Home Adaptations - Chair Lift

As we grow older the utility of important home features and designs starts requiring modifications and/or adaptations. The need for accessibility becomes real.

The fancy fixtures and fittings, the exquisite chandeliers, the rose wood staircases etc etc, starts to become more of a liability rather than objects of luxury and design.

On one hand, growing old is probably the best phase of life however it has its limitations. The mental and physical faculties tend to get weaker as we age.

Though we all know age is just a number, yet there are certain realities of life which cannot be overlooked. I guess that's the truth about getting old, at least as of date.

Recently we got an internal chair lift installed in our home. This was installed not to make a style statement or to boast about, it was purely out of need.

For my 83 years old father, movement inside the duplex house had been restricted only to the lower level. The effort to climb a staircase to the upper floors had become a challenge. As a result the upkeep and maintenance of the upper floors started to get affected.

The solution came in the form of a chair lift for staircase. This home adaptation has not only helped him with his movement but has given him a renewed sense of confidence and dignity.

In my opinion, if one has the means then it is worth investing in assistive / adaptive technology.

Pankaj Mehrotra

The document can be accessed on: Home Adaptation - Chair Lift Download

The document can be accessed on: Home Adaptation - Chair Lift Download

Senior Living - Bathroom Doors

Bathroom is a personal space where we lock ourselves inside and in a rather weird way, feel secure the most.

For seniors, the bathroom space may not be the most secure place, especially if it is locked from inside. The reason being, most fatal falls happen inside the bathrooms.

While the reasons for falls could be many however the solution is only one i.e. the emergency response time. It is the first responders, be it family or care givers who face the challenge.

The biggest question is, how to open the door if a person has fallen inside the bathroom?

Since the location of the elder in the bathroom cannot be pinpointed hence the task at hand becomes ever more problematic.

Breaking down the door could be a solution but then, what if the door falls on the elderly, what happens if the door is unbreakable or what if the door hits the head of the person while opening?

The best way to address this issue is by replacing the locking system with a two way door opener.

A door knob which can be opened from both sides or a locking system similar to a airplane toilet which shows occupied or vacant can be replaced with the existing latch.

If replacing the bathroom lock is not possible then the main room door knobs could be replaced and the bathroom could be left unlocked.

Ideally a spare key to the bathroom lock should be hanged outside the bathroom / room door or kept at a place which is accessible to all.

Falling inside the bathroom is not a scene from a suspense thriller movie, it is a reality which is faced by many elderly people.

The document can be accessed on: Bathroom Doors Download

Vehicle Modification Guidelines for Elderly & Differently Abled

As India progresses towards a more inclusive approach w.r.t accessibility for elderly and people with reduced mobility, it is important that necessary knowledge sharing be promoted so that maximum people can benefit.

Guidelines on Provisions for Adapted Vehicles is a good document available on the website of Ministry of Road Transport and Highways (MORTH) regarding queries related to modification of private and public vehicles for use by wheelchair users and people with reduced mobility. Some of the topics which the document covers are;

1) Technical and safety requirements

2) Approval of retro fitment/ adaptation kit for four wheeled vehicle for differently abled drivers

3) Recommended modifications

4) Requirements for testing the wheelchair tie-down and occupant restraint system

5 Vehicle adaptation legal provisions made by the Central Government of India, facilities in India and good engineering practices

Motor Vehicle Amendment Act 2019 has introduced terminology of Adapted Vehicles in section 2 and alteration provisions under section 52 thereof. This standard has been formulated covering adaptations for vehicle of category M1 covering requirements for accommodation and accessibility for differently abled drivers and passengers of reduced mobility.

Some of the parameters considered for adaptations are:

1. In a family a person who drives vehicle (driver) may be with reduced mobility and using wheelchair or may have reduced upper limb function, however other family members may be with normal mobility and function;

2. To have vehicle with provision for mobility of passenger with reduced mobility (wheelchair user or elderly people without limb disability);

Further this standard covers adapted vehicles of category N1, so that by introducing ad-on controls (secondary controls), N1 vehicle can be driven by a person with disability and earn livelihood in specific applications.

This standard also covers small M2 vehicles which can be adapted for providing Taxi service for passengers with reduced mobility.

The document can be accessed on: Guidelines on Provisions for Adapted Vehicles Download

or the website at: https://morth.nic.in/

Fire Safety Guidelines for Elderly Care Homes

Operations & management of elderly care homes can be a tricky business. Homes for the elderly are not only about boarding & lodging, there is a crucial element of safety & security, of which Fire Safety is of foremost importance.

Fortunately for India we have not had many cases of fire in senior citizen homes however a recent fire in a care home was a rude reminder on the need for fire safety precautions, training & preparedness.

Unfortunately very few elderly care homes have documented SOP's on fire safety standards especially w.r.t emergency evacuation.

On one hand, clearance from the fire department is mandatory for most buildings, but then a lot of times the rules are blatantly flouted due to which fires have taken place in health care facilities.

We normally assume that if the fire department has given approval then there is nothing to worry about, however when a fire breaks out the blame game starts.

Fire safety approval is not a simple formality which can be justified by placing a few fire extinguishers or doing an yearly audit, it is much more than simple paperwork. It is about safeguarding lives.

Fire is a potential hazard for all, be it elderly care homes, hospitals, health facilities etc. The consequences of fire in health & senior care homes can be especially serious because of difficulties & dangers associated with the emergency evacuation of residents, many of who may be dependent or have mobility impairment.

Fire safety procedures should ensure that outbreaks of fire do not occur, however if an outbreak cannot be prevented then it must be rapidly detected, effectively contained & quickly extinguished.

The home management has many responsibilities as part of fire safety procedures, a few are listed below:

1) Daily monitoring & maintenance of equipment’s & appliances which are prone to catch fire.
2) Providing fire training to all staff regarding;
a) Local fire procedures & evacuation plan
b) Means of escape
c) Location of fire alarm alert systems
d) Fire fighting equipment
e) Identifying any premise / site for fire risks
f) Information on location of residents alternative accommodation
g) Organising a fire evacuation practice at least once a year
h) Ensuring records of testing & maintenance of fire alarms, emergency lighting & fire fighting equipment are being maintained.
i) Ensuring staff are aware of the procedures & actions required for reporting fire safety defects
j) Ensuring written records are updated in the fire risk assessment action plan & the
fire log book etc.

For senior living operators it is important that country / state fire safety standards should be referred for developing training modules.

Resource document "Fire Safety Guidelines for Homes for the Elderly" by Health Care Standards Directorate, Malta, is a simple and relevant read.

The document can be accessed on: Fire Safety Guidelines for Elderly Care Homes Download

Window Guards (Anti-fall bars) for Elderly People

Windows and balconies in Senior Living facilities can be a potential hazard which can result in falls and injuries among elderly residents.

Even a fall from ground-floor window can be dangerous, especially for the elderly, and falls from windows on the first floor upwards can often be fatal.

Unfortunately in India there is not much architectural information on the best practices for Anti-fall bars or Window Guards in residential care settings.

The Health and Safety Executive (HSE) UK, identifies the following three broad categories of falls from windows in residential care homes.

1) Accidental falls — these occur where a person unintentionally falls through or from a window. Such an accident can occur because the person sat on the window sill and lost his or her balance, for example, or where the person did not realise the window was open and leaned against it.

2) Falls arising out of a confused mental state — a significant number of reports of window-related accidents in the care sector refer to the mental state of individuals as a factor in the cause.

Confused or disturbed residents may be inclined to try to escape from a perceived hostile environment, or use a window believing it to be a door, possibly unaware that they are not at ground level. Unfamiliarity with new surroundings may also cause confusion, as might uncomfortable temperatures, broken sleep and effects of certain medication.

3) Deliberate falls — cases have been recorded of people deliberately exiting a window as a form of self-harm or suicide.

The HSE guidance states that care home managers must adequately manage the risk of falls from windows or balconies by carrying out appropriate risk assessments of both the premises and service users.

Risk assessments should take into account:

* The mental state of residents with dementia, learning disabilities or illness.

* The effect of drink and drugs (both prescribed and illegal).

* Confusion and depression or any history of self-harm or suicide.

* The size, condition and design of each window.

* The height of the window sill (i.e how easy it would be to climb out or topple out).

* The availability of items to climb up to gain access.

* The nature of the surface below the window.

The attached HSE information sheet (HSIS5) provides advice on controlling risks to people who use health and social care services associated with falls from windows or balconies.

Since most care homes and retirement homes in India are being built vertically, hence it is important that national standards and guidelines should be incorporated into the National Building Code w.r.t Senior Citizen Care Homes.

The document can be accessed on: Falls from windows or balconies among Elderly Download

or the website at: https://www.hse.gov.uk/

Sluice Room in Care Homes for Older People

Designing of care homes should ideally be a collaborative effort of different stakeholders, one of them is inputs of the clinical and nursing staff.

While normal assisted living facilities and low dependence care homes may not require specialised areas like a Sluice Room, however Care Homes who offer Rehabilitation Care, Memory Care and High Dependence Care often have a sluice room.

Sluice room is a closed area where human waste is properly and safely disposed of. It is an area where used disposables such as incontinence pads and bedpans are dealt with, and medical and surgical instruments are sterilized and disinfected.

Essentially, Sluice Room is a place where waste is disposed and instruments are cleaned.

The idea behind the design of this room is to help prevent other sanitation facilities from being contaminated with human waste and ensure that the movement of all waste products is accountable to a single end destination.

While developed countries have well defined policies and guidelines for Designing and operating Sluice Room in Aged Care facilities, unfortunately in India we still have a long way to customise the guidelines for Senior Citizen Care Homes.

Though National Guidelines for Infection Prevention and Control in Healthcare Facilities, Ministry of Health and Family Welfare, Government of India, and the national initiative 'Kayakalp', for sanitation and cleanliness in Public Health Facilities in India, Government of India briefly mentions about Sluice Room, however in my view the importance of sluice room has been undermined.

Since there are no national level standards and guidelines for sluice room in Elderly Care facilities in India, hence it is recommended that policy makers should throw some light on this subject and develop the national standards.

The document can be accessed on: Sluice Room in Care Homes Download

or the website at: https://www.ddcdolphin.com/