promoting safety and wellbeing in the home...

~ There’s No Place Like Home ~ Promoting Safety and Wellbeing

in the Home Environment

� MGS 2014 Conference - April 9-10, 2014

� Dawn Braach, OTR/L Community Medical Center

� Kathleen Laurin, Ph.D., University of Montana Rural Institute - MonTECH

~ There’s No Place Like Home ~

Introductions

Plan for the afternoon:

▪ Discussion of Home Assessment Purpose and

Process

▪ Issues and solutions for supporting individuals with

urgent needs

▪ Following two sessions will discuss Universal design,

visitability, examples and solutions for aging in place

for those without urgent needs


Promoting Safety & Wellbeing in the home environment ~ There’s no place like home ~


Objectives for the afternoon:

� Awareness of the challenges in regards to the normal

aging and physical/cognitive conditions affecting safety

in the home

� Understanding Home Safety Evaluations

� Issues & solutions for supporting individuals with

chronic/progressive/urgent needs

� nonstructural/low tech equipment considerations


Quick look at the

terminology:� Aging in Place (AIP) without urgent needs

� AIP with progressive/chronic needs

� AIP with sudden/traumatic needs

� Our focus for this session is on progressive/chronic and

sudden/traumatic needs of individuals

� Explanation of ADL’s and IADL’s


The Challenges

The Silver Tsunami is coming!

� By 2020, Montana will rank #4 in population over the

age of 65.

� In Montana as of 2013, approximately 110,000 were

fulltime caregivers to a spouse/disabled loved one.


Challenges:

In 2009 CDC stats:

Out of 100 people:

� 21 have arthritis (rheumatoid or osteoarthritis)

� 17 have respiratory condition (COPD, severe asthma)

� 7 have diabetes

� 5 have orthopedic (hip/knee) replacements

� 3 have had a stroke

� 3 with MS, ALS, Parkinson's, Dementias


Challenges: continued 2

Approximately 80% of those over 65 have at least 1

chronic disease and 50% have at least 2 chronic

conditions.

Lastly, approx ¼ of those over 65 have significant mental

disorders of depression, anxiety and varying type of

dementia including Alzheimer's.


Home Safety Assessments:

Two Distinct Approaches1. The Problem specific evaluation (ie: urgent problem

of falls in the home)

� Generated by PCP/CM or the individual/family

member

� Billed through Medicare, Medicaid, private

insurances

� Completed by a qualified HCP (will be discussed

later)


Home Safety Assessments,

continued:

2. Comprehensive Assessment – starting at the curbside and going throughout the home. Will be thoroughly reviewed in next sessions of “Universal Design, part 1 & 2.”

� Not generated by a doctor’s order, not billed through

Medicare, etc.


Types of assessment tools

There are many to choose from, however the following will be found to be helpful tools to consider:

� For therapists: CHER, CASPAR

� For case managers/caregivers: Checklist for Safety

� Individuals: AARP Home Checklist

� Builders/remodelers: Home Audit Form

� Resource links provided on slide #24


My role as an occupational therapist

goal of home safety evaluations:

� Understanding the medical issues associated with a

client’s physical, cognitive and emotional challenges

� Determination of what obstacles in their home may be

causing the most problems

� Finding the right fit

� Planning for progression


Who does it?

� Situation and individual needs will inform who should be

involved in the home assessment and modification

process

� A team approach is most often the best approach

� Credentials and certifications indicate an individual has

met minimum standards; do not ensure expertise in

specialty areas


Team Members

� The individual and other members of the household

should be active participants in identifying solutions

� Individual with expertise in understanding medical

conditions, functional abilities, task analysis,

environmental access (O.T., P.T., Rehabilitation

Specialist)

� Architect, contractor, builder, skilled trades, designer

etc.


Critical Skills and Experience for

Home Assessment Professional

� Knowledge and training in understanding medical

terminology and levels of functioning (physical and

cognitive)

� Able to understand and plan for changing and

progressive health conditions

� Skilled in task analysis and able to identify barriers to

optimal functioning and independence including impact

on other household members and caregivers


Critical Skills and

Experience� Knowledgeable of adaptive techniques and assistive

technologies

� Knowledgeable in home safety and fall prevention (for

all family members and caregivers)

� Proponent of Independent living, maintaining personal

autonomy, and functional independence to greatest

extent possible


Critical Access Issues

� Entrance and exit from the home

� Bathroom access

� Bedroom


Non-structural/low tech

modifications

� Non-structural/low tech modifications for AIP with

chronic/progressive and urgent/critical needs

� Many assume home modifications ALWAYS involve

structural changes, but there are other ways to make a

home accessible.


Entrance/Exit from the home

� Ramps

• Aluminum vs wood

• “Make it or break it” pitch

of the ramp

• Adequate landing at top

of ramp/turning radius


Bathroom

� #1 location of falls requiring hospitalization

� Grab bars – One size & location does not fit all!

� Shower seats – adjustable height is always needed

� Hand shower wand – the most expensive is not always

the best


Bathroom, continued:

� Product examples


Bedroom:

� When is an electric

bed/hospital bed

warranted?


Summary:

� We’ve addressed the challenges to home safety/wellbeing with normal aging, and those with chronic/progressive and urgent/traumatic needs.

� We’ve explained the 2 roads of Home Safety Assessments

� We’ve reviewed the process of Comprehensive Home Evaluations, the team approach and what is involved.

� We’ve reviewed several non-structural, low tech equipment suggestions appropriate for chronic/progressive and urgent/traumatic needs.

� Please join us for “Universal Design – part 1 & 2 for in depth considerations starting at the curb side and going throughout the home.


Assessment Tool Links

CHER

http://www.shdesigns.net/cherreg

CASPAR

http://www.ehls.com/accessibility-consulting-services.html

Checklist for safety

http://www.cpsc.gov//PageFiles/122038/701.pdf

AARP

http://assets.aarp.org/www.aarp.org_/articles/livable_communities/aarp_home_fit_guide_042010.pdf

International Association of Certified Home Inspectors (InterNACHI) http://www.nachi.org/aging-in-

place.htm


Contact Information

Kathleen Laurin Ph.D.

UM Rural Institute –MonTECH

700 SW Higgins Ave., Suite 250

Missoula, MT 59803

877.243.5511

406.243.5751

[email protected]

http://montech.ruralinstitute.umt.edu/

Dawn Braach, OT/L

CMC Outpatient Rehabilitation

Dawn Braach, OT/L

Outpatient Rehabilitation

2728 Ft Missoula road

Building #4

Missoula, Montana 59804

(406)327-4050

[email protected]


Universal Design and Home

Modifications to Support

Aging in Place – Part 1

� MGS 2014 Conference - April 9-10, 2014

� Kathleen Laurin, Ph.D., University of Montana Rural Institute – MonTECH

� Dawn Braach, OTR/L Community Medical Center


Aging in Place

� Growing older without having to move from one’s home

� Meets the needs of the individual as well as family and friends who may visit

� Includes maintaining personal autonomy and functional independence

� Nearly 90 percent of seniors want to stay in their own homes as they age


Universal Design

Universal design is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design (Ron Mace, 1985).

For more information on UD for built environments visit:

The Center for Universal Design at:

http://www.ncsu.edu/www/ncsu/design/sod5/cud/


Universal Design by Another

Name� Accessible design

� Inclusive design

� Human centered design

� Lifespan design

� Barrier free design

All are focused on social sustainability


Principle One:

Equitable Use The design is useful and marketable to people with diverse abilities

� It provides the same means of use for all users: identical

whenever possible; equivalent when not

� It avoids segregating or stigmatizing any users

� Provisions for privacy, security, and safety are equally

available to all users

� The design is appealing to all users


Principle Two:

Flexibility in Use The design accommodates a wide range of individual preferences and abilities

� It provides choice in methods of use

� It accommodates right or left handed access and use

� It facilitates the user’s accuracy and precision

� It provides adaptability to the user’s pace


Principle Three:

Simple and Intuitive Use Use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level

� It eliminates unnecessary complexity

� It is consistent with user expectations and intuition

� It accommodates a wide range of literacy and language

skills

� It arranges information consistent with its importance

� It provides effective prompting and feedback during and

after task completion


Principle Four:

Perceptible Information The design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities

� It uses different modes (pictorial, verbal, tactile) for redundant presentation of essential information

� It provides adequate contrast between essential information and its surroundings

� It maximizes “legibility” of essential information

� It differentiates elements in ways that can be described (i.e., make it easy to give instructions or directions)

� It provides compatibility with a variety of techniques or devices used by people with sensory limitations


Principle Five:

Tolerance for Error The design minimizes hazards and the adverse consequences of accidental or unintended actions

� It arranges elements to minimize hazards and errors:

most used elements, most accessible; hazardous

elements eliminated, isolated, or shielded

� It provides warnings of hazards and errors

� It provides fail safe features

� It discourages unconscious action in tasks that require

vigilance


Principle Six:

Low Physical EffortThe design can be used efficiently and comfortably and with a minimum of fatigue

� It allows user to maintain a neutral body position

� It uses reasonable operating forces

� It minimizes repetitive actions

� It minimizes sustained physical effort


Principle Seven: Size and Space for Approach and Use Appropriate size and space is provided for approach, reach, manipulation, and use, regardless of user’s body size, posture, or mobility

� It provides a clear line of sight to important elements for

any seated or standing user

� It makes reaching to all components comfortable for any

seated or standing user

� It accommodates variations in hand and grip size.

� It provides adequate space for the use of assistive

devices or personal assistancehttp://www.ncsu.edu/www/ncsu/design/sod5/cud/


Visitability

Refers to single-family or owner-occupied housing

designed in such a way that it can be lived in or visited by

people who have trouble with steps or who use

wheelchairs or walkers.

� one zero-step entrance

� doors with 32 inches of clear passage space

� one bathroom on the main floor you can get into in a

wheelchair

For more information visit http://concretechange.org/


Design Guidelines

Guidelines and resources for UD design/modifications of

single family residential homes are becoming more readily

available

Know and Use Applicable Scoping Requirements, Building Codes, and

Universal Design Principles!


What Standards Apply Where?

� In commercial spaces the Americans with Disabilities

Act (ADA) and state and local building codes

� ADA does not apply to single family homes and

duplexes – use only as guidelines; base modifications

on individual’s needs and apply principles of Universal

Design

� Multi-family housing is covered by the Fair Housing Act

� U.S. Access Board http://www.access-

board.gov/?parentFolderId=213&linkId=7666&linkExter

nal=false


Home Assessment

� Type of assessment is dependent on the goals to be

achieved

� Regardless of goals the assessment should consider all

options

� Assessment should be performed by qualified

independent individual/business that does not have a

financial interest in work to be performed or products to

be purchased


Process of Discovery

� What are the goals

� What are the obstacles

� What are the changing dynamics

� What are the constraints


Process of Problem Solving

� Mission is problem solving (current and preventive)

� Interactive process to identify solutions

� How are you doing this now?

� Could you please show me how you do this?


Solutions are more than tools

� Assistive technologies and other equipment are

important tools but not the solution in and of themselves

� Multiple solutions/options must be presented in a way

that does not overwhelm the consumer

� You must stay current…new solutions/options are

constantly evolving


Safety and Security

Always check for working:

� Smoke Alarms

� CO Detectors

� Fire Extinguishers

� Emergency Communication options (911, personal alerting/emergency response, cordless phone battery back-up)

� Emergency Exits

� Doors and Locks

� Intercoms/home monitoring

� Lighting (entry/exit, pathways, etc)


Home Modification Process

� Assess (individual, household members, caregivers,

and environment)

� Plan, design, and prioritize options

� Create a specific scope of work

� Draw necessary plans to support comparable bids

(based on type of work; could be sketch or may require

blueprints)


Home Modification Process #2

� Review bids

� Verify licensure, insurance, references

� Choose a contractor

� Contractor completes work according to

agreement/contract


UD and Home

Modifications Part 2

� MGS 2014 Conference, April 9-10, 2014� Kathleen Laurin, Ph.D., University of Montana Rural Institute – MonTECH� Dawn Braach, OTR/L Community Medical Center


Outdoor Access to Home

� Consider width, slope, grade, and surface of sidewalks,

driveways, and all access routes

� Use landscaping to change grade

� Good automatic lighting

� Zero step entrance and automatic opener for primary

entryway

� High contrast for stairs (eliminate when possible)


Outdoor Access to Home, cont.

Mailbox in safe and accessible location (sometimes need USPS approval to relocate)

� Ramps, Lifts, and/or Elevators (outside and inside)

� Porch and Deck access

� Railings and Handrails


Garage Considerations

� Automatic Door Openers

� Current Safety Options on Overhead Doors

� Clear Access Routes and turning radius around vehicle

and to other elements (doorway, workbench,

garbage/recycle containers)

� Lighting


Considerations throughout

Home� Lighting

� HVAC control

� Stairs

� Floor surface

� Pathways

� Elements that require reaching, bending, lifting, grasping, vision, and/or hearing

� Door and cabinet hardware

� Lever or automatic faucets with anti-scalding devices


Lighting Tips for Home

Safety� Homes are often under

lit in critical areas.

� Lighting needs increase as we age (over 50 need 2-3x more light).

� Use natural light whenever possible:• Position reading chair near

window

• Open curtains/shades

• Keep windows clean


Balanced light levels are

important� Homes often have dark walls or a single point of light

that can cause shadows.

� Due to optical and perhaps neural changes to the eye, older adults cannot adapt to dim lighting conditions.

� Luminance levels in transitional spaces (hallways, foyers) should be similar to those of adjacent spaces.


Types of Lighting

� Full Spectrum: Closest to actual sunlight. High in blue light spectrum. Blue light is responsible for glare and may be harmful to retina.

� Incandescent: Safest light source for eyes. Not economical nor is it good for contrast or accurate color perception.

� Halogen: Brightest and whitest, which is excellent for contrast. Good for use where a lot of light is desired. Heat intensity can be a problem.

� Fluorescent: Bright and economical (67% less than standard incandescent). Cost more, but last 6-16x longer. Modern fluorescent tube lamps and “compact fluorescents” are of the “warm white” variety, so they are bright and safe.


Lighting tips

� Make sure there is adequate lighting in places where it may be difficult to move around (hallways, stairs).

� Install light switches in accessible locations.

� Install switch plates that are lighted or contrast with wall color.

� Install preset light timers in difficult areas.

� Watch TV in a lighted room, as it is easier on the eyes. Make sure lighting is not placed where it will cause glare or reflection off of the screen.


Positioning Considerations

� As much as 10x more light will be needed to see fine details

� Directional light sources should be used to maximize visibility and minimize energy use and heat

� The location of the light fixture with respect to the person and the visual task is critical (avoid glare and shadows)


Access to Lighting

� Sensor lights (touch, motion, or clapping) are helpful when mobility and dexterity is limited.

� Make sure the bulbs are easy to change.

� Make sure your lamp or light fixtures are easy to clean.

� Rocker switches are easier to access.

� Install light switches at the top and bottom of stairs.


Contrast

� Because contrast sensitivity is reduced as we age, the visibility of important objects (such as the edge of countertops, steps, door jams) can be greatly improved with paint, colored tape or similar techniques.


Lighting Resources

� Lighting Research Center

http://www.lrc.rpi.edu/

� AARP Information from LRC

http://www.lrc.rpi.edu/programs/lightHealth/AARP/index.

asp

� http://www.lrc.rpi.edu/programs/lightHealth/AARP/design

ers/lightingOlderAdults/index.asp


Flooring

� Pros and Cons to many floor types – best choice depends on location, purpose, needs

� No throw rugs!

� Anti-slip surface

� Carpet should be maximum ½” pile, minimum or dense padding for assistive devices (walkers, scooters, wheelchairs)


Living Room

� Arrange furniture so that there are clear pathways and

no tripping hazards

� Arrange TV/Computer so that direct outside lighting

does not create glare

� Have a space to keep useful items within comfortable

reach (phone, remote, drinks, light)


Kitchen

� Organization

� Counter heights, work spaces, task lighting

� Lever or automatic faucets

� Front or side controls for cooktops and ovens

� Heat resistant surfaces next to cooktop

� Type of Refrigerator (side by side, freezer on bottom, freezer bottom French door top)

� Microwave (location, control panel)

� Pull out or pull down shelving


Kitchen Ideas/Examples

� http://www.hgtvremodels.com/kitchens/universal-

design-style-kitchens/pictures/index.html

� http://www.nextavenue.org/article/2013-09/coolest-and-

most-accessible-kitchen-cabinets-ever

� http://www.kraftmaid.com/learn/universal-design/


Bath

� Access

� Non-slip Surfaces

� Grab Bars – Beware of unintended supports such as towel bars, soap dishes, shower chairs, sinks, etc.)

� Bathtubs and Showers (safety and access)

� Toilets – Bidets, risers, standing bars,

� Transferring considerations (lateral, front, angled)


Bath continued

� Type and location of accessible shower elements

� Water Controls

� Grab bar type and location to match purpose (sitting,

standing, balance, transferring)

� Seating (transfer benches, fixed and fold-down

benches, power seats)

� Shelving


Examples/Products

� Walk-in/roll-in curbless shower with linear drain systems

� http://www.hgtvremodels.com/bathrooms/universal-

design-features-in-the-bathroom/pictures/index.html

� http://best-

bath.com/Products/10/Designer%20Series/2/Barrier%2

0Free

� http://www.showerbay.com/


Examples/Products #2

� http://optionsil.com/model-home/bathrooms/3

� Products -

http://www.elderdepot.com/customer/home.php?click=1

� http://www.us.kohler.com/us/ADA-Compliant-

Products/content/CNT15600007.htm


Bedroom

� Organization

� Appropriate Bed height

� Standing Bar

� Closet Design and Function

� Easy slide drawers

� Adjustable lighting


Laundry

� Access route

� Access to machines (front loader, platform or pedestal)

� Control Panel

� Lint screen

� Rolling hampers

� Easy pour cleaning solutions


Electronic Controls for Daily

Living

� Also called environmental controls

� Wireless technology

� X-10, Insteon, Z-wave, combine several electrical appliances into one system

� IOS and Android options

� Infrared motion detectors that turn on lights when movement is detected. Good for night lighting to prevent falls


Monitoring Technologies

� Remote Vital Signs monitoring and remote passive activity/safety monitoring

� Rely on sensors of various kinds (e.g. motion, pressure)

� Some systems use cameras for video monitoring

� Most systems are highly customizable

� System may require family or care giver monitoring or may offer central monitoring service


MonTECH Services

� http://montech.ruralinstitute.umt.edu/

� Funding - http://matl.ruraldynamics.org/


Contact Information

Kathleen Laurin Ph.D.

UM Rural Institute –MonTECH

700 SW Higgins Ave., Suite 250

Missoula, MT 59803

877.243.5511

406.243.5751

[email protected]

http://montech.ruralinstitute.umt.edu/

Dawn Braach, OT/L

CMC Outpatient Rehabilitation

Dawn Braach, OT/L

Outpatient Rehabilitation

2728 Ft Missoula road

Building #4

Missoula, Montana 59804

(406)327-4050

[email protected]

promoting safety and wellbeing in the home...

Documents