Thank you to the American Occupational Therapy Association for this video on simple strategies for preventing falls around the home. Falls are not a part of normal aging nor dealing with chronic illness. Many simple strategies can help to prevent falls when they are caused by hazards in the living environment.
Sometimes we find ourselves in a situation where we don’t have exactly what we need to get a job done. When the “job” is taking care of ourselves, we might easily substitute say, a household item, for a proper piece of durable medical equipment. I understand this.
However when the “job” is taking care of a loved one, we need to be really careful. Often when first posed with an accessibility or care need does the loved one want to inconvenience us or cost us extra time or money. In doing so our loved one may overestimate his or her ability to help (e.g. reach something from the floor or take a shower after a medical procedure) posing a risk for injury to both of you! Here are some examples. See if any sound familiar to you?
CASE #1: An item falls to the floor near a door where a person with low vision has just entered on a rainy day. Oh dear. The floor is wet but it is hard to see and the keys are lying right next to the puddle! Rather than asking for help or even gently nudging the keys to another place next to a chair (or counter to support body weight and balance), he or she reaches down and risks slipping on the wet floor. The dog or cat strolls by providing a bit of distraction, further affecting the ability to make a good decision as well.
CASE #2: Mom is recovering from surgery and anxious to get back to work. She prides herself in her independence and keeping her home nice for guests. Adding any bathroom equipment would bring a “hospital” feel to the rest room that is also used by family when they visit. How embarrassing! So she has her son retrieve a 2-step, step ladder from the garage and place it inside the tub/shower to use as a shower chair instead of purchasing a shower chair and tub rail. Both of the latter could be removed for guests, placed in storage when no longer needed, and even be taken with her when travelling. Oh well. The step ladder has sharp edges from that project cleaning the gutters last Fall and ends up scratching her leg when using it as a shower chair. Mom uses the towel rack as a “light hand hold” for about 2 weeks, eventually loosening the wall anchors and posing a grave risk for falls should it come loose sometime getting into or out of the tub/shower.
CASE #3: Brother is quite independent during the daytime now, maneuvering his wheelchair and going to the bathroom independently since recovering from a serious stroke awhile back. He likes to surf the internet when home alone but has no cell phone or land line available to him until evening when the family returns. One morning he wakes up to the smell of natural gas and realizes he has no easy way to get out of the double-front door on his own or call for help.
As you can determine from these examples posed by everyday activities, there are simple solutions to these problems when we prepare ahead of time for them! In my Living Safely Program presentations I would divide the topic into 3 areas: Medical Conditions, Slips-and-Trips, and Behavior. In Case #1, every effort must be made to dry ones footwear when entering the home in addition to minimizing glare from lighting or sunshine on smooth flooring surfaces. The latter makes it nearly impossible to see water on the floor. In Case #2, we need to provide the right equipment for the right task, check it often, and offer to help with the softer concerns (such as appearances) when necessary. In both Cases #2 & 3, we need to problem-solve scenarios with our loved ones in advance and include them in coming up with the best solutions. Emergency contact systems are now available that look more like a “Fitbit” for kids than a wrist-operated medical alert button; an emergency-only cell phone is quite inexpensive to own and operate these days.
We could chat at length about other considerations in each of these situations. Feel free to comment your suggestions and experiences below. I would love to hear from you!
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One year ago, Alaska joined the ranks of Texas and Kansas in passing legislation to allow Medicaid reimbursement for used durable medical equipment (DME). An update in the April 2016 issue of Home Medical Equipment News finds that supportive legislation to actually implement the bill is yet to come! Residents and suppliers are still waiting.
The bill may require Medicaid beneficiaries to purchase used or refurbished DME if, “the equipment is available; less expensive; is able to withstand three years of use; and meets the needs of the recipient.” Clearly the law is intended to save money for the Medicaid system and not necessarily protect and provide for the person receiving the equipment.
DME providers are concerned about additional paperwork and audits that would tie up their shrinking resources with mounting government red tape already on the books. Many questions remained un answered:
- Who honors the warranties and makes the repairs?
- What about sanitation issues and liability?
These issues appear to have stalled implementation of such programs in all three states to date.
Thoughts from an O.T.
Often I have searched the back shed of a rehabilitation facility, used equipment closet, or the lending closet of various charities and organizations to search for free stuff for my patients. Most of the time the items were stained by something nasty, dirty, or unmentionable! Often there were scratches in the materials that could lead to a skin abrasion if just the right care was not taken in its use. Suction cup footers can be missing; a retractable pin for making height adjustments might be bent or missing as well. The list goes on. We made the best selections and decisions possible in each circumstance, trying to locate or get someone to purchase the missing parts and sanitize the equipment as best we could before issuing it to our patient. We tested it for safety and completed training in our occupational therapy visits then sent the happy patient on his or her way. I often wonder what happened later . . .
We probably should have prayed more! Flash forward 4 years from my last home health care visit and the accumulation of a boatload of knowledge about environmental hazards (can you say mold?) that can plague virtually any living environment. Some surfaces will never come clean from the mycotoxins that make a person sick from mold. Mold, like noxious chemicals, are everywhere. While we might say that providing the equipment was, “better than nothing,” we might also remind ourselves that by issuing that equipment as a healthcare provider, we were endorsing to the patient that it was in good and working order. And we are assuming some measure of liability in the process. That, dear friends, is not within the realm of a State license for an occupational therapist or occupational therapy assistant! A statement like that comes from the store that sold the item long ago to someone else or even to the manufacturer who made it in the first place.
Things are probably better when a family member goes and picks up, picks out the equipment when it is used. I am really not sure about this. I recall when the director of a home health care agency for which I was working suddenly asked us to clean out our inventory of new/demonstration bathroom safety equipment. We were horrified! What were we going to show our patients? A photocopied picture of a tub transfer bench when they knew that a shower chair from Walgreens was cheaper (but inadequate for their needs)? My whole career was spent demonstrating real-life equipment in real-life situations so the patient and their families could see and feel, build confidence, and then go ahead and get the items that they needed. It was a tough transition indeed.
But our director, Betty was right. We were assuming too much liability by transporting equipment from one house to the next. Those items had started out “new” but over time became “used.” Transporting then sanitizing them every single patient treatment visit consumed precious time, and sometimes still wasn’t exactly what the patient needed. The best scenario turned out to be referring a family to the showroom of a local home medical equipment provider where everything was available for them on display. Sometimes this did all come together and sometimes not. Most of the time we bumbled along with some of us pirating our own stash of 3-in-1 commodes, reachers, leg lifters, and more.
I think that basically Betty did not want to see the stuff in our office . . . It took up a lot of space that in time we did not have when we moved to a new location. I think there probably is still a tabletop arm bike and raised toilet seat in the trunk of one of my co-worker’s car!