room and the person’s performance, and show pictures of the recommended modifications within the application (Home for Life Design, 2017). The other, the Home Accessibility and Safety Checklist, allows the clinician to rank modifications by priority through determining a desired time frame for completion (Living in Place Institute, 2017). Both allow for pictures to be taken and drawn over. Both are valuable depending on the desired features due to the ability to save information, take pictures to be printed out immediately on reports, and rank modifications without needing to carry paper and pen. Unfortunately, neither is free. Both require an annual fee for use; however, the Home for Life app is available to anyone willing to pay the annual fee. The Home Accessibility and Safety Checklist is only available if the Certified Living in Place Practitioner certification has been obtained.
They all differ from each other in setup, populations, and focus on the home assessment. Most of these assessments have reliability and validity studies with a focus on the functional abilities of the client. However, they do require a skilled professional for completion and may not specifically address/ evaluate the environment (Siebert, Smallfield, & Stark, 2014). Electronic assessments There are two electronic assessments at the time of this publication. Given the movement toward electronic medical records and use of apps in daily life, this number is expected to increase over the upcoming years. Electronic assessments can be useful; they save information in a database, and depending on the assessment, provide different reports. Both available assessments work on tablets. One assessment, the Home for Life app, has features that allow the clinician to rank the safety of the
OVERVIEW OF SPECIALIZED CONCERNS RELATED TO AGING IN PLACE
associated healthcare costs (Keall et al., 2015). These home modifications were not necessarily expensive. At times, they could be considered simple home maintenance. Materials for most modifications are available in local hardware stores, big- box stores, and online retailers; it is not necessary to purchase from durable medical equipment companies. When considering solutions, being current on possible products and equipment is important, as well as creative problem solving. lights do not need to be replaced for several years. Other puck lights are touch activated and can also be used; they are typically cheaper than motion sensor lights. Finally, the location of the rods in the closet can be difficult for people if they begin to use a wheelchair or develop shoulder problems. Lowering rods and designing a closet with rods at various heights help mitigate this issue and prevent future difficulties. The closet in Figure 6, designed for an aging adult with a recent diagnosis of rheumatoid arthritis, has multiple levels of rods and shelves, which ensures easy clothing retrieval. Figure 5: Rocker Switches
There is also some evidence that supports the cost effectiveness of home modifications and aging in place for the older adult and the health industry. The use of home modifications and assistive technology has been found to reduce hospitalizations and rehabilitation unit stays, therefore decreasing health- related costs (Graybill, McMeekin, & Wildman, 2014). Falls are one of the leading causes of injury, death, and forced relocation for older adults; home modifications have been proven very effective in reducing falls, related injuries, and Bedroom The most common challenges related to the bedroom are navigating to the bathroom from bed at night, using light switches, and clothing management in closets. Due to medication side effects or incontinence, older adults often urinate at night. The natural aging process affects the speed to which their eyes can adjust to changes in lighting, and sometimes they cannot get to the light switch across the room without having to ambulate. The inability to see creates a fall risk. Several solutions exist to address this issue. Motion sensor night lights are useful to illuminate the pathway to the bathroom. Some have the capability to turn off once the person has passed the light. Another solution is to place adhesive motion-sensor rope lights under the side edge of bed frames. When a person places his or her feet on the floor, the lights will activate, but because they are under the bed frame edge, the brightness will not be overwhelming. This will help illuminate the floor and assist with location of any mobility device. In terms of lighting, blue or green light should be avoided; it disrupts people’s circadian rhythms. Toggle light switches are the usual choice in most homes and buildings. However, someone with arthritis, hand contractures, or decreased hand strength can have trouble with the precision and strength required to pinch the toggle and move the switch. Rocker switches require less physical effort and precision to manipulate. They can also be activated with a shoulder or elbow if required. All homes designed for older adults should use rocker switches versus toggle switches (see Figure 5). While the white switch plate in Figure 5 on a white wall does not have good contrast, the use of the rocker switches will support the ability to turn lights on and off. Closets present a unique challenge. The door handles can be difficult to manipulate if they are round knobs. Replacing all door handles throughout the house with lever handles reduces strain on hands and allows doors to be opened with elbows or additional assistive devices. Lighting can be an issue if the closet has no light or if the light is activated with a pull cord. The addition of motion sensor adhesive puck lights can illuminate the closet well. These lights are LED and run on batteries; LED Bathroom The bathroom can be a challenging environment for an older adult. The bathroom is a common place for falls and injuries to occur, and difficulties with toileting and bathing are a frequent
Note. From Western Schools, © 2018.
Figure 6: Closets
Note. From Western Schools, © 2018.
reason for older adults to move into facilities (Arcelus et al., 2009). Typical problem areas include tub and toilet transfers, glare from tiles and counters, manipulating faucets, safety in a
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