One-size fits all is not the way to go when adapting a home to make it safe, functional, and convenient for seniors, according to Dr. Barry Trentham, Associate Professor, Occupational Therapy, University of Toronto.
“There are always some basics,” he says, “and there are all kinds of check lists available, but it’s too easy to just look at those check lists and make the changes. If they’re not suited to what the older person is interested in, what they do or how they do it, then they can be as much of a hazard as not doing anything.”
Having worked as an occupational therapist with seniors facing physical and emotional challenges in everyday life, as well as earning a Ph.D. from OISE/University of Toronto’s Institute for Life Course and Aging, Dr. Trentham is well versed in the intricacies of helping seniors maintain their independence.
“My philosophy has always been there’s no reason any older person should be in a nursing home unless there’s major cognitive issues that really make life for the family difficult. Most homes, with some resources and problem solving, can be adapted to changing needs from a physical perspective. Assisted living or retirement homes are also other options,” offers Dr. Trentham.
An occupational therapist can help you and your family assess the situation, suggest appropriate adaptations, show everyone involved how to properly use those adaptations, and in general be part of the discussion around what can be done to keep a senior functional and safe in their chosen environment.
“Having someone to help you in making the decisions as a family member is very helpful,” says Dr. Trentham. “When my mother was going through all kinds of difficulties, it was much easier for her to hear from somebody who wasn’t family. It’s nice to have an outside person help the family have these conversations.” Dr. Trentham recommends connecting with an occupational therapist through your local Community Care Access Centre, your Family Health Team, or your family doctor (see resources at the end). The therapist should visit at least 3 times, get to know the individual, and then work with everyone to create a plan that fits their needs, lifestyle, and budget. This ‘getting to know you’ process also builds the trust and understanding necessary to a successful solution to the issues.
“If it’s not part of their regular routine it just doesn’t work. If the senior is part of the process of problem solving, they are going to buy into it more. Very often they have ideas on how they want things changed. It’s a negotiation and that is where the involvement of an occupational therapist is much more important, when it zeros in on how they do things,” explains Dr. Trentham. He also believes that while safety is vital, taking into account the whole person – their hobbies, social activities, community engagement – is equally important to their continuing health, both physically and mentally. “We forget about how this person is going to be engaged during the day. Are they going to be able to get outside, visit friends, access the TTC or community resources? All those things need to be considered, particularly if somebody is moving into their children’s home,” says Dr. Trentham.
He gave the example of his own mother, where the occupational therapist suggested changes related to safety, but didn’t ensure she was able to access her computer and art supplies to create cards for her friends and family – both activities very important to her emotional and mental well-being.
Areas to Assess
Whether you are adapting your parents’ current home, they are coming to visit, or will be moving in with you, there are a few basic areas you can assess for safety and functionality, says Dr. Trentham.
“There are so many things that can be done in the home, and of course it depends on if the person is in their own home, moving into their children’s home or visiting. There are all kinds of adaptations, but depending on what the problem is, whether it’s mobility, cognitive, sensory, it will require different approaches.”
He suggests going through your home, room by room, starting at the front entrance, and looking at how things are set up while keeping in mind the seniors’ particular needs.
• Front Entrance: there should be railings on both sides; proper lighting; no cracks or broken and uneven steps
• Front Hall: is there somewhere to sit down to put on shoes, if not a long-handled shoe horn can be helpful; good lighting
• Stairs: railings on both sides if necessary; remove or secure carpets or runners that are easy to trip on or which might slip; adequate lighting
• Living/Family Room: if your couch is low and difficult to push up from, raise it with couch blocks or make sure there is a firm chair with arm rests; scatter rugs should be firmly fixed in place or removed; proper lighting for tasks; avoid glare through windows if the person has cataracts;
• Kitchen: items that are frequently used should be accessible without too much bending, reaching overhead, or twisting; heavy items should be stored as close to waist level as possible
• Bathroom: if the person needs help getting in and out of the shower or bathtub, there are many railing options, temporary or permanent (permanent ones should be placed with the help of an occupational therapist); a raised toilet seat or bars next to the toilet, especially if it’s low; non-slip mat in the shower or bathtub; secure any scatter rugs or mats; make sure your hot water isn’t too hot, older people often burn more easily; if the person is likely to put their weight on a towel rack for help getting in and out of the tub, make sure it’s secure
• Bedroom: raise the bed if necessary with blocks; secure or remove scatter rugs; adequate lighting; clear path from the light switch to the bed.
Whatever changes you do make with the help of an occupational therapist, it’s important to remember that they will likely need to be reassessed in the future. “Needs change, particuly with people with chornic illness or age-related conditions. Those change over time and their needs change,” explains Dr. Trentham. It’s also important to make sure everybody who will be using the devices or adaptations – the senior, their spouse, family members, personal support worker – all know how to use them properly and safely.
Where to Get Help
There are a number of resources within the community, many of which are covered by OHIP. If the agency you contact, or your family health team, community health centre or other service does not have an occupational therapist on staff, or with whom they regularly work, Dr. Trentham suggests asking why not. “Advocacy is important. If they don’t have these services, which they should have, make a stink about it.”
Community Care Access Centres (CCAC): Can be found across the province and provide a wide range of health-related services, including occupational therapist services. It’s important, notes Dr. Trentham, “to make the case that you are concerned about safety.” Following an initial screening interview, you will be referred to the appropriate services. If, after the initial 2 or 3 visits you feel more help is required, you can “make the case to be seen for longer.”
To find your local CCAC visit http://healthcareathome.ca or call 416-750-1720
Other Agencies: The Red Cross, VHA Home Health Care and other agencies can provide private services, including visits and assessments from occupational therapists. These services are NOT generally covered by OHIP, but may be covered by private insurance.
Red Cross Community Health Services: http://www.redcross.ca/what-we-do/community-health-services-in-canada
VHA Home Health Care: http://www.vha.ca/ or call 1-888-314-4622
Closing the Gap Healthcare Group: http://www.closingthegap.ca/ or call 1-877- 560-0202
Family Health Teams/Family Doctor: According to Dr. Trentham, it’s becoming more common for family health teams to have an occupational therapist as part of the group. If not, your family doctor can make a referral.
Community Health Centres: Some will have occupational therapists on staff. If they don’t, ask why not, urges Dr. Trentham.
Ontario Society of Occupational Therapists: They have a listing of all registered occupational therapists in the province, including those in private practice.
Other Community Agencies: To address specific issues, such as visual impairment, hearing impairment, etc., contact agencies that specialise in those areas, as they will have staff trained in assessing and recommending adaptations specific to those concerns.