HME Handbook: Home Access

How to Approach Home Access for Seniors

Falls pose a significant risk to seniors trying to continue living independently in their homes.

For many patients, home access truly means just that: being able to access and live in the home. It is about removing boundaries and enhancing adaptability. But for seniors, home access takes on an additional dimension: safety.

We all know seniors are susceptible to falls, but not everyone realizes how likely they are to fall. As a rule of thumb, one in three U.S. seniors fall each year, and a fall in the home can have serious medical repercussions for an older person. Even slight falls can result in significant injuries, and the likelihood of falls can increase due to environmental factors and issues such as physical instability or mental impairments such as dementia.

Moreover, the kinds of chronic conditions often served by HME providers provide a contributing role in seniors’ risk for falls. Seniors with chronic conditions fell and required emergency transport up to 54 percent more often than their peers with no chronic conditions, according to a study from medical alert service Philips Lifeline. Even patients with diseases unrelated to mobility, such as COPD or diabetes, recorded higher instances of falling, according to the study.

The upshot is that providers wishing to help seniors age in their homes need to provide the kind of access that also enhances safety. Let’s look at two primary areas where providers can ensure safe home access.

Start with Stairs

Whether patients are trying to get in their home or they need to travel between floors of their homes, stairs are a clear danger point for seniors, and a fall on the stairs can easily prove fatal.

To gain entry to the home when the front door is off the ground, the provider must consider installing one of two solutions: a ramp, or a vertical platform lift (VPL). 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.

While ideal solutions for many instances, VPLs require some additional expertise. A provider might want to partner up with a contractor or elevator company that has the necessary qualifications, licensing and code familiarity. VPLs require a proper foundation, the right electrical hookups, and attention to clearance issues. Also, they must be durable enough to weather outdoor conditions, and supply safety features, such as manual cranks if there is a power outage.

Inside, the two main options are stairlifts and in some cases incline lifts, or VPLs. For stairlifts, a key question that needs to be answered is whether the senior can transfer in and out of a stairlift. If yes, stairlifts offer an elegant solution to a key safety problem. If not, incline lifts can be used, but in terms of space they need room not only on the stairs but for a landing for the platform, both upstairs and down. Inside VPLs can often be made possible using closets or corridors that line up between floors, or what is called a three-wall bump out. This is where an addition is made to the house to accommodate the stairlift; it’s almost like an elevator shaft.

Prioritize the Bathroom

More than 80 percent of home accidents occur in the bathroom, according to the National Safety Council. Fortunately, bath safety products don’t have to cost a lot to make big differences for aging in place customers. For starters, grab bars are critical. They should be strategically located in and around the bathing area, as well as around the toilet. This has two benefits: it ensures that the patient is supported and kept safe from a fall, but it also helps the patient gently lower and raise himself or herself while bathing or using the toilet. In terms of the toilet, ideally the patient would use a raised toilet so that he or she does not have far to travel when rising or lowering. Commode lifts are another option in this case.

For the bathing area, the ideal situation would be to have a bathing stool or bench that the senior can use in conjunction with a handheld shower to protect against falls. Along with the aforementioned grab bars, the shower floor should be lined with non-slip material or strips. In general it also is a good idea to avoid having bathmats or other items on the floor that could cause a fall. Also, another bathing option could be a bath lift, which raises and lowers the client into the tub.

Also, ensure that the bathroom is brightly lit and that there is a bright enough night light to help the patient negotiate the bathroom at night, when poor vision could otherwise contribute to a fall. If possible, situate a chair or stool in the bathroom that the senior can use while grooming themselves or applying makeup, and ensure there are nearby grab bars, as well. Lights and stools are simple, non-DME products providers can stock that pay major bath safety dividends.

Points to Remember:

  • The home can be a dangerous place for seniors due to falls, which can have serious repercussions for older folks.
  • Two key areas to attend to are stairs (both inside and out), and the bathroom. Both areas pose considerable risk for older clients.
  • Outside, ramps and vertical platform lifts (VPLs) can help patients gain access to doors that aren’t at ground level. Inside, stairlifts, incline lifts and VPLs can help clients safely travel between floors.
  • In the bathroom, providers want to address key danger points — the toilet and the tub or shower — with the right safety products.

Learn More:
Check out HMEB’s Home Access Solutions Center and Bath Safety Solutions Center. Also visit Accessible Improvement of America ( and the National Association of Home Builders ( to learn about home access education options.

This article originally appeared in the June 2017 issue of HME Business.

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