Knowing when to make modifications to your home usually is not the issue. If you are asking “when” then the answer is generally, “yes, now is the time to do something!” Perhaps a better question is “how many changes do I need to make living easier in my own home?” Evaluate where actual slips and trips, accidents and injuries have occurred (or “near misses” have occurred) most often and you will start to get an idea where these changes need to be made.
While the answer to all of these questions will vary for each person, family, type of living environment, availability of resources (including help implementing the modifications), here are some general principles I offer to guide you.
Making changes without the advice of an objective, third-party (or one that is not related to you) will be filled with bias that can both help you and hurt you. The person with the need for changes in his or her living environment needs someone who will be honest, clear, direct, and diplomatic in the rendering of advice. I remember a friend who was trained as an occupational therapy assistant (and thus well-qualified to offer help) having difficulty convincing her brother about some bathroom equipment that her mother desperately needed for her safety when undergoing chemotherapy. She asked me to do a friendly “home safety assessment” with her family at their home. I was delighted and was able to bring over some sample equipment too. The changes were made, I got to make some new friends, and my friend’s mother felt more comfortable taking care of herself.
Getting the bare minimum of what you need or skimping on the quality of what you need can create more danger instead of relief. The best example is using suction cup grab bars where installation of a permanent grab bar is needed. (For more information please see Res and Rec: Suction Cup Grab Bars.) Another example is using a piece of plywood as a ramp instead of portable metal ramps designed for this purpose. Remember that the most FATAL area of the home is any stairway! Sometimes the simplest place to start to make one’s home more physically accommodating is by reducing clutter, improving lighting (especially in the bathroom, kitchen, and stairways), removing loose rugs, etc.
Making a change for one person in a household must involve more than just the one person for success. Everyone in the home needs to become familiar with the equipment or changes that will be implemented and buy-into the ideas. I remember the home of a patient where the wife did not want to use the raised toilet seat-with-attached-arms that were needed by her husband to prevent falls when toileting. Another wife did not want the toilet modified in a bathroom that would also be used by guests to their home. In yet another scenario, a family member insisted that she would place-and-remove the bathroom equipment each and every time the item was needed by her disabled family member. Look more closely. Can you see the potential breakdowns in all of these scenarios?
I love, love this YouTube video from our occupational therapy colleagues at Entwistle Power Occupational Therapy in Canada for general bathroom safety considerations. Here is a great place to start in asking the right questions for this area of the home that can be one of the most dangerous!
Request from your medical doctor, a home health evaluation from an occupational therapist. If the person in need is not largely “home bound” and thus ineligible for a service that is billable to insurance, it is possible that a local agency will do an evaluation on a private pay basis.
Should you require remodeling or home modifications, check out Home Living Experts and their comprehensive product catalog. There is nothing like pictures of typical modifications to familiarize yourself with the possibilities. And if you live in the Midwest of the United States, then I highly recommend Home Living Experts for the entire project. On the East Coast, start with Shoshana Shamberg of Abilities OT Services and Seminars.
When hiring anyone including a contractor to assist you in your project, consider these recommendations from Home Living Experts. (See their website for more details.) 1. Ask for a minimum of 3 references. 2. Talk to their clients yourself.
3. Contact local associations such as the Home Builders Association (HBA) for qualified professionals in your town. 4. Ask for someone with the right background & credentials (for example Certified Age-in-Place Specialist through the HBA) 5. Ask the contractor/remodelor for references on projects that they were involved in that was $50,000 or more (to see how they handled problems and customer service complaints).
Make the temporary or permanent changes 1) as aesthetically pleasing as possible and, where possible, 2) usable by the person independently.
First, try to match the décor of the room in which the product will be used most often. For other solutions and where safe to do so, draping a coordinating plush towel over the tub bench to warm the seat, choosing a brass finish on the grab bar that leads into the kitchen, or crafting a leather necklace with a pouch to hold a cell phone can make things less hospital-like! Someday adult diapers will come in colorful styles with lacy trim . . . perhaps rock-n-roll themes? You think I am kidding?
Second, research in the British Journal of Occupational Therapy has demonstrated that equipment added that can be used independently by the person in need will most likely still be in use 18 months later. This is especially important for Baby Boomers who are enduring an onging period of illness or recovery. Most of us like to do things for ourselves when we can!
Consider what you will need in the future should the temporary disability continue for longer than expected and plan accordingly. Will there be future surgeries in a year or two? Planning ahead and getting the right equipment or home modifications will often save you money in the long run. This is especially important when making larger investments such as installing a curb-less, walk-in shower or even something as simple as adding dual instead of singular handrails along the steps at the entry of a home. Everyone can benefit from installation of grab bars; universal design can be a key selling feature when selling a home in which accessibility features have been added.
While there are numerous considerations when making home modifications, I hope that these few will get you started on making the best plan for you and your loved ones. For a more comprehensive dawn-to-dusk, room-by-room guide I offer these additional resources:
1) The Safe at Home Checklist from our friends at Rebuilding Together .
2) Follow this blog for Active Tips and more by clicking the “Follow” button.
Take care, Julie, O.T.