Age In Place Definition
Written by webtechs

Age In Place Definition

Age In Place Definition

Age in place is a term commonly used to describe an individual living in the residence of their choice, as they age, for as long as they can. This does include being able to have services as needs change over time.

What Does It Mean To Age In Place?

Aging in place takes place during a period of time in an elderly citizen’s life where they can have the necessities craved during daily life, while also maintaining quality of life overall.

The goal of aging in place is to help seniors live in their own home all while receiving care and services, when needed. Any elderly person wishing to age in place should prioritize maintaining and/or improving their quality of life. It’s recommended to develop a thorough plan regarding your home, finances and future care.

Aging Changes

Aging undoubtedly brings changes to us all. As seniors age, it’s crucial to plan for changes and what impact these changes may have on their lives.

Here are a few examples of changes that can be experienced:

  • Decreased muscle strength.
  • Lack of endurance.
  • Reduced vision.
  • Increased risk of falls and illness.
  • Decreased mobility.
  • Reduced hearing capabilities.

These changes can impact one’s daily life. When physical and mental capabilities lessen and needs change, many daily activities can be altered, including:

  • Transportation needs.
  • Socialization.
  • Home upkeep.
  • Staying safe inside the home.

For seniors looking to age in place, there are many ways to remodel your house, creating a forever home. Safety is crucial when planning any updates or remodels to the home after age 55. Customizing your home to age in place will undoubtedly make it a safer and more valuable environment. Here are a few ways to create a safe house for senior living.

How To Age In Place At Home

Of course, any home remodeling must accommodate any potential changes in mobility. Mobility can be a challenge specifically in the bathroom. Some simple renovations could include adjusting the height of the toilets, step-through tubs, bath bars and showers.

Stairs present a new set of issues for seniors as they age in place. Adding a chair lift can be a great way to make second-story access possible for all. Chair lifts enable seniors to access areas they typically cannot without mobility issues.

Alzheimer’s patients generally have no issues with mobility. This means safety should be the focus when remodeling the home. For example, electronic door chimes that sound throughout the home are an easy way to alert anyone currently caring for the patient.

As we age, we may lose our ability to see into darkened areas and at night. Lighted switches and motion-activated lighting are two convenient safety features to add to the home. In addition, lighted cover plates and outlets will undoubtedly make it easier for seniors to find the switch.

Senior In Old Home

Age In Place Home Modifications

There are many minor and significant updates one can make to create a safer living environment. Whether it’s a minor adjustment or full-scale remodel, here are a few simple steps you can take to age in place as comfortably as possible.

First-Floor Living

The suggestion is for all senior citizens to move permanently to the first floor. This is the safest way to age in place at home. There are many home designers that can configure the home to your liking and safety needs. Some necessities for first-floor living include a full bathroom, efficient kitchen space, living spaces and laundry access. Roomy pathways are also recommended. Install railings in pathways and secure all carpeting to the floor.

Easier Entryways

The best way to create easier access to your home is by installing a no-step entrance. This means you should create a flat landing outside the door that is also sheltered from any potential inclement weather. Secondly, add doors that are at least 36 inches wide with lever handles in place. A nearby bench is a good idea to have indoors, as this can serve as a safe place to change footwear. All rugs inside and outside need to be secured with nonslip rubber pads underneath.

Safety In The Bathroom

Falls in the bathroom can be extremely dangerous for the elderly. Thankfully, many bathrooms can be designed with safety in mind. Design the bathroom with lots of space for the potential of wheelchairs or even installing more grab bars in the future. Entry doors should slide open like barn doors. Tub/shower areas should come complete with grab bars. You can also install grab bars around the toilet.

Kitchen Designs

Ensure all frequently used items are always within easy reach. Open kitchen plans, which are very popular nowadays, typically maximize lighting and sightlines. Layered lighting tends to be aging-friendly. There really is no limit on designs or types of materials to use for the kitchen, the goal is simply to keep everything within reach and make the space easy to maneuver.

Kitchen Safety

Age In Place Remodeling Services

Thinking about adding safety grab bars, a raised toilet seat or other modifications to prevent falls in your home? Our physical and occupational therapists provide free home safety screenings, and will make clinically guided fall prevention recommendations, as well as create a customized plan to fit your individual needs. We follow up with clinically guided installation of all of our fall prevention home safety products.

Our clinically guided solutions will ensure you and your loved ones can navigate your home environment safely and with confidence. Visit our Home Safety Solutions page to learn about the products and services we provide and install (we are licensed, bonded and insured), to help you prevent falls in your home.

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What Is A Home Safety Assessment
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What Is A Home Safety Assessment?

What Is A Home Safety Assessment

A home safety assessment is an overall evaluation of your home to identify potential hazards, especially for senior citizens.

Home Safety Assessment For Seniors

If you are an older adult or have a loved one living on their own, a home safety assessment is a great way to find and eliminate any safety concerns. This assessment is typically performed by a licensed healthcare professional, including medical social workers or occupational therapists. The assessment may include things such as home improvement recommendations. Medical professionals may recommend installing handrails and extra lighting, for instance.

Since falls are one of the most common causes of injury among seniors, these assessments are a crucial preventative measure towards improving safety. One in four Americans age 65-plus fall every year, according to the National Council on Aging. Falls are the number one cause of injury-related deaths for seniors today.

Home Safety Checklist

A home safety assessment offers a unique way to proactively assess your home’s safety. This assessment can help seniors who live independently or have an older home with potential dangers. Check out the CDC’s guidelines here for more information.

A home safety checklist needs to include the following items:

Floors

  1. Keep paths free of any furniture in each room of the house.
  2. Secure all throw rugs with double-sided tape or nonslip backing.
  3. Make sure there are no other objects, such as papers, boxes, shoes or blankets on the floors.
  4. Keep all wires securely taped or coiled next to walls.

Kitchen

  1. Keep most frequently used items on the lower shelves.
  2. Have a sturdy step stool in the kitchen, if needed.

Bedrooms

  1. Tub and/or shower floors should have nonstick rubber mats.
  2. Have grab bars to use for getting in and out of the tub.
  3. Grab bars can be placed around the toilet, as well.

Bathrooms

  1. Light(s) should be near the bed within reach.
  2. Light the path from the bed to the bathroom well with nightlights.

Stairs

  1. Remove any loose objects from the stairs/steps.
  2. Fix any broken or uneven steps.
  3. Make sure there is no loose or torn carpeting in the area.
  4. Have sufficient lighting above the stairways.
  5. Make sure there is a light switch at the bottom and top of the staircase.
  6. Have handrails on both sides, making sure they are not loose or broken.
  7. Handrails should run the full length of the stairway.

How To Get A Home Safety Assessment

Thinking about adding safety grab bars, a raised toilet seat or other modifications to prevent falls in your home? Our physical and occupational therapists provide free home safety screenings, and will make clinically guided fall prevention recommendations, as well as create a customized plan to fit your individual needs. We follow up with clinically guided installation of all of our fall prevention home safety products.

Our clinically guided solutions will ensure you and your loved ones can navigate your home environment safely and with confidence. Visit our Home Safety Solutions page to learn about the products and services we provide and install (we are licensed, bonded and insured), to help you prevent falls in your home.

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Questions For Assisted Living Interviews
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Questions For Assisted Living Interviews

Questions For Assisted Living Interviews

If you are searching for “questions for assisted living interviews“, our checklist will help!

Questions To Ask Assisted Living

The choices may seem limitless when it comes to assisted living options. The three things that should be top of mind are care, community and cost. Use our list of questions below if you are planning an assisted living interview for your loved one(s).

1. Questions About Care

The first questions that come up should all be about care in the community. You need to find a community that has a level of care that meets your loved one’s specific needs. Here are a few questions to ask during the interview:

  • What are all the services included in the monthly agreement?
  • Are services available a la carte?
  • How many staff members do you have compared to the amount of residents?
  • Can a resident transition if comprehensive care options are needed?
  • How do your care services compare to other communities in the same area?

2. Questions About The Community

You need to make sure your loved one will feel comfortable and safe in their new community setting. Most communities should feature a variety of activities, exercise facilities and transportation services. Ponder these few questions regarding the community:

  • What are the most common activities for the residents?
  • How are the activities chosen?
  • What is the usual level of participation for the activities?
  • Are there flexible menu options for residents with various dietary needs/restrictions?
  • What is the social experience like around the community?

3. Questions About Costs And Administration

Obviously, you’ll want to know exactly what you are paying for each month. Here are a few examples of what to ask regarding costs and administration:

  • What is included in the monthly fee(s)?
  • Would there be a circumstance where costs are increased?
  • What are the current emergency handling procedures? 

More Assisted Living Interview Questions:

Assisted Living Questionnaire 

Interview Questions

Assisted Living Questions

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Non-Slip-Shower-Floor
Written by webtechs

What You Should Know About Non-slip Bathtub & Shower Floor Treatments

A Non Slip Surface Treatment For Fall-Proofing Your Bathroom

We spend a great deal of time in a place where significant fall risks lurk – the bathroom. The bathroom is the number one place for falls in the home – ironically, it is also the most likely to be overlooked when it comes to fall prevention safety.

The moment you set foot into your bathroom, you have entered a zone of unstable footing due to slippery or wet showers, tubs, and floors. Bathroom rugs are often slippery and gather when stepping onto and are also significant trip and fall hazards.

Rather than elect to become another bathroom fall statistic, understanding fall risks and implementing interventions can significantly reduce your risk of slip and fall accidents.

Coefficient Of Friction – Measuring The Fall Risk

Coefficient of Friction describes friction levels on flooring both dry and wet. Floors with low COF levels are more likely to be slippery and pose a fall risk. OSHA and ADA recommend friction levels of flooring surfaces to be .5 and above in order to be considered safe. Friction levels falling below that are critically dangerous when wet. Most homes have floor, tub and shower friction levels of .5 or below.

What You Can Do To Reduce Fall Risk In The Tub or Shower

Most homes use non-slip mats in the shower. Not only can these become breeding grounds for, harboring countless bacteria and mold, but they are also major trip hazards and should not be used for sure footing. According to PrudentReviews, “If you don’t like the idea of an anti-slip shower mat, you can install clear anti-slip adhesive treads or apply an anti-slip formula specially designed for showers and baths“. As you can see, non-slip shower treatments are a longer-lasting, healthier alternative to tub or shower mats.

Non-Slip Shower Floor Surface Treatment

Non-Slip-Shower-Floor

Non-slip shower floor surface treatments are simple to apply, environmentally friendly, and drastically reduces fall risk by increasing the friction levels on wet floors, bathtubs, and shower surfaces. There is no visible change to the surface – the only time you will notice the treatment, is when the bathroom, tub or shower areas are wet.  Then, you will have increased friction for better traction and safer navigation on wet surface areas.

The non-slip shower flooring solution will take your once dangerously low friction levels to OSHA and ADA safety recommended higher levels so you can navigate your bathroom safely and with confidence.

Non-slip bathroom floor treatments are just one of the elderly fall prevention solutions we offer. To learn about our full line of services, visit our FAQ page, or give us a call at 480.214.9725.

Non Slip Bathtub Treatment

Non-Slip-Bathtub-Treatment

When searching for non-slip bathtub treatment solutions, experts like HomeGuide say you should apply a non-slip spray. We agree! We specialize in the application of non-slip, long-lasting bathtub treatments, which when applied causes a chemical reaction that leaves the surface of hard mineral existing floors and porcelain/enamel bathtubs with a higher friction level and no visible changes. Our product has been developed and proven for concrete, quarry tile, Spanish tile, ceramic tile, glazed brick, marble, terrazzo, porcelain/enamel, and many other hard mineral surfaces.

The end result is an increase in the coefficient of friction up to 400% when subjected to water.

  • Reduced risk of falling
  • No more rubber mats or decals
  • No more worries when floors are wet
  • Feet will no longer slip out from under you
  • USDA approved
  • Non-toxic/environmentally safe
  • No downtime! Floors immediately available for use upon completion
  • Easy floor care
  • 2-year warranty
  • Meets ADA and OSHA Standards

What are Non-Slip Floor Surface Treatments for Bathtubs and Showers?

Bathtub Non Slip Coating

“Non-Slip Surface Treatment” or “Anti Slip Surface Treatment” make surfaces slip-resistant in shower bases, bathtub bottoms, concrete or tile floors. When applied, a chemical reaction happens that causes the surface to have higher friction levels with no visible changes.

Applications include:

  • Bathtub floors
  • Shower floors
  • Concrete
  • Quarry tile
  • Spanish tile
  • ceramic tile
  • Glazed brick
  • Marble
  • Terrazzo
  • Porcelain
  • Enamel
  • Many hard mineral surfaces

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2024 Home Safety Assessments And Evaluations
Written by webtechs

Young At Heart, But Not Physically – When Denial Gets In The Way Of Safety

As we age, there is no doubt in our hearts we feel young. And although being young at heart is wonderful, this ethereal feeling is no match for the ever-changing state of our bodies and the status of our health.

The changes that take place with our health that can dramatically affect our ability to navigate our home environment safely. Although falls are not necessarily a part of aging, 40% of nursing home admissions are due to slip and fall accidents. These accidents can affect the course of our ability to be independent and live quality lives at home.

Of course, walking around in bubble wrap to keep from falling in your home is not a doable solution – it’s hot, unsightly, and frankly not a fashion stopper. Many individuals elect to do nothing, feeling invincible. This denial can lead to unexpected accidents, which then brings you into crisis mode. However, seeking preventative solutions in advance of a potential crisis, is the best way to stay safe while aging at home. Intervention IS prevention.

At the top of your list should be a home safety assessment. The American and British Geriatric Societies report, “Multi-factorial risk assessment and intervention strategies are effective in decreasing the rates of falls and have a similar risk reduction to that of other prevention measures such as statins for cardiovascular disease”.

What can I expect from a home safety assessment? Who will evaluate my environment? What happens following the assessment?

Our physical therapist provides a home safety assessment. During the assessment, not only will you be evaluated navigating your home environment, but the environment itself will be evaluated for safety hazards in a variety of rooms – including the bathroom, where falls occur most frequently in the home.

The therapist will make clinical recommendations based on your individual diagnosis or physical limitations to ensure optimal fall prevention safety outcomes, customized for you in your space.

We complete the process by providing and clinically installing all needed items. We provide a warranty for all of our products and services, and we are licensed, bonded and insured.

You may not have concerns about falling now, but denying that it’s a possibility puts you at greater risk. Once injuries occur from falls, often there is no turning back. Protect your health, independence and future, scheduled your clinically guided home safety assessment.

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Functional Capacity Evaluations (FCEs) and Physical Therapy
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The Importance of Clinically Correlating Functional Capacity Evaluation (FCE) Findings

In Chapter 16 of Guide to the Evaluation of Functional Ability, Genovese & Galper 2009, the chapter authors clearly make the case that a Functional Capacity Evaluation (FCE) is a clinical evaluation used to answer questions about an evaluee’s abilities (and limitations) relative to a medical condition(s). Moreover, because the FCE is a clinical evaluation, it needs to be performed by a qualified health care provider.

The discussion points out however, that many FCE evaluators do not produce reports that clinically correlate medical findings (found during the FCE or from review of medical records) with the functional findings of the FCE. In fact, the authors point out that reports they have reviewed provide evidence that some evaluators believe:

  • An FCE is a “plug and chug” totally objective process, and that all the clinician has to do is gather data and input it into their computer program;
  • The protocols are stand-alone and that the scoring procedures allow an evaluee’s physical abilities to be determined independent of any clinical judgment;
  • The evaluator’s role is more technical than clinical, simply observing performance and recording results.

These points could not be further from the truth. Clinical judgment within the functional testing process is not only a positive, it is a must in order for the FCE findings to be meaningful and useful.

Some FCE systems boast that their systems use “distraction-based” testing that is intended to investigate the issue of validity of effort and are entirely focused on objectively determining non-cooperative and poor effort in a legally-defensible way. These systems miss the point of why FCEs should be used.

The FCE as a clinical evaluation performed by a qualified health care professional will identify:

  1. Are there activities the evaluee cannot do or should not do because of an underlying health condition;
  2. Are there activities that might worsen the condition, delay or interfere with the recovery;
  3. Are their activities that may put the evaluee or others at risk if performed by the evaluee.

As the authors so eloquently point out, a skilled FCE evaluator must demonstrate that the underlying health condition has an effect on the evaluee’s functional performance, or visa versa.

It is for these reasons that the FCE can only be properly performed by professionals knowledgeable in anatomy, physiology, pathology, kinesiology; have skills in clinical and functional evaluation methods; and are able to draw conclusions by considering the evaluee’s injury or illness in the context of all the other findings.

Clinical judgement based on solid testing protocols and scoring procedures is the gold standard for determining an evaluee’s function.

Sandy Goldstein, PT, CDMS is a physical abilities measurement specialist, and performs functional testing for SSDI, STD, LTD, PI, WC, Pre-Vocational Planning as well as return-to-work transitions. He can be reached at https://measurabilities.com/ or 480-285-6212

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Fall Risk – How to Determine if You or Your Loved One is at Risk of Falling in the Home

Here are some simple questions you can ask yourself to determine if you or a loved one may be at risk for falling in your home:

Do you exercise regularly?

  • Maintaining a regular exercise program to increase strength, balance and coordination and greatly reduce the risk of falls. Recommended exercise for fall reduction are evidence-based exercises/programs such as Tai Chi.

Are you taking multiple medications?

  • Taking multiple medications can increase fall risk, due to side effects and possible drug interactions. Regularly reviewing medications with a healthcare provide can reduce the risk of medication related fall risk. It’s important to remember to dispose of unused or expired medications.

Have you modified your home environment?

  • Modifying the home environment to reduce hazards such as slippery floors, poor lighting, uneven surfaces, removal of cords and other household obstacles can reduce the risk of unnecessary falls in the home. The bathroom is the number one place for falls in the home. Addressing balance issues in the shower and commode areas through the addition of safety grab bars, shower chairs, transfer benches and toilet risers can reduce the risk of falls in the bathroom.

Have you had a home safety assessment to determine if you are at risk of falls in your home?

  • Studies have shown that addressing multiple fall risk factors from daily activities and exercise, medication, footwear, eye exams and home environment, have the ability to reduce fall risk as statin medication does for cardiovascular disease.

Having a home safety assessment performed to identify fall risk and provide safety recommendations followed up by installation, can greatly reduce your risk of falls in your home environment. You are unique and your needs are too!

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Doctors Who SWAG – The Harmful Impact of Guessing for Disability & Workers’ Compensation Patients

For many worker’s compensation or disability patients, their primary care doctor is the go-to to treat and diagnose their injuries. However, few family physicians are trained to determine a patient’s ability to work – despite being asked to do so repeatedly.

Too often, I’ve heard stories of doctors who SWAGGED (took a scientific wild a** guess) at a patient’s capacity for work without testing. While this SWAG is based on the doctor’s knowledge of the patient’s injuries, guessing at function without testing to confirm it is akin to throwing out a broken lamp without first testing the light bulb to ensure it’s working. And it can have devastating consequences for patients.

Over the years, I’ve done thousands of Functional Capacity Evaluations, or FCEs, but there’s one in particular that I’ll never forget.

Meet Bob, a Plumber

Bob was a 50-something male who had suffered a compression fracture of his thoracic spine eight years prior. If you’re not familiar with the term, a compression fracture is when a bone in the spine fractures or dissolves. This is a common injury caused by falls or other traumatic injuries.

In Bob’s case, the damage was to the thoracic area, located in the middle of the spine. After surgery and extensive physical rehabilitation, he was declared maximum medically improved with permanent restrictions.

The problem here is that Bob was never tested; rather his physician gave him a note stating he should not lift more than 20 lbs. The note had no timeline or follow up scheduled. Bob literally folded up the note, placed it in his wallet, and ceased working as a plumber – his career of nearly 25 years.

For the subsequent eight years, Bob worked as a cashier. By the time he came to me, Bob was barely able to keep afloat and was basically starving. He’d just applied for SSDI and vocational assistance and needed to be evaluated as part of his claim.

The Functional Test Yielded Surprising Results

The functional testing revealed that Bob could safely lift 50 lbs. Based on a reasonable degree of medical and ergonomic certainty, the testing showed that he could have likely worked as a plumber all along.

This is a stark lesson to all medical, vocational, and human resources professionals. The advantages of going the extra step and using objective functional testing to assess function and fitness-for-duty cannot be overstated.

In Bob’s case, a referral for an FCE could have circumvented years of missed wages and distress.

Research supports that job-specific testing is superior to functional estimates by a physician.

The well-known research study Comparing self-report, clinical examination and functional testing in the assessment of work-related limitations in patients with chronic low back pain (Brouwer et al., 2009) showed the importance of functional testing. Researchers concluded that the limitations derived from physicians’ clinical examination were higher than those derived from Functional Capacity Evaluation.

With our clients’ lives and livelihoods at risk, I strongly advocate objective functional and fitness-for-duty testing. Not because it is my line of work; it’s simply the right thing to do. Ethically and legally, we medical, vocational and human resources professionals owe it to our clients to not cut corners when assessing function and fitness-for-duty.

When objective testing is performed, the results provide evidence-based information on which stakeholders can rely to place a worker into a specific job, or at least, to specific job tasks.

workers-comp-comic-frank_and_ernest

References

Brouwer, S., Dijkstra, P. U., Stewart, R. E., Göeken, L. N., Groothhoff, J. W., & Geertzen, J. H. (2009, 7). Comparing self-report, clinical examination and functional testing in the assessment of work-related limitations in patients with chronic low back pain. Retrieved from Northern Centre for Health Care Research, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands website: https://www.tandfonline.com/doi/abs/10.1080/09638280500052823

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Minimizing Fall Risks When Leaving Hospital
Written by webtechs

Fall Risk at Discharge – What You Need To Know

  • There is a high incidence of falls after hospital discharge, particularly among patients who are functionally dependent. Major fall risk factors at discharge include: decline in mobility, use of assistive devices and cognitive impairment/confusion.
  • Patients who were functionally dependent and needed professional help after discharge had the highest rate of falls.
  • Hospitalization in older adults, including those who are admitted for medical problems, rehabilitation and acute care, has been shown to be associated with decline in function and mobility – creating a higher risk of slip and fall accidents.
  • The period after discharge has been shown to be associated with high risk of falls, social problems and medication errors, with up to 30% of older people experiencing an adverse event following hospital discharge.
  • 45% of older people fall in the period following discharge.
  • One study examining the incidence of falls in older, recently hospitalized medical patients requiring post-discharge home care, found that falls were substantially increased during the first month after hospital discharge.
  • Research has shown that fall prevention home safety assessment and home safety modification intervention immediately following discharge critically reduces the risk of falls once at home.
  • A full clinical assessment of function as it relates to how individuals are navigating their environment doing daily tasks (restroom, shower, walking through the home). Installation of safety grab bars, commode risers, shower chairs, ramps and rails are just a few of the modifications which can be made that will reduce fall risk.
  • Typically, upon discharge, families and are overwhelmed and often don’t know where to turn for resources (you can bring in MB home safety here if you’d like). Coming home following discharge is a critical time, where patients are often in a weakened, tired and cognitively impaired state. Family members rush to “get something in”. Just having a “safety grab bar” won’t do the trick, where your bar is placed and clinical attention to the placement of any modification is imperative in not risking further injury.

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How Does Your Home Rate on Fall Prevention Safety? A Room-by-Room Guide

We’ve all read about things we can do to avoid unnecessary slip and fall accidents in our home, but how closely have you looked at specifics. Here are a few things you can do in your home, you may not have thought of, addressed or knew would assist you in being falls free in and around your home:

  1. Ensure exterior pathways are free of holes, loose stones/bricks, uneven pavement, debris or other slipping hazards.
  2. All entrances are clutter free.
  3. Handrails are present on both sides of all steps and stairways both inside and outside the home.
  4. Kitchen cabinets are easily accessible, with frequently used items placed on lower shelves.
  5. Uncarpeted steps feature a non-slip surface such as adhesive strips.
  6. Electrical and phone cords are placed out of the way, along the wall.
  7. Hallway lighting is easily accessible.
  1. Safety grab bars are present at shower entry and interior of shower as needed.
  2. Bathroom rugs should be rubber, based, non-slip. Bathroom floors, tubs and shower surfaces are treated with non-slip product to ensure increased COF (Coefficient of Friction), when surfaces are wet – critically reducing fall risk – Note: The Bathroom is the number one place for falls in the home).
  3. Access to telephones both landline and/or mobile in or near multiple rooms, including the bathroom.
  4. Furniture should be arranged to allow for easy, obstacle free passage.
  5. Do doorways safely accommodate walkers, wheelchairs and/or transport chairs?

If you or a loved one is uncertain about falls risk factors in your home, schedule a free home safety assessment today, performed by a MEASURAbilities Home Safety Physical Therapist, who will provide clinically guided solutions for you in your environment.

Learn About Our Home Safety Assessments Performed by a Physical Therapist

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