“The Dance” – An Educational Contribution from Andrew Sever, MS, OTR/L, CAPS, CEAC with EnABLE Home Solutions, LLC

Andrew Sever

A local builder who specializes in accessibility called me the other day to ask me if I could help one of his clients, an elderly couple who still lived in their home. The husband, who was in poor health, had fallen a few times in the bathroom and his wife wanted to make the room safer for him. Given my background as an occupational therapist, he thought I might be able to help. Before hanging up, he mentioned to me that the couple had already hired him to complete the renovation, so there was no need for me to look at the bathroom when I was there.
I thought to myself, “Why wouldn’t he be interested in my input about the bathroom?” After all, as an occupational therapist, I am clinically trained to assess a person’s ability to perform everyday activities despite any physical, cognitive, psychological or emotional limitations they may have. I evaluate the environment in which they perform those activities and identify obstacles that may hinder their performance. By having this skill set, I could offer valuable information about how the husband (and wife) function within the bathroom so he could design a plan that would address their specific needs.
Mrs. D. answered the door when I arrived at the house. She was a sweet, petite lady with a strong southern drawl. Her husband, Dr. D. (a retired college professor), was sitting in a recliner, with his head bent forward and coffee stains on his shirt. I soon learned that Dr. D. had been diagnosed with Parkinson’s Disease twelve years earlier and that he also suffered with macular degeneration. When I asked the couple how I could help them, “The bathroom!” Mrs. D. quickly exclaimed. “He always falls in the bathroom even though there’s a grab bar right there.”
Now, I know the builder discouraged me from entering the bathroom but I REALLY wanted to see the layout. I’ll just look, I thought.
Dr. D put on a pair of glasses with prism lenses that he wore as a result of the macular degeneration. Despite his wobbly stance and hunched forward posture, he slowly walked into the 300 sq. ft. elegantly designed bathroom. He did not attempt to use the walker sitting next to his chair. There was a double vanity to the left, a large garden tub to the right, a shower stall directly in front and a small water closet off to the side. Mrs. D. informed me that the builder planned to remove the shower stall and garden tub and make one large, barrier-free shower stall. “He showed me a beautiful shower chair made of Brazilian walnut that folds down from the wall” she said. I know that chair, I thought. No comment, at least not yet.
I asked Dr. D. if he would show me how he walks to the commode. As he entered the small room, I noticed the horizontal grab bar installed on the wall to our right. Upon reaching the commode, halfway through the 180 degree turn Dr. D. lost his balance and almost fell. Thankfully, I was prepared to catch him as I knew many people with PD have difficulty keeping their balance when turning in tight spaces. “That’s what happens,” Mrs. D. mumbled under her breath (but loud enough for me to hear).
It was at that time Mrs. D. left to answer the phone. “Can I ask you something, doctor?” I said. He nodded. “There are only two reasons I can think of that explain why you did not use this” as I pointed to the grab bar. “One, you forgot it was there and you and I both know you are having trouble with your memory because you said so earlier. Two, you didn’t use it because you didn’t WANT to use it.” Silence. “Which one is it?” I asked with a concerned voice. He thought for a second, “A little bit of both” he sighed with a sense of relief. I smiled back, “Fair enough.” He explained that the location of the grab bar forced his wrist into an awkward position, making it uncomfortable to use. After a few minutes, we determined that in order for Dr. D. to comfortably grasp the grab bar, it simply needed to be lowered two inches.
While exiting the bathroom, Dr. D. had a slight loss of balance which he was able to self-correct. It was barely noticeable, but it was there. When I asked him what had happened, he shook his head and said, “The lines on the floor look like a maze and with these glasses, I feel like I’m walking through the fun house at a carnival.” Looking down, I noticed the floor was made of 18” light beige squares of Spanish tile. Unfortunately, the grout between the tiles was dark brown and sharply contrasted the tile. He was right, it looked like a maze. “What? This floor has been here 20 years and you never mentioned a word!” Mrs. D. exclaimed.
After the three of us returned to the living room, I told Mrs. D. that I had identified three modifications that would make Dr. D. safer in the bathroom. First, I recommended the build should lower the grab bar next to the commode by two inches. Second, whatever style of flooring she chooses to install in the bathroom, she should make sure the color of the grout matches the color of the tile. Third, I pleaded to Mrs. D. to never allow Dr. D. to sit on the shower chair the builder recommended she purchase. She looked confused. I explained that the $700 Brazilian walnut shower chair is wall-mounted, armless, and only has a seat depth of 14”. Due to her husband’s Parkinson’s Disease, he had minimal flexibility in his hips, a tendency to lose his balance backwards when turning in tight spaces, and problems with his memory. This particular seat combined with Dr. D.’s deficits was a recipe for disaster. I provided the couple with a few options of chairs that not only addressed Dr. D.‘s needs but were much more cost-effective.
What makes someone an “accessibility specialist?” Anyone who pays to sit in a classroom for three days can become certified as a “specialist.” Moreover, anyone who sells a shower chair, installs grab bars, or builds ramps can call themselves an “accessibility specialist.” I do not build and I do not sell products. I understand that “aging in place” is like a dance between a person and his environment, no matter what obstacles may be present. Occupational therapy provided me with the educational background, medical knowledge, and wealth of experience helping seniors so that I may best choreograph “their dance.”

Andrew Sever, MS, OTR/L, CAPS, CEAC is the President of EnABLE Home Solutions, LLC, an independent consulting company who performs comprehensive assessments of your loved one’s skills, abilities, and safety within their home environment, and offer recommendations that will meet their current and future needs.

EnABLE Home Solutions, LLC has no financial ties or agreements to any other company or institution. When we when make recommendations to the homeowner, our only incentive is improving the client’s safety and function.

For additional information on available services, please call (770) 841-9089 or visit http://www.enablehomesolutions.com.

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