Environment Reintegration

Home Assessment

As one gets older, the home can present new challenges as balance and eyesight worsen. A home assessment identifies potential safety hazards in one's home. This includes tripping hazards, i.e. uneven ground/steps and torn carpeting, poor lighting, wheelchair accessibility, and much more. As PTs and PTAs, we can make recommendations and help patients make informed decisions about remodeling their homes to their needs. Based on patient concerns, we can give exercises to address strength, balance, and other areas. We can also teach patents how to operate equipment/assistive devices as needed. Below is a link to a comprehensive home assessment tool.

ADA Accessibility Guidelines

ADA guidelines provide recommendations for building access so people with disabilities can function in their homes, community, and workspace. Major areas to be aware of include the following:

• Ramps: At least 36-48 inches wide. 1- inch rise for every 12 inches of ramp (1:12).
• Landings: 60x60 inches. 
• Turning Space: 60 inches in diameter.
• Doorways: Minimum of 32 inches wide; 36 inches preferable.
• Hallways: At least 32 inches wide; 40 inches preferable.

For more information regarding ADA accessibility guidelines in the home and public buildings, click on the link below.

Stages of Grief: Death and Dying

Hospice care is available to patients with a terminal prognosis of less than six months to live and can be given at a nursing home, hospital, or in their own home. This focuses on providing comfort to and improving the quality of care to patients and their families.

Once diagnosed, patients and friends and family of the patient may go through the five stages of grief, defined as the way people learn to accept their fate. The stages that people typically go through are denial, anger, bargaining, depression, and acceptance. However, not everyone goes through all these stages, or they may go through them in a different order. Some people may also experience different emotions than these, or they may relapse back to a previous stage. Below is a description of each stage.

•  Denial: The patient refuses to believe that their condition/illness is terminal. The therapist should be working to establish trust with patient without forcing them to accept their condition. 
• Anger: The patient may become frustrated and project his/her feelings onto healthcare workers, family, or friends. The therapist should not take their anger personally and realize that this expression is necessary to move on. 
• Bargaining: After dealing with anger, the patient may resort to making trades/negotiations with a higher power. Patients may try to make a deal based on being a good person or dedicating their lives to a good cause. 
• Depression: The patient may become discouraged and sink into depression. He/she may lack motivation or have no interest in any medical intervention. At this point, it becomes especially important for the therapist to listen and communicate empathetically with the patient.
• Acceptance: The patient acknowledges fate and realizes that there is only so much that can be done. They may start spending more time than ever with family and friends. They may also settle unfinished business such as going over wills or finishing paying bills for peace. The therapist should continue to encourage the patient and his/her friends to ask questions and spend time together. 

As PTs and PTAs, we should be understanding and sensitive to the patient's emotions through it all. Listening to the patient with empathy and compassion establishes trust between us and the patient. It is important to remember that the grieving process is different for everyone, and it takes some people longer than others to reach the point of acceptance. Attached are some links that further explain this concept.