Products & Technology
Getting a Foothold in Home Access
Home access offers providers a shovel-ready retail opportunity. How can they scale the learning curve?
- By David Kopf
- Jan 01, 2015
As providers search their markets for new revenue sources beyond Medicare, one key opportunity that is looking increasingly attractive is home access. Providing home access lets providers leverage many of their existing patient and referral partner relationships, while providing a muchneeded service.
Home access also offers providers a migration path for ramping up this new line of business. HME providers can start off by offering simple items related to their expertise, and then build from there. For instance, a provider serving senior patients could start by offering bath safety products, and then move into other areas of the home, such as the kitchen or stairs to provide additional solutions.
There is considerable market potential for home access services. Multiple patient groups benefit from home access, such as mobility patients, bariatric patients and seniors. Clearly, patients in wheelchairs and other mobility devices have distinct and clearly recognizable home access needs that can differ greatly from the home access need. If anything, mobility patients represent the “obvious” home access market need.
Also, there are patient demographics that are expanding the home access market, specifically, an aging United States, and our nation’s obesity epidemic. Both senior and bariatric patients need home access solutions, and their numbers are considerable. There were 40.3 million people age 65 and older in the United States in 2010, and the 77 million-person-strong Baby Boom is well into retirement. Also, depending on the study, the population of patients either weighing 300 pounds or more, or with a body mass index of 40 or more, is high as 9 million people.
The first step in establishing a business in home access is to gain expertise. Providers must competently understand patient needs, the products that address those needs and the various complexities, business relationships and legal requirements that become involved in more in-depth home access jobs.
The VGM Group’s Accessible Home Improvement of America (AHIA), which is a special network of providers and contractors that offer home access services and products, has outlined various levels of home access service capability for holders of its Certified Environmental Access Consultant (CEAC) credential.
CEAC providers can work up from one level to the next while ensuring they cover the minimum standards for safety, competence and capability. Moreover, other home access businesses that might want to work with them will be able to get a clear picture as to the extent of the provider’s home access skill and knowledge. Let’s take a look at them:
Level 1 — The provider understands and can competently offer threshold and suitcase ramps, basic assistive transfer devices, bath safety, and multiple aids to daily living.
Level 2 — The provider can offer products requiring simple installation, such as portable ramps with handrails, standing poles, bedrails, portable patient lifts, trapezes, and bath and tub lifts. This also covers all products that require operational training and simple technical instructions.
Level 3 — The provider understands light remodeling and has the necessarily knowledge to comply with applicable local building codes and license requirements. These providers can assess needs and provision of products and equipment, accordingly. They are manufacturer trained for more complicated modular ramps, grab bars, and bridge lifts. Also included are modular ramps with platforms and turns, grab bars and handrails.
Level 4 — This designates CEAC (and CAPS; see Level 5) certifications to comply with all applicable local building codes and license requirements. Providers will give clients an assessment and have obtained manufacturer training. These providers can sell and install stair lifts, vertical platform lifts, and ceiling lifts. They can also sell and install roll-in showers, walk-in tubs, vertical and incline platform lifts, and wall- and ceiling-mounted track lifts.
Level 5 — This is a CEAC designation for Certified Aging in Place Specialists (a National Association of Home Builders credential), certified or licensed healthcare professionals, licensed contractors, and remodelers.
Projects at this level are considerably involved and typically require a team approach. These providers comply with any applicable building codes and license requirements along with involving the licensed trades, such as plumbers and electricians. Typical projects for these providers would be complete bathroom modifications or renovations, such as roll-in showers, walk-in tubs, widening doors, kitchen modifications, additions and elevators, along with the more advanced previous levels. Other projects included in these providers’ expertise are wooden ramps and decks, complex bathroom, kitchen and bedroom remodels, power door openers, non-slip flooring, room additions, and indoor elevators.
Bath safety represents the easiest access point into the home access business, and one that can truly help patients. Simply put, patients of all sorts need to use the bathroom throughout the day. But for bariatric, geriatric and mobility patients, bathing can pose both frustration and safety hazards.
For instance, stepping into a shower stall or tub poses the risk of falls for senior and bariatric patients, and for mobility patients, bathing comes with even more complications due to their mobility limitations. And if bathing complications result in reduced frequency of bathing, this can mean that a patient risks hygiene issues that can cause sores and infections.
The first thing is to consider the patient’s needs, and that varies in terms of disability. For geriatric and bariatric patients, a primary concern is falls. Older and overweight patients can suffer severe injuries from a fall; bariatric patients because of their weight and geriatric patients because of their age. So strategically placed grab bars and rails are important, as well as bathing benches or chairs and non-skid surfaces for the shower or tub.
Moreover, bariatric patients run additional risks from average bathroom fixtures catastrophically failing on them, since those fixtures cannot support the patient’s weight. Fixtures such as sinks and toilets must be built to support bariatric patients’ weight.
For patients with mobility limitations, providing ample room for maneuvering and performing bathroom tasks is important, but can be difficult to accommodate given the cramped size of most average bathrooms. Patients might be fully capable of performing all their bathroom tasks on their own, as long as they have freedom of movement. When it comes to bathing, patients might require special shower chairs or transfer chairs that let them transition from their regular wheelchair into the shower.
A safety remodel can range from adding some key pieces of DME to completely enlarging the room, and everything in between. A complete bathroom remodel can range between $15,000 and $30,000 on average. However, it might not be necessary. Simple fixes that increase maneuvering space as well as safety might include removing cupboards or installing pedestal or hanging sinks. That said, if the bathroom is too cramped, it will need expansion. Other modifications include moving the toilet and removing the tub and installing a roll-in shower, which requires a change in drainage system and other plumbing modifications.
A central question is which bathroom will be upgraded to accommodate the patient’s needs. This requires a look the entire household’s needs and daily activities, not just the patient’s, to see which room is best. Often a patient might, for various reasons, live in a two story home even though the patient might not be able to easily negotiate the stairs. As a result, a common bath safety remodeling projects is to covert a downstairs room into a bedroom, and to have a downstairs half bathroom converted into a full bath.
Another option is to relocate the shower to another part of the house. If, for instance a patient cannot afford a full bathroom remodel, or lives in a rental, a portable shower might be a good option. A fold-away wheelchair shower, which can be used by not mobility and bariatric patients, provides them with a safe, private place to bathe themselves, or with a caregiver’s help.
Another key access opportunity starts with the front door. Patients with mobility limitations must have a method for entering a home, and when the front door is off the ground — as most front doors are — that means home access providers need to look at installing one of two solutions: a ramp, or a vertical platform lift.
Where ramp installations are concerned, there must be a foot of ramp for every inch of rise between the ground and the 5-foot-by-5-foot platform that is placed in front of the entryway the platform provides a level spot for the patient to open and close the door. That said, the landscape where the ramp will go needs to be assessed as well. If the ground slopes away from the house, then the ramp will actually need to be longer.
A patient’s mobility capabilities might be more compatible with one device or another. For instance, a manual wheelchair user might find having to roll up a gradually inclining 50-foot ramp a challenge. And, if the patient is a manual wheelchair user, regular landings must be factored into the ramp’s design so that the patient have the ability to rest if he or she gets tired going up the ramp. This is also a safety factor, as well, as landings help prevent the possibility of gravity taking over and a manual wheelchair user accidentally rolling down the ramp with no control.
Additionally aesthetics are an important consideration, as well. We are talking about a patient’s home, and he or she might not like how a large, aluminum ramp might look in the front yard. Similarly, a homeowners association might have rules governing the look and placement of home access devices, and obtaining approval for a ramp or VPL might be required. And, if the patient is renting, then the landlord will need to approve, as well. In situations where a ramp is not possible, installing a platform lift is the right option. These devices can travel vertical or along an inclined path, but the key is hat the patient stays in the mobility device and is carried by the platform. All that’s needed is a four foot-by-four foot concrete pad for the foundation of the lift. This saves considerable space.
Once inside the home, patients often still need to get from one floor to the next. Here stair lifts and sometimes platform lifts come into play. A key question that needs to be answered is whether the patient can transfer in and out of a stairlift. Presuming her or she can’t, then it gets back to a question of an incline lift or a vertical lift. Incline lifts not only require the use of the stair but need room for a landing for the platform, both upstairs and down. That can be a space consideration.
In that case the strategy then becomes looking for a way to install a vertical platform lift within the home. That could be made possible via closets or corridors that line up between floors, or what is called a threewall bump out. This is where an addition is made to the house to accommodate the stairlift; it’s almost like an elevator shaft.
This article originally appeared in the January 2015 issue of HME Business.