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Aging in the Home
by Dr. Oneida Cramer
Barrier free home environments enable the independence of elderly people by helping to keep them living in a residential setting for a longer time. So, as homeowners consider downsizing their present dwellings, they might want to think about an architectural design strategy that will support them when they are older.
?Nothing beats a spacious interior especially in the master bedroom and bathroom,? said Med Tex Staffing Private Duty Care spokesperson, Joel Nugent. ?We have caregivers who have to go in and make the best possible use of space because there may be a hospital bed or a variety of things that are not in a home-like setting.? Sometimes, homeowners, in anticipating their future needs, take down walls or remodel to open up a large bedroom and expand the master bath.
?A Jacuzzi actually helps to relax the bones and increase flexibility,? said Nugent. ?It can really assist in some rehab and healing processes, skin conditions. When you are in pain, you not only physically tense up, you emotionally tense up. A relaxed person obviously will heal better and faster.? Sometimes, a separate shower is as worthwhile as a whirlpool if a patient is not flexible enough to sit down in a whirlpool bath. They may sit in a shower chair in a shower stall.
?The most frequent modifications we put in (a home) are grab bars and bathrooms that allow people to get in and out of the showers,? said Linda Mason, Visiting Nurse Association Group Vice President for the Long Care Aging Nutrition Volunteer Services. ?We also do hand held showers and roll-in showers?modifications to the bathroom where you can roll a person into a shower on a wheelchair or a shower chair. Basically it?s a shower with modifications so you don?t have to lift the wheelchair over (the threshold).? These showers tend to replace tubs if space does not allow for both a separate shower and tub in the room. To be wheelchair accessible, the bathroom should have wall-hung toilets and sinks and, perhaps, a linen chest for storage in place of a vanity around the sink.
Access to the bath requires a doorway wide enough to pass a wheelchair.
?The width of the doorways need to be at least 33 inches, ideally 36 inches so that patients can propel themselves through the doorway,? said Connie Parry, Team Leader on the In-Patient Physical Therapy Service at Parkland Health & Hospital System.
Otherwise, the occupants have to reach through the door and won?t be able to push via their wheels. A standard wheelchair (measured by seat width) is usually 16 inches for an average size adult. Add on the wheel and handgrip and the chair extends to 20-24 inches or more. But people who weigh more than 180 pounds usually go with a wider wheel chair. So, ideally, doorways throughout the house should be as wide as the front entry.
Hallways should also be spacious enough to accommodate two people: for instance, one person on a walker with a caregiver to the side makes the safest situation.
?For the elderly, no fall is a good fall,? said George Miles with CareStaf home health care services. Yet, an older person?s biggest fear is falling, something that can happen if a walker or a sock catches on a scatter rug or tangles in plush carpet. So, the biggest deterrent to falls is smooth unobstructed flooring.
?Carpeting is very difficult to maneuver if you have to use a wheel chair,? Mason said. ?And we don?t want flooring that is so slick to incline someone to slip and risk a fall.?
Thresholds, when the surfaces change from one room to the next, sometimes give individuals problems, according to Parry. Eliminate the little threshold?it?s only an inch or two?but it?s enough for somebody to stumble over.
People need to keep in mind that for every inch in step elevation, wheelchairs need a foot of ramp incline; for instance a six-inch step requires a six foot ramp in order for the person to propel a wheelchair up the ramp, according to Parry. If the grade is too steep, the person risks flipping the wheelchair backwards or just physically not being able to execute the incline. Steps greater than six inches should also be revised because a step that is higher than six inches takes quite a bit of strength to execute, especially in the absence of a railing. In the case of a large entry step sometimes found in older homes, an insert step will limit each elevation to a max of six inches.
?When they talk about being able to get in and out of their home, those railings become important because even though a person may not be in a wheelchair, it may be hard for them to climb stairs,? Mason said. So, having a long ramp with railings is very beneficial to an elderly person with bad knees.
?We strongly discourage a two-story residence, ? Mason said. Some individuals put in elevators and have the disabled person living on the second floor. But when considering rescue and getting the person out quickly, the second story residence disables the process.
Making the kitchen accessible to people with chronic disabilities can be as comprehensive as lowering countertop surfaces and adding bi-level workspace. Yet minor changes can also make a major impact on accessibility and safety. For instance, when purchasing appliances, consider the potential of burns or injury if the control knobs are located across the isles behind the burners rather than in the forefront, according to Mason.
?I would eliminate all gas?like a gas range?or change that to electric because of the possibility (of burns),? said Nugent, who also recommends keeping a fire extinguisher handy.
?Select levers (rather than knobs) for faucets so that you can turn on the water more easily,? Mason said. ?When we do door knobs, a lot of times, we do levers as opposed to knobs because someone who?s got arthritic hands may be unable to grasp the knob and turn it. But that person can push down a lever because it doesn?t require the same amount of dexterity.?
Keypad locks allow the immobilized to open doors, and non-glare lighting with accessible control switches help reduce the likelihood of falls or taking the wrong medication. Other important features include weatherizing the home for winter and taking additional security measures such as installing motion detectors, maintaining a well-trimmed landscape, and using automatic light timers on the home exterior. On the interior, place phone lines and/or panic buttons throughout the house for emergencies.
A number of services, such as Independence Plus Residential Repair through Visiting Nurses Association, are available to assist homeowners with residential modifications.
?We do more than just the medical necessities,? Mason said. ?No one activity will allow patients to be in that home if you don?t provide for a safe environment and accessibility. That?s where we?re headed.?
Dr. Oneida Cramer
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