December 2012

Greg Sieb, licensed contractor, CAPS (Certified Aging in Place Specialist)  & Suzi Klyber, OTR/L
Granting You Access

Contact info:
Email: Greg@grantingyouaccess.com
Phone: (703) 433-0380
Website: www.grantingyouaccess.com

GREG

The focus of Granting You Access is education and modification to make homes safe, accessible and comfortable, to help people stay in their homes and to maintain their quality of life. You can continue to do everything you want to, you just may have to do it a bit differently.

When they do an assessment, they look at your capabilities:
– Climb steps with our without railings
– Balance deficits
– Sit to stand
– Reach high and low without leaning back or losing balance
– Endurance deficits
– Visual deficits

What is most vital is to allow you to access and live safely in your home.
When asked if someone should move to and Assisted Living Facility, etc., the answer would be, “Where is your life?” Meaning, where are your friends, doctors, church, etc.? For 10 – 15% of what you’d pay a realtor, Greg can modify your home.
Plan for what you may need down the road even if you don’t need some modifications straight away.

Greg discussed issues and changes that can be made in various parts of a home.
Many of the photos he showed in his PowerPoint presentation are also available on his website: www.grantingyouaccess.com

Front doorway
Tend to have wide unbalanced steps.
Solution: add a hand grip at the entrance that you can slip your hand through
Railings for support – for all ages. Should extend beyond the top step and the bottom step so the railing is next to you at either end
Portable ramps for walking/wheelchair access.
HOA cannot deny you to have a ramp. Reston tried but got sued and lost.
Permanent ramps provide universal access.
Entry way can include a heated walkway to melt the ice off.

Garage
Steps with railing or a ramp with railing can access the door into the home from the garage.
Level at the top and onto the first step so you’re not dealing with light differences and trying to step down at the same time.
Ramps:
– 4 foot aluminum ramp is about 16 pounds.
– For every inch of height – 1 foot of length. For homes it can be ½ of that
– Height has to be appropriate according to the homeowner’s deficit
– Take into account health and strength of caregivers to push patient up the ramp
– Portable ramps can fold over or be leaned out of the way
Lighting should not be too bright but needs to distinguish floor from end of step (bottom or top).
Use visual change from step to floor such as a traction strip or painting it red. Red is the first and last color a person sees so white, black, and red are the major contrasts to work with.
Communicate with the primary user to determine what they can see.
Vertical lifts can be installed for porches and garage entrances.

Bathrooms
Grab bars need to be at the correct height and location for the primary user. Placed at your center of gravity (your belly button). The center of vertical bar should be at belly button height.
Weakest part of the body is the back of shoulders. Is primary user a ‘pusher’ or ‘puller’ (triceps or biceps) Depending on which muscle group is stronger, determines whether you need a vertical or horizontal grab bar.
Suction cup grab bars can be easily pulled off, especially if on fiberglass or on grout lines. If you clean the suction cups too well they won’t stick well.
Folding bars for showers. Also fold up bench.
An accident waiting to happen . . . is relying on a handle on a glass door. Safety glass breaks up into little pieces or glass door can pop out.
Designer grab bars combine style with safety. Some come with towel racks.
Tub cuts allow a step for safe access. But it’s not a bath anymore – can only be used as a shower.
Options for the commode.
– 3 sizes – 12 inches to 15/16 inches to 17 ½.
– If the seat is too high, and you’re too short your heels will be off the floor and you use momentum to get off the floor which is unstable. Knees should be level with your hips so you have full use of your quads when you slide forward and come up.
– Raised seat with rails is better if it doesn’t have legs so you don’t catch your foot or walker on a leg.
Install a grab-bar all along the wall so you can use it instead of bringing walker into the room.
Sliding shower head and shelves can be positioned for reaching without stretching.
A pause button can stop and start flow of water.
No-barrier designs allow for all abilities. For instance, a flat floor for a shower to walk or roll straight in.
Non-slip floors.
Bathroom chairs with solid legs that can be adjusted. Do not use aluminum legs because they can be uneven; when they have soap scum on them they can’t be adjusted. They also rust, and screws can break.

Beds
Bedrails to assist with sitting and standing. They also allow you to roll.
EZ Adjust by Standers can extend after installation. http://stander.com/
There’s a travel model you can get that can fit in a suitcase
To get out of bed: Feet should go off the bed as you’re pushing your body up off the bed but you have to be on your side.
Poles can be placed in any room with options to assist in standing or passing through intersections safely.
Bedside commodes reduce the risk of night time travel.
Doorways can be widened or hand grips installed for access without a walker.

Stairways
Railings assist in open spaces.
Don’t pull yourself up the stairs using the railing on one side – have railings on both sides instead. If you only have one rail, side step.
A caregiver can stand behind the person going up or down the stairs who could then rest on the caregiver’s bent leg.
Stairlifts, while over $1000 provide safe options when stairs present high risk or reduce your ability to reach bedrooms. Nothing goes in the wall – everything stays on the stairs.
Lifts can be combined with railings or adaptive equipment for continued access.

Kitchen
Islands give you workspace and support.
Remodel under counters for legroom.
Drawer dishwashers are higher up so you don’t have to bend over.
Replace cabinet handles with easy to grip handles.
Reorganizing storage shelving increases space and improves safety.
– Accessible slides and shelves
– Shelves within reach.

SUZI

Some helpful hints . . .
* Always put one foot forward to reach or to reach for something down below (like tying a shoe) because you’ll be more stable. When both feet are together you bend from the waist. With one foot in front, you’ll bend from the hip which helps to breathe better, too.
* When you’re working at the kitchen counter, stand directly in front of your work so you’re not leaning and you’re more stable. Step to the side so you can move in front of the thing you’re working on.
* Turn your body completely when you’re turning to walk. Look first and then turn.
* Stabilize yourself before bending. Put your hand on something to stabilize yourself when you go to bend or reach.
* When carrying something keep your hands at belly button level rather than too high (chest high), or hands at your side, at thigh height.
* Put your groceries in a box or tub so you can carry them at belly button level.
* Keep hands closer to your body when carrying something or using things in the kitchen.
* You can get shelves that will slide appliances closer to you so you’re not reaching to the back of the shelf.
* If you’re carrying laundry downstairs, put it in a pillow case and throw it down the stairs to keep your hands free.
* Ladies should carry handbags at waist height rather than at thigh height.
* Take a warm shower at night because it will relax the muscles and help you to sleep. Not too hot because it lowers body temperature and makes it harder to perform. The warmer the water the harder it is to breathe.
* Use smaller bath towels because they’re easier to use.
* When putting on your coat, do it when you’re sitting down and your coat is on the back of your chair. Put your arms in first and then coat will come off the chair as you stand up.
* Carry a portable phone with you rather than rushing to answer the phone. Or let it go through to voice mail.

In closing:
Where do you have fingerprints on the wall? That will show where you need a rail.
Start with the things you don’t feel safe with and make those changes first.
There’s no upside to risking falls. You’ll never rehab 100%.

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