Getting Around The Home
General considerations for making adaptations or choosing equipment. Adaptations to the home or equipment may make it easier to get around the house. But it is important to remember that changes can have an impact on all those living there so they should be thought through carefully. For example, a stairlift may help someone negotiate stairs but consider the space restrictions on the stairs as a result of the installation. Anything that changes the physical environment may have an impact on the safety of the environment for other people who share that space, particularly older people and children. Plan for everyone in the home.
When making adaptations or choosing equipment, consider the current factors that are restricting mobility and ability to do things and any future changes that may occur eg as a result of a deteriorating condition. The type of device or equipment you choose may differ if it is to be used independently or with assistance. It may not be possible to plan for every eventuality but your doctor, occupational therapist, physiotherapist or public health nurse should be able to help you choose the solution which best meets your current and/or changing needs.
A flat level surface makes moving around easier for people using wheelchairs, mobility aids, or those with walking or balance difficulties. Where there is a change in floor levels, a ramp or series of slopes can be integrated into a building quite easily to make it more accessible. Where possible, ramps should be installed in addition to stairs, as some people find stairs easier to climb than walking on an incline. The height of the change in level will influence the length of ramp required. The slope should be no steeper than 1:20. Handrails should be provided on each side and on landings. Guidelines on the installation of ramps can be found in the publication Building for Everyone from the National Disability Authority .
Portable ramps can be used in many different access situations, eg curbs, steps, and vehicles. Their weight can determine how portable they really are and it is worth checking the total weight and size with integral handles and carrying case when selecting one. Portable ramps can be folding or modular; fitting together with clamps or bolts, or telescopic; sections sliding into one another. The width of the ramp can be one piece or two channels for the wheels of the wheelchair. Side wheel guards are raised edges on the side of the ramp channel/s and are important to prevent the chair falling off the side of the ramp. Some ramps have integrated handrails. The landing area at the end of the ramp should allow for a wheelchair to become level and to be able to turn.
A platform lift is a platform which can carry a wheelchair from one level to another. A platform lift can be installed at the entrance to a building or within a building, as a last resort, if there is insufficient space for the length of a ramp. The platform should be at least 800mm x 1100mm and a landing area of at least 1800mm x 1800mm is needed at top and bottom so that there is room for the wheelchair to get on and off. Gates for the lift should lock automatically while the lift is in transit. For more details on access and health and safety guidelines, visit the National Disability Authority's publication Building for Everyone.
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The stairs can often cause difficulty or be unsafe for people with limited or deteriorating mobility. In some cases this may mean that a bedroom or bathroom may have to be moved downstairs. But for other people, certain adaptations or equipment may be all that is required to able to continue to get up and down the stairs safely. For example, hand rails on both sides of the stairs will help going up and down stairs and using a high contrast colour can make the rails more visible. The guide for height of rails on stairs is 840mm-900mm height but this can obviously vary depending on the person using it. Consider extending the rail beyond the first and last step by 300mm so that there is something to hold on to before starting to climb or descend the stairs.
A stairlift can help overcome difficulty managing stairs in the home but it may not be a suitable option for all, particularly if the user needs a high level of support when sitting, or needs to be lifted on and off the stairlift. If this is the case, other options such as a ground level extension to the house may be a more suitable alternative.
There are a number of different types of stairlift. The most common type is the seated stairlift where the person sits with their feet supported on a footrest and the seat travels on a rail fitted to the stairs. Stairlifts can be fitted to a straight staircase or a curved staircase or one with a turn. The stairlift can be controlled by the user on the starilift or by remote control. Issues to consider include the space at the bottom and top of the stairs and can you get around once upstairs. A platform stairlift can take a wheelchair but needs to be wide enough to take a wheelchair and are rarely used in the home.
A through-floor lift is another option giving access to the first floor. The minimum size lift 1100mm x 1400mm will allow a person using a wheelchair enter the lift and reverse out from the same position. When planning space on both floors, it is essential to allow for the lift itself, the door opening and wheelchair turning space at the entrance to the lift. An automatic cut out mechanism should always be incorporated in the lift to allow for obstacles or people obstructing its passage.
For more information on the equipment described in this section, see Choosing Equipment to Get Up and Down Stairs.
Rails can give support to help negotiate steps, inclines, a length of corridor, when moving from sitting to standing, getting in and out of bed, the bath or shower. In fact, they can be very useful virtually anywhere in the house. A grab rail can be used to help with balance or when standing to do an activity like dressing or washing. For more specific information about rails and their positioning in different situations, see Choosing and Fitting Grab Rails and/or Choosing Equipment to Get Up and Down Stairs.
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Handles on doors can be stiff or hard to grip and holding and turning keys can be difficult for someone with limited finger dexterity. Changing to a lever door handle instead of a round knob handle, or adding an extension to an existing lever handle can make them easier to use. A plastic key holder can be attached to a key extending the gripping area making it easier to hold and turn.
An electronic door opener can be fitted to a door so that it can be opened by a remote control switch. The device does not interfere with the existing functionality of the door and other people can still use a key. A door intercom system can be fitted to allow you to speak to and/or see the person visiting before you decide to let them in, which can improve safety and security for anyone living alone. For people who can not hear the doorbell, a system which activates a flashing light when the bell is pressed can be fitted at little cost.
Like doors, windows can also be adapted to open electronically using a switch or remote control. Alternatively and at little cost, an extension handle can be used to open and close windows.
Curtains can be operated in a number of different ways. A simple pull cord system may be enough to ease their opening and closing. A more sophisticated remote control system can also be installed to operate the curtains and a timer or light sensor (dawn and dusk) used for automatic opening and closing.
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A transfer board can fit between two surfaces at the same level to assist moving from one to another. For example, to move from a wheelchair to another chair or to a bed, the board helps to bridge the gap. The board may be straight or a curved shape to allow it to facilitate movement around something eg an armrest and it can be used independently or with assistance.
If you can stand but have difficulty taking steps, a turning circle can be used but usually only with assistance. A handling belt can be worn by the person turning with the person assisting holding onto the belt. There are courses in moving and handling which can be taken, teaching the best and safest techniques for both the person assisting and the person being moved. Help and advice can also be given by a physiotherapist and/or occupational therapist.
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Sometimes people require help to move from one position to another but any manual lifting and handling can place a severe strain on the person assisting and result in back pain or other injuries. A hoist can help with lifting a person if they have difficulty moving themselves but reduce the strain on the person assisting. It is essential that a full assessment of the lift and the risks involved should be carried out by an occupational therapist or physiotherapist, and an appropriate moving and handling solution recommended.
A hoist can be a self-standing mobile unit manoeuvred on the floor a mobile hoist, or positioned overhead on a track an overhead hoist. When choosing a hoist solution, consider where you need to move: from the floor, bed, chair, bath etc, as this will influence the type of hoist and sling required. It is very important to consider changes that may occur if you have a deteriorating condition as this may influence your hoist and/or sling requirements. You might need to consider a mobile hoist if it is not be possible to make structural changes to the house to install an overhead hoist and/or if you have a need to move the hoist to other locations. On the other hand, an overhead hoist reduces the floor space required and the amount of effort involved in moving the hoist. An overhead hoist can offer the option of independent use if the person can position and connect the sling to the hoist unaided.
When choosing a hoist and sling, it is important to try a number of options. Mobile hoists can be brought to your house with the community occupational therapist and the sales representative from the hoist company so that you can try them out in the home. For an overhead hoist, contact your local hospital or clinic to see if they have an overhead hoist that you could try. Though the introduction of a hoist can reduce the amount of effort involved in lifting, it does continue to demand time and effort from carers and this has resulted in hoists being abandoned as carers revert to lifting again.
It is essential that a full assessment of the lift and the risks involved be carried out by an appropriately qualified professional such as an occupational therapist or physiotherapist who will recommend the most suitable solution. For more information on the equipment described in this section, see Choosing an Overhead Hoist and/or Choosing a Mobile Hoist.
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