Post on 13-Jul-2015
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 1
Home Modifications No Contractor Required
Antoinette Verdone, MSBME, ATP ALS Clinical Conference
November 2014
A Little About Me • Rehab Engineer • 15 years experience • 5 years with MS Dept of Rehab • 5.5 year with ALS Assn of NYC • 4th year in private practice in TX
• ImproveAbility, LLC
Where did this come from? • Working with clients with ALS, after
working in a state where structural modifications were funded.
• “Traditional” home modifications are usually not possible/practical for clients with ALS. – Expense – Time – Temporary Need
Where did this come from? • I realized that this information could be
beneficial for other situations as well. – Other progressive/changing disabilities
• MS, Huntington’s Disease, Parkinson’s Disease – Straight out of rehab
• Acute Stroke, or TBI/SCI – Apartment living – Temporary housing – In the process of doing real home mods
• Loan Programs
At Every Home Visit… • Smoke Detectors • Emergency Exit • Notify 911 • Method to Call for Help
– Personal Emergency Response System
– Alerting system inside home
Personal Emergency Response Systems
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 2
Wireless Doorbell: Alert Inside Home Assessment – Questions to Ask
• The flow of your assessment really is very dependant on the goals. – With ALS it is a touchy subject. – Try to take the approach of presenting
options. – Lets only do this once.
Assessment – Questions to Ask
• This is a problem solving mission. – What are the goals?
• Is moving between floors necessary?
– What are the obstacles? • Only half bath on main floor.
– What are the constraints? • Family does not want to do permanent changes to
the home. • Client has condition where functional abilities will
decline/improve.
Assessment – Questions to Ask
• Focus of the assessment should be to gather as much intel as possible.
• Try not to give rush recommendations.
• New solutions every day!
• 24hr rule.
Assessment – Questions to Ask
• In general, I start with – “How are you doing this right now?”
• In some cases, you may want to have the client perform certain transfers/maneuvers in front of you to understand the problem fully.
Assessment – Questions to Ask
• Focus on: – Getting in/out of the home. – Using the bathroom. – Taking baths.
• Access to other items is not a goal of this type of evaluation.
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 3
Assessment - Recommendations
• Take time to lay it all out and come up with solutions.
• I feel very strongly that the client/family should be given a report in writing detailing options/recommendations.
• Often there are multiple solutions, and this can overwhelm the client/family if not presented in an organized manner.
Assessment - Recommendations
Make your life easy!
Measurements
• Because we are not talking about “real” home mods, you do not have to go crazy with the measurements.
• A picture is worth 1000 measurements!
Critical Measurements • Entry Doors
– Don’t forget Threshold. • Inside and Out
– Be aware of grade.
Threshold
Landing
Critical Measurements • Doorways
– ADA – 32” clear width, 30” ok – 36” doors preferred – Screen Door
• Hallways – Minimum 36” – 48” preferred – Note “pinch points”
• Thresholds – Anything over ½” should be ramped. – “Get level” when measuring.
If your client is currently in a wheelchair, then they
can just show you the problem spots.
Critical Measurements • Bathroom
– Door Threshold • inside and out
– Tub • Tub Doors? • Height of Tub Edge
– Shower Stall • Threshold – inside and out • Size of stall – built in seat? • Type of door
• TAKE A PICTURE
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 4
Critical Measurements • Bathroom
– Door Threshold • inside and out
– Tub • Tub Doors? • Height of Tub Edge
– Shower Stall • Threshold – inside and out • Size of stall – built in seat? • Type of door
• TAKE A PICTURE
Critical Measurements • Toilet
– Height of Toilet Seat
Questions about Assessment?
• Ramp – Modular (removable)
Getting In/Out of Home
Getting In/Out of Home • LIFT – There are portable versions
www.adaptivelifts.com
Getting In/Out of Home • Ramp/Lift Alternative – Stair-Trac
http://youtu.be/8xAa4LBocYQ
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 5
Doorways • Thresholds – more then ½” should be ramped.
• www.safepathproducts.com (manufacturer)
Doorways
• Offset or Swing-Away Hinges
Doorways
• Door Opening
IR and RF Available ↑
• Answering Door
Doorways
www.optexamerica.com (manufacturer)
• Answering Door Doorways
www.ring.com www.lockitron.com
Transferring Client – Hoyer Lift Alternatives
• Hoyer/Ceiling Track Alternative Voyager/EasyTrack
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 6
Transferring Client – Hoyer Lift Alternatives
• Hoyer/Ceiling Track Alternative Voyager/EasyTrack
Transferring Client – Hoyer Lift Alternatives
• Hoyer/Ceiling Track Alternative
www.liko.com
Grab Bars Grab Bars
Grab Bars • Super Pole
www.healthcraftproducts.com (manufacturer)
Bathroom - Fixtures
• Hand Held Shower – with on/off
www.dynamic-living.com
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 7
Bathroom – Toilet Access
• Raised Toilet Seat
Seat with Arm Rests Attached↑ Seat Without Arm Rests↑ Not Recommended
Bathroom – Toilet Access
• Raised Toilet Seat
Seat with Arm Rests Attached↑ Seat Without Arm Rests↑ Not Recommended
Bathroom – Toilet Access
• 3-in-1 Commode
Bathroom – Toilet Access
• Toiletvator
Bathroom – Toilet Access
• Toilet Seat Safety Frame
Bathroom – Toilet Access
• Bidet
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 8
Bathroom – Tub/Shower
• Shower Seat/Chair
Bathroom – Tub/Shower
• Tub Transfer Bench
Bathroom – Tub/Shower
• Tub Transfer Bench - Sliding
Bathroom – Tub/Shower
• Tub Transfer Bench - Sliding
Roll In Shower Alternatives
www.myshowerbuddy.com (manufacturer)
Roll In Shower Alternatives
www.myshowerbuddy.com (manufacturer)
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 9
Roll In Shower Alternatives
www.myshowerbuddy.com (manufacturer)
Roll In Shower Alternative
MultiChair – www.nuprodx.com
Roll In Shower Alternative
MultiChair – www.nuprodx.com
Roll In Shower Alternative
www.pviramps.com www.guldmann.net
No Bathroom Access
• Bed Bath Products
EZ-Bathe EZ-Shampoo EZ-Shower
No Bathroom Access
• Portable Shower System - FAWSsit
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 10
No Bathroom Access
• Portable Shower System – LiteShower
Trade Off
• There is a trade off – Often giving up independent usage
• Some options more expensive – Portable Ceiling Track – Toilevator?
Funding • There is not a lot of good funding
resources out there in general for home modifications.
• Some of the more basic items are inexpensive – swing away hinges, grab bars
• Most of the products highlighted here are not covered by insurance
• These products don’t fit into “home modification” funding sources
Funding • Sources of Funding
– Long Term Care Insurance – Vocational Rehabilitation – Veterans Administration – Grant/Loan – Rural Development – Local Community Block Grants
• HUD – Residential Rehabilitation
– Loan /Recycling Programs – Disease Specific Organizations – Patient/Family
ImproveAbility, LLC • Full service AT consultants. • Home Mods – can give general
recommendations and/or create space plans and specifications for contractors.
• Will travel and/or provide evaluations via phone/video chat.
• When in doubt, just give us a call!
Resources
• Sign up for my monthly newsletter: – http://eepurl.com/epp-M
• Visit my blog – http://improveability.wordpress.com/
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 11
ImproveAbility’s Remote Assessment
• We can provide an assessment for client’s.
• Fee - $250 • Client/Family/ALS Contact responsible for
completing home assessment form and providing pictures.
• We provide recommendations/suggestions and additional information.
• If client wants to do structural changes, we can provide specs and drawings for an additional $250.
Sample Recommendations (No Structural Changes)
ALS Home Assessment Form Recommendations
Patient’s Name: Herb Agrell Date of Home Visit: 10/13/10 Date of Report: 10/21/10 Address of Home Being Assessed: 131 Ruth Street, West Islip, NY 11795 IMPORTANT NOTE: All recommendations in this report are made with total accessibility in mind. With ALS, it is difficult or impossible to know what the future will bring, but hopefully, these recommendations will be helpful for planning. Some of these products or suggestions may not be needed at this point in time. All of the recommendations are made at this time so that options can be considered. All recommendations are made with the perspective that no matter what your physical abilities are, you would be able to access your home. It may take a considerable amount of time to implement some of these recommendations, so it is important to act now so that your home will remain accessible to you. Emergency Contacts: It is recommended that you verify that all of your smoke detectors are in working order. Please have an emergency evacuation plan in place. You can contact your local fire department for assistance with making an evacuation plan Notify your local emergency response agency that there is a person with a disability living at your address.
Patients with ALS should always have a way of calling for help. Please consider purchasing a personal emergency response system, if you have not already done so. Moving Between Floors: WILL Since the long term plan is that the patient WILL NOT be moving between the floors of the home, the following things should be addressed: We discussed that you may consider a stair lift to make getting up/down the stairs inside the home. You must understand that this is a temporary solution. But, in your case, this is the only way to access the bathroom. At some point you may need to consider bathroom alternatives and live only on the main floor of the home. See the attached sheet for stair lift companies to get some estimates on prices for stair lifts. This will help you to determine if this is something you should consider. Entrance to Home: To enter your home at the back door, you have 11 inches to accommodate.
A ramp could be installed at this entrance. It would need to be at least 11 feet long. A ramp cannot be installed at the entrance to your home.
Explanation/Further Information: In addition to an 11-foot ramp, you will need a level landing at the door. This can be accomplished with a metal modular ramp. Also, the door at the back of the home will need to be modified such that you have a MINIMUM of 32" clear width to go through the doorway. A standard 36" swinging door will provide sufficient space to enter/exit the doorway.
ALS Home Assessment Form Recommendations
Doorways and Thresholds: Notes about Doorways/Thresholds: All doorways that do not provide 30" CLEAR WIDTH should be noted as possible problems for wheelchair access. Also, any threshold more than 1/2" should be ramped. Bathroom Access:
It is recommended that you purchase a hand held shower. The hand held shower should have on/off control on the handset. Additional Bathroom Access Recommendations: YOU SHOULD REMOVE THE TUB DOORS AS THEY ARE A SAFETY HAZZARD. We discussed the use of a Tub Transfer Bench - see attached sheet. We currently have standard and sliding Tub Transfer Benches in our loan closet. Please let me know if you would like to try one of these. We also discussed a seat for you to use while shaving. We have shower seats that are height adjustable, up to 21", which you could use to sit on while you shave. Again, let me know if you would like to try this. Recommendations Regarding Toilet Access: We did discuss raising the toilet seat using a toilevator - see attached sheet for more information. We also discussed the use of a Super Pole (see attached sheet) to help with bathroom and bedroom transfers. Additional Recommendations: I have attached information on funding for home modifications. If you qualify for any of these programs they may help to pay for the ramp and/or stair lift. I have included information on the Tub Slider and the FAWSsit shower system for your information.
I know this is a lot of information to take in, but I wanted to address everything that we talked about during our visit. If you have any questions or concerns, please do not hesitate to contact me. Any questions regarding these recommendations should be directed to: Antoinette Verdone, MSBME, ATP Assistive Technology Specialist The ALS Association Phone: 212-720-3054 Email: verdone@als-ny.org
Case Study – Structural Changes Case Study – Structural Changes
Case Study – Structural Changes
Antoinette Verdone, MSBME, ATP
ImproveAbility, LLC 12
My Contact Info ImproveAbility, LLC
Antoinette Verdone, MSBME, ATP
512-522-1705 (voice/text) antoinette@ImproveAbility.com
www.ImproveAbility.com