Prevention of Home & Work Related fall-Injuries:
Using a Transdisciplinary Approach
Dangerous septic tank retrofit, Augusta, GA
Instructor’s Home Office; Redlands, Miami, FL
Course Instructor: Dr. Jose R. Rafols
OTD, MHSA, OTR/L, CEAS
Prevention of Home & Work Related fall-Injuries:
Using a Transdisciplinary Approach
Conflict of Interest
In the effort to comply with appropriate state boards
and professional associations, I declare that I do not
have an affiliation with or financial interest in a
commercial organization that could pose a conflict
of interest with the following presentation:
Prevention of Home & Work Related fall-Injuries:
Using a Transdisciplinary Approach
Course Objectives
1. Will be able to identify 75% of the abatement recommendation discussed in the
2.
3.
4.
5.
seminar, as well as, direct clients and family members to the risks factors that
lead to falls at home, per recommendations from the National Center for Injury
Prevention and Control, Atlanta, Georgia.
Will be able to offer six out of eight contemporary off-the-shelve products, such
as, tub-benches, grab bars, motion sensor switches, etc., to minimize and/or
prevent fall-related injuries in and around the client’s home.
Will be able to identify three emerging practice trends in Telehealth,
Telemedicine, and medical surveillance to enhance the home-bound client’s
ability to gain access to health care services.
Will understand five primary causes of falls and related injuries among the
elderly which impact functional mobility and independence with ADL’s.
Will have a superior understanding of the use of readily available training
materials, such as, handouts, brochures and governmental websites to use
adjunctively to educate clients and care-givers on fall prevention.
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
The leading causes of falls among Aged Adults
Prevention of Home & Work Related fall-Injuries:
The leading causes of fall among Aged Adults
Causes of Falls:
I. Decreased Visual Acuity
II. Decreased Balance
III. Gate Disturbances
IV. Decreased Strength
V. Decreased Cardiac Capacity
VI. Decreased Bone Density & OA/DJD
VII. Decreased Cognition
VIII. Complication from Co-morbidities
IX. Adverse Drug Interactions
X. Fear of Falling
XI. Environmental barriers/obstacles
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
Decreased Visual Acuity … as aged adults
develop Cataracts, Glaucoma, and require
corrective lenses to see, they may not see
obstacles in darkened areas of their homes.
II. Decreased Balance … cause aged adults to loose
their balance easily; they also loose their
balance due to LE-weakness, and vestibular
irregularities.
III. Gait Disturbances … are often caused by poor
choice of shoes, use of slick-socks, improper use
of assistive ambulation devises and generalized
weakness in LE’s.
I.
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
IV. Decreased
•
•
•
•
Visual Acuity … visual
impairments rises with age in older
adults:
From 1.1% throughout ages 65-to-69 years
and this rises to 16.7% at age 80 and above.
Nearly 22 Million Americans are diagnosed
with Cataracts.
More than 150 million Americans use
corrective eye-ware to compensate for
refractive errors (e.g. poor eyesight).
Americans spend more than $15 Billion
dollars each year on eye-ware.
Diagnosis- that impact
the Visual System due
to age related decline
are:
 Macular
Degeneration
 Glaucoma
 Diabetic Retinopathy
 Loss of peripheral
vision
 Visual acuity &
contrast sensitivity
 Dry Eyes
 Reduced Pupil Size
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
IV. Decreased Cardiac Capacity … due to inactivity
the aged adult’s cardiac vital capacity is
impacted; thus, they are unable to engage in
moderate cardiopulmonary exercises.
• The aged adult may have trouble performing
cleaning chores in & around the house.
• The aged adult will have trouble with moderate
lifting, bending, squatting, pushing, pulling tasks at
work.
• The aged adult may have trouble taking care of a
loved one, as a result decreased cardiac capacity.
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
VI. (a) Decreased Bone Density … as aged adults
enter their 5th, 6th, and 7th decade of life,
they lose the rigid supportive framework
within their bones; as the bones become
more brittle and less supportive, they
become more susceptible to fractures due to
falls.
VI. (b) Osteoarthritis … causes disuse, more so
in the morning, and this leads to inactivity,
joint-stiffness, and decreased functional
range of motion and pain. (*OA-impacts
the weight-bearing pillars of the body first;
e.g. hips, knees, ankles, wrists, and
shoulders).
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
VII. Decreased Cognition … aged adults with
cognitive impairments or “altered mentation”
present difficulty in complying with homeprograms. It is best to farm-out these
responsibilities to health care surrogates (e.g.
reliable care-givers) who will insure compliance
with HEPs, home-safety, poly-pharmacy and
medical surveillance.
• Alzheimer's Disease
• Dementia
• Parkinson’s Disease
• Aged Adults with mild cognitive impairment
are two times more likely to fall as compared
to normal older adults.
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
VIII. Complication from Co-morbidities (CMs) … aged
adults presenting with several CMs, such as, CVA, CHF,
DM-II, PVD, or HTN require “close medical
surveillance”.
• Doctors who manage these patients report that if their
clients present with three (3) or more Co-morbidities a
“red-flag” should be raised and Comprehensive Health
Care Management should be instituted.
• Health Care Providers (HPCs) … must coordinate care,
poly-drug adherence is a must, a weekly exercise regime
should be incorporated into the aged adult’s schedule,
and finally, the aged adult must touch-base with a nurse,
PCM or doctor at least once a week.
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
IX. Adverse Drug Interaction … aged adults usually take
more than one type of medicine. Key to this complex
issue is that aged adults do not metabolize medication at
the same rate as do younger adults.
• Current poly-drug surveillance is hard to implement
when patient/clients do not return to the attending
physician’s office for routine check-ups.
• Education on how to properly administer, safeguard,
and store the medication is not always followed.
• Mixing of prescription drugs, OTC meds and Herbs &
Supplements without the attending physician’s
knowledge can lead to unexpected drug interactions.
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
X. Fear of Falling … the aged adult is typically cautious when
walking in and around obstacles; they have good reason to:
• One in three adults age 65 and older fall each year.
• Over 95% of hip fractures are caused from falls; the fx
rate for females are three times greater than they are for
males (*Why?).
• Every 15 seconds, an older adult is treated in the
emergency room for falls & every 29 minutes an older
adult dies from fall-related injuries.
• In the United States, 16 percent of all Emergency
Department visits and almost 7 percent of all
hospitalizations are for fall-related injuries .
Prevention of Home & Work Related fall-Injuries:
The leading causes of falls among Aged Adults
XI. Environmental barriers … the aged adult is often
immersed in a dangerous environment (e.g. home)
that poses great hazards, such as:
• Slick surfaces
• Uneven surfaces or stairs
• Darkened hallways, corridors, entryways, and rooms
• Clutter filled rooms
• Narrow doorways
• Lack of hand-rails and grab-bars … for stability
• Too much furniture which leads to trip hazards
• P3 (pools, patios & pastures): the exterior of the house
• Transitional Spaces
Prevention of Home & Work Related fall-Injuries:
Adverse Drug Interactions
In the United States $75 Billion Dollars are spent annually on Prescription Medicine
(Pham and Dickman, American Family Physician, 2007)
Prevention of Home & Work Related fall-Injuries:
Managing Adverse Drug Interactions
Adverse Drug Interactions … the aged adult who is
labeled as a polypharmacy candidate is one that has
several co-morbidities and consumes four or more
prescription medications daily.
• Providers resort to polypharmacy for symptom
management among patients with complex
medical problems.
• Avoid or use with extreme caution when
administering … Digoxin (Lanoxin), Glyburide
(Diabetic Medication), Robaxin (muscle relaxant),
Benzodiazepine (Valium), Chlordiazepoxide
(Librium), Meperidine (Demorol), OTC-drugs,
such as, Tylenol PM and Benadryl.
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






Gigoxin
Glyburide
Robaxin
Benzodiazepine
Chlordiazepoxide
Meperidine
OTC-drugs
Herbs and Remedies
Prevention of Home & Work Related fall-Injuries:
Managing Adverse Drug Interaction
Why should we (e.g. providers) be concerned with Polypharmacy?
• Because more than 40% of ambulatory adults older than 65 years of age use at
least five (5) medications per week, and 12 % use at least ten (10) medications
a week (Pham and Dickman, 2007).
• Because about one in three older adults taking at least 5 medications will
experience an adverse drug event each year (Pham and Dickman, 2007).
• Patient non-adherence (non-compliance) occurs at 40-60% of those taking
prescription medication. This issue is dual-hatted as it indicates that patients do
not take their prescribed medications when told to and when told to stop taking
them-patients continue to consume these medications-thinking they are
beneficial (Pham and Dickman, 2007). .
• Two-thirds of older adults do not tell their physician in advance that they plan
to underuse a medication because of its cost, and in follow-up visits 35% never
discuss that they have underused or misused the medication. (Pham and
Dickman, 2007).
Prevention of Home & Work Related fall-Injuries:
Managing Adverse Drug Interaction
What are the six questions seniors should ask their provider (MD, PA, NP, PCM)?
1.
What is the name of the medicine?
2.
What is the medicine supposed to do?
3.
How and when do I take it and for how long?
4.
What foods drinks, and other medicines or activities should I avoid while taking
this medicine?
5.
What are the possible side effects and what do I do if they occur?
6.
Is there any written information about the medicine?
*By having the patient/client ask his/her provider these six questions they can
prevent confusion and potentially avert adverse drug events (ADEs).
Prevention of Home & Work Related fall-Injuries:
Managing Adverse Drug Interaction
Tips on prevention adverse drug interactions:
I.
II.
III.
IV.
OTC’s … even though OTC (over the counter) medications do not need a
prescription they can lead to serious side effects among aged adults; thus, you
should ask your provider prior to taking them.
Med-Log … make a list of all the medications you take, their doses, and how
often you take them; remember to update any new drug(s) or doses to your list
when a change is made.
Med-Reconciliation … make an appointment once or twice a year to review your
medicines with your PCP/PCM; ask whether you need to continue taking each
one at its current dose.
Med Instructions … take your medicines exactly as directed by your health care
provider; try to have all your prescriptions filled/dispensed at the same
pharmacy…most pharmacies have medical data-bases that alert the pharmacist
of possible drug interactions.
Prevention of Home & Work Related fall-Injuries:
Managing Adverse Drug Interaction
Medication “Do’s and Don’ts”
I.
II.
III.
IV.
V.
VI.
VII.
Do … throw away medication if the medicine has expired
Do … make a list of your medications and understand what each one
does
Do … ask questions (to MD, PA, NP, Pharmacist, etc.)
Do … use a pillbox (dispenser) to help you remember when to take your
medication.
Don’t … take medication that has passed its expiration date.
Don’t … stop taking medication just because you feel better .
Don’t … ingest alcohol when you take your medication, unless you have
spoken with your doctor first; drinking alcohol when taking sleep,
anxiety or depression medicines is considered unsafe.
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessment: A Walk Through the Interior & Exterior
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessment & Safety:
 Home assessments are performed to ensure patients can safely
return and/or reintegrate into their home environment.
 Home assessments … just follow the A, B, C’s:
a. (Allow) … for safe and clutter-free mobility within the
patient’s home.
b. (Barriers) … identify potential barriers that could lead
to falls & do so before the pt. returns to his/her home.
c. (Convey) … the importance of fall-prevention and
home-safety to family members and care-givers.
 The general consensus is to grey in place, thus, older adults
want to return to their home after D/C.
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessment & Safety:
 Home assessments
 Should be performed prior to the patient
returning to their respective home. (*GoldStandard)
 Should be performed in a standardized fashion
that includes the interior & exterior of the
structure (e.g. home, mobile-home, apartment,
townhouse, condo, etc.).
 Should never be complex, lengthy or costly.
 Should never cost the homeowner a lot of
money to abate the safety hazard; 85% of all
abatement recommendations for home
modifications cost absolutely nothing (Stevens, J.A.
2005: NCOA National Center for Injury Prevention & Control, CDC)
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments & Safety:
 Home assessments evaluate the following
barriers:
1.
2.
3.
Throw-rugs, area rugs or afghan rugs
Extension cords or loose telephonecords strewn over common areas
Floor-surface:
a. Tiled surface
b. Wood surface
c. Carpeting
d. Polished or stained concrete
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments & Safety:
 Home assessments evaluate the following barriers:
4.
Entry threshold (e.g. weather seals) can
become a trip hazard-when using a walker.
5.
Long transparent O2-tubing
6.
Stairs and flimsy hand-rails (banisters)
a. cause bowing
b. not made for weight-bearing
c. can be pulled from the
wall (*improperly anchored)
d. require additional support
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments evaluate the following
barriers (Cont.)
7.
8.
9.
10.
11.
Narrow doorways (*old homes)
 old homes have very narrow
doorways (>25 inches wide)
Dimly lit hallways/passage-ways
Bathtub height (*difficulty with
transfers)
Bathtub & Shower water temperature
Steps/stairs leading to the
entrance/exit of the home.
The Laws of Unintended
Consequences.
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments evaluate the following
barriers (Cont.)
12.
13.
14.
High kitchen Counters/cabinetry
 Difficult for wheelchair bound patients to
access.
 Expensive retrofits for kitchen cabinetry can
be prohibitive in cost.
Central Island Designs
 Force patients/clients with walkers, canes,
and in wheelchairs to navigate around these
Islands.
Crowded Kitchen floor-plans
 Patients incur falls w/in kitchens because
they must crisscross the area often (or)
must navigate around the kitchen’s central
island.
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments evaluate the following barriers
(Cont.)
15.
16.
17.
Flimsy night tables at bedside
 Patients tend to weight-bear over furniturewhich lead to falls at night
Bed height-may be too low or too high
Cordless or Wall-mounted Telephones: cause
unnecessary walking to answer the phone
 Move phone to night table & avoid using long
telephone extensions or use cell-phones.
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments evaluate the following
barriers (Cont.):
18. Floor vents for (AC/Heating)
 trip hazards
19 Iron steam heaters (*radiator type).
 May cause burns due to polyneuropathy and
being insensate (* a hazard for both the
elderly and the children).
20. Exposed pipes (*in the bathroom sink).
 Ditto-as per above
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments evaluate the
following barriers (Cont.):
21. In-door Pets (*poor vision among the
aged cause them to trip or fall over their
pets).
Pets congregate around their owners
when they stand up.
 Pets enjoy lying next to their owner’s
feet
 Pets require care, maintenance, and
supervision
 Safety concern for recurring falls (get
help!)

Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
“My pets! They are adorable and very loved, but they run around
and get under your feet. My grandma has a hard time moving
around the house in her walker sometimes when they are playing.
So, they were responsible for causing her to fall a few weeks back.
My grandmother tripped on one of their play-toys.”
Quotes from the granddaughter of an elderly patient who tripped and sustained a Fx’ed Hip (2009)
Tannen
Bailey
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments evaluate the following barriers
(Cont.):
22. Light switches (automatic: motion sensors).
 Keep the patient’s “hands on the wheel”
when using assistive ambulation devices.
23. Rocking chairs (or) chairs w/casters
 Chairs/sofas/benches should always be
stationary.
24. Piles newspapers & magazines
 pack-rat mentality-can’t bear to throw
anything away.
 These are important decisions-enlist the
assistance of family members.
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments (special considerations)
25. Mobile Homes:
 Gaining entry into a mobile home may prove
difficult, as a result of the steps that lead
into it.
 Metal grating steps are narrow.
 Metal grating steps are steep (steep-pitch).
 Most steps do not have hand-rails.
 This is a dangerous “transitional space” for
patients with questionable mobility and
balance.
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Home Assessments (special considerations)
26. Mobile Homes:
 Mobile homes do not allow for extensive
modification due to their construction.
 Narrow hallways and doorways.
 Small bathrooms, bedrooms & closets.
 Walls are thin and constructed out of
aluminum, plastic, and/or fiberglass .
 Impairs the patient’s ability to ambulate with
canes, walkers and wheelchairs.
Prevention of Home & Work Related fall-Injuries:
“Let’s take a close look at the many barriers & obstacles”
Mobile Homes:
Floor plans-of- single wide
mobile homes are less
accommodating than
are double wide homes
Prevention of Home & Work Related fall-Injuries:
“What you should be looking for”
Mobile Homes:
 Keep in mind that patients that live
in mobile homes may be renting, thus,
any modifications that are recommended
must be cleared through the landlord
first.
 You cannot advocate for extensive retrofits to mobile homes, as any structural
change to the home have dangerous
consequences to the structural integrity.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
CDC-Center for Disease Control & Minnesota Safety Council, 2004
RMFs
Retrofits, Modifications and Functional Improvements
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Bathtub grab-bars need to be mounted vertically, as
well as, horizontally.
 Grab-bars should have a non-slip rough finish.
 Grab-bars must be secured with proper anchors to
support wt. bearing.
 [Do not] … use slick porcelain-finished grab bars .
 [Do not] … use suction-cupped grab bars.
 Shower-stalls are preferred over tub-showers:
Promotes energy conservation & safety.
 Hand-Held Shower-head is preferred over a
standard overhead shower.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Sliding glass doors mounted on bathtubs and showers
(trip & fall hazard):
As a rule of thumb, glass, water and slick-tile
should never mix.
Sliding glass shower doors are generally made of
non-tempered glass, thus, it will shatter and form
sharp edges.
Patients with poor balance or cannot transfer
independently may weight-bear on the metal
towel-rack and shatter the glass.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 The bed-height should be raised or lowered for
the elderly or disabled patient to use safely.
 Be careful with bedside-rails … these ought to be
installed properly to prevent falls.
 Bedside rails also promote transfer independence
into/out of the bed.
 Night-lights are an invaluable tool for bedrooms,
bathrooms and dimly lighted hallways.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 The bed-height (plastic risers); these are
commercially available and inexpensive; (A) Courtesy of
North Coast Medical; Furniture Riser Set, 2013
 Bedding causing a trip-hazard (e.g. fluffy
comforters):
Beds with draped sheets, comforters, or fancy
ruffles that are used around patients with poor
ambulation skills or balance… must be
removed.
A
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Doors with keyless entry or “Smart-key
Systems” can be retrofitted to the homes’
entrance to mitigate the need for keys
 Great for Arthritic & Neuro-patients; and
enhances the security of ones’ home.
 Door handles should be lever-handles not
of the door-knob type.
[B] Lathem Keyless Entry Door Lock
Model#LX100R
B
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Uneven driveways, entryways, decorative
pavers, stamped-concrete need to be
assessed.
 Uneven surfaces can cause patients to lose
their balance when ambulating over them.
 Concrete sidewalks with cracks are very
much a trip hazard; these need immediate
attention.
 ½ to ¾ inch plywood can be placed over
these irregular surfaces until the patient’s
balance or ambulation-skills improves.
B
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Self-dimming lights are used in frequently
traveled areas of the house, such as, the hallways,
bathroom, kitchen and entrance.
 These lights are triggered by movement
(e.g. motion sensor).
 Patient or family member adjusts the
“time-on” and “width” or sensitivity of the
sensor (beam).
 When sensor is triggered-the light is turned
on for a preset period of time, then it turns
off automatically.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Transitional Spaces:
 Entry foyer (front-door)
 Bath tub or shower
 Stairs & Sunken-living-rooms
 Pools, Patios & Pastures
 Transitional Spaces & increased threat of falls:
 Patients incur a greater risk of falling
 Places that are regarded risky if the patient has
low vision, poor balance, and less than ideal
functional ambulation skills.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Poor Ergonomics and overuse syndromes:
problems crop-up at home, as well as, the
office-workplace (*Cumulative Trauma
Disorders: CTDs).
 Assess the person’s equipment & how they use
it; such as:






Keyboard positioning
Monitor location
Monitor screen (Polarizing filters)
Lumbar support and overhead lighting
Mouse placement and wrist guard
Computer chair with 5-casters vs. 4 casters.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Many workers are opting to work from their
homes part-time or full-time.
I.
Workers are more productive working from
their homes than they are in traditional
worksites.
II. It reduces the physical-space requirements
of the “home-office” (e.g. headquarters).
III. It reduces the “down-time” incurred from
non-productive vehicular commutes.
IV. Young parents are better able to balance
children, families, and work
responsibilities.
Raftey, I. (2013). Telecommuting, CNBC
Telecommuting
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Campbell, R.J. (2008)
(Computers & Seniors)
 Seniors and computer-phobia (*A known myth):
 Seniors are interfacing with the home PC with
increasing frequency because they need goods and
services.
 Seniors have accepted this foreign method of
communication because they are “home-bound”.
 Seniors make up 28% of all online users w/in the U.S.
(the 55+ y/o)
 Seniors are the fastest growing segment of internet
users in the U.S.
 Seniors spend more time online than do teenagers (1319 y/o).
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Adler, R. (2002)
(Computers & Seniors)
 Seniors and computer-phobia:
 Seniors make up 60% of all healthcare spending in
the U.S. ($2.28 Trillion dollars annually).
 Seniors purchase 51% of all over the counter
medicines.
 Seniors spend over $7.5 billion dollars on online
purchases annually.
 Seniors are very comfortable in the use of Skype to
connect with their children and grandchildren &
will use this “media” to speak with their
doctor/nurse.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Home Ergonomics … (Computers-&-Access)
 Telehealth and Seniors … telehealth,
telemedicine, and tele-consultation are becoming
acceptable means of monitoring seniors:
 Because they are unable to use public
transportation and/or cannot drive to the PCM’s
office.
 Because technology (bandwidth, and internet
speed) allows connectivity from virtually any
remote location on earth.
 Because elderly pts with more than three
comorbities are considered “high-risk-patients”
and are the most vulnerable to relapse &
readmissions.
Telehealth Program LDLP
at FL International University
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Home Ergonomics … (Medical Surveillance)
 Telehealth and Seniors … allow PCMs and
specialists to reach-out to home-bound patients:
 Frequent check-ups (Face to Face and VideoTeleconference) keep high-risk patients out of
hospitals.
 Telehealth allows for what is referred to as
“Telemonitoring”… vital signs, drug compliance,
wound-care check-ups, proper use of O2, etc.
 Allows the PCM/Specialist to answer questions.
 Allows for the three “R’s” (reassure, review and
redirect) in a timely manner.
Telehealth Program LDLP
at FL International University
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
RMFs
(Retrofits, Modifications, and Functional Improvements)
THINK
FUNCTION
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Approach homes and surrounding areas as potential
hazards.
Look at toilet heights.
Look at floor surfaces, such as, unrecognizable steps
(or) step-offs.
Non-tempered glass in shower-stalls.
The entry-portal of the house and the height of the
threshold.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Shower glass panes: recommend use of
another shower or remove glass doors and
hang shower curtains.
 Concrete stairs: build an appropriate ramp;
however, with this abatement a ramp could
not be placed; grab bars were installed in the
door-way & double sided bright tape placed at
edge of each concrete step.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Low lying toilet seat: use three-in-one toilet
chair or the elevated toilet (plastic toilet seat
insert) to promote ease of use.
 Raised threshold @ entryway: change out for
the kind that connects to the bottom of door,
thus, allowing for smooth transition from outside-to-inside and vise-versa.
Ask the patient, spouse, family members or
friends if they feel comfortable doing the retrofits
or modifications or if they prefer to hire a
certified and licensed ADA contractor.
Seek-Help!
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Home safety should never be taken for granted.
 Never assume the patient’s home is safe, just because they
have never fallen or incurred injury.
 The patient’s or caretaker’s recollection may be clouded
(*poor judgment or poor cognition).
 As you begin to conduct home or environmental
assessments, think … how would I abate these obstacles or
safety concerns and how much will they cost?
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Camouflaged Cats: the area rug in the living
room had to be removed-as the cats blended
into the “background”.
 Outdoor Terrace: there was a dangerous stepoff from the terrace to the backyard; a gentle
concrete incline was used to abate the
situation; grass was also planted-to even out
the holes & rough terrain.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Suspicious Shoe-boxes: the walk-in closet was
cleaned up and the empty shoe boxes were
discarded.
 Computer-Clutter: the work station was
reorganized, plastic tie-ons were used to
secure loose cabling; everything on the floor
was removed.
 [Note]: Walk-in closets are cramped and do
not have much room to maneuver, thus,
anything on the floor needs to be picked up or
removed.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Concrete barriers & safety hazards-lead to falls
 Home decorations-obstruct home mobility
 Doorway obstacles & narrow doorways-limit
entry/exit with assistive ambulation devices
 Awkward stair height-pose trip hazards
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Retaining wall: this safety and trip hazard
caused the patient to incur poly-trauma,
hospitalization and incapacitation due shoddy
construction & poor decision making skills.
I. a pneumatic chisel was rented & the
4 inch retaining wall was removed.
II. also a proper drain-field w/drain was
installed by a licensed plumber.
III. grab bars were mounted on each side of the
door-frame for transfer safety.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Christmas Tree Crowding: the tree was
crowding into the kitchen entryway; abatement
consisted of moving the tree back 24 inches.
 Bathroom door will not open-fully: the
entertainment cabinet (console) was moved 20
inches to the “right” to allow the patient with a
quad-cane to access the bathroom.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Narrow bathroom Doorway: Some
bathroom doors can be as narrow as 24”
inches; this obstacle impairs pt’s with
walkers from entry/exit safely.
 Shallow Tiled Stairs: the depth of these
tiled stairs are shallow & make it awkward
to negotiate; visually impaired pts. may
have difficulty seeing the demarcation of
each stair.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Welcome mats & loose floor mats-pose a trip hazards
 Entryway of homes/apartments
 Bathrooms
 Optical Illusion- many tiled surfaces will appear the same;
these surfaces pose several trip hazards in home
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Unwelcomed-Welcome: the welcome mat
was removed and a lower-profile mat with
rubber backing was used in its place.
 Slick Carpeting in Bathroom: slick area
carpet was removed and a porous/absorbent
mat was used; also grab bars were installed
in the shower-stall.
* The patient was also cautioned
against using the aluminum towel-rack
for weight bearing purposes.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Optical Illusion: sunken living rooms or
awkward steps in patient’s homes cause
visitors to trip & fall:
*this situation was remedied by
changing out the corner-tile to a darkbrown tile and a laminated sign placed
on the column stating there is a “stepdown”.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Shoring up the hand-railing of stairs-to
support more weight-bearing.
 Use of house-hold appliances (e.g.
washing machine)
 Misguided Steps throughout transitional
spaces
 Round doorknobs; level type are better
suited for patients with RA, OA and CVA.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Stair-rails: stair-well was fitted with rails on both
sides to allow better support; the wall-mounted
rail (banister) was reinforced with additional
support cleats to allow for robust weight bearing
by the patient.
 Top loading washing machine: is very difficult to
use if you are W/C bound or have poor standing
balance; abatement consisted of having a churchgroup adopt pt., and every 7-10 days assisted with
the chore (*church groups are referred to as FBOs:
faith-based-organizations).
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Retrofits, Modification and
Functional Improvements
 Misguided step … the shallow stairs into the
family-room look very similar causing the
pt. with impaired vision to miss one &
fall;
* stairs were outlined with double-sided
strips of green & orange tape to identify
the edges of the stairs.
 Round Door-knobs … these door knobs cause
difficulty when opening doors; however,
they may be swapped out for lever-type
door knobs-to facilitate opening.
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Fall Prevention is a Transdisciplinary Effort

Prevention of falls is not some initiative that depends
solely on home-assessments, it must be multi-focal
(*multidisciplinary) in nature:
I.
II.
III.
IV.
V.
VI.
Home-site assessment by a qualified OTR/PT
Pharmacological reconciliation (PCP/PCM)
Adaptive Equipment needs from an OT or PT
Gait analysis and mobility from a PT
Neurological assessment by a neurologist
Follow-up assessment by nurse case manager or
MSW; ensure pt has access to communityresources.
VII. The family members or care-givers (*very
important).
Prevention of Home & Work Related fall-Injuries:
Abatement Considerations
Home Ergonomics & Safety (Resources)



NIH Senior Health (Fall Proofing Your Home);
nihseniorhealth.gov/falls/homesafety/01.html
GO4Life (Prevention of Falls-Tip Sheet); National
Institute on Aging, U.S. Department of Health &
Human Services:
http://go4life.nia.nih.gov/sites/default/files/
PreventingFalls.pdf
NCOA (National Council on Aging); (pdf) factsheet on seniors & falls at home; also,
“Debunking the myths of older adults and falls”
fallsfree@ncoa.org
Prevention of Home & Work Related fall-Injuries:
Ergonomic Considerations
Home Ergonomics & Safety (Cont. Resources)



National Institute on Aging (Prevention of Falls and
Fractures among the elderly);
www.nih.gov/health/prevention/falls-ar
Center for Disease Control & Prevention CDC-P) and
National Center for Injury Prevention & Control
(NCIPC) Fall Prevention Check-List in English,
Spanish, & Chinese
National Resource Center for patient safety-falls tool
kit:
www.Patientsafety.gov/safetytopics/fallstoolkit/index
.html;
Prevention of Home & Work Related fall-Injuries:
“What is functional mobility?”
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Functional Mobility …is impaired when medical conditions, such as,
CVA/stroke, LE-amputation, osteoarthritis (DJD), disuse atrophy, spinal
cord injuries, COPD and cardio-vascular complications impact the patient's
ability to safely navigate through their homes:







Kitchen mobility tasks
Bathroom mobility tasks
Bedroom mobility tasks
Gaining entry/exit into the home
Pools, Patios, & Pastures (P3)
Home management Tasks
Leisure Pursuits & Hobby tasks
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Functional Mobility
Each room has a different set of criteria to assess,
and each space within the home is uniquely
different.
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Concerns regarding wet-areas and back splash on
kitchen counters and floors.
Most kitchens require repeated movement to
various stations (e.g. stove top, oven, sink, food
prep-area, food pantry, refrigerator, etc.).
Kitchens
Counter top surfaces are high for the W/C-bound
Electrical hazards pose safety concerns-multiple
electrical appliances located near water-source
(*GFI-Outlets “ground fault interrupter”… these
outlets are used in bathrooms, kitchens, near
pools, & outdoor areas).
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Bathroom Mobility:



Standard bathtubs are difficult to get
into/out of with impaired mobility.
Bathrooms have tiled surfaces-which
cause slips & falls.
Standard bathrooms are small, cramped and
do not allow for mobility with wheelchair
(*ADA requirement is 5 X 5 ft turning radius).
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Bathroom Mobility:



Most residential bathrooms have a
TTS configuration (e.g. tub, toilet, sink) and
getting to them can be tricky, if not, down-right
dangerous.
Doorway entry is difficult due to narrow door
width (*pt’s with walkers, wheelchairs, and
canes modify how they enter/exit the bathroom).
Double hinges for narrow doorways allow the door
to open up wider and allow patients better access.
*****
Picture
of double
hinge
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Bathroom Mobility
• Bathrooms: glass-tile-water do
not mix well; thus, when
possible eliminate one of these
variables from the equation
(*the sliding glass panels were
taken off as an abatement
recommendation).
• However, there still remains a
step-down shower stall to
assess and abate…?
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Bedroom Mobility:

Bed-rest or convalescing patients spend a considerable amount of time in this
room:
 The Bedroom is turned into a multi-purpose room (e.g. patients entertain,
eat, perform hygiene and toileting ADL’s, as well as, watch TV and sleep).
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Bedroom Mobility:

Transferring into/out of the bed can become a chore when ambulation and
balance are impaired (e.g. bed height):

Use plastic risers to bring the bed up to a height
where the patient can safely transfer in/out of.

If plastic risers are not available you may substitute
PVC tubing (polyvinyl chloride) to raise or lower the
patient’s bed to the appropriate height (*PVC
tubing is strong, lightweight and inexpensive).
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Bedroom Mobility: (Continued)

Weight-bearing over flimsy furniture leads to falls.
Patients who have poor balance will
weight-bear on furniture
 Recommend that night-tables
be sturdy in the event the patient
weight-bears over it (*they often do!)
 Bed-rails must be bolted onto the bed-frame;
the kind that slides between the box-springs
& mattress is unacceptable & unsafe.

Prevention of Home & Work Related fall-Injuries:
“What to look for”
Bedroom Mobility:
Bedrooms, Clutter, and Oversized Bedspreads
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Bedroom Mobility: (Continued)

Patients get tangled in their bed-sheets, comforters, or bedside furniture.

Patients using walkers, quad-canes or
crutches are particularly vulnerable to
entanglement.
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Entry Portal:
The Entry-Portal can
be any of the
following:
the homes’ main
entrance, the
carport entrance,
a utility room,
the garage
entrance…etc.
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Gaining Entry/Exit from Home/Apartment:

The Entry Portal for a pt’s [home] is a safety
concern because of the many obstacles found
in this area; obstacles such as: stairs,
weather-stripping, insufficient railing-support,
poor-lighting, cracked-cement, narrow entry-ways,
and the need for proper ramp-abatement.
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Gaining Entry/Exit from Home/Apartment:



Weather … impacts the patient’s
ability to enter/exit the home safely.
Poor lighting … also impacts safety;
particularly with patients that have
decreased visual acuity.
Ramps must have a 1:12 ratio, with
regards to incline (*min) and must be
installed by certified/licensed
& bonded contractor.
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Pools, Patios & Pastures: (P3)


Pools and Patios are areas of concern, due to water and slick surfaces.
Pools and patios areas are becoming popular areas for family gatherings
 Pools and patios: are used for
entertainment and relaxation
 Pools and patios: are elaborate,
made of varying materials
(e.g. pavers, stamped concrete,
loose polished rocks, etc.).
 Pools and patios: often require stepping
outside the house (*transitional space).
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Pools, Patios & Pastures (P3):

Lawns, gardens, and pastures are relaxing, therapeutic, and offer patients
a chance to be out-doors; however, unsupervised use can lead to falls and
injuries among patients with decrease ambulation/balance:





Exposed tree-roots or loose gravel beds
Uneven concrete disks or blocks
Tall grass (uncut or unkempt lawns)
Mulch beds around trees and bushes
Extension cords for water fountains
and decorative lights
Prevention of Home & Work Related fall-Injuries:
“What to look for”
The current trend is to maximize the outdoor living
experience, and therefore, these outdoor spaces will continue
to be very elaborate and popular.
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Home Management Tasks:

Patients who wish to age in place … are still required to manage the home &
its surroundings. Who will do the following?
a.
b.
c.
d.
e.
f.
Painting & weather proofing the home
Cutting the grass & trimming bushes/hedges
Retrieving the mail (Postal Service Variances)
Curb side trash pick-up (Large Trash-bins)
Compliance with home-owner’s association
Paying the electrical & gas bills
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Home Management Chores:
Who will assist your
patients in doing these
important chores?
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Leisure Pursuits & Hobby Tasks:
 Patients who return to their HOR
(home of residence/record) wish to
return to the things that they enjoy.
 When conducting
a home evaluation also
ask if the patient engages in a particular
hobby or leisure pursuit: If [Yes] …
the evaluator needs to look at
modifying the task to fit the patient’s physical
and/or cognitive abilities.
 Biomechanical & Safety may have to be woven
into the activity (e.g. no prolonged standing,
joint protection, use of splints, built-up handles,
improved lighting, etc.).
Prevention of Home & Work Related fall-Injuries:
Ramps: “What to look for”
http://www.access-board.gov/adaag.htm
Information on ADA guidelines for wheelchair ramps.
ADA Homepage for Accessibility Guidelines for Buildings and Facilities
Functional Mobility
Ramps: “What to look for”
Heads-up (more information on Ramps):
ADA: Accessibility for Building and an Facilities, (Guidelines for ADA rated wheelchair ramp s):
Standard Chapter IV, Section 206 : http://www.ada.gov/reg/regs2010/2010ADAstandards.htm
Updated: 11-15-2010
Prevention of Home & Work Related fall-Injuries:
Ramps: “What to look for”
Information Regarding Ramps:
 ADA guidelines call for 1:12 inclination; however, 1:16 or 1:20 is





recommended for those with limited ambulatory skills.
Handrails must be placed on both sides of the ramp (*rails must be
smooth & free of splinters).
Min. ramp width is 36 inches; however, 42 inches is better
Ramps must have a landing that is 60 inches long @ the bottom and
top; the landing must be as wide as the ramp.
Pressure treated lumber and galvanized nails/screws are mandated.
Post supports are 4 X 4 posts and are inserted 18 inches into ground
with concrete.
Prevention of Home & Work Related fall-Injuries:
Ramps: “What to look for”
Information Regarding Ramps (More ADA Standards):
 W/C ramps can be permanent or portable structures
 Handrails on ramps are required if the ramp is more
than 6” high or longer than 72” long.
 The ramp should not exceed 36” in height without
some sort of directional change (e.g. switch-back).
 Ramp landings must be 60” square at the bottom,
the top and along any directional change.
 Ramps may be built out of a variety of materials,
such as, aluminum, treated lumber, concrete, etc., as
long as they meet ADA’s building criteria.
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Where do falls occur around the home?
I.
II.
III.
IV.
V.
VI.
Bathrooms
Stairs
Kitchen
Entrance or Entryway
Patio or grassy areas
Doorways and halls
Center for Disease Control and Prevention (2010e);
http://www.cdc.gov/homeandRecreationalSafety/Falls/fallcost.html
And Carter, SE, et al. (1997): Environmental Hazards in the Homes of Older People
Prevention of Home & Work Related fall-Injuries:
“What to look for”
Rubenstein, L., and Josephson, K. (2006).
What leads to falls at home?
 Lack of physical exercise … caused from poor muscle tone and decreased balance.
 Impaired vision … age related visual impairments and poor lighting are generally
regarded as two main factors for falls @ home.
 Poly-medication … taking several meds at the same time cause, lethargy, vertigo,
syncope, etc. (meds such as, sedatives, anti-depressants, and anti-psychotics) (*NIH
Senior Health 2013).
 Several co-morbidities … cause fatigue, need for supplemental O2, several medicines,
decreased mobility, and dependence on health care provider.
 Surgery …post operatively patients are weak and debilitated.
 Environmental hazards … one-third of all falls among the elderly population are
caused from hazards originating in the home (*NIH Senior Health 2013).
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
CDC: What you can do to Prevent Falls, e-brochure, 2012
Exercises to Improve Balance:
I.
Tight-rope walk: walk a straight line 10, 20, 30 feet with hands out
to the side for balance (*place a strip of masking tape on floor).
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
CDC: What you can do to Prevent Falls, e-brochure, 2012
Exercises to Improve Balance:
II. Rock-the-boat: with hips shoulder-width apart, weight shift Rt-to-Ltto-Rt; while wt. shifting to one side, lift the opposite foot off the ground
(*hold X 5, 7, 10 sec’s).
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
CDC: What you can do to Prevent Falls, e-brochure, 2012
Exercises to Improve Balance:
III. Heal-to-toe: walk placing the toe of one foot immediately behind
the heal of the opposite foot (*do this X 15-20 steps).
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
CDC: What you can do to Prevent Falls, e-brochure, 2012
Exercises to Improve Balance:
IV. Flamingo Stand: while stabilizing (holding) on to the back of chair,
stand on one foot (*hold for 10 sec, then change to other foot).
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
Impaired Mobility Advisory:
 In 2009 more than 14,400 people over age 65 died
and 1.7 million were treated and hospitalized
because of falls (CDC-Foundation, 2009).
 Among adults 70 years old, 3 in 10 will fall each
year; 1 in 10 will suffer a serious fall injury, such as,
a broken bone or head injury
(www.fallprevention.org ,2010).
 About 53% of the elderly population who are
D/C’ed from the Hospital for fall related injuries
will experience another fall w/in 6 months. (CDC
2007).
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
Impaired Mobility Advisory:
 Falls are the leading cause of death among the elderly
due to injury…[87%]... of all fractures among the
elderly are due to falls (CDC-Foundation, 2010).
 The financial toll for older adults who sustain falls is
expected to increase as the population ages and may
reach $54.9 billion by 2020 (CDC-Foundation and
CDCP, 2013).
 66% of persons who fall will experience another fall
within six months; 50-66% of all falls occur in or
around the home (NCIP Estimates, 2012).
 Hip Fx’s are the most frequent type of fall-related
fracture. The average hospitalization cost was
$18,000; this was 44% of the direct medical-cost for
hip Fx’s (NCIP and Pain, Wipf & Ericson, 2011).
Functional Mobility
A Transdisciplinary Approach
Falls at home (What we know):
1.
2.
3.
4.
5.
We know where our patients/clients fall most often.
We know what the leading causes of falls and injuries
are at home.
We know which patients are most vulnerable to falls
and injuries.
We are well-prepared and well-equipped to rehab
patients once they do incur injury from falls.
And yet, we will freely return (e.g. after D/C) the
patient back to the same environment that caused
their injury and hospitalization in the first place.
American Academy of
Orthopedic Surgeons, 2010
(AAOS)
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
Navigating through, around and over obstacles in the home is most challenging
when the patient presents with neuro-musculo-skeletal injuries (NMSIs).
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
Functional Mobility…(*Recap and Review)
 Occupational Therapist (Role) …receives the
recommendations on functional-gait and
assistive devices offered by the physical
therapist and dovetails these recommendations
into the patient's functional activities
(e.g. bathing, dressing, cooking, bed-mobility,
toileting, dressing etc.).
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
Functional Mobility…(*Recap and Review)
 Physical Therapist (Role) …performs gait
analysis and training while using assistive
ambulation devices (canes, walkers
& crutches, wheelchairs, etc.) to ensure the patient
can ambulate safely when working with
the occupational therapist or engaged
in functional tasks.
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
Equipment Index:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Automatic (motion sensor) light switch: Home Depot and Busy Mart stores
Bathroom Grab bars: Cambridge Moms Site
Handheld Shower Head: Model Number 75527SN; Lowes hardware
Plastic Furniture Riser (Set of Four): Online Product Number 729561; Target Stores
Lever Handle for Doors: Model Number 720 CHL; Handle Sets web site
Keyless (Smart Key) System for Doors: Lathem Keyless Entry Door Locks Model#LX100R
and Keyless Entry System Model Number 2835-SN; Home Security Stores
(Manufacturer: Digital Systems).
Easy Ergonomics for Desktop Computer Users (PDF Handout/workbook, 2005):
www.dir.ca.gov/dosh-publications/computergo.pdf
Plastic (Cable tie-ons) Nelco Products: Nelco-Products
GFI (Ground Fault Interrupter) Outlets: Grainger Company
PVC (Polyvinyl Chloride) Tubing/Pipes: US-Plastics
Bedside Rails to enhance transfer independence: SKU No. 00001vSTD5800; Parent giving
Prevention of Home & Work Related fall-Injuries:
A Transdisciplinary Approach
Questions?