Assistive devices enhance HH patients' independence
Study: Patients satisfied with inexpensive gadgets
Helping home care patients select assistive equipment — everything from jar grips and tub seats to button hooks and reaching devices — can help them compensate for physical limitations and increase independence in the home.
A study of state home care patients in Massa-chusetts showed high satisfaction among patients outfitted with even inexpensive assistive devices, says Alison S. Gottlieb, PhD, senior fellow with the Gerontology Institute sat the University of Massachusetts-Boston.
In the study, home care case managers helped nearly 200 clients select devices that helped patients in areas of dressing, bathing, general mobility and expressive activities such as hobbies or communication.
Cost not barrier to patients
The devices were purchased by the home care providers as part of a state-funded home care program. But Gottlieb says even home health agencies that are unable to buy devices for patients can help them find inexpensive, low-tech items they can purchase on their own. The devices can significantly ease patients’ lives and allow them to more fully participate in their own care.
She notes that while clients in the state program were allotted up to $150 each for assistive devices, the program spent about half that amount. Clients averaged four items, each costing an average $19.
"Some of these clients or their families could have afforded some of these items, even if the agency couldn’t," Gottlieb says. "We’re talking about some items that only cost $10."
The most important goal, she says, is to educate clients and care providers that the assistive devices exist, and that they can make a difference for patients whose declining skills have caused them to withdraw from activities of daily living.
"People just don’t know about this stuff," Gottlieb says. "That’s a big problem."
Barriers to assistive devices
As people get older, their various physical limitations — failing eyesight or hearing, arthritic hands, loss of balance and dexterity — can complicate previously simple maneuvers, such as dressing oneself or preparing meals.
It’s at that point that Gottlieb says intervention can be most useful, before patients have given up trying to handle the tasks themselves.
"If they’re now using Meals on Wheels and someone’s doing their bathing twice a week, they become reliant on that and it’s harder to reverse it," she says. "Whereas, if you have somebody who is having trouble doing these things, but still is motivated to do them, then you give them a tool that could make it easier and teach them how to do it."
Patients who have undergone rehabilitative therapy already may have been introduced to some simple assistive devices. And Gottlieb says most are familiar with bathing devices such as tub seats, grip bars and hand-held shower nozzles because they’re often installed to help home health aides with bathing.
But for patients who haven’t been in a rehabilitative setting or who initially declined assistive devices, there’s often a lack of knowledge about what’s available and how it can help.
In addition, Gottlieb says, trying something new can be a hard sell for an older person who is used to doing things the same way.
"If you or I were to use a device, we might say, What a nifty gadget,’" she says. "But if you’re an 80-year-old who’s been using an old-fashioned potato peeler, it’s harder. There are much easier potato peelers out there that use half the strength. But older people don’t like to change and if they’ve had it for 50 years and it still works, they don’t want to give it up."
Beyond client reluctance, Gottlieb also found that case managers were themselves not very knowledgeable about the vast array of devices available. And many of them were reluctant to advise clients on their use, in part because of a fear of liability in case the client suffered an injury while using a product.
Because of that fear, Gottlieb says her program didn’t take responsibility for any items that had to be installed. If a person chose a bathroom grab bar, for example, family members were required to install it themselves.
But with most of the devices, she says, there is little reason for such fears.
"Actually, even things like canes and walkers, if they’re totally the wrong size, can be a problem, but nobody is going to injure themselves on a Good Grips can opener," she says. "Either they can use it or they can’t. I don’t think it’s dangerous."
Training, tryouts are key
The Massachusetts assistive device program began with the case managers, who, in the state system, coordinate contracted home health services for clients. Gottlieb says many knew little or nothing about assistive devices.
Training sessions were set up with experts from a nearby rehabilitative hospital who explained how the items worked and how to determine which items were best for which patients.
She says occupational therapists (OTs) are also well-suited to giving this type of training. "OTs are used to thinking about the whole person and their total well-being," she says. "You want somebody who is focused on thinking about older people and equipment."
Familiarize staff with devices
Gottlieb says many agencies may find the expertise among their own staffs. That not only helps with training, but also allows staff to follow up later as cases arise that require discussion.
Based on feedback from agencies in the demonstration program, she says trainers should come prepared with a variety of assistive devices, to show the staff how each works.
"They need opportunities to use the items themselves," Gottlieb says. She also suggests giving staff opportunities to present cases to the trainer to get suggestions on items they should try.
That kind of hands-on experience also is vital when introducing items to the client, Gottlieb says. Having a person look at pictures in a catalog can give some idea of how a device works, but unless a client tries it out, there’s no way to know whether he or she can actually use it.
A jar opener, for example, may require strength that a person doesn’t have, or may require the use of two hands when the person only has strength in one.
"If you have a demo kit you can take with you, you can say to the client, Look, I see you’re having a problem with opening jars — do any of these items work for you?" Gottlieb says. "And the person can try the equipment, see that it works well for them, and they can get one for themselves."
Once the person has obtained the item, the nurse should check on a subsequent visit to ensure that the client is able to use it and doesn’t need further instruction, she says.
Gottlieb says that an agency dealing with a more complex case can suggest to the physician that the client get an OT assessment.
Success equals independence
While there is no hard data in the Massachusetts project showing that assistive devices allowed people live at home longer, the study is replete with anecdotes showing how relatively inexpensive items helped patients maintain more independence in their own homes:
• One client, with limited thumb mobility, worked with a case manager to obtain foam tubing, which she used to build up her toothbrush, the handles of cooking utensils, a long-handled bath brush, and even paint brushes, to help her continue to pursue her hobby.
• A woman recovering from stroke and hip replacement used a rolling cart to help serve meals.
• Another client, who received a wall-mounted electric can opener, told researchers that it was the first time since her stroke that she was able to do something for herself instead of asking for help.
Gottlieb says such useful items are becoming easier to find and less expensive. Many kitchenware companies, for example, have moved toward the goal of "universal design" — making products easier for everyone to use. As a result, an ergonomically designed can opener that once might have been available only through a specialty catalog now can be purchased at any kitchenware store.
"Universal design is a big improvement, but it’s still not going to solve the problem for seniors in the short term," she says. "There’s a need to get these things in people’s hands to try them out."
• Alison Gottlieb, Senior Fellow, Gerontology Institute, University of Massachusetts-Boston, 100 Morrissey Blvd., Boston, MA 02125-3393. Phone: (617) 287-7300. Fax: (617) 287-7080. E-mail: gerontology@ umb.edu.
A copy of the study, Providing Low-Cost Assistive Equipment Through Home Care Services: The Massachusetts Assistive Equipment Demonstration, is available on the Gerontology Institute’s web site, at www.geront.umb.edu. Also on the site, at www.geront.umb.edu/current/assistequip/reports/resourcemanual.pdf, is a manual that includes resources for information on assistive devices used in the demonstration.
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