Moving about safely at home is an important issue for the individual requiring care and the caregiver. If someone has had a surgical procedure, has a disability or illness, or has physical or cognitive limitations in performing daily activities safely, it is best to seek a doctor's referral for occupational or physical therapy to improve mobility. This is usually a reimbursable expense under Medicare, Medicaid, or private insurance.

Bathroom Area

The therapist can work with you and the older adult or person needing care to evaluate situations and develop customized solutions to enhance their safety and abilities. For example, in the bathroom area the therapist may make specific recommendations such as installing grab-bars and nonslip rugs, using a bathing aid like a seat or bench, long-handled wash sponge, wash mitt, or a flexible shower hose. The therapist will also assist in determining the safest way to transfer the person in and out of the tub or shower, as well as using techniques to conserve energy while bathing, dressing, or grooming. Other factors such as temperature, ventilation and lighting should also be considered.

Bedroom Area

In the bedroom, the therapist can train the individual and the caregiver in the best techniques to use to turn the person needing care in their bed, help him or her come to a sitting position, and move to a chair, wheelchair, or other ambulation device, such as a walker. Aids can enhance mobility in bed. Such aids include a strap that assists with turning or raising the person in bed or a half bed rail that enables a person to stand with some support when pushing up from the bed. Other aids reduce the risk of bed sores. Some people also benefit from a bed with electronic head and foot controls in order to change their body position. Again, the occupational therapist or physical therapist can help determine what other changes in the environment would enhance bedroom safety, such as eliminating trip hazards, increasing lighting, or utilizing the services of a medical alert. A medical alert is a small pendant or bracelet an older adult can wear. This device has a button that can be pushed when the individual has an emergency which activates a response system and sends assistance if needed.

In Case of a Fall

When you assist someone who has fallen on the floor, the first thing to do is assess for injury. Ensure the person has an open airway, is breathing, and then treat the bleeding. If the person is unconscious or injured, do not move them. Call 911 or other emergency number and request assistance immediately. If the person is conscious and uninjured, bring a sturdy chair (with no wheels) next to the person. Assist the person from a side lying position, into an "all fours" position facing the chair seat; assist them in propping their arms for support upon the chair seat, instruct the person to slowly rise by using their strongest leg to lift themselves onto the chair, and then finally turn into a sitting position. If another person is present, have them support the chair so that it does not tip or slide. Do not pull on the person's arms or lift him under his armpits since this may cause an injury. Positioning of the caregiver's hands on the person's torso or around the pelvis may provide more support.

Assess for injury again and monitor the person for the next several hours, since signs of injury may not be immediately apparent. If there is any question about the person's condition, seek medical assistance.

Also, if the person has just had a surgical procedure, has an illness or disability, or physical or cognitive limitations, he or she may need training with an occupational or physical therapist in "fall recovery" techniques specific to the situation. For example, an individual with a spinal cord injury will need to learn to do "fall recovery" using a wheelchair without the benefit of his legs to lift himself back into the chair.

Summary

In all living situations, whether in the kitchen, bedroom, or bathroom, an individual's safety and independence depends on physical and cognitive capacities; the removal of environmental barriers that hinder the person's capacities (for example, trip hazards, clutter, damaged appliances, poor lighting); the kinds of tasks and activities that need to be done (bathing, cooking, dressing, writing, using the telephone, etc.); and the availability of support from family, friends, and community. Many daily tasks and activities can be improved by modifying the way the task is done, or finding adaptive equipment or assistive technology that helps compensate for lost function.

For more information

You may want to visit these other eXtension resources:

• Easing Life Tasks with Assistive Technology
• Assistive Technology and Adaptive Equipment
• Choosing a Long-term Care Facility
• Furnishing a User-Friendly Home
• Home Modifications Funding and Caregiver Information
• Talking With Your Health Care Providers
• Working With Your Health Provider for Better Care

Contact an Area Agency on Aging to find a reputable local medical alert response service:

• National Association of Area Agencies on Aging at http://www.n4a.org.

To learn more about modifying your home so that you will be able to age in place or to find a local Certified Aging in Place Specialist, contact AARP at http://www.aarp.org.

References

• American Academy of Orthopaedic Surgeons (2009). Getting up from a fall. Retrieved March 30, 2009, from http://orthoinfo.aaos.org
• Rigby, P., Stark, S., Letts, L., & Ringaert, L. (2009). Physical environments. In E.B. Crepeau, E.S. Cohn, & B.A. Boyt-Schell (Eds.). Willard and Spackman's Occupational Therapy (11th ed., pp. 821-849).