Home Accessibility Before Hospital Discharge in Baton Rouge, LA
I have five questions about accessible home routes from Baton Rouge area hospitals: 1) How will the person get from the car to the house? 2) Where will the person sleep? 3) Which bath will the person use? 4) Is there stairs on the person’s daily route? 5) Will there be enough space for the transfer to be done safely?
These questions are a starting point for many people including the caregiver, therapist, case manager, and accessibility specialist.
From the hospitals in Baton Rouge, Central, Walker, Denham Springs and Livingston, my intent is to assist the discharge process and not make clinical judgments. At 101 Mobility of Baton Rouge, I evaluate the home to ensure the equipment and route selected by the hospital will function in the home.
From the Home
Prior to Equipment Being Delivered, I Review the Following with the Caregiver
How will the person get from the car to the house?
Where will the person sleep?
Which bath will the person use?
Is there a staircase on the person’s daily route?
Will a transfer be done on this equipment?
Entry
The first thing I review is access to and from the house from the car.
I start with where the vehicle stops. From there I work out the route to the destination door.
- How many steps does the route have?
- Is there a landing or porch?
- Which door will be used?
- Is there enough room to use the mobility device to get to the door?
- Is there a threshold?
The products that are prescribed by a hospital for home use need to accommodate the mobility devices and work with the environment of the user’s home, especially the entryways.
A prescribed temporary ramp may help if other elements of the system work together.
A Multi-Fold Ramp may help if the system requires the use of a ramp for a short period of time.
The folding design helps with mobility.
A ramp, like any other product, has to be evaluated with the environment it will be used with to help determine if it is the best solution.
If a product does not work with the environment it will be used with, a different product or solution should be used.
I determine the height of the bed and the distance from the bed to the closest wall or surface. Then I do the same thing to the bath.
I identify the level of the house where the patient will perform daily activities.
- What room will the client be staying in?
- Where will the client be using the bathroom?
- Are these both accessible without the use of stairs?
This will decide the level of accessibility of your home.
A client may be able to physically enter the home, but there may be no means of access to either of these two crucial locations.
I assess these distances and the obstacles between them.
I also assess door clearances and turning radiuses.
There are a number of potential trade-offs. For example, it may be better to place the client in a temporary, more accessible bedroom (on the first floor) and, in the process, delay the need to install a permanent, expensive accessibility improvement in the regular (less accessible) bedroom.
This is just one example of many potential trade-offs.
A less expensive, more temporary solution may meet a client’s needs for accessibility while they recover.
In some cases, it may be better to focus on different, more temporary solutions, such as access ramps and other aids, if stairs will still be the primary means of accessing the second level.
This may be preferable to addressing other access concerns on the first level of the home.
These issues are distinct from each other to avoid assuming a single solution for multiple issues.
Access to staircases with straight runs
The assessment of staircases with straight runs includes consideration of Bruno Elan Straight Rail Stairlifts.
The Elan stairlift is restricted to use with straight staircases and has a rail mounted to the staircase, as opposed to a wall, surface. When not in use, the seat, arms and backrest of the chair fold up to reduce the space occupied by the stairlift.
There are other factors to consider aside from the staircase including door clearances and landing space.
If there are turning staircases, or if the permanent nature of a stairlift is not desirable by the client, a stairlift would not be recommended, even if discharge is imminent.
Access to permanently mounted ramps
A similar line of thinking is applicable to the use of a temporary, foldable ramp.
A foldable ramp may be employed if the mobility aid is small enough to be transported on a ramp of an appropriate size, and if the ramp is of the correct configuration to provide adequate clearance to the landing. If a different configuration of permanent ramp is needed to provide access, the foldable ramp is not a suitable long-term solution.
Transfers
If a mechanical device is to be used for transfers, the Eva450 or 600 Drive (Handicare EvaDrive) may be considered to evaluate space constraints.
I evaluate things like base width, maneuverability, clearance at doorways, charging and storage location, caregiver access and working space, and the route caregivers will take between transfer points.
I am not qualified to determine whether a patient lift is warranted, or to select the most appropriate inter-restore transfer technique.
Those decisions are to be determined by the care professionals involved in the case.
I assess the equipment to determine if it facilitates the specified transfer procedure.
Prior Information
Prior relevant information facilitates an efficient site visit.
Therapists, case managers and family members are not required to design or develop the solution. They are required to identify the problem route or area to be assessed.
Information that may be required to identify the problem route may include: The home address, anticipated date of discharge, the expected primary access route to the home, the expected mode of transportation and mobility aid to be used at discharge, the expected sleeping location, the expected problem routes to other service areas (i.e. bathrooms, other sleeping areas, etc.) and the expected problem routes to and from the primary access point to the home.
The photos of the doorways, shower/tub, and route to the bathroom will help in determining what to measure.
Any equipment or methods of transfer described by the care team.
I must document the instructions of the therapist or clinical team. This ensures the home assessment will not contradict the care plan.
The expected length of time the person will require the assistive devices.
The expected length of time the person will require assistance will help determine what kind of devices (permanent vs. temporary) we will assess first.
This information provides the caregiver with the information needed to develop a care plan to meet the expected outcomes of the person.
The expected outcomes are described by the member of the rehabilitation team.
I help to clarify if the outcomes are physically feasible.
The equipment has been set up or rented. This means we must return to the beginning; is the route to the equipment clear? Can the equipment be used in its intended location? Is the equipment obstructing the pathway to the bathroom? Is the pathway to the bathroom obstructed? Are there sufficient clearances for caregivers to assist with a transfer? We demonstrate the normal operation of the equipment and it’s intended use. If the equipment is a ramp, we demonstrate the normal storage and placement of the equipment. If the equipment is a stairlift, we demonstrate the controls and normal storage and use of the equipment. If the equipment is a patient lift, we demonstrate it’s normal operation and the caregiver’s role in the process, and we continue to assist and support the care plan established by the member of the clinical team.
Our team is clear about who to contact when there is an equipment-related issue. Once our product is installed, our service and support team are available to perform any service or repair the product may require.
Our team has extensive experience in equipping and modifying homes to welcome patients back from the hospital. If your patient or family is planning to return back to Baton Rouge, Central, Walker, Denham Springs or Livingston, we can perform a free in-home consultation to evaluate the home entrance, sleeping, and bathroom levels, stairs and/or lifts, and any required equipment.
What should be evaluated at home prior to a patient’s discharge?
The following should be evaluated prior to discharge: the route from the patient’s vehicle to their sleeping location; the route from their sleeping location to the bathroom; the stairs; and sufficient space to move the patient, if necessary.
How far in advance should I schedule a home accessibility evaluation?
This evaluation can be scheduled as soon as it is determined the patient will need it.
Can a temporary ramp be used after patient’s discharge?
Yes, a temporary ramp can be used to access the home if the length of the ramp, the height of the home entrance and other factors are taken into account.
Should the bedroom and bathroom be on the same floor?
Not necessarily, but if the bedroom and bathroom are on the same level, it may simplify the layout of a temporary accessibility plan, especially if there are no stairs to that level. If there are stairs to that level, that staircase requires a separate accessibility plan.
Can 101 Mobility assess what patient lift or transfer method is necessary?
101 Mobility cannot determine what patient lift or transfer method is necessary. A physical therapist, occupational therapist, or other clinical professional on the patient’s care team may determine what patient lift or transfer method is necessary. 101 Mobility can assist in the evaluation of the available space of a patient’s home to include door clearances, caregiver clearances, and determine if the necessary equipment to carry out the patient’s transfers would obstruct other clearances in the home.
What should a therapist or case manager send in advance?
The care team may have already determined the best way to transfer a patient. In that case, the plan may include the equipment and/or methods that team has identified. In addition, the care team may have identified the best route to transfer the patient. The care team may also have a timing and a plan for a patient’s transfer to the mobility device and to other rooms of the house. If this information is documented, it should be provided to 101 Mobility prior to the home consultation.
What if the home is not set up to support the original plan?
The home may not always support the original plan. If this is the case, an alternative plan would be devised to support the patient, which may include using a different access point to the home and/or a different plan to place the furniture and equipment for the patient’s support.
About the Author
Jonas Boutte is the owner of 101 Mobility of South Louisiana and has hands-on training from accessibility-equipment manufacturers including Bruno, Harmar, Stiltz, Staying Home, EZ-ACCESS, National Ramp, and others. He helps Baton Rouge-area families evaluate ramps, stairlifts, patient-handling equipment, platform lifts, home elevators, and other accessibility solutions and remains involved from consultation through installation coordination and ongoing support.
