October 8, 2008 – Six weeks after James Fair, a 22-year-old combat engineer, began serving in Iraq in the fall of 2003, he detonated a homemade bomb while walking away from a barbed wire fence he had just erected near Falluja. He lost his eyesight and both arms below the elbows, and sustained brain injuries.
Seven months later, when he was released from a military hospital – the blue scars from the powder burns on his face still visible – he moved in with his then wife in Kansas but left after two months, because, he said recently, she “couldn’t take care of me.” After that, he returned home to Western Pennsylvania to live with his mother, Lonnie Mosco, and her new husband, Scott, in a small two-story house they had moved to in his absence.
There were only two bedrooms, so Mr. Fair shared one with his 8-year-old half sister. To keep him safe from hazards like the stairs, family members “took turns walking him wherever he needed to go,” Mrs. Mosco said. They also assisted him in countless other ways, from changing television channels to cleaning him when he went to the bathroom. Attending to his needs became a nearly full-time job for the Moscos, one they could see stretching out for the rest of their lives. And the constraints of the house made things worse.
At the time, the Department of Veterans Affairs offered permanently and severely disabled veterans a maximum of $50,000 to modify their homes or build new ones that accommodate disabilities (in July, the amount was raised to $60,000). But the Moscos knew they would need more, so Mr. Fair, with guidance from a Veterans Affairs counselor, turned to one of roughly a dozen national nonprofit groups that have sprouted to build housing for veterans like him.
The group, a Massachusetts-based organization called Homes for Our Troops, agreed to build the family a free house, and in March, they moved in. A comfortable if compact three-bedroom ranch house, it is one of the most technologically advanced projects Homes for Our Troops has completed so far, with an array of low- and high-tech features tailored to Mr. Fair’s disabilities. It is a test case of the ways design can improve the lives of severely wounded veterans and their families, and of the limits of its power to turn around a situation like Mr. Fair’s. The house includes design elements common to most Homes for Our Troops projects, like wheelchair-accessible doors and kitchen appliances (which are lower than standard ones) and bedrooms separated by public areas, to create zones of privacy. Other features address needs particular to Mr. Fair, now 27, who does not use prosthetic arms because he finds them uncomfortable and clumsy. There is a toilet with a built-in bidet that washes and dries the user, for example, and voice recognition software that, once operational, should allow him to hear weather reports, unlock doors and change TV channels.
These things are making a difference, Mrs. Mosco said, and the family is grateful for them. But the house has its share of aggravations, particularly for Mr. Fair. He did not want it to be wheelchair accessible, for example, because he does not use a wheelchair. Homes for Our Troops insisted, because in many cases a veteran’s injuries worsen over time, and Mr. Fair has shrapnel in his leg that may have serious consequences down the line. But this is not something he likes to think about. “James gets upset even talking about wheelchairs,” Mrs. Mosco said.
Paul Gemme, the projects manager who oversees the construction of most Homes for Our Troops houses, said the work is rewarding but also challenging, in part because the veterans he builds for are often frustrated, and have higher expectations for their new homes than a charity can meet.
“A lot of human emotions come into this,” he said. The veterans “are in a situation they never thought they would be in. We have had to employ a lot of Psych 101.”
Another challenge, he added, is staying on top of the Veterans Affairs department’s intricate list of building requirements for contractors using V.A. money. Homes for Our Troops finances its work mainly with private and corporate donations, but also depends on its veteran clients signing over V.A. grants.
According to the department, about 500 veterans of the wars in Iraq and Afghanistan have the sort of injuries that make them eligible for its lifetime grant of up to $60,000 for housing modifications or new construction – a seemingly small number considering that both wars are known for high survival rates among the severely wounded, thanks to improvements in body armor and field medicine. Some 15,000 people have been injured seriously enough not to be returned to action within a few days.) Of the 500 who qualify, the department says, 95 have been approved for some or all of the grant, 55 are in the process of being approved and some 350 are not yet pursuing the opportunity.
The Veterans Affairs department itself acknowledges that even those who receive the maximum grant will not be able to build new houses, or even do significant retrofitting with $60,000. So to the extent that the department is financing construction work, it is in partnership with a patchwork of groups like Homes for Our Troops.
Brian Bixler, the chief of specially adapted housing for the Veterans Affairs department in Washington, offered a positive take on this system. “It is a great bonus that they have enough people who care about them to provide them with any kind of assistance they need,” he said.
The “they” he referred to, of course, are relatively few veterans lucky enough to have had groups like Homes for Our Troops building or renovating for them. That organization, founded in 2004, has so far built 32 houses, is building 19 more and has a list of dozens of families waiting for land and materials to be donated. Others, like Building Homes for Heroes on Long Island and Rebuilding Together in Washington, D.C., have also been able to take on only modest numbers of projects for severely wounded veterans.
Carl G. Lewis, an architecture professor at the University of Illinois at Urbana-Champaign, sees another downside to depending on multiple small charities: Under this decentralized approach, he said, there has not yet been much sharing of information about what designs and technologies work best for new veterans. Mr. Lewis, who under the Clinton administration served on the United States Access Board, a federal agency that develops design standards, said that the guidelines set by the V.A. for remodeling and new construction are better suited to the needs of veterans of previous wars. Wheelchairs were then more uniform and generally more cumbersome, requiring large turning radiuses, and brain trauma, which calls for architecture rich in visual and tactile cues, was less common than it is now.
“In previous wars, it took a long time for that dialogue about what is really needed” to cope with new forms of injury to take place, he said, and that seems to be happening again.
Ideally, Mr. Lewis added, a new home for a severely wounded veteran might be designed after a conference with the veteran, his physical and psychological therapists and an architect. But the $250,000 that Homes for Our Troops spends on an average project does not allow for that level of customization. In this price range, the group is not building mansions or even therapeutic dream houses, but basic homes without high-end amenities or even finished basements. “With every family we work with,” he said, “we have a come-to-Jesus conversation, where we explain what can and cannot be done. We can put in the plumbing for that extra bathroom in the basement, but we are not going to build it.”
Still, Mr. Gemme said, Homes for Our Troops is eager to ease challenges brought on by war wounds in any way it can. In some cases, this has meant building separate wings of a house for parents who have become full-time caregivers. In others, it has meant building a lift so smaller spouses of paraplegics can bathe them without help.
In Mr. Fair’s case, the central issue was his desire for more independence and privacy, which he made clear early in the process. Without arms, he found himself dependent on others for the basic tasks like dressing and feeding. But the help he needed in the bathroom was the most humiliating.
He relied heavily on his stepfather, Scott Mosco, a former trucker now on disability himself, whom he barely knew before he shipped out. The situation was so extreme, Mrs. Mosco said, that it became difficult for her husband to go out. “He couldn’t go Christmas shopping because he would be away too long,” she recalled.
Homes for Our Troops found a toilet of a type popular in Japan to deal with this problem – he can press the buttons with his arms. It also improvised a full-body dryer from one used in pet shows for Mr. Fair to use when coming out of the shower. (A model on the market in Great Britain was too expensive.)
More ambitiously, the organization has been trying, through a subcontractor called CleverBuilt Smart Homes, to program the house to be responsive to Mr. Fair’s voice – an effort that has put additional strain on the client-contractor relationship. Although so-called smart homes with integrated environmental controls are becoming common, voice prompts are not yet in widespread use, and there have been problems with implementation. The computer has been befuddled by ambient noise. The men from CleverBuilt Smart, who are donating their time, are working on a microphone that they can attach to Mr. Fair’s arm. But even that may not solve the problem, as Mr. Fair has not yet trained the computer to learn his voice. It is a tedious process and has turned contentious.
Mr. Fair says he hasn’t had any training. The contractors say that his brain injuries have made him resistant to trying, and made it hard for him to concentrate when he does.
There has also been tension around some of Mr. Fair’s requests, which were turned down. He dreamed of a wood-burning fireplace, but Homes for Our Troops worried it would be dangerous, given his blindness, and put in a gas model instead. He asked for variations in flooring – “I wanted different textures in all the rooms, so I can know where I am just by stepping in,” he said – but the organization insisted on wheelchair-friendly wood laminate. But to minimize ramping, which Mr. Fair also disliked, it recessed the house into the foundation, making it level with the ground and garage.
For all the problems, Mrs. Mosco, who works as a deli manager and could not have afforded the house on her own, said it has been a boon. “It is hard having to give up your life again,” she said of the adjustment she went through when her son came home. The new house has given the family breathing room.
And the potential of the voice recognition software, even if not yet achieved, is not lost on her. “The TV is his life,” she said. “Right now when he wants us to change the channels we jump.”