downstairs?
Usually move downstairs. A first-floor bedroom with an accessible bathroom on the same level is more practical than remodeling a second story, which is also the ALS Association's guidance, and it removes the stairs from daily life entirely. Where the first floor cannot hold a full setup, a vertical platform lift or through-floor home elevator moves the wheelchair between levels.
Does insurance pay for ALS home modifications?
Usually not. The ALS Association notes that home renovations are typically not covered by insurance, and the exceptions are specific: VA grants for eligible veterans, some Medi-Cal managed care plans through CalAIM Community Supports in California, workers' compensation when the ALS is accepted as work-related, and some long-term care policies. ALS Association and ALS Network equipment loan programs cover gear rather than construction, and prescribed equipment such as the power wheelchair is commonly covered through Medicare.
Tell us what the clinic team recommended.
A free virtual Home Safety Check walks the home with you over video in about 20 minutes, and you finish with a written list sequenced to the build-ahead plan: what to do now, what to finish before the wheelchair arrives, and what goes into every open wall. If you already know what you need, schedule a Free In-Home Estimate and we plan the full arc in one visit, with the therapist's recommendations in hand. For a full clinical audit with a written Home Safety Report, ask about the Home Safety Assessment.
Book the Free Home Safety CheckOr call or text (805) 500-0801 to schedule a Free In-Home Estimate.
- The ALS Association, 10 Things to Know: Improving Your Home's Accessibility (home evaluation through the clinic care team; entry and bathroom as priorities; first-floor bedroom over a second-story remodel; planning for needs now and in the future; renovations typically not covered by insurance)
- The ALS Association, Living With ALS: Making Sure Your Home Environment Is Safe and Livable (proactive home modifications to retain independence as mobility changes)
- U.S. Department of Veterans Affairs, VA Makes Specially Adaptive Housing Grant Eligibility Automatic for Veterans and Servicemembers With ALS (2008 presumption of service connection for ALS at any time after separation; 100 percent disability evaluation since 2012; automatic medical eligibility for the maximum SAH grant)
- U.S. Access Board, 2010 ADA Standards for Accessible Design, Chapter 6 (roll-in shower and grab bar reference ranges; the full room-by-room table is in the wheelchair bathroom guide linked above)
- California Department of Health Care Services, Medi-Cal Community Supports Supplemental Fact Sheet (Environmental Accessibility Adaptations, Home Modifications)
This guide is for educational purposes and is not medical advice. ALS affects every person differently, and every scope, sequence, and equipment decision in this guide is made with the person's own ALS clinic team, occupational therapist, and physical therapist, whose recommendations override any general guidance here. Reference measurements are starting points, not requirements in a private home, and the final dimensions come from the person's actual equipment. Benefit and coverage rules change by program and by year; eligibility determinations belong to the VA and the plan, so confirm any benefit directly before relying on it.
