How OTs Can Help Turn a House Into a Home

Eve Vickerson, Myositis Association Australia Liz Ainsworth, Occupational Therapist and Access Consultant, Home Design for Living

Ahouse is a physical structure, whereas a home is all about living. A home offers comfort, meaning, safety, and a feeling that you belong. It is a springboard for life.

Occupational therapists with specialist environmental modification knowledge and skills can help older people and people with disabilities turn their houses into homes.

As well as maintaining or improving people’s essential physical health, safety, and independence requirements, home modifications can result in a range of outcomes that are often much broader than what may have been expected at the outset.

The following are two case studies on home modifications proposed by an occupational therapist. In each case, the home modifications have aimed to contribute towards greater personal autonomy and control for both people involved.

The case studies include two people living with myositis and are being showcased to coincide with Myositis Awareness Month in May. Myositis is a group of rare muscle diseases involving inflammation within the muscle tissues. Over time, it can cause significant muscle loss with a comparable decline in strength, dexterity, and mobility.

People with this condition may acquire mobility and other equipment and rely on the help of carers and paid support workers over time. Because most homes are not designed to cater for people’s changing needs, environmental barriers tend to emerge, requiring a home modification and equipment response. Case Study One: Changing Needs Over Time

Background Jim is a retired veterinary surgeon who lives with Inclusion Body Myositis (IBM), a form of the disease that currently has no effective treatment.

Initially, Jim modified his house by installing a ramp and handrails. At this stage he was walking with the assistance of a walker. As the disease progressed, he encountered a change in his physical and functional status and acquired different types of equipment. A particular issue of concern was the lack of access provided by the bathroom.

Home Modification Features A significant component of Jim’s home modifications was improvements to the bathroom. The environment created ‘excess disability’ to the extent that he was abandoning tasks and being at risk of having accidents and injuries.

Important design considerations were:

• To provide a level access shower • To maintain cost-effectiveness by keeping as many areas in their current location to prevent changing the plumbing • Jim’s handedness for access and use of each item in the room (e.g. grabrail, cupboard with door and drawers, power points, etc.) • To comply with the waterproofing requirements of the Building Code of

Australia that applied at that time. As a result of the need to have a level access shower and the requirements of Queensland state legislation and the National Construction Code (Building Code 2019), the whole bathroom needed to be altered to include:

• Adequate space leading up to, and around, each area for Jim (and his carer) • Asbestos removal • Level access for walking and wheeling using mobility equipment without the need to negotiate a small step at the doorway • ‘Slip resistive when wet’ flooring for wheeling and walking–for Jim, his carer, and for family using the area • A slimline sink, microtrap, and lever handle on single-lever mixer tap for ease of use in standing and then sitting. A shallow sink prevents reaching low into a deep sink, a microtrap ensures the pipework does not scrape on the knees, and a lever handle ensures ease of reach and a sink height that suits all users. • A wall-hung cupboard beside the sink to prevent any water damage to the base and to provide turning circle space under the cupboard suitable for feet on footplates • Drawers below the bench for easy storage access. The drawers featured easy-glide runners with stops and

D-shaped handles to allow good grasp given Jim’s hand size and function. • Level access shower with a continuous shower track and safety glass to contain the water • A handheld shower and lever tap

• Towel rails that were designed as grabrails so they can take weight or enable the carer to lean on them when they need to rest during the routine • A fan/light/heater for steam evacuation, lighting the room, and warming the area in the cooler months for comfort.

Jim also had a bidet installed with a custom height raiser that he helped design and made himself at the local Men’s Shed. Working with a specialised artisan, Jim made melamine slices that could be placed under the bidet to raise it to the desired height. The bidet will have to be changed to an alternative toilet at a later date to suit mobile shower commode access.

Case Study Two: Future-Proofing

Background Gordon is a musician and keen veggie grower who lives with Inclusion Body Myositis (IBM). He is walking but also relying more on wheeled equipment in his home. Gordon’s priority is to future-proof his home to ensure maximum liveability as his health needs change over time.

He has made a range of modifications to provide access into the home, such as platforms and ramps, but now needs to change areas within the home to cater for a powerchair, other mobility equipment, and care support. A range of areas within and outside the home are becoming harder for him to access and use.

Home Modification Features Gordon’s occupational therapist has performed an assessment, and recommended the following modifications and equipment to address some of the environmental barriers within and outside the home:

BATHROOM • Fitting a low toilet with the Aerolet toilet lifter and bidet seat to assist with toileting,

moving from sitting to standing, and setting the toilet out to accommodate a mobile shower chair in the future • Installing grabrails that are towel rails to provide support in standing during selfcare routine and for carers to use to rest • Installing grabrails in the shower for standing routine and to lean on when seated • Cutting back the glass in the shower for future mobile shower commode use • Etching on the floor to provide greater grip when wet.

BEDROOM • Removing carpet that has a ‘pull effect’ on equipment and replacing it with tiles that will also be longer-lasting, harder wearing, and easier to wheel on • Reinforcing the ceiling for future ceiling track hoist for bed mobility and transfers. ENTRIES • Installing threshold ramps and step ramps to address changes in level for walking and wheeling with mobility equipment. ELECTRICAL • Introducing environmental controls to operate in the bedroom (and other areas of the home) for lights, blinds, air conditioning, and security. EXTERNAL ACCESS • Raising low garden beds for easier access when standing or seated • Replacing turfed areas with concrete to provide flexible and increased access around the home in all weather conditions.

This helps with socialisation, care of pets, accessing the power box and other electrical items, and gardening. • Providing a cover over a door entry for safety in all weather conditions. APPLIANCES The following appliances are recommended to ensure Gordon does not fall when reaching in standing, to accommodate a sitting position, and to use his hands that are deteriorating in grip function:

• Remote control for the range hood so he can operate it from different parts of the kitchen • A drawer-style dishwasher with D-shaped handles • Refrigerator freezer with a water dispenser on the door, fridge at the top, and freezer drawers at the bottom.

There’s No Place Like Home

In each case study, the occupational therapist has recommended home modifications and appliances for Jim and Gordon that help maintain and improve their independence and functional performance, and strengthen their sense of personal autonomy and control in the home.

In Jim’s case, the home modifications helped him to adapt positively as his myositis progressed. “It means that I can get around and be fairly self-sufficient,” he said.

For Gordon, his planned home modifications will help him continue to do some of the things he loves (like caring for a thriving veggie garden) while future-proofing his home to avoid costly and time-consuming alterations in the future.

“When you’re on your good days, what’s there now is fine. But when you’re on your bad days, it’s not real good,” Gordon said. “A lot of the improvements that the occupational therapist is looking to do will certainly make it easier for me to be able to do things myself rather than relying on others all the time.”

LEARN MORE

If you are interested in forming a myositis working group with other occupational therapists, please contact Jane Day at jane@thebullantnest.com

About the Authors Eve Vickerson is a freelance health writer working with the Myositis Association Australia–a volunteer-run charity with nationwide membership that provides a support network for people living with myositis. Learn more at www.myositis.org.au.

Liz Ainsworth is an occupational therapist who specialises in working with older people and people with disabilities by providing advice about their minor and major home modifications.