How You Can Ease Your Transition Home from Rehab

Who is in Charge with the Return Home from Rehab?

We often work with people who are returning home from rehab. There are so many things going on when someone is attempting to return home, especially if their abilities have changed and they are using new mobility equipment like walkers or wheelchairs. People may also have different priorities when they go back home. Some want to simply change as little as possible and try to live as much the same as before. Others throw themselves into change, challenging themselves to create new ways of accomplishing tasks. 

It often takes effort to communicate what needs to get done in the home and get that work done quickly enough. Therapists in rehab do a fantastic job of helping people regain and build skills, but beyond a discharge visit, they aren't often able to spend time planning modifications and people may often need to solve many problems by themselves. Discharge visits often occur just before a person returns home, which doesn't leave much time for construction professionals to provide quotes and get the work done. Home Health Therapists need to focus on the person's recovery and may not have the therapy time available or expertise to manage any construction that is needed. Traditional contractors may be knowledgeable about building but not understand how to design an environment that bests matches an individual's abilities or where to find the best technology for use in the home. 

So, with all the changes, different goals, and people involved, what is most important? Who is in charge? The answer? You, the client are the most important part of the homecoming process and things work out best in the long run if you are involved in what is going on. 

The therapists attempting to help you get stronger, the contractors making changes in your home, and the caregivers (family or professional) assisting with activities of daily living are all working to make you as comfortable, independent, and safe as possible. You have some responsibilities as well, though. It’s very likely that you are going to be the only one who is participating in the whole process from beginning to end. It's up to you to learn what you can from your therapists and incorporate what you learn from them with your own goals for living. It's up to you to make sure the recommendations from the therapists are conveyed to and understood by the contractors who you work with. It’s up to you to make sure that the equipment and modifications put in by contractors are used safely by the caregivers. You are the one in the unique position of being able to steer your own recovery. Don’t hesitate. Take charge and establish communication. Let people know what you need, and what everyone’s recommendations are. The better your team works together, the more successful your return home will be.

Rehab and remodeling can both be overwhelming experiences. Follow these tips to make your transition home much smoother

• Understand your needs. Before reaching out to a contractor, it's important to understand your unique needs. Your therapists can help you plan for the near and far future.
• Find the right contractor for the job. Not everyone is experienced in the type of home modifications and equipment you need. It's important to find a contractor who can accommodate your specific needs so that you can be as comfortable as possible in your home. Rehab staff may have a list of people they've worked with in the past. You can also check with the National Association of Home Builders for availability of a Building Professional with a designation called Certified Aging in Place Specialist (CAPS). You may be able to locate a company that works with home modifications in your area through National Resource Center for Supportive Housing and Home Modifications. Some companies like ours specialize in home modifications by combining therapists and contractors in one service.
• Don't forget training in the new environment. Once your home modifications have been installed, you still need to learn how to use them effectively in your daily life. It takes training and time to get familiar with any new addition to your home. 

So, share the news and share the video. You or one of your caregivers are really in charge of your recovery, from your first steps to your return to a safe home. Everyone working with your is part of your team, and it’s your responsibility to help them coordinate, cooperate, and help you. If you live in the Greater Omaha, Lincoln, or Council Bluffs, Iowa areas, Total Home Access Solutions, a division of Total Respiratory and Rehab home modifications services are available to you. We would love to help you through the process of getting home from rehab. Give us a call for any questions or to go over your options, we'd be honored to help.

5 Things You Must Know About Grab Bars

Grab bars are one of the most versatile, frequently used, and easily available home modifications on the market today. They’re sold not only in specialty stores, but also are available from both major and local hardware stores. More houses are even starting to be built with grab bars ready for use. Despite becoming more common, there are still many misconceptions about grab bars.  Mistakes are still being made that effect a person’s safety and quality of life. 

Here  are five things everyone should know about grab bars before they recommend one or buy one.

1. Grab bars are not magic, nor are they one size fits all. Grab bars, like any other home modification, work best if they are placed where they are needed. Location will be determined by the difficulty a person has (if any) with balance or strength, how far they can safely reach, and the environment. If you aren't simply planning for the future, you can consult with an occupational therapist, physical therapist, or a certified aging in place specialist before deciding exactly where to put a grab bar.
2. Grab bars don’t just have to go into studs. Grab bars can be secured with reliable new technology.  Blind fasteners rated for grab bars can be used to place grab bars exactly where they need to be if a stud or blocking is not available. 
3. Grab bars don’t have to be permanent to be secure. Many people worry about the resale value of their house if they get a grab bar, or are afraid that they will have to move and won’t be able to take their grab bars with them. Traditional wall mounted grab bars can be beautiful, but they are not the only choice for balance support. Floor to Ceiling poles like the Superpole from Healthcraft, bars that attach or clamp to fixtures like the tub and toilet, and even high quality suction bars may be used on the right surfaces.    
4. US Accessibility Standards or the American with Disabilities Act Guidelines and other codes may not apply to your home. Many people are not sure what codes apply to them. Many guidelines cover placement of grab bars in commercial or multi-family homes. If you don’t live in a home like this, you can put grab bars exactly where you need them. If you live in a place where codes define where grab bars are located, you can usually still exceed the guidelines and put in more grab bars in additional locations. This is a good thing, as the codes are designed to appeal to as wide a base as possible, but individual people benefit from individual customization with home modifications like grab bars.
5. Grab bars are not just for people who are aging or have a disability. Grab bars can help anyone in the bathroom. People of all ages can fall. Nearly a quarter of a million people are injured each year in the bathroom, and 80% of those are from slipping and falling. A grab bar will reduce the risk a fall will occur. Having a grab bar or bars installed can not only make the home more safer and more accessible, it may actually increase value to certain markets.

So, share the news and share the video. Here are 5 very important things people should know about grab bars. You may be surprised how many people will be amazed that there is anything to know about grab bars at all!

Shoes and Quality of Life

I recently met with Jack Pietenpol of Diabetic Outreach to learn more about how shoes play a pivotal role in the quality of life.  As a professional who helps with accessibility and safety in the home, I was aware of how shoes affect balance and mobility.  I wanted to learn more about what makes a shoe fit well and where people can go for customized shoes.   Jack was a terrific help and I know you will a learn a lot from the interview like I did.

People with diabetes and many other medical conditions really need the exercise of walking.  Shoe choice and fit may make the difference in how safely a person moves around and how comfortable they are moving which affects the amount of walking or exercising they choose to do.   Jack covered some of the features in the therapeutic shoes he fits that contribute to skin health and balance.   He also shared some helpful tips: 

Don't assume your size never changes over time and from brand to brand.  Shoes should always be measured whenever you go to a shoe store and if all possible, have your fitting done late in the afternoon. This is because, no matter how healthy we are, feet tend to swell as the day goes on.

Shoes do not last forever. Shoes may be aesthetically pleasing, but time brings odor, bacteria and worn out support from the abuse. You may not be able to see how the support is worn, but if you wear your shoes seven days a week, Jack states that they will only last about 18 months. 

Avoid premature aging. A great tip that jack offers is to have a at least a second pair of shoes that you can switch out to ensure your other shoe is airing out in order to prevent premature breakdown.

The footwear that Jack handles is classified as therapeutic, however anyone can wear them for support, comfort and to accommodate depth issues. When you make an appointment with Jack, you will complete a 15-30 minute evaluation that will determine your goals, your level of ambulation, the footwear you seek and what you expect out of that footwear. From there, Jack will determine what type shoe fits you best.

Custom fitted shoes sound great, but people often wonder how they price in comparison to normal shoes.  I was amazed to find they were less than I thought they'd be. They are certainly worth checking into if a person is walking less because of pain or discomfort.  As Jack explains, in some cases, Medicare and Medicaid will cover the costs once a year.

If you have any questions for Jack, his phone number is (402) 477-1110. Jack also offers in-home appointments for patients with mobility and transportation issues! 

Would you refer us to your friends? If you have any friends, family, or co-workers who would benefit from our home accessibility solutions would you make sure they know about us? We really appreciate your referrals - we'll take excellent care of them!

Automatic Door Opener

Automatic door opener

Is a power door opener a luxury or a necessity? Frankly it depends upon how much effort it takes to open the door another way. I have plenty of friends and clients who use mobility equipment who might say they've gotten used to the extra steps they use to open and close doors compared to those of us who stand and walk. We don't have to think about our balance, backing up with our mobility equipment to get out of the way when we are moving the door, or having to turn our walker or wheelchair around and approach the door again in order to close it.

Lever handles and building in some space beside the door when possible, so a person can stand or sit to the side of the door while it swings open past them are two manual ways to make opening a door easier for some people. Of course sometimes it isn't practical to provide additional space beside the door.

Two manual approaches to closing the include tying a string to the door and catching it with your hand or  wheelchair as you pass through and adding an extra handle. These pictures from www.howtoadapt.com shows both. When I work with people who choose to add a handle whether it is screwed in, magnetic, or suction, I strongly suggest they take the extra time to turn around and reach forward to get hold of the handle in order to protect their shoulders, but that of course takes time.

Opening and closing a door with the push of a button seems like a really good idea to me. It could protect a person with poor balance, save a person time and aggravation, and frankly make it possible for some people to handle the task on their own. Total Home Access Solutions, installs Open Sesame Power Doors in private homes and residential communities.

This American company provides a reliable door opener that is flexible enough to work with in-swinging or out swinging, right hand or left hand doors, which allows my clients to re-use their opener if they move. We can provide a variety of switches which best meet a person's requirements.  These openers don't interfere with another person's manual use of the door and charge themselves so they are always available even if the power goes out. Give us a call if you want more details about how these doors work.

Is a power door opener a luxury or a necessity? If you can't open the door any other way; If the cost of remodeling to provide room around the door exceeds the cost of a power opener; if you run the risk of falling when you operate the door; or if you would like to get through the door and close it behind you with the same effort that most people expend, I think you'll be among the people who consider a power door opener a necessity for successful independent living.

Let us know what you think!  BPhillips@Totalrr.com

The SureHands Lift and Care Systems Body Support Can Help with Clothing Adjustments at the toilet

It takes more than just getting into the room to be able to make use of the toilet.  You need to deal with your clothing as well.  What if you can’t stand up or balance while standing?  What if you are a caregiver for someone who depends upon you to transfer or move from one surface to another?

One solution is the SureHands Lift& Care System Body Support.  It can be used with any of the ceiling based or wall based motors.  Unlike many slings, the body support leaves the buttocks area clear during the secure transfer.  This makes this a great lift support for speedy, secure, and often independent transfers, but it is also great for clothing adjustments during toileting.

Once a person is positioned over the toilet, pants can be moved over the hips to the level of the body support.  This is easier with looser pants.  Individuals with sufficient hand strength and dexterity and  arm mobility may be able to do this themselves.  It is a relatively easy task for most caregivers.  Once the person is lowered to the toilet, the thigh and chest cuffs become loose.  As the thigh cuff is removed the pants can be pulled further down each leg.  Some caregivers find it helpful for hygiene to lift a person into the air slightly for cleaning.  Other people can accomplish cleaning while seated.

When the person is ready for pants to be pulled up, the top of the pants are gathered and pulled up as high on the thigh as possible. Work with one leg at a time.  Sometimes you will need to repeat this process.  If a person’s leg can’t be lifted high enough to clear enough space to pull the pants up, a caregiver can prop their leg up on something or lean them slightly  to the side.  The goal is to gather the pants up so that most of the fabric needed to pull over the hips is over mid thigh.  Place the thigh cuffs just below the gather of material and lift the person slightly.  With the cuffs at mid thigh the person’s buttocks will be lower than usual so best practice is to lift just high enough to clear the toilet and work fairly quickly to pull the pants up over the hips.  Depending upon how tight the pants are, this step may take a little tugging to clear any folds of fabric at the thigh cuff.   Lower to the toilet and reposition the thigh cuffs correctly as high up on the legs toward the hips as possible.

The body support makes dressing during toileting activities possible for many people.   Give us a call today if you have any questions or wish to schedule a private consultation.

402-291-9514

Is your bathroom the scariest room in your house?

Are you afraid of what may happen when you are in your bathroom? Do you stay up at night wondering just how safe your older parents are in their bathroom? If so, you are not alone. Ask anyone what is the scariest place in their home and if they have a disability or mobility/balance issues, they will probably tell you it is the bathroom. It doesn’t have to be that way.

We know instinctively that the bathroom is a dangerous place. Falls occur from slips and trips. Slips occur most often on wet surfaces. What floor do we tend to drip water on most often? Trips come from obstructions we don’t see. Which room is often small with limited storage so things may be placed on the floor or on storage shelves placed in the walkway? Many falls occur when lighting is inadequate. What room in older homes is usually lit by a single set of lights that we reduce even further when we close shower curtains? Better yet, if we wear glasses, what room do we routinely take them off in? Other falls occur when a person’s ability to balance isn’t adequate for the tasks they are engaged in. What room requires us to step over a 15” high barrier such as the side of a tub, get on the floor such as getting into a tub, bend over such as pulling up pants after toileting? To top it all off, which room of our house is so small that if we fall on the floor we are likely to block the door shut with our body so no one can get in to help us? Of course we know the bathroom is a scary place, but it doesn’t have to be.


Safety can be improved in most bathrooms with careful attention to matching the environment to a person’s abilities and a willingness to try something new. It may be as simple as a well placed grab bar or a rug to absorb moisture that is really slip resistant to. For some homes, it may be a little more involved such as replacing a standard tub with a barrier free or walk in shower, or adding a walk in tub. Thinking about making a change may be difficult, but consider the alternative.

Take a look at these facts from the article Falls Among Older Adults: An Overview the Center for Disease control www.cdc.gov

• More than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001).

• Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (CDC 2005).

• In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2005).

• The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006).

How can we look at facts like these, know the bathroom is one of the most useful, but most dangerous places in our home, and still not take action to save ourselves and people we love?

Take action today. Educate yourself on ways to make your bathroom safer. It may be easier and less expensive than you think it will be. If you want some help planning a functional and beautiful bathroom experience give us a call. You are worth it.

Access client shares his wood working access ideas with a web site!

Another Reason Why We Love Touching People’s Lives!

When Bob contacted me to improve the accessibility of a house he and his wife had recently purchased, we sat together and discussed what was important for him to do in the house.   His determination to resume woodworking was clearly almost as important to him as being about to move through the doorways of the home and to be able to use the fixtures in the bathroom safely.  He had us work on access through the house while he worked on creating a workshop that was accessible to him.

A recent amputation meant he needed to use a wheelchair at times and he was having difficulty using his wood working techniques designed for a person who can stand and balance.   He went on line for some helpful ideas and found only one article related to wood working and access.  Bob did not let this stand in his way. He took the initiative and started the website http://wheelchairwoodworker.net/ to share his innovations of making his wood working shop safer and more accessible with other people who had similar disabilities.

Bob’s website is active in two ways; he is first documenting the transformation of his workspace from the large traditional shop he had in his previous house to two separate rooms in his house. The second way Bob uses his website is to bring people to together so they have a platform to share their thoughts and input.  Bob states that his website has been an overwhelming success and encourages people to not be afraid to speak up on his site. Bob gives a great deal of thanks to his wife, who happens to be an occupational therapist and was not afraid to encourage and push him toward recovery.

Accessibility is about making your home a place where you can do what is important to you.  Please contact me if you have any questions about removing barriers for daily activities like bathing or cooking, but also about removing barriers to enjoying recreation too.

Oasis Seated Shower System™ a new way to bathe people

Oasis Seated Shower System™  a new way to bathe people

Helping people bathe is not one of those activities that most of us spend much time worrying about.  Of course we were taught the importance of good hygiene from our parents and our mentors as we growing up.  Of course we are influenced by the multitude of advertisements for personal cleaning products.   For the most part though, we jump in and out of our showers and tubs without a lot of effort or thought about what we are doing.

When a person is unable to clean themselves, the bathing activity requires a great deal more attention.   Even if a health professional is the person doing the bathing,  being undressed and allowing someone to touch you is a process that is uncomfortable socially for most people.     If a person is unable to stand up, getting really clean around the genitals and anus may be very hard to accomplish.   Health professionals such as Nurses and Occupational Therapists spend a great deal of time and energy devising procedures and ways to help keep other people clean.  The consequences of inadequate hygiene such as UTIs (urinary tract infections) can be very debilitating, or even life threatening for people.

If reading my last paragraph made you a little uncomfortable, imagine what trying to clean someone else must be like or what having someone bathe you must be like.  

I'm really excited to present the Oasis Seated Shower System™  because I love to help people find solutions.  This technology allows really excellent cleaning with less hands on touching during the process.  People are still present and still helping with moving a person, drying them, doing little extra touches with hair, hands, or feet so there is still the one to one human contact, but some of the most uncomfortable and difficult  cleaning is taken care of with no touching.  Dangerous things like having a person with poor balance standing or leaning to the side to clean the buttocks area are eliminated.  

The Oasis is easy to use and set up.  It uses the existing shower water supply and drain so there is no construction.  It  actually uses less water than a traditional shower or tub and because water doesn't circulate inside the seat, it is a very clean and low maintenance piece of equipment.

Here is a link to another cool video about the Oasis.   http://www.youtube.com/watch?v=ZfOsPTtWsPI
Remember, in a few short years, you will be able to say, "I was among the first to see the Oasis.  It was the start of how we bathe people today!".  


Right now I have a loaner I can take to facilities and let a few people try it out for themselves to see how much better their residents and bathing staff feel using the Oasis than they do using the old fashioned methods.    If you have any questions about how it might fit for you, give me a call 402-291-9514 or email, BPhillips@Totalrr.com.

Check out our flyer!

Magic Wand of Accessibility

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Sorry Virginia, there is no magic access wand.

Sometimes we can tell that we are disappointing the person standing in front of us at a health fair or talking to us on the phone. We are simply too responsible to attempt to solve their home accessibility answer without more information and usually without going to their home. Sometimes they’ve given long explanations of what is going on and what isn’t working, and we have listened. But even when they can accurately describe their abilities and what their home looks like, they are only able to give us their perspective of those things. 

While our client’s perspective is critical and plays a huge role in the recommendations we make, they deny themselves the benefit of our objectivity and experience over the years if they ask us to rely solely on their impressions. 

Here are a few reasons why a responsible access consultant won’t just attempt to solve problems for people without a good individual and on-site review:

1. There are accessibility guidelines that some people think can be used like a cookbook for access such as the Americans with Disability Accessibility Act Guidelines, but these are not designed to meet the personal need of every individual and they aren’t required in private residences unless they’ve been incorporated into a building code.

2. Every person is different from others and should be treated individually. Even two people with the same medical condition, same age, same size, and same sex, will have different goals, preferences and abilities.

3. Houses are very different from each other.
In short, there really is no notebook or cookbook that says what is exactly right for every person and we know there is really no such thing as accessibility magic wands so we have to rely on good old evaluation, knowledge about a multitude of options, and the experience to match those options with the individual’s needs. We feel like the best way to solve an access issue is to listen to a person to understand their goals and observe them in the environment they want to change. So if you give us a call with an access question, we really don’t want to disappoint you. Expect a thorough residential access answer to include a visit to you in your residence. 

If you want an objective, professional solution to your residential access problem, call us and set an appointment with one of our designers. We provide in-home assessments with no travel fee in the Greater Omaha, Nebraska area. All other areas in Nebraska and Iowa are possible with a travel fee. We will give you a firm estimate of your costs for consultation when you call to make an appointment.