Elderly Home Modifications
[ photo by Scott Webb ]
Elderly home modifications may be required to return home.
Temporary changes to a home often are necessary in order for someone to go home directly from the hospital or from rehabilitation. The physical and occupational therapists are not just experts in guiding one to regain strength, balance and endurance for improved functional independence; they are also experts in working with the surrounding environment to make it the safest place in which to allow one to be mobile and tend to their individual ADLs. Let me walk you through an example of this common scenario.
Sue was in rehabilitation following a fracture around her prosthetic hip joint. As you can imagine, the surgical repair of this was quite extensive given the fact that she already had her prosthetic joint in place. She had originally gotten the hip replacement because the pain from the arthritis in her hip was affecting her active lifestyle. (Related blog posts: Should I Get A Knee Replacement? and What To Expect After A Knee Replacement)
Complicating Sue’s rehab was that her prosthesis had also developed an infection just prior to the fracture. She had recently undergone a surgical washout of the prosthetic joint and was being treated with IV antibiotics. In addition, she was required to be non-weightbearing through the affected lower extremity. Fortunately for Sue, she was very active prior to the fracture, so she was in excellent physical condition. She was tired of having to ride in the golf cart; she wanted to walk the course!
Progress in rehab will dictate home modifications.
Sue had been in acute rehabilitation for just under a week and was doing a great job of getting around with her rolling walker while maintaining her non-weightbearing through the affected leg. Sue was feeling good about her progress with rehab, so good in fact, that she declared she planned to go back to sleeping in her second floor bedroom as soon as she got home!
Her home did not have a first level bedroom, and she missed her own bed. All of that was quite understandable, but the key part of this tale is that Sue actually broke that hip while undergoing treatment for the infected prosthetic and attempting to get back down the stairs from her bedroom. Even without the fall that caused the hip fracture, a full flight of stairs on someone who is non-weightbearing is not the best option. It took several conversations with Sue and her husband (who was fully in agreement that she should not be doing a full flight of stairs) to finally convince her that the safest option for her would be to set up a temporary bedroom downstairs until she would be able to put weight through that affected extremity. (Related blog posts Taking Care Of Elderly Parents At Home and When Aging Parents Need Different Levels Of Care)
Sue’s husband lovingly converted their home office into a temporary bedroom for Sue by borrowing a family member’s twin bed and setting it up next to the desk. They already had a bathroom with a shower on the main level, which meant she would be able to do all her grooming tasks on the main level without even needing to add additional durable medical equipment (DME) to the house. Once these things were set up at the house, Sue was able to discharge to home just a few days later. She had mastered the two steps to get into the house from the garage, and she was a pro at using her rolling walker and hopping around on the one leg to get from one spot to the other.
Be flexible and creative when making home modifications for elderly parent.
Sue is a fictional example I have named but is a classic picture of several of the patients I have had through my years working in inpatient rehabilitation. So many of these patients are quite resistant to converting one part of the house to a bedroom. When this is the recommendation, however, it is generally not a something that has been well thought out by the therapy team.
The team of physical, occupational and speech therapists work together to determine what the safest home set up will be for those patients wishing to return to home. Except in terms of permanent disability or those in end-of-life care, this is often a temporary thing. Just as in Sue’s case, once the required medical treatment (IV antibtiotics in her case) was completed and clearance for full weight bearing was given by the surgeon, normalcy within the home could return.
I have not personally experienced an injury in which I was not able to climb the stairs to my own bed, so I cannot say why there is often so much resistance to these temporary changes, but it is there. Oftentimes, more has to be changed than just putting a bed in a spare office or the dining room.
Sometimes the occupational therapist will recommend a bedside commode be placed next to the bed because a wheelchair just won’t fit in that tiny main floor half bath. Or maybe it has been advised that someone not go into the sunken family room with three steps to get there because the modifications just cannot be made to get the person safely down to their beloved TV chair.
I remind my patients in these very specific situations that these are temporary changes. My go to answer when someone is resistant to the changes is to listen to the recommendations of the therapists since they have specific training on how to make elderly home modifications to keep one moving about safely. If resistance is still met or further guidance is still needed, this is where I can step in to provide direction and reassurance as a physiatrist. Most of us want nothing more than to be in the comfort of our own homes. Sometimes getting home means home might look a little different for a while, but at least it is home!
Have you had to make home modifications for an elderly parent or loved one with temporary limited function? Share your ideas in the Comments section. Have specific questions about this or other topics related to care of an aging parent? Schedule a consultation and get all your questions answered.
© 2021 Jessica Kluetz, DO