Age in Place Home Modifications Work

Don’t fight your *problem. Know that there is a solution.

-Joseph Murphy

I came across another content rich article written by a Physical Therapist and ergonomics expert, Shane Haas that is exceptional. Mr. Haas is in the business of solving problems for aging in place; enjoy his insights and remember there is a solution.

Therapists help patients see that home ergonomics modifications can work.

by Shane Haas, PT, MSIE, CPE

Aging in Place

The benefits of applying ergonomics to the home are happier, safer and more independent patients. Ergonomics is the science of creating the best fit possible between people and their surroundings. Developed in production-based work as a way to reduce injuries, improve job productivity and increase employee satisfaction, ergonomics has since grown into other industries, including home care. Despite being long removed from the factory floor, the goal of home ergonomics remains true to its roots: adapt the environment to fit the individual.

Given the challenges of aging or living with a disability, the vast majority of patients still wish to remain living at home. The problem is that many homes, once places of comfortable living, become source of obstacles. Few homes are built with consideration of the changing needs associated with aging or living with a disability. To meet these challenges, adaptations to the home are often needed. A basic understanding of home ergonomics will help ensure such adaptations are a success. It should be noted that fall prevention efforts are more effective when adaptations are combined with other strategies (e.g., exercise, medication management, dietary supplements, footwear management).

Home Ergonomics

It is the focus of this article to highlight ergonomic modifications to the home environment. Home ergonomics deals with a population that is often old and physically limited. In industrial ergonomics, a young and physically fit population is more common. In industry, common hand tools of interest include hammers, wrenches and drills. In home ergonomics these are replaced by canes, reachers and walkers. In home ergonomics, the focal point is a single user, the patient, with particular attention being paid to his unique capabilities and limitations. In contrast, in industrial ergonomics the focus is on multiple users with attention to trends and population-based data. In industry, solutions are based on information from organizations like NIOSH and OSHA; in home ergonomics, it is the Americans with Disabilities Act (ADA).

To better fit the surroundings to the individual, the typical ergonomics approach is to reduce or eliminate risk factors in the environment. The most common ergonomic risk factors in the home are excessive force and awkward posture. Excessive force is exemplified in tasks that require significant strain or call for more strength than the patient is able to generate. Patients are often too limited physically to safely lift or control their own bodyweight which leads to struggles with basic tasks like getting up from a chair or climbing stairs. Limitations in hand strength creates other unique problems such as the inability to remove lids and tops, manipulate kitchen utensils and controls, and handle items in the bathroom.

Awkward posture is a significant deviation of the body from a neutral position. Whether sitting or standing, the further the deviation from neutral the more awkward the posture. Examples of awkward posture include low chairs or commodes that position the knees higher than the hips. The lack of adequate space under a sink forces awkward posture, as wheelchair users must twist to the side to access the sink. Narrow doorways create awkward postures as patients turn walkers sideways and use small, choppy steps to get through the door.

We will review five common activities of daily living and discuss possible ergonomic improvements for each. These improvements target reducing or eliminating excessive force and awkward postures, in order to create the best fit possible between the patient and the home. Solutions listed focus on inexpensive adaptive aids and not larger, more expensive home renovations.

1. Transfers into and out of the shower. Does the patient need to hold onto anything (e.g., wall, faucet, towel rack) while getting into and out of the shower? Is the patient able to safely lift the legs over the edge of the shower or tub (up to 18 inches)? If a lack of secure hand holds is noted, consider adding grab bars. Follow ADA standards for grab bar selection and placement. If grab bars are not able to be installed due to lack of landlord approval, poor wall durability, etc., consider alternatives such as a suction-cup grab bar, tub cane or security pole. If an inability to safely lift legs over the edge of the shower or tub is seen, adding a transfer bench can increase safety as the patient is able to remain seated during the transfer. Other showering aids to consider include anti-slip mats or strips, hand-held showers and long-handled sponges.

2. Transfers on and off the commode. When seated, are the knees positioned at a height noticeably higher than the hips? Does the patient need to push off of or hold on to anything (e.g., toilet paper holder, corner of the sink) during the transfer? To help correct low seat heights (typical height is 15 inches), consider adding an elevated toilet seat, placing a frame over the toilet, or changing out the commode with a taller bowl (17 inches). If pushing off is noted, think about adding toilet safety rails or grab bars. A flip-up grab bar may be needed if there aren’t walls near the commode. For steadiness upon initial standing, consider an angled grab bar which allows the patient to both push off and hold onto once standing.

3. Transfers into and out of home. Are there steps or stairs to get into and out of the home? If so, are there adequate handrails? Is the patient able to lift and place the assistive devices (e.g., cane, walker, crutch) on the steps safely? Can they open, close and lock the door? A ramp may be needed if the patient is unable to safely ambulate up and down stairs. If already in place, does the ramp comply with ADA standards? Common ramp-related mistakes could be the slope is too steep, a lack of sufficient landing space, inadequate handrail(s) and poor structural integrity.

If wheels aren’t needed, but balance is still limited, consider adding handrails or secure handholds at the steps or stairs to help increase steadiness at these transition points. For rolling walkers and wheelchairs, doorway thresholds higher than ½ inch can impede rolling. Think about adding a threshold ramp. Threshold ramps come in various materials and sizes, ranging in height from 1- 4 inches. If opening or closing doors is a problem, consider removing a storm door (or the door closers on the storm door) or adding an automatic door opener. If manipulating door handles and locks is a problem, consider using lever handles and remote deadbolts.

4. Transfers into and out of bed. When preparing to get into bed, is the patient able to sit on the edge of the bed with hips far enough back to prevent sliding off? Can he lift his legs up and into the bed? Does the patient grab and pull onto anything (e.g., headboard, side of mattress, night stand) when trying to get out of bed? If the bed is notably high, e.g., the patient is unable to sit far enough back on the bed to get in, consider adding a footstool with a handle. A leg lift can be used to help lift legs into the bed. If the patient grabs and pulls on anything to get out of bed, think about adding bed cane or rail to provide a secure hand hold for transferring out of bed and give support upon initial standing.

5. Transfers on and off a seat. Similar to transfers on and off the commode, when the patient is seated in their recliner, couch, or chair of choice, are the knees positioned at a height noticeably higher than the hips? Does the patient need to grab or hold on to anything during the transfer? If the seat is too low, consider adding furniture risers. Stackable risers are available for graded adjustments in seat height. Specially designed risers are also available for the uniquely shaped bases on recliners. Adding a couch cane will provide a secure hand hold to aid in standing. While not recommended as the best first option for seating problems, if patients need assistance beyond furniture risers and couch canes, consider replacing recliner with a lift chair.

In home ergonomics, small changes can result in big improvements in the fit between patients and their surroundings. Removing sources of excessive force and awkward postures eliminates obstacles in the home. Fewer obstacles helps return the home to a place of comfort and security, fulfilling the benefit of home ergonomics: happier, safer and more independent patients.

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Shane Haas, PT, MSIE, CPE is Senior Fall Prevention Specialist, Adapt It Ergonomics. He graciously granted permission to reproduce this article.