The 2013 HME Handbook: Home Access

Safety Starts at Home

How to provide safe home access for senior patients.

Home AccessThere are strong reasons for why seniors should keep living at home. By staying in their homes they can lead the sorts of active lives that foster better overall health and improved therapeutic outcomes. Moreover, seniors want to live at home. Not only does the home represent the place where they have lived their lives and perhaps raised their families, but it also characterizes their continued independent living. Who wouldn’t want to retain that for as long as they could?

But there’s a hitch with that active, independent lifestyle: seniors need to reinforce their home safety. Among adults aged 65 or older, falls are the leading cause of injury death, according to data from the Centers for Disease Control.

More startlingly, the CDC reports that one in every three adults age 65 and older falls. In 2008, more than 19,700 older adults died from unintentional fall injuries, and in 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized. And, probably most telling, 54 percent of all elderly fall-related deaths occur in the home, according to the National Safety Council.

And, as most any HME provider knows, the population of seniors is massive and growing. According to the Census Bureau, there were 40.3 million people age 65 and older in the United States in 2010, which was up 5.3 percent from 35 million in 2000. With the 77 million-person-strong Baby Boom well into retirement, it’s no wonder the AARP reports that by 2030 one in every five Americans will be age 65 or older.

Ensuring these seniors live safe, independent lives represents both an essential ethical and business agenda item for HME provider businesses. This is doubly true given the urgency for providers to develop new revenue streams in the face of radical reimbursement cuts, such as the 45 percent average cut to the product categories covered by Round Two of competitive bidding. And home access and safety represent a Medicare-free retail opportunity that can incorporate some fairly significant margins, depending on the products and services offered.

So what are some key considerations for providers looking to provide safe home access for seniors?

Provide an in-home assessment. Start by setting an appointment to inspect a senior client’s home in order to evaluate any and all home access needs. The goal is to survey possible requirements and then provide a range of solutions starting at the simple and affordable and working up to more complex, tailor-made solutions.

Train your team. Some of the solutions that you will offer will require some expertise for assessment and installation. Items such as ramps, stairlifts, patient lifts, hoists, accessible tubs and similar items will require at least vendor training, and perhaps additional certification (for more on training options, read the “Learn more” box).

Focus on the bath. The bathroom represents a key trouble spot for senior home safety; that intersection where tile and water meet represents the nexus for many slips and falls, and with so many hard surfaces, the results of these falls can be particularly bad. The provider must ascertain if the patient needs help bathing, getting on or off the toilet, reaching faucets, or even entering the bathroom. Then the provider will need to determine the right DME to address these problem areas. The provider should also inspect the kitchen — another point where water can cause a slip — with the same attention to detail.

Review entries and stairs. Getting into and out of the home can be a point of safety, as well. The patient might need a threshold ramp to gain access to the home, or perhaps a ramp or lift just to get to the front door. Once inside, the client might have to get to a second floor, which can represent a significant danger area for seniors that lack a decent level of stability. Installing a stairlift can prevent a catastrophic fall, while also safeguarding a senior’s independent living.

Offer funding options. Know that home access is essentially a retail business. Medicare and private payor insurance carriers typically do not fund bath safety and home access equipment and services. That said, there are some options for seniors that need financial assistance: Medicaid waiver programs, area councils on aging, specific disease state advocacy and support groups, and the Veterans Administration. Also, and perhaps first to consider, are family members, who might be very willing to assist their loved ones. Regardless, the onus is on the provider to catalog the various resources available to seniors to assist them in their home safety needs.

Points to take away:

  • Living at home helps seniors lead the sorts of active, independent lifestyles that promote overall health and better outcomes.
  • The Census Bureau reports there were 40.3 million people age 65 and older in the United States in 2010.
  • Falls are the leading cause of injury death for seniors, and 54 percent of all fall-related deaths for seniors occur in the home.
  • Providers can help these seniors and their businesses by providing home access and safety services.
  • Key areas of attention are the bath, stairs, entries, and the kitchen.
  • Seniors might need help affording these solutions, so providers should catalog the various funding sources available.

Learn More:

  • The VGM Group’s Accessible Home Improvement of America ( division offers a Certified Environmental Access Consultant program to help provider understand which solutions are right for patients and how to install them so that they function properly and meet code.

This article originally appeared in the June 2013 issue of HME Business.

HME Business Podcast