Home Modifications and Aging in Place Design: How PTs Can Help
By Megan Krischke, contributor
Home health physical therapists have the privilege of helping patients adapt to physical challenges or to regain function and reclaim their lives at home after a significant medical event. Changes in physical capabilities may mean that a patient needs to renovate his or her home, or it may require just a few simple modifications.
Whatever the scale of change needed, it is important that someone who understands the patient’s medical condition--and the needs that go with it--speak into the planning process before time and money are spent on renovations. Home health PTs are well-positioned to fill this role.
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“The number one mistake I see people make is that they skip the planning and design phase and just start making changes. Therapists need to be advocates for their patients. Often it is vendors who are offering people advice and there is a conflict of interest there,” remarked Frank Gucciardo, PT, MS, CAPS (Certified Aging in Place Specialist).
The goals of home modification projects
Gucciardo’s firm, Frangeli Consulting & Design in Dix Hills, N.Y., is an evidence-based design practice, which means they account for the medical reality of the client and structural realities of the property and then create a design to meet the client’s needs.
Every redesign project his firm undertakes aims to achieve four things:
1. Maximizing independence for the client with the least restrictive environment
2. Ensuring that reproducible caregiving can happen at the lowest possible skill set
3. Ensuring that both the client and caregiver are safe in the property
4. Maximizing the client’s quality of life
Home health therapists should also consider these goals when they are helping patients think through their home modification needs, said Gucciardo.
Making aging in place improvements
Bonnie Lewis, Allied ASID, Assc. IIDA, CAPS, a senior living interior designer in Scottsdale, Ariz., noted that many people balk at making changes to their home because they don’t want it to feel institutional.
“If the work is done beautifully, however, you won’t even realize that it is there,” she remarked. “I believe that anyone who is over 50 can benefit from making aging in place (AIP) improvements in their homes. Any therapist will know that just one fall can start a downward health spiral for a client. What if we were proactive to prevent falls from happening in the first place?”
Lewis says that one of the simplest changes that can be made to improve the safety of a home is better lighting. As we age, our eyes let in less light. Better lighting not only can help prevent trips and falls, it also creates a more cheerful environment that is good for the emotional well-being of the occupants.
How physical therapists can help
Lewis encourages therapists to speak up about changes that need to happen in the home.
“People are resistant to change and they will have a harder time hearing about the need for change from their adult children. PTs can come in as a professional voice, assess their environment and make recommendations,” said Lewis.
In addition to operating her New Jersey-based AIP Designs business, Dina Leyden, PT, CAPS, is still involved in clinical practice.
“Patients often want to show you what they can do, not what they can’t. So ask them, ‘What do you have to ask for help with?’ ‘What do you want to be able to do without help?’ Ask them to walk you through their daily routines.” she suggested.
A proactive home health PT can help clients find a number of modifications that can increase ease of use. For instance, there are both pull-out and drop-down shelves that can be fitted to existing cupboards. Any PT could walk into a showroom and have an immediate sense of which faucets a client would or wouldn’t be able to use.
“PTs should also be aware of a building concept called universal design. The idea behind it is that the home would be safe and easy to use for people aged 3 to 103,” explained Leyden. “If you know your client is remodeling by choice or necessity, you could encourage them to look into this concept and to explore consulting with an aging in place specialist.”
“PTs do need to be aware of the limits of their own knowledge and expertise,” remarked Gucciardo. “If a patient requires anything beyond moderate assists, it is time to call in the next level of experts.”
All three experts cautioned that, after a medical crisis, one of the quick fixes people turn to is adding grab bars. Grab bars are a great tool, but only if they are properly installed. Home health physical therapists can help clients to recognize the need for professional installation so that the bar doesn’t pull out of the wall in an actual fall situation.
“I’d like to see the heath care community get behind helping people make modifications to their homes. Without the right modifications after an incident, patients can end up back in the hospital and then hospitals lose their reimbursements. Having a medical team advising home modifications is good for the patient and it is good for the hospital,” Gucciardo stated.
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