Step Ladders 101

March is National Ladder Safety month and quite timely given the little case study in my recent post (  So let’s chat about the type of ladder most likely to be found in homes and apartments everywhere:  step ladders.

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Since the experts at the American Ladder Institute have all the data, I have included a link to their website below for your reference.  Here are some of their top tips that stood out to me from my experience performing home safety assessments for persons of all ages as an occupational therapist:

  • Inspect the device before each use: Is it clean?  Do all parts work properly?
  • Use the step ladder fully open and locked on a clean, smooth, hard surface.
  • Place the stool in front of you and never overreach beyond the stool when in use.
  • To protect children, do not leave a step stool set up and unattended.
  • Do not store other materials on the step stool while it is in storage.  Fold it up and put it away.

Further, the person using the step latter must have intact balance, leg strength, climbing, vision, and judgment skills to use this piece of equipment safely.  If any of these requirements cannot be met then consider advising removal of the step ladder from the home.  Falls on stairways and ladders can be the most hazardous places inside or outside a dwelling, even deadly, as compared to any other place in the home.  Preventing injury here is generally non-negotiable when caring for loved ones or even in public places (such as with co-workers!).

If items inside the home can only be accessed with a ladder then offer to help the person living there place personal items within reach.  Look around to see if there are things needing repair and assist in addressing them.  While there could be dozens of reasons why a person would engage in risky behavior involving a step ladder, attempt to problem-solve alternatives that you and your loved one can agree upon together.

Take care and happy National Ladder Safety Month!

Julie, O.T.


From:  Ladders 101:  Choosing the Right Ladder at:

Care of Step Stools can be found in the following standards:

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Millennials: the New Caregivers

In her article in the January 2017 issue of HME News, Associate Editor Tracy Orzel brings the Millennial generation into the forefront.  “In 5 more years, they will be buying for their parents,” sites Orzel.  I am taking notes as both a Baby Boomer and Occupational Therapist specializing in home safety!  She explains the trend as follows:

Out of 75.4 million Millenials born between 1980 and 2000, 9.5 million are already caregivers, according to a study conducted by the National Alliance of Caregivers and AARP.

Medical and DME providers will need to pay greater attention to price with up-front estimates than their parents generally required.  “Millennials are also more likely to turn to Google for healthcare information and buy products online first, before going to a doctor,” states industry expert Nashlah Boyayan.  Companies in the healthcare arena need to have a strong online presence but not necessarily one that includes social media; the average Facebook user is now age 40!

“Testimonials and online reviews are key,” continues Boyayan.  “They are based on stories.  As humans we are wired for narrative and so it’s important to use it in your marketing and your message.”

We will be planning for this trending and the needs of both Baby Boomers and their Millennial caregivers as our company develops.  Be sure to keep up with the latest news from Two Step Solutions via our Facebook page and Twitter feeds @twostepsolutions.

Take care, Julie, O.T.



Medicaid and used durable medical equipment

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!