Environmental Modifications to Facilitate Safety and Function at Home Annette Lavezza OTR/L Team Leader Johns Hopkins Hospital
Active Types of Interventions Systems and solutions that require learning new information in order to operate Examples: Microwaves; remote controls
Passive Types of Interventions Changes that alter the environment without requiring any learning Examples: automatic lights
Kitchen Access to glass and raw foods in refrigerator Install a latch to prevent access unless living alone
Remove clutter from counters If possible periodically check the perishable supplies for freshness Do not store cleaning and food supplies close together and always store cleaning supplies in original bottles
Stove Use Replace with microwave Stove Top Fire Stopper http://www.lifehome.com/products/1026.asp Disconnect or turn off at circuit breaker
Microwave Closely evaluate the complexity of the oven Minimize buttons; mark buttons with numbers Begin training early prior to it being unsafe to use the stove Purchase dishes and containers that are microwave safe and remove others
Bathroom Scald Burns: occur when water is above 120 degrees Anti scald devices Easily secures onto existing faucets Adjusts flow of water for hot water surges Lower water heater temperature Overflowing water Automatic shut off faucets Community Occupational Therapists and Associates, Safety Assessment of Function and the Environment for Rehabilitation
Entering and exiting the shower Grab bars positioned for a natural reach MUST be installed into wall studs Towel racks are NOT grab bars Standing from a toilet seat Place an over the commode raised seat with arms
Place non skid aids in the bottom of the tub Ensure that any rug has secure backing
Living Room/Family Room Unattached rugs Double sided rug tape Remove small scatter rugs
Medication Inaccurate administration or missing doses Automatic dispenser with alarms Most useful are systems that alarm and then dispense medication Always have a family member fill Ensure the device is lockable Check the volume and length of the alarm
Limit access to the original over the counter bottles and prescriptions Place locks on medicine cabinets Only store medication in one location
Wandering Door alarms Lock door with device that is easily removed but requires new learning Only an option if they live with a person capable of removing during a fire
Motion detectors with remote alarms or verbal feedback Alarms that sound when someone stands from a chair Register with Safe Return through the Alzheimer s s Association http://www.alz.org/maryland www.alz.org/maryland/
Fall Risk Remove all unattached rugs Thresholds are most dangerous; label with bright tape to cue Bed and chair alarm pads Remove unnecessary clutter Community Occupational Therapists and Associates, Safety Assessment of Function and the Environment for Rehabilitation.
Miscellaneous Inability to dial telephone One button dialing with picture labels Unable to operate TV remote Tape all buttons except channel up Purchase device with only a few buttons Remove candles Ensure smoke detectors are active Notify local fire department Purchase automatic shut off appliances Community Occupational Therapists and Associates, Safety Assessment of Function and the Environment for Rehabilitation
Driving American Medical Association s s Guidelines for Assessing and Counseling the Older Driver. http://www.ama-assn.org/ama/pub/category/10791.html assn.org/ama/pub/category/10791.html
Self Assessment Sample questions Getting lost Others are worried about my driving Cars appear out of nowhere Others drive too fast/honk at me Feeling tired after driving Being stopped by the police recently Dislikes night driving, busy intersections, left hand turns Recent near misses http://www.ama-assn.org/ama1/pub/upload/mm/433/appendixb.pdf assn.org/ama1/pub/upload/mm/433/appendixb.pdf
Questions for Caregivers Does your loved one Fails to yield right of way Fails to obey lights and stop signs Drive too slowly or quickly Gets lost Trouble staying in the lane Slow reactions Poor decisions related to driving Tickets/near misses/fender benders Comments from other http://www.ama-assn.org/ama1/pub/upload/mm/433/appendixb.pdf assn.org/ama1/pub/upload/mm/433/appendixb.pdf
Strategies Talk to your loved one in a non threatening and safe environment Determine alternate modes of transportation Encourage them to make an appointment with their physician and discuss driving Call in advance to alert the physician Ask them to take a formal driving assessment with a driving rehabilitation specialist http://www.ama-assn.org/ama1/pub/upload/mm/433/appendixb.pdf assn.org/ama1/pub/upload/mm/433/appendixb.pdf
Driving Programs in Maryland Doctors Community Hospital 8118 Good Luck Road Lanham, Maryland 20706-3596 Dana Nixon, OTR/L, DRS 240-965 965-8438 (phone) OT Department 301-552 552-8144 301-552 552-7975 (fax) www.dchweb.org Rehabilitation of Frederick 85 Thomas Johnson Court, Suite C Frederick, Maryland 21702 Tim Jones, OTR/L, CDRS (301) 682-9110 (phone/fax) (304) 261-6002 6002 (cell phone) ottjones1@yahoo.com Good Samaritan Hospital 5601 Loch Raven Blvd. Baltimore, Maryland 21239 Karen Amoyal,, DRS (443) 444-4600 4600 (phone) (410) 444-4607 4607 (fax) karen.amoyal@medstar.net National Rehabilitation Hospital 2 Irving Street, NW Washington, DC 20010 (van in addition to car) Glen Digman,, OTR/L, CDRS (202) 877-1705 (phone) (202) 877-1524 (phone) Ken Byers, OTR/L202) 877-1909, byersken@hotmail.com
Adventist Rehabilitation Hospital of MD 9909 Medical Center Drive Rockville MD 20850 Jennifer Milsovic,, OTR/L 240-864 864-60576057 (questions regarding driving program) 240-864 864-62026202 (to schedule a driving evaluation) Sheila J. Jackson, C.D.R.S. Certified Driver Rehab Specialist 50 Irving St. NW Washington, DC 20422 (202) 745-8000 ext. 7623 E-mail sheila.jackson@va.gov Workforce and Technology Center 2301 Argonne Drive Baltimore, Maryland 21218 (van and car) For scheduling: Dan Dubay (410) 554-9208 (phone) John Arthur, DRS (410) 554-9205 (phone) Art Kleiman,, DRS (410) 554-9250 (phone) F.O.F. Occupational Therapy Services, LL Focus on Function 1700 Reisterstown Road, Suite 217 Pikesville MD 21208 Kim High, OTR/L, DRS 410-484 484-2761 phone 410-484 484-2762 fax
Resources www.alzstore.org www.radioshack.com/home/index.jsp www.sammonspreston.com www.beabletodo.com
References American Medical Association s s Guidelines for Assessing ancd Counseling the Older Driver. www.ama-assn.org assn.org Community Occupational Therapists and Associates. Safety Assessment of Function and the Environment for Rehabilitation
Contact Information Annette Lavezza OTR/L Acute Care Services Team Leader 600 North Wolfe Street Meyer 2-109 Baltimore MD 21287 410-955-6763