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Home Safety. Julie B. Manton, Occupational Therapist VA Greater Los Angeles Healthcare System. Fall Prevention Why do people FALL?. Fall Prevention Why do people FALL?… continued. Orthostatic hypotension Bed rail - if not a hospital bed, there are attachable rails.
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Home Safety Julie B. Manton, Occupational Therapist VA Greater Los Angeles Healthcare System
Fall Prevention Why do people FALL?… continued • Orthostatic hypotension • Bed rail - if not a hospital bed, there are attachable rails. • Impaired balance – physical therapy, or exercise classes, such as tai chi can help. • Debility – 1 day in bed could take as long as 1 week to return to baseline • Transfer training - bed, toilet, tub and/or shower & vehicle • Trip hazards - throw rugs, furniture, power cords, clutter, even pets. • Install safety gates & rails by stairs. If not carpeted, use safety strips. • Restrict fluids at night - use bedside commode, urinal, diaper or pull-ups • Consider mattress on the floor – It’s harder to get up from, and a shorter distance to fall, lessening the likelihood of injury.
The bathroom IS the most dangerous room in a home, followed by the kitchen!
And then there was light • Keep the home well lit. • Nightlights or motion detector lights • Be mindful of sundowning.
Medications & Toxins Better safe than sorry! • Keep all medications, sharps, weapons, household cleaners, insecticides, and other poisonous chemicals locked away. • Hot tubs and pools should be fenced off. • This is adult baby proofing!
Bathroom Safety • Grab bars – typically installed 3’ to 3.5’ from the base of the tub or floor of the shower • Shower chair vs. tub transfer bench • Curtain vs. sliding or glass door • Walk-in shower (ideal) • Walk-in tubs (not ideal) • Hand held shower hose • Skid resistant flooring or strips
Bathroom Safety… continued • Raised toilet seats add 4”+/- to the height of a toilet, and come with or without arms. The average toilet height is 14”. • ADA compliance is 17-19”. • Ground Fault Circuit Interrupters (GFCI) were required after 1971. • Water temperature should be set to below 120 F (48.9 C).
The best kitchen safety practice is - SUPERVISION! • Stove/burner safety knobs or removal of knobs. • Appliances with a • Disconnect garbage disposal or use a cover lock. • Safety latches on drawers. • Secure cleaning products, alcohol & matches. • Artificial fruits & vegetables can become a choking hazard.
Bedroom Safety – Yeas • Monitoring devices, including baby monitors, motion cameras (e.g. Blink), bed, door & window alarms, and/or motion detectors, which activate a light or sound. • Smoking apron – If cessation is not possible.
Bedroom Safety - Nays • Electric blankets & heating pads have the potential to burn those with decreased sensation. • Candles – Unattended are never safe. • Burning incense can cause a variety of health problems, from respiratory issues to an increased risk of lung cancer.
The Wanderer • Keyless window & door locks placed near the top or bottom of window frames or door jambs; • Remove locks from rooms where a person could get trapped, such as the bathroom. • GPS tracking devices – e.g. TrackR, Tile, etc. • Car keys need to be locked away, or the car battery disconnected or removed.
Tr TrackR
Gait/Transfer Belts… continued • Standard Gait Belt Fits Waist Sizes: Up to 51 in. (130cm). • Bariatric Gait Belt Fits Waist Sizes: Up to 71 in. (180cm). • Gait belts come in a variety of styles, such as metal & plastic buckles, with and without handles, washable and Velcro (not the most optimal choice). They too come in numerous sizes. A regular belt will also work.
Gait/Transfer Belts… continued • To be used while ambulating a person with an unsteady gait; • Someone who is a > fall risk, or has a history of falls; • Has weight bearing restrictions (50% or >). • CAUTION: Not everyone is safe to use a gait belt with.
Gait/Transfer Belts – Dos • Position belt around waist, above pelvic bone and below rib cage and breast tissue; • Tighten the belt, but allow for a two finger space between the belt and the torso; • Hold the belt with the palm facing out and fingers pointing up.
Gait/Transfer Belts – Don’ts • DO NOT place belt directly over G-tubes, suprapubic catheters, ostomies, hernias, or recent surgical or incisional sites. • DO NOT use belt with anyone with severe COPD, or a woman who is pregnant (also consider anxiety). • DO NOT place belt directly against the skin.
Which mobility device is appropriate? • Single Point Cane (SPC): • The SPC has one point of contact with the floor. It is most appropriate for someone with a slight impairment in balance, and not a history of falls. • The SPC is also appropriate for use when someone needs to minimally unweight the opposite leg. • The SPC is either adjustable in height or not (wood).
Which mobility device is appropriate? • Quad Cane (QC): • The QC has a rectangular base, with four supports that contact the floor, and have either a small (narrow) or large (wide) base. The QC provides more support than a SPC, and are typically used by someone with hemiplegia or paresis.
Which mobility device is appropriate? • Hemi Walker/Cane: • The hemi walker combines both a quad cane and a pick-up walker. They have a larger base, which provides for more lateral support. The hemi walker is designed to be used by someone with a more severe hemiplegia, yet still ambulatory, or for those transitioning from using a walker to a cane.
Which mobility device is appropriate? • Walkers: • Pick-up Walkers (PUW) are typically recommended for those who are unilaterally non or limited-weight bearing. • Front Wheel Walkers (FWW) have two wheels in the front, and are the safest walking device to use. • 3-Wheel Walkers are narrower, and fit through tighter spaces, but are not as safe as the FWW.
F Front Wheel Walker
Which mobility device is appropriate? • 4-Wheel Walkers with larger wheels are safer than those with smaller wheels. • Rollators have 4 large wheels, hand brakes, and a seat. This is ideal for someone with < endurance, however they need good balance and cognition. Some rollators come with a basket. An O2 tank holder can be attached. They too come in different sizes: petite, average, tall and bariatric.
Adjustment IS needed • Canes: While standing, grab the cane handle, and have the elbow bent approximately 15-20 degrees. • Walkers: While standing, have arms hang loosely at sides. The distance is measured from the floor to the wrist. • Rollators: Adjust handles to wrist level, the arm should have a slight bend when gripping the handles.
Manual Wheelchair (W/C) • A standard manual w/c is 18” (wide) x16” (deep). • The appropriate size does matter! • If a w/c is too small, it can cause skin breakdown, and if too big, will make it difficult to push. • Typical measurements for a standard w/c are: Hip width (widest part) and add 2” Pelvis to back of knee and subtract 2”
Manual Wheelchair (W/C)… continue • The average height w/c user is 5’10”. Typically anyone over 6’1” needs a taller w/c. • A hemi-height w/c is for someone under 5’2”. • The smallest non customized adult w/c is 16”x16”. • The largest non customized adult w/c is 27”x20”, but be mindful of doorway widths, especially if the home is older, which can vary from 18” to 36”. • Leg rest height is adjustable, and should be to maintain a 90 degree hip angle. • Standard wheelchairs weigh approximately 45 lbs.
Other Wheelchair Options • Transport or Companion chairs are light weight chairs with 4-small casters. These chairs are designed to be pushed by a caregiver. They weigh between15 to 20 lbs. • The Drive Nitro Duet is a Rollator/Transport chair in one. • Ki Mobility has a customized manual w/c, which can be converted to a transport chair, by removing the rims.
Power Mobility • Before recommending a power device, such as a power chair or scooter (not the Bird!), think about: • Cognition – How safe will the user be? If they come to the end of block, and there is no curb cutout, yet they want to cross the street, what will they do? • Vision & Hearing – Are they adequate? • Accessibility into the home – How will they get the device into their home, especially if there are stairs? • Accessibility in the community – How will they get the device from point A to point B?
Power Mobility… continued • Where will they charge it? The batteries (1 or 2) need direct current, and are not to be charged via an extension cord or cheater plug, or left on a prolonged charge. The battery can be removed from the device to charge, but weighs approximately 40 lbs. • Where will they store it? If left outside, it will either be stolen, or damaged by the elements.
Power Mobility… continued • Power chairs are more for indoor use, but can be used in the community as well. • Power scooters are more for outdoor use, as most homes do not have the space to use inside. There are 3-wheel scooters, which have a tighter turning radius, but are more tippy than those with 4-wheels.
Power Mobility… continued • Power chairs and scooters, such as Pride’s Go-Go or Golden Technologies’ Buzzaround scooters, can be broken down into 5 parts for transporting in a vehicle. • The battery is the heaviest part, and weighs approximately 40 lbs. • The other parts are cumbersome. It is doable, but not something anyone would want to do multiple times a day. Having a lift installed on the vehicle is an expensive option, if the vehicle can handle the weight.
Power Mobility Options • Full power • Power add-on (E-fix W/C Power Conversion) Able to still propel the chair manually if desired. • Power assist Wheels (Xtender W/C) Xtenders decrease energy expenditure by up to 45%. Warning: Most users of FULL POWER gain between 40 to 80 lbs in the first year of use.
ID is key • Medical alert bracelet • ID bracelet with phone number • Current photo – Camera on Smart/iPhones • Clothing description • GPS tracking devices. There’s even chipping! • Neighbors can be an additional set of eyes
