Problem Solvers

Safe Bariatric Living Spaces

Two experienced home access experts discuss how providers can create safe bathing environments for bariatric patients.

Bathrooms get a lot of attention when it comes to keeping bariatric patients safe in their homes. But challenges also abound in patients’ living spaces, which include bedrooms, living rooms and common areas.

When Blair Ferguson, President, Beyond Barriers Minneapolis, goes into a home to assess a client, he first notices the personal hygiene of the person. It will also be obvious if the individual is spending the entire day in the same bed or chair without being transferred. Both of these are commonly a direct result of their living environment not being able to accommodate their specific needs, he says.

“Tactfully ask if the client is able to utilize all the facilities of the home and move about it or at least be transferred by their care providers to minimize bed sores and a better quality of life,” Ferguson says.

Living space safety concerns

“One of the main safety concerns commonly encountered is being able to safely lift and transfer a bariatric client,” says Ferguson. “This includes safety for the client but as importantly the safety of the care provider performing the transfer. Floor lifts may accommodate the needs if the floor surface is smooth, transition-free, and hard enough to allow the maneuvering of the lift, and if you have enough care providers to assist along with having adequate space. A much more efficient and safer means to transfer is with an overhead ceiling lift and if properly installed can lift up to 1000 pounds although reinforcement of the structure may be necessary.”

Another main safety concern in living spaces is egress — in this case, the client’s ability to get out of the home in case of an emergency. Ferguson says that HME providers must make sure the doors and paths of travel are negotiable by the client with or without a mobility device and that the client can get to a safe place outside of the home.

“A second consideration is that many of these individuals have chronic medical conditions or are not mobile and we need to consider making the home EMS friendly,” says Ferguson. In other words, can an ambulance crew and firefighters get their equipment, such as an ambulance stretcher, and the client in and out of the home safely?

Steve Carricato, Home Accessibility Manager, Premier Home Care, says that specific to bariatric patients, providers need to pay attention to furniture height — low furniture is difficult to get in and out of — and clutter.

“We go into a lot of homes and you can tell immediately if you are going to have issues,” Carricato says. “When you have very cluttered rooms, it’s easy not to see something on the floor.”

Another important observation to make, he says, is make sure patients’ beds are at the right height and an assistance or transfer devices that can hold their weight is being used to help them in and out of bed. Carricato says one option is a floor-to-ceiling pole that you place next to the bed. A ceiling-mount trapeze might also work. Carricato says it is also important to carry a wide range of furniture products in order to meet the weight and construction challenges of bariatric patients.

Home modifications

Besides the sale of appropriate HME/DME equipment, including mobility devices and lifting and transferring devices, the provider may be able to consult or provide the home modifications necessary to use the equipment they provide. This may mean doing the home modifications themselves if they are set up and licensed to do so or having the necessary business relationships with companies that are qualified and experienced to do the work.

“Dealing with the environment for a bariatric need differs slightly because of additional loads placed on the structure, such as overhead lifts and point loads on tile floors, along with being able to accommodate installing larger-than-normal doors, which also involves structural modifications,” says Ferguson. “Providing or being a resource for these services may provide an additional revenue resource even if you subcontract the work to a qualified company.”

Typical home modifications include widening doors, both interior and exterior, commonly using a 42-inch door instead of the usual 36-inch door, says Ferguson. This may involve moving walls and placing doors in new locations.

“New flooring is frequently installed, as carpet does not withstand anything rolling over it with significant weight involved,” Ferguson explains. “Special consideration needs to be applied when dealing with tile floor because the additional point loads applied can cause the tile to ‘pop’ if not done correctly, resulting in costly call backs.”

Get educated

“There is a significant lack of knowledge regarding environmental modifications for bariatric clients,” says Ferguson. “Along with that is a lack of experience with companies able to perform appropriate modifications and have the skill sets to accommodate the additional structural reinforcements that would be appropriate.”

Carricato suggests that an HME provider who wants to get serious about home access and how to help specialized clients, such as bariatric patients, should look into becoming a Certified Environmental Access Consultant, a designation offered by the Accessible Home Improvement of America (AHIA).

This article originally appeared in the April 2014 issue of HME Business.

About the Author

Joseph Duffy is a freelance writer and marketing consultant, and a regular contributor to HME Business and DME Pharmacy. He can be reached via e-mail at joe@prooferati.com.

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