presentation 216 antoinette verdone home accommodations for als_ no contractor required_handouts

Antoinette Verdone, MSBME, ATP

ImproveAbility, LLC 1

Home Modifications No Contractor Required

Antoinette Verdone, MSBME, ATP ALS Clinical Conference

November 2014

A Little About Me •  Rehab Engineer •  15 years experience •  5 years with MS Dept of Rehab •  5.5 year with ALS Assn of NYC •  4th year in private practice in TX

•  ImproveAbility, LLC

Where did this come from? •  Working with clients with ALS, after

working in a state where structural modifications were funded.

•  “Traditional” home modifications are usually not possible/practical for clients with ALS. – Expense – Time – Temporary Need

Where did this come from? •  I realized that this information could be

beneficial for other situations as well. – Other progressive/changing disabilities

•  MS, Huntington’s Disease, Parkinson’s Disease – Straight out of rehab

•  Acute Stroke, or TBI/SCI – Apartment living – Temporary housing –  In the process of doing real home mods

•  Loan Programs

At Every Home Visit… • Smoke Detectors • Emergency Exit • Notify 911 • Method to Call for Help

– Personal Emergency Response System

– Alerting system inside home

Personal Emergency Response Systems



Wireless Doorbell: Alert Inside Home Assessment – Questions to Ask

•  The flow of your assessment really is very dependant on the goals. – With ALS it is a touchy subject. – Try to take the approach of presenting

options. – Lets only do this once.

Assessment – Questions to Ask

•  This is a problem solving mission. – What are the goals?

•  Is moving between floors necessary?

– What are the obstacles? •  Only half bath on main floor.

– What are the constraints? •  Family does not want to do permanent changes to

the home. •  Client has condition where functional abilities will

decline/improve.


•  Focus of the assessment should be to gather as much intel as possible.

•  Try not to give rush recommendations.

•  New solutions every day!

•  24hr rule.


•  In general, I start with – “How are you doing this right now?”

•  In some cases, you may want to have the client perform certain transfers/maneuvers in front of you to understand the problem fully.


•  Focus on: – Getting in/out of the home. – Using the bathroom. – Taking baths.

•  Access to other items is not a goal of this type of evaluation.



Assessment - Recommendations

•  Take time to lay it all out and come up with solutions.

•  I feel very strongly that the client/family should be given a report in writing detailing options/recommendations.

•  Often there are multiple solutions, and this can overwhelm the client/family if not presented in an organized manner.

Assessment - Recommendations

Make your life easy!

Measurements

•  Because we are not talking about “real” home mods, you do not have to go crazy with the measurements.

•  A picture is worth 1000 measurements!

Critical Measurements •  Entry Doors

– Don’t forget Threshold. •  Inside and Out

– Be aware of grade.

Threshold

Landing

Critical Measurements •  Doorways

–  ADA – 32” clear width, 30” ok –  36” doors preferred –  Screen Door

•  Hallways –  Minimum 36” –  48” preferred –  Note “pinch points”

•  Thresholds –  Anything over ½” should be ramped. –  “Get level” when measuring.

If your client is currently in a wheelchair, then they

can just show you the problem spots.

Critical Measurements •  Bathroom

– Door Threshold •  inside and out

– Tub •  Tub Doors? •  Height of Tub Edge

– Shower Stall •  Threshold – inside and out •  Size of stall – built in seat? •  Type of door

•  TAKE A PICTURE



Critical Measurements •  Bathroom

– Door Threshold •  inside and out

– Tub •  Tub Doors? •  Height of Tub Edge

– Shower Stall •  Threshold – inside and out •  Size of stall – built in seat? •  Type of door

•  TAKE A PICTURE

Critical Measurements •  Toilet

– Height of Toilet Seat

Questions about Assessment?

•  Ramp – Modular (removable)

Getting In/Out of Home

Getting In/Out of Home •  LIFT – There are portable versions

www.adaptivelifts.com

Getting In/Out of Home •  Ramp/Lift Alternative – Stair-Trac

http://youtu.be/8xAa4LBocYQ



Doorways •  Thresholds – more then ½” should be ramped.

•  www.safepathproducts.com (manufacturer)

Doorways

•  Offset or Swing-Away Hinges

Doorways

•  Door Opening

IR and RF Available ↑

•  Answering Door

Doorways

www.optexamerica.com (manufacturer)

•  Answering Door Doorways

www.ring.com www.lockitron.com

Transferring Client – Hoyer Lift Alternatives

•  Hoyer/Ceiling Track Alternative Voyager/EasyTrack




•  Hoyer/Ceiling Track Alternative Voyager/EasyTrack


•  Hoyer/Ceiling Track Alternative

www.liko.com

Grab Bars Grab Bars

Grab Bars •  Super Pole

www.healthcraftproducts.com (manufacturer)

Bathroom - Fixtures

•  Hand Held Shower – with on/off

www.dynamic-living.com



Bathroom – Toilet Access

•  Raised Toilet Seat

Seat with Arm Rests Attached↑ Seat Without Arm Rests↑ Not Recommended


•  Raised Toilet Seat

Seat with Arm Rests Attached↑ Seat Without Arm Rests↑ Not Recommended


•  3-in-1 Commode


•  Toiletvator


•  Toilet Seat Safety Frame


•  Bidet



Bathroom – Tub/Shower

•  Shower Seat/Chair


•  Tub Transfer Bench


•  Tub Transfer Bench - Sliding


•  Tub Transfer Bench - Sliding

Roll In Shower Alternatives

www.myshowerbuddy.com (manufacturer)







Roll In Shower Alternative

MultiChair – www.nuprodx.com


MultiChair – www.nuprodx.com


www.pviramps.com www.guldmann.net

No Bathroom Access

•  Bed Bath Products

EZ-Bathe EZ-Shampoo EZ-Shower

No Bathroom Access

•  Portable Shower System - FAWSsit



No Bathroom Access

•  Portable Shower System – LiteShower

Trade Off

•  There is a trade off – Often giving up independent usage

•  Some options more expensive – Portable Ceiling Track – Toilevator?

Funding •  There is not a lot of good funding

resources out there in general for home modifications.

•  Some of the more basic items are inexpensive – swing away hinges, grab bars

•  Most of the products highlighted here are not covered by insurance

•  These products don’t fit into “home modification” funding sources

Funding •  Sources of Funding

– Long Term Care Insurance – Vocational Rehabilitation – Veterans Administration – Grant/Loan – Rural Development – Local Community Block Grants

•  HUD – Residential Rehabilitation

– Loan /Recycling Programs – Disease Specific Organizations – Patient/Family

ImproveAbility, LLC •  Full service AT consultants. •  Home Mods – can give general

recommendations and/or create space plans and specifications for contractors.

•  Will travel and/or provide evaluations via phone/video chat.

•  When in doubt, just give us a call!

Resources

•  Sign up for my monthly newsletter: – http://eepurl.com/epp-M

•  Visit my blog – http://improveability.wordpress.com/



ImproveAbility’s Remote Assessment

•  We can provide an assessment for client’s.

•  Fee - $250 •  Client/Family/ALS Contact responsible for

completing home assessment form and providing pictures.

•  We provide recommendations/suggestions and additional information.

•  If client wants to do structural changes, we can provide specs and drawings for an additional $250.

Sample Recommendations (No Structural Changes)

ALS Home Assessment Form Recommendations

Patient’s Name: Herb Agrell Date of Home Visit: 10/13/10 Date of Report: 10/21/10 Address of Home Being Assessed: 131 Ruth Street, West Islip, NY 11795 IMPORTANT NOTE: All recommendations in this report are made with total accessibility in mind. With ALS, it is difficult or impossible to know what the future will bring, but hopefully, these recommendations will be helpful for planning. Some of these products or suggestions may not be needed at this point in time. All of the recommendations are made at this time so that options can be considered. All recommendations are made with the perspective that no matter what your physical abilities are, you would be able to access your home. It may take a considerable amount of time to implement some of these recommendations, so it is important to act now so that your home will remain accessible to you. Emergency Contacts: It is recommended that you verify that all of your smoke detectors are in working order. Please have an emergency evacuation plan in place. You can contact your local fire department for assistance with making an evacuation plan Notify your local emergency response agency that there is a person with a disability living at your address.

Patients with ALS should always have a way of calling for help. Please consider purchasing a personal emergency response system, if you have not already done so. Moving Between Floors: WILL Since the long term plan is that the patient WILL NOT be moving between the floors of the home, the following things should be addressed: We discussed that you may consider a stair lift to make getting up/down the stairs inside the home. You must understand that this is a temporary solution. But, in your case, this is the only way to access the bathroom. At some point you may need to consider bathroom alternatives and live only on the main floor of the home. See the attached sheet for stair lift companies to get some estimates on prices for stair lifts. This will help you to determine if this is something you should consider. Entrance to Home: To enter your home at the back door, you have 11 inches to accommodate.

A ramp could be installed at this entrance. It would need to be at least 11 feet long. A ramp cannot be installed at the entrance to your home.

Explanation/Further Information: In addition to an 11-foot ramp, you will need a level landing at the door. This can be accomplished with a metal modular ramp. Also, the door at the back of the home will need to be modified such that you have a MINIMUM of 32" clear width to go through the doorway. A standard 36" swinging door will provide sufficient space to enter/exit the doorway.

ALS Home Assessment Form Recommendations

Doorways and Thresholds: Notes about Doorways/Thresholds: All doorways that do not provide 30" CLEAR WIDTH should be noted as possible problems for wheelchair access. Also, any threshold more than 1/2" should be ramped. Bathroom Access:

It is recommended that you purchase a hand held shower. The hand held shower should have on/off control on the handset. Additional Bathroom Access Recommendations: YOU SHOULD REMOVE THE TUB DOORS AS THEY ARE A SAFETY HAZZARD. We discussed the use of a Tub Transfer Bench - see attached sheet. We currently have standard and sliding Tub Transfer Benches in our loan closet. Please let me know if you would like to try one of these. We also discussed a seat for you to use while shaving. We have shower seats that are height adjustable, up to 21", which you could use to sit on while you shave. Again, let me know if you would like to try this. Recommendations Regarding Toilet Access: We did discuss raising the toilet seat using a toilevator - see attached sheet for more information. We also discussed the use of a Super Pole (see attached sheet) to help with bathroom and bedroom transfers. Additional Recommendations: I have attached information on funding for home modifications. If you qualify for any of these programs they may help to pay for the ramp and/or stair lift. I have included information on the Tub Slider and the FAWSsit shower system for your information.

I know this is a lot of information to take in, but I wanted to address everything that we talked about during our visit. If you have any questions or concerns, please do not hesitate to contact me. Any questions regarding these recommendations should be directed to: Antoinette Verdone, MSBME, ATP Assistive Technology Specialist The ALS Association Phone: 212-720-3054 Email: [email protected]

Case Study – Structural Changes Case Study – Structural Changes

Case Study – Structural Changes



My Contact Info ImproveAbility, LLC


512-522-1705 (voice/text) [email protected]

www.ImproveAbility.com

presentation 216 antoinette verdone home accommodations for als_ no contractor required_handouts

Education

home assessment questions

assessment recommendations

traditional home modifications

atp improveability

real home mods loan

atp als clinical conference

tx improveability

als assn of nyc