Providing a safe, comfortable living space for an aging individual who is faced with Alzheimer’s, dementia, severe arthritis, or other degenerative conditions can be accomplished when proper home modifications are found to suit the individual’s needs. In addition to installing the proper devices in the home to help the individual remain as independent as possible, staying socially and physically active is crucial when it comes to maintaining a healthy and balanced lifestyle.

According to Georgios Voulgaris, a physical therapist with Talbert Medical Group, Downey, Calif, elderly individuals returning home from the hospital or undergoing physical therapy, or those who simply cannot take care of themselves, should be evaluated. In addition, a patient’s history, as well as an overview of what brought them to their current health status, should be considered.

Some experts suggest that Baby Boomers make in-home accessibility modifications before they are actually necessary.

“I would first check the arrangement of the patient’s bed to make sure they have enough space around it. I also would look at the bathroom to see if the toilet is raised, or if there are bars for the person to hold onto in order to get in and out of the bathtub,” Voulgaris says.

A senior’s needs also are evaluated when a therapist assesses whether they can stand next to the sink to wash their face, brush their teeth, and tend to basic grooming requirements, Voulgaris notes.

Voulgaris says that the therapist must assess whether a person is able to get up from the bed or a chair, or if they can sit on and rise from a toilet without assistance. In addition, shower and bathtub access must be considered.

“This is where the installation of safety bars is very important in order to aid the individual with getting in and out of the bathtub. Safety bars are, for the most part, relatively inexpensive and can be purchased at any home improvement store,” Voulgaris says. “Also, if the patient is not strong enough to walk to the bathroom, I would recommend they get a commode that can be placed next to the bed.”

The kitchen is also a crucial consideration, according to Voulgaris.

“It is important to find out if patients will cook for themselves, or if they will have someone else do the cooking for them,” he says. “Also, is there enough space at the table where they eat? Are there things on the floor that the patient can trip on? These are all things I would look for in the house environment—in addition to the patient’s [mobility issues].”

According to Voulgaris, the patient’s level of strength and range-of-motion abilities should be considered. Does this person walk with a cane? Do they need a walker? Also, is there enough space in their environment for them to be completely mobile?

“A person should always be able to move from room to room with their walker or cane,” he says. “If there is not enough space, I would talk to a family member about making more space. If the family member is not obliged to accommodate the patient and make more space, then I would ask the agency to evaluate the situation to find out what other resources are available to help.”

Voulgaris suggests evaluating wheelchair accessibility and installing ramps (if they are not present), which are usually installed by homeowners, not agencies. In addition, safety bars can be placed in the entrance of the house if a person has difficulty ascending or descending stairs. “I would recommend the placement of bars so the patient can hold on to help them on the way up,” he says.

As for the issue of seniors remaining socially and physically active, Voulgaris recommends that aging individuals become involved in their community’s senior center.

“Most seniors face similar problems, and it is great to talk with others who have the same problems, and they can give each other ideas,” says Voulgaris, who also points out that physical therapy is the focus of his team at Talbert Medical Center, which provides a fitness program for seniors.

“We have Arthritis Foundation classes, aquatic physical therapy, and our Silver Sneakers program,” he says. “The program is run by a national chain that brings in its own instructors. It’s a network—the participants join each other for potlucks and they exercise three times a week.”

PLANNING AHEAD

For seniors and their families who want to understand how to find assistance from Medi-Cal, Medicare, and Medicaid, they can consult with health care insurance counselors, advocacy programs (such as AARP), or their discharge planner.

According to gerontologist Erin Westphal, special projects coordinator for the Los Angeles Department of Aging and project coordinator for the Los Angeles Foundation on Aging, Medicare does not pay for long-term services; however, it will pay for some short-term programs.

“If someone is being discharged home after a medical procedure where they are going to need a nurse to look at their wounds to ensure that healing is happening, Medi-Cal will pay for that for maybe an hour or 2 hours a week—tops,” Westphal says. “For low-income individuals in California, Medi-Cal is available. The rest of the nation calls it Medicaid. If a patient qualifies for Medicaid, then it is possible that they could apply for the in-home support services program, which helps offset the cost of the caregiver based on the person’s impairments.”

The individual is then assigned a predetermined number of care hours per week. Once these are exhausted, then it is up to them to find a caregiver.

“In some cases, [a member of the family becomes the] caregiver, or some families hire a caregiver and an in-home support program helps offset the cost. However, it doesn’t cover the total cost of that caregiver,” Westphal says.

Forward-thinking individuals also can purchase a long-term health care insurance plan that will help pay for in-home health. When looking for custodial care to help with bathing, cooking, and cleaning, most people will need to pay out of pocket, according to Westphal.

“The key is to plan in-home modifications ahead of time. It is important to plan appropriately. If you suddenly fall and break your hip, the process of installing home modifications takes a lot of time,” Westphal says.

DEGREES OF NECESSITY

According to Shu-chuan Chen Hsu, MA, OTR/L, CHT, supervisor of occupational therapy at University of California Irvine (UCI) Healthcare, individuals with Alzheimer’s or dementia are faced with more safety issues, since they no longer have the cognitive ability to perform their daily tasks. A patient with Parkinson’s or severe arthritis has limited joint mobility, which would require assistant devices to help them increase functional independence.

For individuals who are not strong enough to walk to the bathroom, a bedside commode is both a convenience and a safety feature.

“Typically, what we do as occupational therapists is see the patient in the clinic after they are referred by the doctor, then we can give the patient suggestions regarding in-home care. For example, someone with severe Alzheimer’s most likely will not know how to bath themselves. Usually the patient’s family has to cover the cost of the caregiver unless they have a home health program,” Hsu says. “We usually tell families to contact the Alzheimer’s Association where they can find all the information they need.”

“During a half-day clinic session, a patient is evaluated by the team members,” says Lisa M. Gibbs, MD, director of the Health Assessment Program for Seniors (HAPS), at UC Irvine SeniorHealth Center. HAPS is an interdisciplinary program that consists of a team made up of a geriatrician, a psychologist, an occupational therapist, as well as a pharmacist, a dietician, and a social worker.

“We deal with patients who have difficulty with mobility, such as those with Parkinson’s, stroke, or severe arthritis. We also work with patients with severe heart failure, heart disease, cancer, and dementia,” Gibbs says.

According to Gibbs, a substantial part of HAPS’ referrals are from family members who have discovered the program through community resources or the program’s Web site.

At the end of each business day, the HAPS team discuss their findings and recommendations with their patients, families, and caregivers.

“If we feel like a home health assessment is needed, we will definitely make that recommendation,” Gibbs says. “If our patient needs physical therapy or occupational therapy, we can make a recommendation that they receive outpatient therapy, which can occur in the home or the clinic.”

Although HAPS caters to memory assistance, according to Gibbs, an individual does not need to have a memory issue to use the program, but it tends to be one of the most common client complaints.

Gibbs says, “We see patients who suffer from memory, psychological, or multiple medical problems, or patients declining in function. They really need all of the members of the team to get together and address the problem. A couple of weeks after the clinic [session], we have a family conference where a psychologist and a physician review the recommendations with the patients and their families and caregivers.”

According to Gibbs, long-term care for patients with dementia depends on what stage of dementia the patient is experiencing. In its early stages, someone often can remain in their own home with the assistance of a caregiver, and even with moderate dementia, they may have the choices of staying home with a caregiver or moving into an assisted living facility or a board and care home.

“As the dementia progresses and there are more issues such as wandering or behavioral problems, then often the long-term care options include nursing homes,” Gibbs says.

Gina Bernal is a contributing writer for Rehab Management. For more information, contact .