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solely on the convenience or “desires” of the injured worker or their families, and 4. Be directed
toward specific functional outcome objectives.

When it comes to applying the concept of medical or functional necessity, the recommended

modifications should always be directed toward a specific functional outcome objective. And when
you really think about it, it is not the specific modification that is necessary, it’s the functional
outcome objective that is necessary. The modification is simply a solution to help you achieve the

necessary outcome objective.

A ramp is not medically necessary. A roll in shower, is not medically necessary. Widening a door,
is not medically necessary. If you have a front door that has three stairs and an 18” rise, a ramp
is not necessary. What is necessary, is the functional outcome objective of gaining access to the

interior of the home. The ramp then becomes just one of the options by which we might be able
to achieve the outcome objective. There are other ways of getting in the home and all should be
considered. The use of a vertical platform lift, considering the use of a different entry, or

constructing a new entry are all ways of gaining access to the interior of the home. Whatever
modification is authorized, becomes the applied method of achieving the necessary objective.

To determine specific objectives, consider starting with a broad frame of reference and then

narrow it down using filters and variables. The primary focus of modifications is usually in one of
two directions. The modifications are usually focused on either functional independence, or on
provision of care. If someone is not capable of caring for themselves, the environment should be

designed for a caregiver to provide the necessary level of assistance. If someone has the ability
to be independent, the environment should be designed to enable functional independence in a
safe and accessible environment. Of course, many injured workers fall somewhere in between

the two. Someone might need assistance with some activities while demonstrating the ability to
be independent in others.

Once you’ve determined the primary focus of independence or provision of care, to create a more
accurate scope of work, start with more specific functional objectives. Don’t just modify a

bathroom for wheelchair accessibility. Modify a bathroom specifically for the method by which an
individual chooses to complete the functional tasks of bathing, toileting, and grooming. Remember

to modify the home to fit the individual rather than forcing an individual to fit the modified home.

You’ll also need to take into considerations all of the influencing variables that are impacting the

environment. Will there be other residents using the bathroom? Will medical equipment be used

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