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Creating a Safe Home Environment: An Occupational Therapist’s Checklist

Creating a Safe Home Environment: An Occupational Therapist’s Checklist

As we age, home safety is more critical than ever. Occupational Therapists (OTs) are being called to action to gauge how recent changes in cognitive function or mobility have altered patents’ safety in their own home. The advent of telehealth/video conferencing has made this easier. A family member/caregiver or the patient can walk you through their daily routine from the walkway outside to the front entrance and every room in the house via video call.

The list below can also be utilized for in-person home visits or converted into a patient survey. Here you will find some observations and practical considerations to discuss with your patient.

Entryways/Hallways/Stairways

According to Aging.com, 30% – 50% of falls are due to environmental causes (e.g., poor lighting, slippery floors and uneven surfaces).

Changes to consider when doing a home safety evaluation include:

        • The lighting and condition of the driveway/walkway leading up to the entrance are worth noting for cracks and uneven levels. Add motion detection lights for driveways and walkways and brighter lights for hallways and stairways if too dim.
        • Place a low bench or table next to the front door to set bags and packages.
        • Take away the “welcome” if it’s a trip hazard or at least move it to one side of the doorway if used for wiping wet shoes.
        • Change the door handle and/or lock if they are too difficult to manipulate.
        • Install sturdy stair railings, or fix those that are unstable – ideally one on each side.
        • Change the tension of the spring for the screen door to slow down the rebound or remove the spring component completely.
        • Provide safety training on how to adjust cadence and negotiate slippery surfaces especially when factoring in ice, rain or snow.
        • Observe the patient’s ability to carry bags or packages from the car to the front door and inside. Can they open the front door and walk through it while carrying bags of groceries?
        • If your patient uses a walking assistive device, do the rubber tips catch on the carpet, or wheels roll too far away from their body on a wood floor? Discuss with PT if modifications are needed, such as ski tips and changing the size of wheels on a walker.
        • Remove indoor rugs or use floor tape to tape down edges and corners to reduce the risk of falls as a result of catching their toes.
        • Thresholds between the changes of surfaces may pose a fall risk if they are too high or anchored improperly, as well as changes in floor surfaces (carpet, tile, etc.) for walking devices
        • Remove clutter, low tables and/or decorative items on the floor.
        • For the stairs, look for the presence, position, and stability of the railing(s), as well as their conditions such as protruding nails, poorly anchored stair runner, condition of step edges (especially wooden stairs), and if the surface is slippery.
        • Note outside curbs and steps may vary from standard heights: indoor stairs (7.5”) and sidewalk curbs (6”).
        • Safety training for maneuvering stairs starting with assessing your patient’s ability to carry a laundry basket full of clothes up/downstairs.

Bathrooms

Statistics show that 80% of falls occur in the bathroom and are more than twice as likely to result in an injury in community-dwelling adults over the age of 85. These findings suggest clinicians should tailor fall prevention protocols and safety recommendations such as:

        • Grab bars in the shower/bathtub and next to the toilet
        • Raised toilet seats with or without handles
        • Shower benches/chairs
        • Detachable handheld showerheads
        • Bath sponge on a stick, reacher, and other assistive devices
        • Non-slip mat for slippery shower/tub surface
        • Non-slip floor mat outside of shower/tub that absorbs water
        • Height of shelves reset at eye level
        • Reduce clutter on the floor, counter/sink and shelves
        • Ample lighting
        • Check patient’s ability to turn 180 degrees (both directions), reach under the sink/overhead shelf, reach for toilet paper while sitting, and step in/out of shower/tub without losing balance
        • Light switch near the doorway

Kitchen

Whether or not your patient spends a lot of time in the kitchen, here are a few safety checks to consider:

        • Decluttering counter spaces to only items used every day and create space for groceries and hot foods
        • Clearly marked stove dials for on/off
        • Smoke detector in working order
        • Patient’s ability to reach for items form overhead shelves and low cupboards, use a stepstool, wipe spilled fluids on floor
        • Step stools with handles
        • Ample lighting
        • Floor surface and narrow spacing for walking assistive device

Bedroom, Living/Family Room, Den

The bedroom and family room/den (where their favorite chair and TV are most likely to be stationed) are typically where people spend the most time. You can provide the following suggestions:

        • Remove small/rugs or using floor tape to tape down edges and corners to reduce the risk of catching their wheels or toes.
        • Clear the pathway and add night lights from the bed to the bathroom.
        • Note hardness, height and armrests of sofas, chairs, and bed for sit to stand transfers.
        • Place telephone and phone charger at the bedside.
        • Ensure smoke detectors in working order.

Fixed surfaces and structures may not be alterable. One example is doorway widths for wheelchair clearance. However, pointing the discrepancies out to your patient will at least increase their awareness so that major projects can be discussed with caregivers. It’s also important to note that your patient may not be amenable to making EVERY change you propose. Prioritizing the modifications that will make the biggest impact on their safety and livelihood can smoothen a weighty conversation.

Sources:

Access the AOTA (website): Home Safety and Accessibility Assessments here.
Access the National Center of Biotechnology Information, US National Library of Medicine (website): Stevens J, et al. Circumstances and outcomes of falls among high-risk community-dwelling older adults. Injury Epidemiology (2014) here.
Access the Dionyssiotis Y. Analyzing the problem of falls among older people. International Journal of General Medicine (online) here.
Access the Aging.com (website) here.
Access the CDC (website) here.
Access the Maryland Health Care Commission (website): Home Safety Assessment here.

Shraddha Majcher, MPT, CEEAA

Shraddha Majcher is a practicing clinician who has traversed the healthcare world for over 20 years, advancing her industry knowledge and experience in rehabilitation. Her expertise includes operational management and interdisciplinary consulting on clinical programs for post-acute care facilities. She has taught a multitude of evidence-based continuing education courses for geriatric patient management and innovative rehab technologies. She is an inspirational educator, as well as an active advocate for therapy services of children with disabilities and their families.
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