Home Safe Home

As the elderly population in the U.S. moves increasingly toward living out their lives in their own homes, safety issues in and around their living spaces are rising to critical importance.

One-third of adults ages 65 and older fall each year, according to the U.S. Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. That rate increases to half for those older than 80. Half of those falls happen at home, causing moderate or serious injuries, such as fractures or head traumas in 20% to 30% of incidents, according to the CDC. Every 35 minutes, someone in that population group dies because of their injuries, the CDC reports.


OTs Step In
Occupational therapists can be proactive in helping the elderly and their caregivers make their homes safe, according to Grace S. Fisher, OTR/L, EdD, a professor in the occupational therapy department at Misericordia University in Dallas, Pa. “We usually don’t see this patient group until after they have fallen,” she says. “Our goal should be to get to them so the accident doesn’t happen.”

Proven interventions that can reduce home falls and accidents help older adults live better and longer, says Pamalyn Kearney, OTR/L, MS, assistant professor and vice chairwoman of the department of occupational therapy at University of the Sciences in Philadelphia.

“When I walk into a home, I’m primarily looking at tripping hazards, lack of supports in areas such as stairways and in the bathroom, lighting, location of smoke detectors and how the older adult performs his or her everyday activities,” Kearney says. “It is important to look at how the individual performs daily activities in the home environment so that recommendations and modifications are matched appropriately to the individual’s habits and routines.”

To help OTs make a detailed account of home safety when visiting their clients, Fisher and her graduate students have spent the past five years creating and testing their Cougar Home Safety Assessment (named after the school mascot) — a 78-point checklist designed specifically with

OTs in mind
“We routinely assess patients’ performance in the home — how they get out of chairs or use the stairs — but we needed a tool to indicate all the features a home should have to be safe,” Fisher says.

Using a thermometer, flashlight, reaching stick, pen and a copy of the assessment, OTs can go through their patients’ homes, escorted by the resident or a caregiver. Questions on the assessment are answered through observation, testing of certain home items and talking to the resident. The Cougar Assessment is broken down into eight safety topics: fire hazards/carbon monoxide; emergency/medical; electrical/water temperature; flooring in hallways, kitchen, bedroom, bathrooms and closets; storage areas; parking areas; entrances; and disaster preparedness.

New Ground for OTs
To validate the content, the assessment has gone through numerous surveys and studies conducted by Fisher and her graduate students, she says.

Now in its fourth version, the assessment can be downloaded from the Misericordia Occupational Therapy Department’s website. Students and OTs update the assessment as they discover new safety issues, Fisher says.

“The Katrina hurricane disaster got us thinking about disaster preparedness, like having a bag packed and water and food stored, which led to adding which room should be used for a safe room for tornadoes,” Fisher says. Other recommendations that have been added include checking for carbon monoxide detectors and fire extinguishers on each floor — areas not typically addressed by OTs.

Often homes are not built with safety in mind, says Linda Lebovitz, OTR/L, MPH, founder of Safe At Home, a home assessment service based in Denver. “All those cute decorator touches are pretty to look at and hard to live with in everyday life,” Lebovitz says. Everything including throw rugs and sunken living areas or bedrooms can be disastrous for the elderly, she adds.

A 2007 study published in the Australian Occupational Therapy Journal found 44 elderly homeowners had nearly six safety issues apiece after their home safety assessments. These included lack of functional carbon monoxide detectors, fire extinguishers and smoke detectors on every floor; throw rugs without nonslip backs; lack of properly installed grab bars or stable surfaces near bath tubs and toilets; lack of nonslip surfaces in and around tubs and showers; no emergency numbers near phones; tap water temperatures hotter than 120 degrees; and cluttered walkways in parking areas and entrances.

Modification Costs
Finding funds to add ramps for stairs or walk-in showers can be difficult for the elderly, says Kearney, who specializes in home environment evaluations and has worked with the Philadelphia Corporation for Aging and Rebuilding Together Philadelphia, which provide financial assistance to help the elderly refurbish their homes for safety. “A lot of our seniors are on a very limited income,” she says.

Kearney recommends OTs check into their local Area Agencies on Aging or Rebuilding Together affiliates for funding or resource help for the elderly to make their homes safe. Eligible older adults also may want to consider joining a local Program of All Inclusive Care for the Elderly, which may provide home modifications as part of its services.

She also advises OTs to let their patients know many modifications can be made for little or no cost. “An older adult can get a tub safety bar at Lowe’s for $25 and have a family member with home-repair skills install it,” she says. “Changing light bulbs to CFLs or the new LEDs or turning down the water heater should end up saving the clients some money on power.”

Unfortunately, reimbursement for home safety assessment is not covered by Medicare unless it is part of treatment, says Lebovitz, who charges $150 for a 90-minute home safety assessment. “Most assessments happen after the fact,” she says. “Medicare doesn’t pay for any prevention in this area.”

Fisher recommends OTs become involved with local churches, health fairs and other community organizations to reach out to the elderly for home assessments — before they see them as their patients after a fall.

(Source: Today in OT)