Aids & adaptions to meet non-medical needs (e.g. cultural/religious practices.)
22/06/2011 11:28 am
I'm looking for policies / guidance / best practice / opinions on aids & adaptions on non-medical grounds.
A specific example would be the Muslim requirement to cleanse with water after defecation. We have started to receive requests for showers / hoses to be fitted to toilets to enable tenants to carry out this practice.
I've discussed this issue with a number of people and opinion is divided. One view is that aids & adaptions should be supplied to meet a physical need only. Another view is that cultural or religious practices are not a choice and that social landlords should aim to meet the individual needs of tenants
I would like to review our aids & adaptions policy to include guidelines for staff when receiving non-medical aids & adaption requests. I'd be interested to know if other organisations have policies covering such requests, and the types of requests you receive. I'd also be keen to get views on the legal and regulatory requirement in this area. I'd prefer that we didn't just work to the 'letter of the law', but also in the 'spirit' of the regulatory framework!
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27/06/2011 2:52 pm
I'm very much with the "physical need" camp- people do have a choice about these things as there have been Muslims living in the UK for a long time, and living in social housing no doubt too for a long time, and they have either managed without or made their own arrangements. If adaptations like this become the norm, how long before we have to provide houes with two kitchens for jewish people or houses with dressing rooms for single women, who, after all, in the UK live in a culture that judges people by their appearance and thus instils a need to have an extensive wardrobe.
My suggestion would be that policy states that requests are treated with sympathy but declined on the basis that if homes were adapted under the same sort of procedures as disabled adaptations, the adaptatiosn would have to be removed should the family move on, otherwise the property would only be able to be let to a family with the same cultural need.
27/06/2011 3:34 pm
Thanks for your input Anon. Having looked into this further it seems there is currently little 'best practice' or guidance in this area.
The point you make re. the 'thin end of the wedge' is another one we've been discussing. One counter-arguement is that we should take a proportional approach - i.e. not being able to do everything is no reason not to do some things.
For example, we have guidelines for translation requests. We would translate, say, a tenancy agreement and terms and conditions. But we wouldn't translate an entire sign-up pack or customer handbook. I'm thinking that we should perhaps have similar guidelines for cultural/faith based adaptions.
28/06/2011 3:29 pm
As far as I am aware there is no Muslim religious requirement to wash with water after defication. There is however, a cultural tradition in the Indian subcontinenet to do this.
There are small cheap devices that are available from Eastern and European countries that can be attached to existing toilets to achieve this. They are also available in larger connurbations with ethnic populations. I have seen several attatched.
You can always offer the client to fund this particular aspect themselves.
28/06/2011 3:31 pm
I addition to this, with regards to cultural based adaptations, there is no best practice I am aware off, however,, it may be well worth liasing with colleagues in LA's with large BME populations like Birmingham or ones in London.
29/06/2011 9:58 am
Interesting question. At Ducane we house a large number of individuals and families with an Islamic cultural backgrounds and have,
over a number of years, been able to meet this requirement fairly cheaply and easily. For example, currently we are refurbishing
112 homes currently,and building a further 44,and we are specifying that the plumbing in bathrooms include a simple fitting plumbed
in behind the WC, that allows a small hand held shower attachment to be fitted for the purpose.
This is pretty low cost and comes high on tenant's wish lists. I suggest that the shower hose fitting itself is then optional for
tenants to purchase if they want, or ignore if this is not an cultural requirement.
07/07/2011 12:16 pm
The question of aids and adaptations to meet faith requirements will no doubt require a review of most HA's policies if they want to broaden their appeal. In the past faith groups have set up their own HA's to meet the requirements of the devout. I am thinking of Jewish charities which cater for the cultural and religious needs of Jews. No doubt Muslim associations will be start offering sheltered housing for elderly Muslims.In the past residential and nursing homes particularly in areas of high ethnic minority populations have recognised the need to provide a culturally sensitive and appropriate service usually this has focused on meals and activities but it also includes addressing toileting and bathing requirements as well as the opportunity and facilities to pray and observe/ celebrate religious holidays and festivals. So one source of advice will be faith groups and Local Authority social services who are providing Day Centres/ Domiciliary Care or Residential care to Muslims. One of the challenges to any service /housing provider is to recognise that there is a difference between cultural and religious requirements.I have experience of providing services to sections of the Muslim community where in one part of town the Muslim community would only accept a women only service where as in another part of town they were happy for instance for day care for men and women to be provided from the same building. So don't be surprised if the advise you are offered varies from one group to another- all Muslims are not the same just as all Christians are not and when some groups say this is against are religion what they mean is it is not socially acceptable with in our group.
.I think it is excellent that housing providers are thinking about cultural and religious requirements and not just assuming every one is the same. We know that Muslims want to wash in running water so would want a shower rather than a bath.The hose by the toilet is like the bidet which I first came across on holiday abroad but notice are in most hotel on suit bathrooms these days. Whilst such adaptions were not what the policy makers had in mind when legislation was passed I would have thought that any HA's that was trying to attract Muslim tenants would revise their policy on aids and adaptations to recognise cultural and religious requirements.
07/07/2011 2:57 pm
The organisation I worked for only provided A&A with an OT referral and presumably an OT would only specify adaptations for physical needs.
Before I left , we were moving away from the requirement of an OT referral for minor works however, so tenants could self refer for handrails etc.
In my view, the A&A budget should be for physical needs only - however a landlord with many muslim tenants (for example) could set aside a separate budget for cultural requirements but I do accept the point that you could be getting into dangerous ground in defining what a cultural need actually is - and how much should landlords spend to meet it.
You could have a half way house policy that doesn't pay towards such adaptations but would not unreasonably refuse permission for the tenant to carry out the works themselves (up to you whether you agree to maintain - guess that would depend on what the adaptation actually was)
08/07/2011 10:05 pm
Very interesting you have raised this. I have dealt with a stage 2 complaint regarding a HO refusing to install a shower douche for her tenant on the grounds that when she accepted the property a little over 2 months ago the tenant agreed to accept it as was. I do agree that this could be the thin end of the wedge indeed. A&A budgets should be used to benefit those with disabilities rather then lifestyle choices or religious beliefs. I did not uphold the tenants complaint for a number of reasons:
1 - The HO visited the property and noted they had carried out a number of modifications to the property, such as tiling throughout.
2 - The HO confirmed that both tenants worked full time. As such they were not in recipt of any benefits. In that light they could afford to make adaptations if needed. Our A&A budget is there for those who are unable to fund modifications or adaptations themselves.
I wish to put a very serious and witnessed scenario to the group,
If it was made Law to provide such adaptations to allow tenants to follow/ practice their religious believes, we must have a level playing field, equality for all. However what if a Rastafarian tenant requests his property be outfitted for means for them to carry out sacrifice of animals? Legal implications aside, would you willing provide the means for the practice to take place in a property?
Whilst diversity needs to be celebrated I do believe we are looking at the thin end of the wedge here and caution needs to be used.
12/07/2011 12:26 pm
I can't wait to see the Aids and Adaption requests coming in from the Mormon Fundamentalists!
19/07/2011 11:31 am
The financing arrangements and legislation governing aids and adaptations does cover primarily adaptations for people with a physical or mental impairment leaving adaptations purely on cultural grounds falling outside of current practice. That’s not to say that adaptations policies should not be sensitive to cultural requirements and require the Occupation Therapists to consider cultural requirements at the initial assessment, however, the primary factor is the nature of the disability. Aids and Adaptations are about assisting the individual to live as independently as possible so rightly are focussed on mobility and the basic human needs such as washing and feeding. Whether an individual cannot live indepenandantly and fulfil basic human needs due to cultural and religious requirements is an interesting question, as physically there is no impediment.
Many landlords will have policies that require the tailoring of services to meet the varied needs of the customer and this is primarily where the opportunity is for building in adaptations due to cultural requirements. Repairs policies, refurbishment specifications, customer choice policies, void and customer care standards should be reflective of the communities that use the services and be flexible enough to allow a range of cultural adaptations as the opportunity arises. A more holistic approach to the delivery of these services taking every opportunity to tailor what's delivered to the individual has the potential to make positive cost effective changes. In my own organisation if the cultural request can be accommodated within the target price for the standard work, no additional charge would be made. However, should the cultural request require additional work and alterations at an additional cost to the original work, then a charge would only be made on the difference.
20/07/2011 1:25 pm
This is an interesting area of discussion and something I am faced with on a regular basis working in an area with high percentage of residents from differing ethnic backgrounds.
I am an occupational therapist employed by a housing department and would like to reiterate the comments made by Shaun Aldis. Under DFG legilsation all assessments of need for equipment ('aids' is really an out of date term now) and adaptations to assist and promote independence have always considered cultural needs sensitivity wherever possible however the disability is the primary issue.
For example i have on a number of occasions recommended for an existing Asian style toilet be removed and a western style wc be fitted due to someone's mobilty problems, safety and independence. Handwash basins are always provided and hand shower attachments can provide a good cost effective solution and demonstrates good inclusive design practice. Showers V Baths is another common issue I'm faced with and whilst bathing equipment can assist someone who has difficulty getting in / out of a bath, bathing with running water is often more acceptable. If funding or local criteria cannot provide a shower over the bath or a wetroom type shower then sometimes providing a bath seat and a plastic jug to wash down with is often more acceptable than using a Bathlift and sitting in bath water.
Another common issue i face is where properties are overcrowded and an additional living room need to be utilised as bedroom for a family member with a disability or that needs to have ground floor facilities. Again the disability needs are the primary concern and the compromise is that sometimes the family lose a communal room on the ground floor which may have been used for social gatherings where the men use one room and the females use the other. This is particularly common with large families living in smaller terraced properties or where extending the property is not feasible or cost effective.
There is a lot of good resources out there to discuss these issues and develop good inclusive working practices. I regularly do visits to families with our Asian Carers Group and social worker to ensure that my assessments are sensitive and appropriate.
DFG funding is tight and local criteria seems to vary from authority to authority however there are opportunities for OT's like my self to work alongside housing associations and local authorities at the design stage with new builds or major refurbs to provide facilities that more appropriately reflect the needs of our wider communities and I feel that this is the key for the future.
It is also important to consider that equipment and adaptations may not be the only solution to these issues. Reablement programmes have seen intensive therapy input and care support for those appropriate to assist them adapt, maintain and sometimes improve following health and / or short term disabilities and these sorts of solutions are vital to an OT's holistic approach when assessing. There are some great care agencies set up that provide appropriate support, understanding of cultural and language issues for families and these can often be implemented a lot quicker than the organisation of permanent and sometimes costly adaptations.
Anyway - just some food for thought!
04/08/2011 5:20 pm
I'm a Building Surveyor at a South London Home Improvement Agency & have come across this issue a couple of years ago.
basically WC douche attachments are illegal under the Water bylaws
please see below........
A douche attachment adjacent the WC contravenes the WRAS Water Bylaws IN ALL CASES. Please see the following attachment:
08/08/2011 4:01 pm
Hi all - thanks for all the contributions so far.
Alasdair - I'm no legal expert, but is it true to say "a douche attachment adjacent the WC contravenes the WRAS Water Bylaws IN ALL CASES"?
The document you linked to suggests there is a requirement to comply with Water Fitting Regulations (WFR), and then goes on to suggest solutions to ensure you are complying.
This may mean an additional cost, that we may need to pass on to the tenant. But am I right I thinking there are ways to fit a shower hose for personal cleansing, and comply with the WFR?
08/08/2011 5:28 pm
Very interesting question, and sadly I am not an expert in this area. I agree with Anon though, Muslims have lived in the UK for a long time in social housing without requesting this. I think going down the route of making adaptations for religious purposes is a 'rocky' one, and I am sure all kinds of 'religious' adaptations requests would come out of the wood work if it were to become custom and practice! I think any adaptations that are not for disabilty/health reasons should be paid for by the tenant. Good luck.