“One of the things I value most in life is being able to function independently,” said David Wells, a clinical social worker in Lexington, KY. Wells, who has multiple sclerosis and began using a wheelchair in 1998, had been living with and caring for his elderly parents. After they passed away, he knew he would have to make some changes if he wanted to remain in the family home on his own.
Wells contacted occupational therapist and home modifications expert Susan Bachner, owner of Susan Bachner Consulting in Lexington, for help. “I had been trying to do the work myself, but I really needed some guidance on what changes would work best for me,” Wells explained.
Bachner, who is a Certified Aging-in-Place Specialist and Certified Environmental Access Consultant in addition to being an occupational therapist with a Specialty Certification in Environmental Modifications (SCEM), put Wells in touch with an architect who could help redesign parts of the house for accessibility. But she did more than that: She evaluated Wells’ home to identify changes that could facilitate ease of movement throughout the home and took a good look at his lifestyle—what tasks he needed and wanted to perform each day—to ensure not only his comfort and safety but also his enjoyment of being at home.
From Bachner’s perspective, home modifications are about finding the fit between people and their environment. “Occupational therapists understand how an environment can make things easier or harder on people, especially if they are elderly or have a disability. I take a good look at the physical setting and the physical, cognitive, and emotional challenges of the people in it to understand what constitutes a good fit between them,” she said. “Above all, how is the person going to function in the physical environment while engaging in the routines and daily activities that make life meaningful for that individual?”
Occupational therapists like Bachner are experts at understanding the interrelationships among the physical, psychological, and social aspects of illness, injury, and aging. For instance, as people age, they may experience subtle (e.g., decreased vision and hearing, declining balance and coordination) or pronounced changes (e.g., severe arthritis) that interfere with their ability to perform daily tasks that promote independence. They may then feel limited in such activities as cooking, cleaning, bathing, dressing, and social participation. Such changes may also make elders more susceptible to falls in the home, which modifications may help to reduce.
Similarly, people with illnesses or those who are recovering from injuries may find that their condition has altered their ability to perform daily routines and roles. Occupational therapists work with people to help restore physical or cognitive function and can also assist in making modifications to the home environment that enable people to maintain maximum independence and promote overall health and well-being.
Many people assume that home modifications always involve structural changes, but as Bachner points out, there are other ways to make a home more accessible: “My most frequent request is for changes to the bathroom to make that space safer and more accessible. Often, simple changes can help—making sure the bathroom floor is free of clutter, rearranging furnishings to improve the flow of the room, adding a grab bar to the shower that is placed at the right height for the person who needs it.”
Although Wells did knock out a wall to make a bigger bathroom, he also made smaller changes that enhanced his ability to perform daily tasks such as grooming, bathing, cooking, and just relaxing. “It was dangerous for me to try to use the bath and toilet as they were, and it was grueling trying to lift my legs over the side of the tub to get in. I was afraid of falling, and getting up out the tub would easily take 20 minutes or more,” he said.
In the bath, Wells had a curbless shower installed, which eliminated the need for him to lift himself over the edge of a tub, and bought a shower-comode chair with waterproof construction so he could sit comfortably in the shower. He also put in a low sink, which allows him to pull right up to the basin and shave in front of the mirror. “It was so much more comfortable, not to mention safer. And I got to take a shower for the first time in ages. It felt wonderful!” Wells said.
In addition, Bachner was able to recommend other modifications and products that could adapt the environment to be a better fit for Wells. “The little, everyday things most people take for granted are difficult for me to do. With MS, my hands aren’t as sure and I have trouble moving around. Sometimes, I have periods where I can’t even get out of bed,” he said.
Wells added low clothing racks to his closets so he can reach his clothes more easily; moved his electricity breaker box lower for ready access; and installed remote-controlled deadbolt locks, smoke detectors, and heating and air-conditioning systems. He also put intercoms at the front and back doors that dial his phone when a visitor is outside, so all he has to do to let someone in is pick up the nearest phone. And, he has put his bird feeders on poles and attached pulleys, which allow him to replenish the food supply without having to stand up and risk losing his balance.
“All these changes—they’re not just about safety and independence, but quality of life. I love being able to do things for myself, but doing the things I want is important, too,” Wells said. “Just being able to feed the birds is a pleasurable activity. To me, it’s a thing of joy.” And occupational therapy made it happen.
