Jill, I'm sure we could all relate to some extent to the frustration in your post. Likewise, reading between the lines of your "questions", the need to work "smarter" by utilising time saving processes is sooo much a part of the job these days!
 
Here in Australia Community Health is one of the most demanding and difficult areas of OT practice. Several friends and former classmates who work in this field; and I've done a stint there myself. Not sure if the same problem would present here though. It's often the other way round- people don't want their bathrooms to look "disabled"- they want to keep their ancient old bath tubs "just in case"!
 
The charter of Community Health might be different here too - because the Community Health Centres are run Community Representatives - therefore they are intrinsically, by philosophy, "client-centred" and client-driven - so if a client absolutely insisted on a bathroom mod- the Occupational Therapist would have to work with them to at least try and ensure it was done according to the Standards. Increasingly, funding to perform the home mod is attached to a pre-condition that the Standards be complied with - the government department that administers the funding for homes is as well as being committed to appropriate design, also very aware of the potential for future litigation (read "cost-containment".) 
 
I know there are comparable Standards for Accesible Design in the UK (our Australian ones were based on them)  - do these apply for public housing in Gibralta?   
 

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