Transcription:
Occupational Therapy in Home Care. Part 2. Tips for Home Safety

Caitlin Whyte: Being safe at home isn't something many people think about in their day-to-day lives. But in episode two, in a three part series on occupational therapy, we are going to explore ways to make your home safer. Joining us again for this series is Nicole Federman, an occupational therapist at Upland Hills Health. This is the Inspire Health Podcast from Upland Hills Health. I'm Caitlin Whyte. Well, today we are going to explore ways to make your home safer, and often events that challenge our independence are accidents in the home. Falls and fires are the first things that come to mind. Is this year experience too, Nicole?

Nichole Federman COTA, CLT: Yes, being safe at home is like absolutely crucial for remaining in your own home. Therefore, being open to interventions and strategies to reduce safety, hazards must be addressed in order to remain safe as possible. So it can be difficult to see any other options when all you or your loved one is seeing our experiences as like that difficulty of those normal daily tasks. And it's hard to get past. Like, what can I do? So OT comes into play here because it can help bridge those gaps. Having the right tools can make a world of difference and occupational therapists are excellent at finding them as well as training to use these interventions safely and properly.

Caitlin Whyte: Absolutely. Well, let's go through your recommendations for a home safety checklist.

Nichole Federman COTA, CLT: Okay, so in this checklist, I'm gonna stress that these recommendations really do depend on the person's individual needs. So there are a lot of them, but I always tell people when I'm giving recommendations, if you take even a couple of them, and we always stress the most important because it is very, it can be overwhelming for patients. So I just wanna stress. All of these are dependent on a patient's individual needs. So the first thing you wanna do is, I tell individuals carry a phone. A lot of people have their cell phones now, so carry a phone with you at all times. And if there's not a phone or an ability to do that, we really stress to consider what's called Lifeline or a Life Alert system, which would be an emergency type button that you can push.

So that's one of the big things that we look at. Those life alert systems, where like if you fall and you're unconscious, you can't call somebody for help, but it, some of these systems have trigger system on 'em where if you fall, it's triggered by the fall and then it calls for help automatically. So that's one thing that we like to talk about every time. And then going through each area in the home as far as entries and hallways. We really try to look at every area in the home, so ensuring that good lighting outside your entrance, going into your home, center lights to automatically turn it on or off.

Choose an entrance to minimize the stairs to so you can navigate, especially with an assisted device. If you have damaged or broken steps, try to get those repaired or unsafe pavement leading into the home. Especially if you're using assistive device such as a locker, you can mark the end of steps or thresholds with contracting tape or even paint color to increase that awareness of the change in height. Consider adding a handrail at least on one side, but ideally it's best to have them on each wall. Removing throw rugs or the use of, if you're not going with the flow rug when entering your home, you can use carpet tape along those edges.

You can have carpet stretched coming into an entranceway. So if you stretch it, it removes those wrinkles and bombs. Also having Industrial type mat that's heavier is better than a flimsier type rug. I would recommend that over even using the carpet tape. Making sure those paths are wide, especially in that high traffic area of your home, to ensure that the walker fits through those doorways. So that's our entries and hallways entering into a living room. Again, we. Remove scatter rugs as much as possible and eliminate clutter on the floor surfaces. So place stuff on shelves or storage.

I know it's hard a lot of times for us to think about removing things from our home. So if you think about donating an item, someone else is able to use that. So if you don't use it anymore, try to donate it or get it out of that area. Run cords behind furnishings. Only use extension cords as needed. So sitting in chairs that keep your knees lower than your hips. And by that I mean if you are sitting where your hips are lower than your knees, it's probably too low of a chair. And that's more difficult to get out of. So risers can be used to elevate your favorite sofa or chair because no one, they go in and these chairs are, they've been there and if you ask someone to remove that chair from their home.

So there are options for that too. There's lots of things out there, even building a platform. We've had families build platforms under these chairs to raise those chairs up so they can, a person can continue to use their favorite chair. Adding just a foam cushion or a folded blanket to the seat if you need to raise yourself up. A lot of times chairs are very deep for people and it's difficult to get out of them. So adding like a small pillow or a blanket roll behind your back if that chair is too long also helps. You can add a good old clapper light switch, control to lamps, or nowadays we have smart lighting that you can turn off and on lights with your voice.

So rearranging furnishings too, to allow quick access to a wall switch or lamps or window shade so that you can open the window without having to squeeze behind something and risk that fall. Moving coffee tables if it's in the path of seating and using a walker, that's a big one. Having to move that either if we can make it wide enough, but sometimes it has to be removed right from the area so that you don't have to go sideways to your area of seating. In the kitchen, cabinets that are too high or too low, we try to educate on moving those items to shelves that are closest to the counter.

It depends on the person's level of reach or bend, of course, but we wanna try to get things within kind of like from your chin to your waist height. For that safest reach and then we, you can add hooks to the walls for pots and pans that you frequently use so that we avoid using a step stool at all, or even having to go way low in the bottom of cupboards to get those pots and pans, making sure that counter space is available and clear clutter. Just so you have a space to work. So moving a kitchen table, sometimes closer to the counter for that additional workspace helps.

We've recommended removing the leaf if it needs to be. So you can move between the table with your assistive device. And other times we've actually recommended to move it closer to the wall to allow the ample space for the walker. So it just depends again on the configuration of the home. We've had rolling carts to add workspace that we can put in the center of kitchen, so you're not having to move something if you have a large kitchen from the counter all the way over to the table. So you've got that place in the middle for transporting goods, changing a door on the fridge.

The opposite side is appropriate for access, and that one is comes up so often that we just go in and ask them to have the per them switch the refrigerator door to the other side so that when you're opening it, it's accessing towards a countertop and not towards the wall. Something simple as getting out that gallon of milk. So that comes up quite a bit. Again, removing scatter rugs, especially if you're using assistive device. You can have a standing mat at the kitchen sink. Those are usually pretty durable. They don't fold up as you walk across them, but that helps if you're doing a lot of counter work.

So lighting, we have people increase wattage of bulbs to, to the allowable level of course. And we have added counter lighting. Under counter lighting. So if you have pets, so for that kitchen area, because you're moving around a lot when you're making meals and doing things like that. Sometimes adding a pet gate while working in that kitchen or even putting the animal, I mean, if it's an area where they can be outside or in their animal crate, it just depends on the person and how they feel about that. But we've made those recommendations.

If it's a safety concern of the pet being under your feet. So moving on to the bedroom. Again, eliminate clutter on the floor. Our bedrooms get kind of tight. We have usually smaller pathways. So keeping cords out of those pathways we run into, again, having, we've recommended having the carpet stretched or if it's a huge concern. We've asked them to remove carpet if needed, depending on if. They're using a wheelchair and it's hard to wheel into that bedroom. Maybe changing that floor space altogether.

So that is something in the bedroom that is important, especially when you're getting up at night to go to the bathroom. You don't want those uneven floor terrain there. So again, removing scatter rugs, but a lot of people want a rug at the side of their bed, especially if they don't have carpet. So again, a little bit of carpet tape or that heavy duty, low pile utility mat with that non-skid back because that helps when getting outta bed from that slippery floor surface. And something that we will have individuals do to stay safe at night.

Adjusting the height of the bed. It depends on, of course, the person. But many times the bed is too low. So again, there's bed risers or blocks that you can put below a bed frame to raise the height if the bed is too high. Cause many times we're seeing these very high mattresses and whatnot. We have had people remove the bed frame or just the caster wheel. They can be at a better height and not risk slipping off the edge of the bed. A lot of times they're agreeable to go to a lower profile mattress or box spring, the lower profile box springs as well.

So there's lots of options. Making sure actually that you place cordless phone or a cell phone next to the bed or during naps, or again, if you have that life. Don't take it off and sit on the nightstand. Those are made to be on. Many times we hear about a fall and the person's life alert was hanging on their bed post or sitting on their nightstand. So you wanna leave those on. They're worried about them going off, so they're made to be worn. So we stress wear them. Placing a couple night lights in the bedroom just to light up the room. Again, we always say kind of have a nightlight in the hallway, but people are using smart lights now.

So that might just be the thing where you say, Alexa, light on just to get up and go to the bathroom. But night lights are a very affordable fix to that. So just having a couple nightlights to light your way out of the bedroom into the hallway. And then once you are in the bathroom, many people just leave a small light on in the bathroom. Placing items on a bedside table or using that touch lamp again as the lighting that can be something too. Using a half bed rail that can slide between your mattress or backs string really does help for a person having trouble getting out of bed.

Once we fall asleep at night, many times we skip an up. It just again depends on the person, but having that bed rail to help them get up out of bed at in the middle of the night has definitely been a good safety major for people getting out of bed. For the staircases again, and sugar lighting, we staircases can be really dark and then it's hard to see as you're trying to advance up the steps if you miss that step. So in adding at least one railing to the entire length of the wall. Of course it's ideal on both sides. Eliminate the clutter. Don't place items on the steps. We see that all the time, so try to keep items off your steps.

I know we're gonna put 'em on there to go up the steps, but, oh man, I'm sure that everybody can relate to at least one fall slip or trip, you know? So keep things off the steps. Having others carry large items for you. But for smaller items, I mean, it can be as simple as just using a grocery bag or any kind of bag. Not huge, but me might have to make another trip using a bag. So you can place it up on each step. So as you go up, you place the bag, up the step, and then you pick it up at the top before stepping up. You wanna be able to have your hands on that rail.

Just placing it up three steps, taking a few steps up, placing it up, three steps. That makes a big difference. And for someone that wants to just take their shoes upstairs at night and putting them in a bag. Because I, they always say, oh, I can carry them. And I'm like, Nope. Put in a bag. Cause if you drop one and you startle yourself, what can happen? So the bag works really well. And then even adding adhesive stair treads to it just depends on the type of steps. So that would be like our staircase area. Going into the bathroom, that's one of our other, bathrooms and kitchens are two of our biggest areas that we look at.

So removing those bath rugs that don't have non-skid bottoms. So if they don't have a non-skid bottom, we are like trying to get that out of there right away. And people say, well, I can just hang it up until I use it for the shower. And that's like the last place we want it when you're stepping out of the shower. So we always try to recommend getting the non-skid bottom. So, Having the grab bars, you can add, grab bars in so many different places. So that, again, is very detailed and that's something that occupational therapy will help with on where.

And then also when we choose those places, the family we work with, the family on them working with a carpenter or who or plumber, whoever's going to do that work for them. Because a lot of times we have issues of where they are. So, we start out with where we want them, and then we go from, there is again, a process and we're often working with other members of the team. Getting grab bars next to the toilet wall or a safety toilet, safety rails that can attach to the back of the seat of the toilet.

They screw into the toilet. Those are definitely safer. The ones that come down and run to the floor are a little safer than the ones that just sit underneath the toilet seat. So again, that's something, it depends on the configuration of the bathroom. I've had to recommend both, and we look at that very individually. So getting a raised toilet seat or some people just opt to put in a higher toilet. Because there's the higher toilets out there. So we go, we look at those things and then adding that rubber bath mat or adhesive, non skid decal to the bottom of the tub.

And again, that just depends on the tub surface, but almost every tub that's put in our shower system has some kind of textured surface, but many times they're still very slippery. So a lot of times that can be a challenge because it's hard to get things to stick then to that surface. So you look at that as well on an individual. When you're walking in the shower, just adding a tub or a shower chair along with grab bars for those walk-in showers, a lot of times you sit down and they're slippery and the soap gets on them and people feel like they're scooting off of them.

So we just adjust the front legs of the chair to one notch higher, and that helps keep a person's tips back in the chair to avoid slipping off. Just something that people find really handy and just adjusting it one knot makes a big difference so you don't feel like you're gonna slide off that. So removing clutter from the floor, there's those slim three drawer rolling carts that we've asked people to consider that can be used between a toilet or, and a wall or even a vanity. Just so there would, again, it depends on the configuration, but it reduces that fall, that person bending to pick something up.

We've had people place just a simple 3M hook. Close by to get their towels or their clothing from there so they don't have to bend and pick things up. Something as simple as using a shower proof versus a wash cloth with pump soap. The pump soap goes a long way versus your bar soap where you have to re soap onto that washcloth. So a person that has to really conserve their energy and have a diagnosis that they need to practice that energy conservation, a shower poof the mesh ball that will have the soap and you can make it through your whole shower, and you don't have to re soap and rinse the wash cloth every time.

So you're just making it easier for yourself and saving some of your. Using a lightweight foam, like non skid net outside the shower, those usually stay on the floor pretty well, so they can be easily picked up instead of some of these heavier rugs. So if a person is at risk for bending to pick up their rug, or they need to use a device to pick it up, we found that those work really well. We ask people to consider Terry Cloth robe or using small bath towels for drying themselves. And again, these are our individuals, but it's just, it's tiring to shower. Sometimes it can be really tiring and also reasons why people don't wanna get in that shower. So using small bath towels.

Less work of having to manage that large towel or using a Terry cloth robe and letting it kind of absorb some of that, that water before getting dressed. And then when we're sitting in the shower, then we look up and, oh, all our soap is too high. So we just work on hanging those shower caddies lower. It makes a difference just to bring things down so that person doesn't have to stand up to get the soap back out of the shower caddy. Hanging over the shower. Replacing those turned faucets. That can be hard, especially our patients with a lot of arthritis or any kind of weakness in their hands, just with a lover style. If it's able and if they're willing to do that, that can make a big difference in the shower as well. So that would be all the areas of the home that I can think of.

Caitlin Whyte: Well, that is a pretty comprehensive list of all the rooms in someone's home. And as we wrap up here, not much more to cover, but at the beginning of this conversation, you mentioned two things that caught my attention that I just wanted to go over quickly. You mentioned the need to be open to these interventions and then training to use the intervention safely and properly. So can you dive into that a bit more? Why did you mention these two things?

Nichole Federman COTA, CLT: Okay. I guess I mentioned those because one of the challenges for therapists in home care is we try to go in and not, I'm not gonna do that all on the first visit, obviously. It's very overwhelming. So we try to open to start with a couple of recommendations at time and really encouraging the person to be open to the interventions and we don't wanna overwhelm them, but it's, if you're not open to those interventions, And you're not open to being trained and using them or getting them while we're in there for service, it's really difficult for us to make sure that you're gonna succeed.

So one, if you can be open to intervention and even something as simple as, okay, we recommended a tub transfer bench over a shower seat so you don't have to step over your tub. But if you're not willing to obtain that and we only our plan of care is at a certain point and I can't, it's just difficult. So that's why I say that we wanna be able to do the most we can in the amount of time that we're with you.

Caitlin Whyte: Well, another episode, shockful of Information. Thank you again for being with us, Nicole. If you would like to work with an occupational therapist, start by discussing this with your doctor and ask for the home care staff at Upland Hills Health. It's important to know that you have a choice. So if you want to work with Upland Hills Health, you may call them directly at (608) 930-7210, or you must ask for Upland Hills Health by letting your provider know Upland Hills Health is your preference. You can catch episode one of this series covering the basics of occupational therapy. And stay tuned for our next and final conversation on bathing and showering. This has been the Inspire Health Podcast from Upland Hills Health. I'm Caitlin Whyte. Be well.