accessible living through home modifications

Accessible Living Through Home Modifications

Gina Arroyo, OTR/L,

Casey Arroyo, Installation Specialist

October 7, 2008

Introductions Received an Associate degree in Applied Science

from Lourdes College in 2001 Worked in TCU, & SNF for almost 7 years mainly

with the geriatric population Received a Bachelor degree in Applied Science with

a focus in OT from The University of Findlay in 2006

Received a Master degree in Occupational Therapy at The University of Findlay in 2008

Owner of CGA Home Modifications in 2007

Introductions Machinist/Toolmaker with 20 years

experience in skilled trades Pursuing an Associates degree in Mechanical

Engineering at Owens Community College “OT in the making!”

Falls – How Big Is The Problem? In 2004, 14,900 people 65 and older died

from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2006).

Outcomes Linked To Falls Many people who fall, even those who are not

injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).

In 2000, direct medical costs totaled $179 million for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).

Who Is At Risk? Men are more likely to die from a fall. After

adjusting for age, the fall fatality rate in 2004 was 49% higher for men than women (CDC 2005).

Women are 67% more likely than men to have a nonfatal fall injury (CDC 2006).

People 75 and older who fall are four to five times more likely to be admitted to a long term care facility for a year or longer (Donald et al. 1999).

Types of Injuries TBI’s and injuries to the hips, legs, and feet

were the most common and costly fatal fall injuries in 2000. They made up 78% of fatalities and 79% of costs (Stevens et al. 2006).

Injuries to internal organs caused 28% of deaths and accounted for 29% of costs from fatal falls (Stevens et al. 2006).

Fall Hazards & Home Safety Issues “I don’t need that yet; I’m not old enough!” As practitioners what have you seen as being

some of the top fall hazards or home safety issues with client’s you have treated in the past?

How have you educated client’s/family members regarding these issues?

What Should We Do? Discuss the benefits of staying active Encourage clients to maintain an active

lifestyle (walking, gardening, & household chores) – mainly just keep moving.

Issue a basic home exercise program. If it is too complicated they will not carry it out.

Provide clients with information on an emergency response system.

Terminology Home Modifications are adaptations to living

environments intended to increase usage, safety, security, and independence for the user. Home modifications are used in conjunction with assistive devices and home repairs” (American Occupational Therapy Association [AOTA], 2005, p. 28).

Home Modifications

Visitability Visitable homes are deliberately designed

with basic access by residents who do NOT have disabilities.

One entrance with zero steps 32” clear passage through all interior doors,

including bathrooms At least a half bath (preferably a full bath) on

the main floor

Universal Design Accessible and barrier-free

living environments for everyone; not just individuals with disabilities.

Aesthetically speaking the environment looks normal and not so institutionalized.

Examples include: lever door handles, countertops at various levels, pull out drawers, 36” doorways, increased task lighting, & 3”-4” step in showers.

The American Disability Act This law was implemented to set guidelines for

accessibility to places of public accommodation and commercial facilities by individuals with disabilities. This act was established in 1990.

CGA Home Modifications tries to install equipment as close to these guidelines as possible. We also recognize that in an existing residential situation ADA standards are not always feasible. There are a lot of factors to consider with each individual.

Aging In Place http://www.youtube.com/watch?v=Dryr2xqc

Gag The “sandwich generation” means that an

adult child is not only caring for their children but are also now caring for their elderly parent.

It may be necessary to make adaptations to the child’s home or to the parents home.

Certifications

CAPS – Certified Aging In Place through the National Association of Home Builders

AOTA Home Modification specialty certification

Home Evaluation You are the professional who knows the

client’s current occupational performance the best.

A detailed assessment will provide the individual who completes the installation with your professional recommendations.

If something is missed it could mean another fall for the client.

Professional Recommendations As occupational therapy practitioners we

understand the course of acute and chronic conditions and their impact on function.

An up and coming trend is home modifications and universal design. We, as occupational therapy practitioners need to advocate our profession and keep these recommendations of accessibility within our scope of practice.

Why? Physicians, and other health care professionals will

continue to value an occupational therapy practitioner’s professional recommendation over a general contractor or handyman.

The CAPS certification and any other certifications are beneficial to contractors who do home modifications for handicap/elderly individuals but do not qualify them to assess an individual or their environment.

Home Mod. Vs. Selling One’s Home In most cases if an

individual prefers to stay in their home it would be more cost effective to modify the home rather than moving.

Simple modifications such as a chair lift can make a home accessible again.

A chair lift also addresses the safety issues that go with climbing stairs.

Professional Installation CGA Home Modifications

highly recommends that any product that is weight bearing should be professionally installed.

Any product that is improperly installed can be very detrimental to an individual.

Accidents caused by improper installation can cause serious injury or death.

Funding “Who’s going to pay for this?” Lifestyle Loan from Toledo Area Credit Union Reverse Mortgage from Wells Fargo Auto-Owners Insurance Gift from children Churches/VFW’s/Eagles Club/Lions Club Contact the Ability Center, the Area Office on

Aging, the Sight Center, and other societies and agencies related to their condition (MS, arthritis)

Funding CDBG – Community Development Block

Grant (The Ability Center) SAH – Specialty Adapted Housing for

Veterans HISA – Home Improvement and Structural

Alterations (Veterans Administration)

Medicaid Waivers Ohio Home Care Waiver Level I Medicaid Waiver Medicaid I & O Waiver Passport As of January 8, 2007 there is a new Medicaid

waiver, the Home Choice waiver that allows individuals to return home after a 6 month stay in a nursing home. Their Medicaid dollars will follow them home.

Be a Patient Advocate

Impact of OT & Home Modifications

Enhances quality of life Supports their functional roles Empowers the individual Decreases falls Decreases burden of care for caregivers Provides a piece of mind for family members

Question How important is your independence to you?

ReferencesAmerican Occupational Therapy Association.

(2005). Occupational therapy practice guidelines for home modifications. Bethesda, MD: Author.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited 2007 Jan 15] Available from URL: www.cdc.gov/ncipc/wisqars.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2006) [cited 2007 Jan 15] Available from URL: www.cdc.gov/ncipc/wisqars.

ReferencesDonald IP, Bulpitt CJ. The prognosis of falls in

elderly people living at home. Age and Ageing 1999; 28: 121-125.

Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006; 12: 290-295.

Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Gary PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997; 26: 189-193.