ABC’s of OT: key components of ENVIRONMENTAL MODIFICATION

The environment in which we live can either support our health and well-being or limit it. This is true of anyone at any age. But as we age, our environmental supports become especially important in decreasing fall risk while maximizing functional mobility and independent task performance.

When I evaluate skilled patients in the SNF, my perception of their home environments is solely based on what the patients and their families report to me. Often, people like to paint a rosy picture that everything is safe and sound within the home. And while it is not my place to judge, it is my job to ensure that I have appropriately educated the patient and his/her family on the safest ways to modify the home environment for maximum support.

The following are my top tips that can be generally applied to the greater population of a typical skilled patient demographic within the SNF setting:

1. Remove the Clutter: this includes throw rugs, extension cords, excess furniture, unnecessary boxes or storage bins, and piles of clothing as well as excess items on counter tops, dressers, and tables

2. Increase the Lighting: make sure all light bulbs have been updated, task lighting is appropriately placed, and curtains/shades are easy to open

3. Move Frequently Used Items within Arm’s Reach: this is especially important in the kitchen in order to limit excessive bending/reaching for heavy pots and pans, cooking equipment, or packages of food

4. Install Railings and Grab Bars as Able: railings can improve safe access to both interior and exterior stairways and grab bars can maximize safety and independence with shower and toilet transfers

5. Increase Visual Contrast: add brightly colored tape to frequently used light switches for easier recognition or to the outer edge of the run of each stair to improve spatial awareness when ascending/descending the stairwell

6. Keep Chairs in Efficient Places: this includes in the kitchen to use during meal prep or cleaning, in the laundry room to use when folding clothes, or in the bathroom to use during grooming or oral care

7. Keep External, Frequently Used Surfaces Clear of Debris: this includes snow removal, and general upkeep of walkways, external stairways, and porches/decks

8. Use Adaptive Equipment: reachers, shower chairs, cabinet drawer attachments, Dycem, and walker trays/baskets can be exceptionally helpful in minimizing fall risk while maximizing independence

It is important to keep in mind that task modification and environmental modification are closely linked.

For example: a patient may have difficulty feeding his dog. So we modify the task by modifying the environment. Instead of keeping the dog food in the bottom of the pantry, we encourage the patient to keep it on the counter closest to the food bowl. A simple piece of PVC pipe can be used to eliminate the need to bend down to the floor to retrieve the bowl (see below). Or we could recommend that the patient purchase an automatic feeder that only needs to be filled once a week.

Related image
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Related image
source

See what I mean? There are so many ways to adapt a task by adapting the environment. As OT’s, activity analysis is our specialty and it is essential when identifying ways to modify the environment in order to maximize safety.

 

In what ways have you modified a patient’s environment to improve safety and quality of life?

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