Care Plans and Home Environments

It is time for the home health care industry to start thinking of the senior as a whole when creating plans on how best to improve his or her way of life.

There are multiple challenges facing discharge planners, social workers, nurses, case managers and families when a patient, client or loved one with physical limitations is released from professional care and sent back home. Challenges consist of managing the senior’s mobility inside and outside of the home, and deciding who will be responsible for the senior’s care going forward. Managing these challenges plays an integral role in ensuring the health and comfort of the senior.

Problems arise when health care professionals and families do not discuss and assess these challenges in one meeting. There is a major gap in developing plans for senior care, as people don’t think about the mobility challenges facing seniors who wish to age at home. Seniors not only need a strong caregiver team, they also need a livable space that possesses minimal mobility challenges.

When we meet with new clients, we perform an environmental scan to see if the space is conducive for a senior who wishes to remain at home. We are specifically looking to identify potential structural and design dangers. Our goal is to help eliminate these risks from the space.

We have found that it is important to have the senior’s family involved during this stage. Making suggestions for home renovations, even if they are minor, can be met with strong resistance from the senior. Having the family’s support can help speed up the process and make the senior more comfortable and confident with the changes. Some of the most common home renovations and improvements to make for seniors staying at home include the following.

• Eliminating rugs. Rugs, which have been known to cause falls, are dangerous to seniors living at home. If a senior insists on keeping the rug, it should be properly taped down to ensure that the corners of the rug can’t be flipped up and that the rug won’t slide. It is best to remove all rugs from bathrooms, as this tends to be a small room that already poses mobility challenges.
   
• Adding an outdoor ramp. This is sometimes the most obvious home improvement, especially if the senior is dependent on a wheelchair or walker. A ramp will make it easier to get the senior to and from doctor appointments, and will increase the likelihood that the senior will get outside for fresh air.
   
• Widening doorways. Homes have varying widths of doorways. Bathrooms tend to have the narrowest doorway, which is a big problem for the senior as there needs to be easy access and enough room for the caregiver to assist properly. If the senior is in a wheelchair, consider widening all the doorways to make getting around the home simpler.
   
• Flattening flooring. Think about the entrance to your bathroom. Is there a door threshold that transitions the flooring from wood or carpet to tile? Door thresholds create fall risks. It’s easy to get rid of a threshold to create a smooth, flat floor.
   
• Inserting grab bars. There should be grab bars in the bathroom near the toilet and in the shower. Both the shower and toilet represent mobility and stability challenges. It might also be helpful to purchase an elevated toilet seat, which will help make sitting and getting up simpler.
   
• Installing a walk-in shower. A lot of falls occur from tripping while getting in the tub or from slipping on a wet floor. Seniors can’t be expected to step over the tub wall each time they need to bathe. This movement is hard to do, especially when the right support, such as grab bars, is not present.
   
• Having two railings. In homes with indoor staircases, it is usually common for there to be only one railing or banister; however, in senior homes, there should be two—one on each side. With this method, the senior will have stability support on both sides. Similarly, implement two railings on the sides of the senior’s bed. Not only will this prevent the senior from falling out of bed, but the railings can provide support to her as she moves to get out of bed.
   
• Taping down cords. In our technology-driven culture, homes are filled with all sorts of gadgets and tools that require cords and wires. These have also been known to cause falls. It’s important to eliminate cords when possible. For example, instead of having a phone with a cord, replace it with a cordless phone. For Ethernet cable or other cords, securely tape them to the floor or run them along the ceiling so they can’t get stuck around the senior’s foot when walking.
   

Many of these home modification recommendations have to do with the bathroom and general living space, as these are the most common places for the senior to be. Depending on the senior, lowering the kitchen countertops to make cooking and preparing food simpler might be necessary. Often, seniors get to a point where they are no longer capable of preparing their own meals, which is one of the many reasons caregivers are needed for seniors aging at home.

It is important to alter planning for senior care to include all areas of aging. As discharge planners and other health care professionals prepare to release a senior patient, they should ask the family questions not only about future care plans, but also about the home environment and the possible health risks and dangers associated with the space.