Combine Simple Solutions and Advanced Products to Shelter Patients ?from Falls

Though much focus has been placed on safety in the home and eliminating falls, there has still been an increase of accidental deaths caused by falls. According to a Columbia University study, the numbers have increased from 29 fall-related deaths per 100,000 to as many as 41 fall-related deaths per 100,000. In addition to this, falls currently represent 15 percent of re-hospitalization in the first month after discharge. Of the many areas where falls commonly occur, the bedroom is one of the most important areas for home safety and accessibility. Safety solutions in the bedroom should start with the home assessment, which includes not only the environmental surroundings, but also the client’s needs and capabilities as well as those of any family caregiver(s) and home health care worker(s). (See “The 
Assessment Process” in the February 2014 
issue of HomeCare.) Solutions can range from simply rearranging and removing common hazards to the introduction of low-tech assistive products and eventually range into higher-tech assistive and mechanical products. Because the bedroom is an area of the home in which much time is spent, making efforts to keep it safely accessible are imperative. There are often hidden obstacles that create safety hazards, so identifying and resolving them is the first simple step to take. When discussing home accessibility, it is important to consider that those at risk are not just the elderly and those categorized as aging in place, but also the families or caregivers impacted by debilitating disease or injury and their need to establish a safe access and mobility environment in the home. In the case of elderly clients, a full fall assessment and prevention program should be initiated. Each year, thousands of senior Americans fall at home. Many of them are 
seriously injured, and some disabled. Falls are often due to hazards that are easy to overlook but not difficult to fix. A checklist can quickly identify and help remedy those hazards in your home. Some common risks can be addressed by answering the following questions.

• When you walk through a room, do you have to maneuver around furniture?
• Do you use throw rugs to cover walkways?
• Are there typically stray items—
papers, books, towels, shoes, magazines, boxes, blankets or other objects—
on the floor?
• Do you have to step over or around wires or cords (lamp, telephone or extension cords)?
• Is the lamp or lighting feature near the bed hard to reach?
• Is the path from your bed to the bathroom dimly lit?

Ambulating Through the Room

Remove throw rugs and floor clutter that can easily lead to tripping and falling, and make sure no electrical cords are crossing walkways. Make sure all thresholds entering and exiting the bedroom are low and beveled to reduce additional trip hazards. Make sure that the bed is set at the optimum height and that assistive devices are in place as needed.

Daily Activities

Clinical studies show that many falls 
occur during everyday activities; when getting out of bed, entering/exiting a room or getting dressed. To mitigate these hazards, evaluate the safety of the daily activities by asking the following questions.

• Is there a sturdy surface or assistive device next to the bed to aid in getting out of the bed?
• Are light switches and door handles easily reached and used?
• Are dresser drawers easy to open?
• Is there a sturdy chair to sit in when dressing or preparing for the day?

Eliminating these basic risks will 
dramatically increase safety in the bedroom and reduce the risks of falls and injuries.

The Caregiver and Proper Care

When working with clients requiring a higher level of assistance and care, there is a common threat of injury to both client and caregiver. These situations are usually brought on by the caregiver working alone, the lack of an adjustable bed, lack of assistive equipment, crowded and obstructed conditions, which result in awkward positioning and forceful exertions. These situations can be dramatically reduced or eliminated with the use of assistive devices and equipment. Always explore the best combination of products to suit the client’s and caregiver’s needs, while taking into consideration what their future requirements might be. Do not just focus on immediate needs. Low-tech options can include friction reducing devices such as slide sheets and repositioning sheets, gait belts, transfer boards, pivot turn discs, manual standing aids, lift chairs and a range of ambulatory products. High-tech options can include portable products, moveable and non-permanent equipment or permanently installed products. Portable mechanical lifts offer the option of easily being moved from room to room and provide a convenient way to travel. When combined with a mobility device such as a wheelchair, transport chair or stroller, the family can gain a new level of independence and accessibility. Moveable mechanical lifts offer a little less portability, but commonly 
offer more width range and higher weight capacities. While these products can still be moved from room to room when desired, the transportability need would be less prevalent in the family’s requirements. Non-permanent frame lifts will offer more range of movement within a specified room (such as the bedroom) and a higher weight lifting capacity, but can be removed when the product is no longer needed. Permanent mounted ceiling lifts offer the higher range of room-to-room mobility and the highest range of weight capacity. For long-term needs, these products are commonly the best solution for performance, accessibility and cost considerations. The key to bedroom safety and home accessibility is to build a complete understanding of the client’s and family’s needs, and then provide solutions with the products and equipment that can best fill those requirements. Training and understanding for the caregiver is as important as selecting the correct products.