Before caregiving, when you shopped for a house, you probably had certain must-have items on your buying check-list, items like granite countertops, stainless steel appliances, shiny wood floors and custom tiling.

After caregiving enters a house, you realize how hard a house, with its multiple levels, tight hallways and awkward bathrooms, can make the experience. Now, your wish list for a house probably includes wide doorways and expanded halls, hand and chair rails, interior and exterior ramps, and a streamlined one-level living quarter.

Maybe you can’t move, but you can look to solutions to help. Whether you renovate an entire floor of your home, build an addition (i.e. the mother-in-law suite) or complete several home modifications in stages, it is possible to age in place (AIP) without moving. Consider these tips for adapting your home – and know that the benefits extend beyond the caree to the family caregiver, too:

1. Simplify, simplify, simplify: Decluttering, streamlining, and organizing the home is one of the easiest (and most affordable) ways to make it AIP-friendly. Those boxes of old magazines, that dining room table piled with paperwork, the hall closet that’s inaccessible because it’s bursting with rarely-used clothes and holiday decorations – we all have them. But overstuffed shelves, drawers and cabinets are not only unattractive, they’re a fall risk, a hazard, an obstacle to efficiency. It doesn’t have to be spring to do some much need cleaning and consolidating. And if your caree requires a transition to a care facility, the work of downsizing from a multi-bedroom home to a single room or apartment will be easier.

2. Ramp it up: Installing ramps at the home’s most-used exits and entrances enhances independence and prevents home “imprisonment”. Additionally, stair lifts allow access to a second floor bathroom or bedroom. These aids also ease the physical burden and stress on a family caregiver’s body if the caree requires mobility assistance within the home.

3. Let there be light: Lighting can make a significant difference when it comes to preventing falls and easing mobility in the home. Certain lighting fixtures (floor lamps, for example) can be dangerous if they have long wires exposed and in the walking (tripping) path. Installing additional lights (or windows to let in more natural light) in high-traffic areas and frequently-used rooms makes the home safer – and more attractive.

4. Watch where you step: You walk all over it every day but probably don’t give it much thought until your balance or gait is compromised. Flooring in all rooms of the house can easily present a fall risk as can rugs that are bulky, shift around easily, or have corners that catch on walkers, canes or wheelchairs. Hard flooring provides optimal mobility.

5. Keep things dry in the water closet: In the bathroom, where the majority of fall-related injuries occur, implement non-skid surfaces. Make sure all surfaces (counters, tubs/shower floors, etc.) stay dry.

6. Lend a hand: Chair rails in hallways, grab bars in the bathroom, and other touch points for safe and supported maneuvering can dramatically reduce the risk of falls and promote independence within the home.

An added bonus? After home modifications have been made to accommodate an aging resident, these features, if done well, can certainly be a selling point for future homebuyers (i.e. those young adults who are already thinking about taking care of Mom, Grandpa, or another senior relative). Invest wisely; prepare your home now.

(You can find more information on AIP adaptations at 101Mobility.com.)

Michelle Seitzer is a freelance writer and editor who specializes in elder care content. Seitzer writes for a number of senior-related websites, including 101 Mobility.com, the nation’s leading sales, service and installation provider of a complete line of mobility and accessibility products and equipment that may be customized to suit each individuals’ home care needs.  Learn more about the company at http://101mobility.com/ or email Michelle (mseitzer@101mobility.com).

On Wednesday morning, Chirag Patel from Halo Monitoring took us into the future, telling us know about emerging technology that can help family caregivers. We learned that Best Buy is pilot-testing a section of stores in Seattle devoted to health gadgets. This to me is wonderful news because of its potential: Imagine! You don’t have to wonder where to buy a gadget or device that helps manage care. You just go to a local retailer. We also discussed Comfort Zone, a tracking device for persons with Alzheimer’s, from the Alzheimer’s Association. You can listen to the show (or download for later listening) here.

On Thursday morning, Jeannie Keenan of My Health Care Manager, joined us an “Ask the Nurse” segment. We discussed incontinence care, when to call 911, how to manage a fall and when to the call the doctor. I also mentioned a show Jeannie and I aired in the summer; she discussed her struggle with infertility as she care for her mother-in-law. If you missed the show, it’s worth a listen. You can listen to Thursday’s show via the player at the end of this post.

On Thursday afternoon, Jamie Goldberg, offered tips on how to design a sensible, stylish bathroom.We focused on three areas of the bathroom: the bath/shower, the floor and lighting.

On Friday morning, Wilma Nachsin joined us for the second of our three-part series on job hunting. Wilma offered terrific tips on how to write a resume with punch. We complete our series on Friday, Nov. 27 at 8:30 a.m. CT.

On Saturday, Table Talk took on Thanksgiving traditions. I shared a five-step process to use if you’d like to ditch a tradition you dislike:

Changing a Tradition
1. Offer an alternative.
2. Allow for resistance.
3. Make adjustments as needed.
4. Ask for feedback.
5. Modify as necessary.

And, Shelley Webb offered tips on how to make a videotape of your care recipients.

I assigned Thanksgiving homework: 1. Think of a simple goal for your Thanksgiving. 2. Tell someone and ask them for help in making your goal a reality. 3. Do it–make your goal your reality. And, don’t forget our Holiday Survival Guide–tips and ideas to manage your holiday season.

Don’t miss our upcoming shows–see our schedule here.

Chirag lives in Chicago, so I met him for dinner about a month ago. I was able to see the technology used in his product—a personal emergency response system that detects falls. The product is light-weight, unassuming and easy-to-wear. What’s most exciting to me is young people developing technology to create better quality-of-life for older adults and their family caregivers. It’s exciting because they provide cross-over into industries (such as consumer electronics) that brings awareness and information to individuals (i.e., family caregivers) who need the products but may be unaware of the availability. (You’ll hear my excitement on the show; you can listen via the player at the end of the post.)

More than 90 percent of the products on display at the AAHSA Idea House are on the market today. Product highlights include:

• A medication dispenser that automatically organizes, reminds, dispenses and monitors an individual’s medication use. The technology enables pharmacies to be notified when refills are needed.
• Electronic distribution of medical records to doctors, family members and caregivers on an ongoing basis. The distribution enables timely responses to the data, thereby improving an individual’s health outcomes and reducing health care costs over time.
• Automatic personal emergency response systems, including fall detection that monitor a person’s events and notify emergency medical services and caregivers immediately when needed.
• A security system that replaces the traditional peephole with an LCD screen to make it easier for people in wheelchairs or other needs to see who’s at their door.
• Hybrid Assistive Limb (HAL), a wearable robotic suit that is designed to multiply a person’s strength by reading bio-electric signals a person generates. The suit uses those signals to guide the movement of robotic limbs strapped to a person’s arms and legs. With HAL’s help, many stroke patients may be able to walk and nurses have extra strength to move individuals who need assistance.
• Height-adjustable kitchen and bath appliances designed to meet different users’ needs.
• A Passive Sleep Monitoring System that monitors a person’s sleep quality, breathing and heart rate as he/she lays on the mattress and enables caregivers to detect sleep-related markers of disease, like urinary tract infections and depression, earlier.

Because technology will become more and more important in your caregiving role, the following resources can help you stay up-to-date:

The Daily Wrinkle: Jill Gilbert of Gilbert Guide gives us a video reviews of aging products and innovators.

Aging in Place Technology Watch: Laurie M. Orlov blogs about and analyzes technology trends.

Microsoft Health Tech Today: Bill Crounse hosts this monthly video covering developments in health care technology.

And, Chicago’s PBS station featured a segment on the Idea House; take a tour:

I wish there was a way of getting something which would let us know when my grandmother gets up from a nap or in the morning. For instance this morning, she got up before any of us were up, and tried to go outside on her own. My brother leaves very early in the morning, and I don’t want the alarm to go off and wake everyone else up. Do you happen to know if there’s something that would just alert us with her? We were thinking of getting a baby monitor.

Hello,

A few suggestions for you:

–I helped some friends care for a stroke patient (Evie). We used a baby monitor to monitor her while she was sleeping. And, to make sure we heard her when she got up from bed, we tied small bells to her slippers. This worked because she always put her slippers on before getting out of bed. This a low-tech option.

–Alzheimer’s Store has a motion detector with an alarm; you can learn more here. The store has other products you might find helpful, including a bed pad wireless remote alarms. Look under “Safety” at http://www.alzstore.com

–AMeds also has a floor mat alarm system. They also sell one for chairs.

–If you haven’t already, you can register her with the Alzheimer’s Association Safe Return program; click here for  details.

You also can check with your local durable medical supply companies to see if they carry these products. If they do, you can visit the store to see. Medicare has a directory to find stores near you here.

To help you find the right equipment (and we include clothing in this category), we’ve compiled a list of online stores:

ActiveForever.com: The company offers an extensive catalog, including diabetes supplies, scooters and skin care products. The Cruisin Cooler Electric Scooter Cooler caught my eye, which the company says “is a motorized beer cooler scooter designed to bring a whole new level of fun to tailgates, BBQ’s, and even parties.”

AlzStore.com: This is my go-to site for great products for persons with Alzheimer’s. You’ll find products that will help prevent wandering, that increase safety and that provide entertainment. My favorite products include the anti-scalding device, no start car battery switch and activity lap pillow. (Mark and Ellen Warner, the store’s owners, are very dedicated to helping persons with Alzheimer’s and their family caregivers. If you can’t find what you need, be sure to ask. They’ll do their best to help.)

Assistech Special Needs: The company carries a complete line of assistive products for those who are deaf or hard-of-hearing, visually impaired, speech-impaired, and physically challenged.

Buck and Buck: The company makes dressing easier, with a variety of clothing created specific to diseases (Alzheimer’s and Parkinson’s, for instance). (Personal Note: I’ve asked Julie Buck, one of the owners, to help a few family caregivers over the years—she has always been gracious and giving. It’s nice to highlight a company whose owner truly works to meet the needs of her customers.)

Caregiver Products: Amy Wright, a physical therapist, organizes her store logically so you can find products that you’ll need in the kitchen, around the house and for getting ready. You also can download a free home safety checklist.

Disability Products: The site offers low-vision products, kitchen aids, and recreation products such as playing card holders. The company says a portion of each purchase is donate to charity.

Dynamic Living: This simple-to-navigate site also is very diplomatic, including a section called “Generously Sized” (products designed for big people). The company enjoys longevity online, opening in 1997.

LifewithEase.com: I like that this company features garden tools (and touts that it’s based in tax-free New Hampshire!). You can purchase Good Grips products here as well as products to aid in travel.

The Mobility Resource: It’s all about getting around on this site. You can purchase turning car seats, accessible vans and car controls.

PersonCare.Net: The company offers products for both hands-on care and Alzheimer’s care. For each product, the company details what it calls the three keys: Who is it for? Why is it needed? What’s the major product benefit for you?

Sears.com: Sears has long carried adaptive devices in its catalog. You can purchase lifts and chairs, bath seats and foot care. You can buy products online and then pick up in a store near you. (Personal Note: My father retired from Sears. A special shout-out to Sears to picking up my college tab.)

Which sites do you use that we’ve missed? And, be sure to tell us about your experiences ordering equipment and supplies online.

Resources

Assistive Technology Fact Sheet

Make Sure the Medical Device You Choose Is Designed for You

Assistive technology is any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently. These tools are also sometimes called “adaptive devices.”

Such technology may be something as simple as a walker to make moving around easier or an amplification device to make sounds easier to hear (for talking on the telephone or watching television, for instance). It could also include a magnifying glass that helps someone who has poor vision read the newspaper or a small motor scooter that makes it possible to travel over distances that are too far to walk. In short, anything that helps the elderly continue to participate in daily activities is considered assistive technology.

Just as older people may have many different types of disabilities, many different categories of assistive devices and services are available to help overcome those disabilities. These include the following:

* Adaptive switches. Modified switches that seniors can use to adjust air conditioners, computers, telephone answering machines, power wheelchairs, and other types of equipment. These switches might be activated by the tongue or the voice.

* Communication equipment. Anything that enables a person to send and receive messages, such as a telephone amplifier.

* Computer access. Special software that helps a senior access the Internet, for example, or basic hardware, such as a modified keyboard or mouse, that makes the computer more user friendly.

* Education. Audio books or Braille writing tools for the blind come under this category, along with resources that allow people to get additional vocational training.

* Home modifications. Construction or remodeling work, such as building a ramp for wheelchair access, that allows a senior to overcome physical barriers and live more comfortably with a disability or recover from an accident or injury.

* Tools for independent living. Anything that empowers the elderly to enjoy the normal activities of daily living without assistance from others, such as a handicapped-accessible bathroom with grab bars in the bathtub.

* Job-related items. Any device or process that a person needs to do his or her job better or easier. Examples might include a special type of chair or pillow for someone who works at a desk or a back brace for someone who does physical labor.

* Mobility aids. Any piece of equipment that helps a senior get around more easily, such as a power wheelchair, wheelchair lift, or stair elevator.

* Orthotic or prosthetic equipment. A device that compensates for a missing or disabled body part. This could range from orthopedic shoe inserts for someone who has fallen arches to an artificial arm for someone whose limb has been amputated.

* Recreational assistance. New methods and tools to enable people who have disabilities to enjoy a wide range of fun activities. Examples include swimming lessons provided by recreational therapists or specially equipped skis for seniors who have lost a limb as a result of accident or illness.

* Seating aids. Any modifications to regular chairs, wheelchairs, or motor scooters that help a person stay upright or get up and down unaided or that help to reduce pressure on the skin. This could be something as simple as an extra pillow or as complex as a motorized seat.

* Sensory enhancements. Anything that makes it easier for those who are partially or fully blind or deaf to better appreciate the world around them. For instance, a telecaption decoder for a TV set would be an assistive device for a senior who is hard of hearing.

* Therapy. Equipment or processes that help someone recover as much as possible from an illness or injury. Therapy might involve a combination of services and technology, such as having a physical therapist use a special massage unit to restore a wider range of motion to stiff muscles.

* Transportation assistance. Devices for elderly individuals that make it easier for them to get into and out of their cars or trucks and drive more safely, such as adjustable mirrors, seats, and steering wheels. Services that help the elderly maintain and register their vehicles, such as a drive-up window at the department of motor vehicles, would also fall into this category.

WHAT ARE THE BENEFITS OF ASSISTIVE TECHNOLOGY?
For many seniors, assistive technology makes the difference between being able to live independently and having to get long-term nursing or home-health care. For others, assistive technology is critical to the ability to perform simple activities of daily living, such as bathing and going to the bathroom.

According to a 1993 study conducted by the National Council on Disability, 80 percent of the elderly persons who used assistive technology were able to reduce their dependence on others. In addition, half of those surveyed reduced their dependence on paid helpers, and half were able to avoid entering nursing homes. Assistive technology can also reduce the costs of care for the elderly and their families. Although families may need to make monthly payments for some pieces of equipment, for many, this cost is much less than the cost of home-health or nursing-home care.

HOW CAN I TELL IF ASSISTIVE TECHNOLOGY IS RIGHT FOR ME?
Seniors must carefully evaluate their needs before deciding to purchase assistive technology. Using assistive technology may change the mix of services that a senior requires or may affect the way that those services are provided. For this reason, the process of needs assessment and planning is important.

Usually, needs assessment has the most value when it is done by a team working with the senior in the place where the assistive technology will be used. For example, an elderly person who has trouble communicating or is hard of hearing should consult with his or her doctor, an audiology specialist, a speech-language therapist, and family and friends. Together, these people can identify the problem precisely and determine a course of action to solve the problem.

By performing the needs assessment, defining goals, and determining what would help the senior communicate more easily in the home, the team can decide what assistive technology tools are appropriate. After that, the team can help select the most effective devices available at the lowest cost. A professional member of the team, such as the audiology specialist, can also arrange for any training that the senior and his or her family may require to use the equipment needed.

Case Study
At the age of 66, Christina did not feel old. After her divorce, she became more active than ever in her church and began doing all the things she had been wanting to do for years. She moved into her daughter Kelly’s house to save money and enjoyed her garden there in the backyard. The only thing that slowed her down was that her hearing and vision were beginning to go. She could no longer appreciate music the way she used to or see well enough to read for more than a few minutes without getting a headache. At the same time, Christina’s medical condition was beginning to affect her life at home. Kelly’s children complained that Christina turned the television set up so loud that they could not concentrate on their homework.

Although Christina was in good health otherwise, the hearing and vision problems eventually got so bad that she went to her doctors for a checkup. Her ophthalmologist told her that she had cataracts and would need operations to have them removed from her eyes. The audiologist said that she would need to get a hearing aid. Both doctors also said that she would require rehabilitative services.

Fortunately, Christina was still able to take charge of the situation and find a solution as quickly as possible. While waiting to get her eye operations done, she had her doctors set up a needs assessment team to explore other options she could pursue to make life easier both before and after her surgery. Christina worked closely with the ophthalmologist and audiologist and had physical and recreational therapists come to the house. They spent a full week analyzing Christina’s condition and her home environment. Then, they looked at alternatives that would allow Christina to remain as active as possible, while still addressing her family’s concerns.

The results were wonderful. Together, the team helped Christina get a good hearing aid that enabled her to hear well again. A special magnification device and telecaption decoder on the TV meant that she could watch television without having to bother the children. More assistive technology enabled her to talk on the telephone and use the computer as easily as ever before. In the end, the operations to remove Christina’s cataracts were successful, and she could see better than before, but she still used the magnifying screens and telecaption devices for convenience. Combined with her new hearing aid, each item convinced Christina that assistive technology can make a big difference indeed.

When considering all the options of assistive technology, it is often useful to look at the issue in terms of high-tech and low-tech solutions. Seniors must also remember to plan ahead and think about how their needs might change over time. High-tech devices tend to be more expensive but may be able to assist with many different needs. Low-tech equipment is usually cheaper but less adaptable for multiple purposes. Before buying any expensive piece of assistive technology, such as a computer, be sure to find out if it can be upgraded as improvements are introduced.

Whether you are conducting a needs assessment or trying to make a decision after such an assessment, it is always a good idea to ask the following questions about assistive technology:

* Does a more advanced device meet more than one of my needs?

* Does the manufacturer of the assistive technology have a preview policy that will let me try out a device and return it for credit if it does not work as expected?

* How are my needs likely to change over the next six months? How about over the next six years or longer?

* How up-to-date is this piece of assistive equipment? Is it likely to become obsolete in the immediate future?

* What are the tasks that I need help with, and how often do I need help with these tasks?

* What types of assistive technology are available to meet my needs?

* What, if any, types of assistive technology have I used before, and how did that equipment work?

* What type of assistive technology will give me the greatest personal independence?

* Will I always need help with this task? If so, can I adjust this device and continue to use it as my condition changes?

HOW CAN I PAY FOR ASSISTIVE TECHNOLOGY?
Right now, no single private insurance plan or public program will pay for all types of assistive technology under any circumstances. However, Medicare Part B will cover up to 80 percent of the cost of assistive technology if the items being purchased meet the definition of “durable medical equipment.” This is defined as devices that are “primarily and customarily used to serve a medical purpose, and generally are not useful to a person in the absence of illness or injury.” To find out if Medicare will cover the cost of a particular piece of assistive technology, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048). You can also find answers to your questions by visiting the website at www.medicare.gov on the Internet.

Depending on where you live, the state-run Medicaid program may pay for some assistive technology. Keep in mind, though, that even when Medicaid does cover part of the cost, the benefits usually do not provide the amount of financial aid needed to buy an expensive piece of equipment, such as a power wheelchair. To find out more about Medicaid in your State call the toll free number for your State. A list of toll free numbers can be reached through the following website: http://www.cms.hhs.gov/medicaid/allStateContacts.asp

Seniors who are eligible for veterans’ benefits should definitely look into whether they can receive assistance from the Department of Veterans Affairs (DVA). Many people consider the DVA to have a model payment system for assistive technology because the agency has a structure in place to pay for the large volume of equipment that it buys. The DVA also invests in training people in how to use assistive devices. For more information about DVA benefits for assistive technology, call the VA Health Benefits Service Center toll-free at 1-877-222-VETS or visit the department’s website at:
http://www1.va.gov/health/index.asp

Private health insurance and out-of-pocket payment are two other options for purchasing assistive technology. Out-of-pocket payment is just that; you buy the assistive technology yourself. This is affordable for small, simple items, such as modified eating utensils, but most seniors find that they need financial aid for more costly equipment. The problem is that private health insurance often does not cover the full price of expensive devices, such as power wheelchairs and motor scooters.

Subsidy programs provide some types of assistive technology at a reduced cost or for free. Many businesses and not-for-profit groups have set up subsidy programs that include discounts, grants, or rebates to get consumers to try a specific product. The idea is that by offering this benefit, the program sponsors can encourage seniors and people with disabilities to use an item that they otherwise might not consider. Obviously, elderly people should be careful about participating in subsidy programs that are run by businesses with commercial interests in the product or service because of the potential for fraud.

WHERE CAN I LEARN MORE ABOUT ASSISTIVE TECHNOLOGY?
Most states have at least one agency that deals specifically with assistive technology issues. The Assistive Technology Act (Tech Act) provides funds to states for the development of statewide consumer information and training programs. A listing of state tech act programs is available at: Abledata

Some area agencies on aging (AAA) have programs or link to services that assist older people obtain low-cost assistive technology. You can call the Eldercare Locator at 1-800-677-1116 or visit the website www.eldercare.gov to locate your local AAA. In addition local civic groups, religious and veterans’ organizations, and senior centers may be able to refer you to assistive technology resources.

The following resources provide information on assistive technology products and services.

DisabilityInfo.gov
http://www.disabilityinfo.gov
This site is designed to serve as a “one-stop” electronic link to an enormous range of useful information to people with disabilities and their families.

ABLEDATA
http://www.abledata.com
800/227-0216 or 301/608-8998
TTY 301/608-8912

ABLEDATA is a federally funded project whose primary mission is to provide information on assistive technology and rehabilitation equipment available from domestic and international sources to consumers, organizations, professionals, and caregivers within the United States.

Solutions: Assistive Technology for People with Hidden Disabilities
http://www.uiowa.edu/infotech/Solutions.pdf
This resource guide provides information on adapted devices for people who have memory problems.

Source: U.S. Health and Human Services

Resources

The Right Device Is Like a Third Hand

Make Sure the Medical Device You Choose is Designed for You

1. Do you have limitations that can affect your use of the device?

___     Could your health (stress, tired, medication effects, disease) affect the way you use the device?
___     Do you have the physical size and strength (hand strength, lifting ability, and endurance) to use the device?
___     Will you be able to see the display, hear the alarm, and feel the controls (knobs, buttons, switches, and keypads)?
___     Do you have the coordination (manual dexterity, balance) to adjust the controls?
___     Will you be able to understand and use the device?
___     Do you need to remember complex instructions to use the device?

2. Is the device right for the environment where you plan to use it?

___     Does the device have safety features to prevent it from harming your children or pets, and to prevent them from harming the device?
___     Will you be able to hear the device’s alarm in a noisy environment?
___     Will the light levels (low or bright) in your environment affect your ability to use the device?
___     Are you using other devices at the same time?
___     Will sources of electromagnetic interference (e.g., Ham radio, AM FM TV broadcast antenna, electrical machinery, hand-held transmitters) affect the device?
___     What things about your home will affect your use of the device (e.g., high heat and humidity, very dry air in the winter, too few electrical outlets, narrow doorways, wood stove heating)?
___     What happens if you put the device in an inappropriate environment?

3. Are there device characteristics that can affect its use?

___     Is the device simple to set up, operate, clean, maintain, and dispose of; and what happens if you don’t do these things properly?
___     What replacement parts or batteries are required, how frequently are they needed, how expensive are they, and are there special instructions for safely disposing of the device or its parts?
___     What reading or training is required of you?
___     Are there things about this device that are different from other similar devices you have operated?

Source: U.S. Food and Drug Administration; Information drawn from “Medical Device Use-Safety: Incorporating Human Factors Engineering into Risk Management”

Resources:

The Right Device Is Like a Third Hand

Assistive Technology Fact Sheet