For someone recovering from a stroke, the transition from a hospital or rehabilitation center to a residence can be difficult. While healthcare institutions are equipped to deal with people who have disabilities, most homes are not. Before a stroke survivor returns home, it is important that a physical or occupational therapist visit and make recommendations on adapting the residence to the stroke patient’s special needs. The goal of this evaluation is to ensure that daily living tasks can be performed easily and safely. Once the evaluation is complete, the therapist will meet with the patient, caregiver, family, and/or friends to discuss the home modifications required. While some of these modifications may be as simple as adding grab bars to a shower or installing a raised toilet seat, others may be more extensive, such as construction of a ramp, changes to flooring, or widening of doorways.
Before evaluating the home, a therapist will first assess the stroke survivor’s overall condition and mobility. In particular, therapists check for weakness, paralysis, pain, numbness, balance problems, difficulty with coordinating movement, memory loss or memory deficits, fatigue, difficulty with thinking, and bladder or bowel dysfunction. All of these factors may impact the patient’s ability to function safely at home and what modifications will be necessary. Once in the home, the therapist will focus on three main living areas — the kitchen, the bathrooms, and the bedroom — as well as checking for anything that may impede an individual’s ability to move safely around, into, or out of the home. Factors such as the availability of a caregiver or live-in relative, or the possibility of continued recovery, may also influence the extent to which home modifications are required. It is important that this evaluation occur prior to a patient’s discharge so that any necessary modifications can be made in a timely manner.
Bathrooms tend to be where the most safety issues arise. Many bathrooms are small, making them difficult to navigate with wheelchairs and other assistive devices. In addition, the use of water in a shower or bathtub often results in slippery surfaces, significantly increasing the risk of falls. Bathrooms are evaluated not only for fall risk, but also for the ease of transfer to the toilet, shower or bathtub, and access to the sink, mirror, and cabinets. Common areas of modification include:
Tub/Shower. The installation of grab bars in or next to the tub/shower may be recommended to provide support for bathing, entering, or exiting. In some cases, a shower chair, transfer bench, non-skid bathmat or bath decals, and/or a hand-held shower head may be necessary. Foot and leg clearance while moving in or out of a shower is another important consideration and may need to be improved by removing a shower door or high metal/rubber runners. Depending on the setup, tub cut-outs or tub steps may also provide safer access. Finally, a therapist may recommend relocation of towel bars, toiletry shelves, or clothing hooks for easier access.
The Toilet. Transferring to and from a toilet seat can be difficult for a recovering stroke patient. Grab bars and/or a raised toilet or toilet seat may be required to assist in moving from a standing to sitting position. In some cases, it may also be necessary to move the tissue paper holder closer to the toilet or remove rugs that increase the risk of falling. Sometimes, the therapist may recommend a three-in-one temporary commode located near a bed or sitting area.
Other Issues. As well as improving safety, it’s important to anticipate how a stroke survivor will access cabinets, drawers, sinks, mirrors, cleaning supplies, dressing areas, and even the bathroom as a whole[FC1] . It may be necessary to change, increase the width of, or remove the bathroom door for easier access.
Generally, bedrooms are evaluated for ease of transfer, fall risk, safe sleeping conditions, and ease of access to closets, clothing, and personal items. Common areas of modification include:
The Bed. These modifications are meant to ensure not only safe transfer to and from a bed, but also the well-being of a stroke patient while at rest. Lowering or raising a bed by installing risers or removing casters, changing the width of a mattress, removing or adding a box spring, adding bed rails, and/or installing bed steps are among the possible recommendations. Sometimes, an adjustable hospital bed in another location may be suggested.
Dressing. Maintaining a stroke survivor’s ability to get dressed with little or no assistance is a major factor in their overall independence[FC2] . Access to clothing, dressers, and closets is vital. Removing closet doors, lowering closet poles, replacing dresser drawers with shelves, baskets, or easy-glide drawers, or purchasing assistive devices, such as grabbers/reachers, sock aids, zipper pulls, and extended shoe horns, may be recommended. It may also be necessary to replace existing clothing with items that are easier to put on or remove, such as shoes with Velcro instead of shoelaces or pants with elastic waists rather than zippers or buttons.
Other Issues. Equipping the bedroom with a phone or other communications device, such as a monitor, helps ensure that the patient will be able to request assistance when needed. In addition, increased lighting and remote devices that control lighting fixtures and lamps may increase safety and comfort while in bed or in the bedroom. Finally, it is exceptionally important that pathways to the bathroom, and in and out of the bedroom, remain clear. Furniture may have to be moved, door pulls or handles installed, and/or wider doorways constructed.
For a stroke survivor, the kitchen can be a dangerous place. Kitchen size can limit movement, and hot or sharp objects may be difficult to handle. From a wheelchair, cabinets, counters, and cooktops may be too high to access easily. Common areas of modification include:
The Stove. The safest stoves to use are those with controls in the front, as reaching across burners and hot surfaces can result in burns. The danger becomes much greater when a stroke results in desensitization to heat or pain. If the patient has issues with balance, even standing at a stove to stir or move a pot can be dangerous and may result in accidents. Possible modifications may include purchasing a new stove, lowering the cooktop, or replacing the stove with a microwave. Alternatively, other kitchen appliances, when placed on a lower table, may suffice. A multicooker or instant pot, toaster oven, or slow cooker can all be used to cook hot meals. Regardless of what appliances the patient will be using, the stove and nearby countertops should be kept clear, and a fire extinguisher within reach, at all times.
Food Storage. Easy access to cooking supplies and food is essential for someone who is disabled by a stroke. In some cases, it may be necessary to move food and pantry supplies to lower cabinets and drawers, or replace cabinets and drawers with baskets. Handles or pulls and/or a grabber may make it easier to remove items from cabinets. A Lazy Susan instead of a lower cabinet can also make it easier to reach cooking supplies. Food stored in the refrigerator may have to be rearranged, by moving items to lower shelves or into the door, for example. Affixing temporary handles to bottles and containers, moving fluids to pitchers, and labeling food containers more visibly can also be helpful.
Kitchen Gadgets and Utensils. When a stroke has impacted the hands, using a knife becomes a dangerous activity. It may be necessary to replace standard kitchen tools with finger loop utensils, rocking t knives, vegetable choppers, and one handed or laptop cutting boards. In addition, silverware with larger handles provides a better grip when hands are weak, and no-slip bowls and plates hold meals in place, preventing them from spilling into a lap or onto the floor.
The well-being of a stroke survivor depends on understanding traffic patterns and keeping all paths to the bedroom, bathroom, kitchen, and other living areas clear. Failure to do so can result in falls and related injuries. Fall risks can be greatly reduced by removing or securing rugs, moving furniture out of the way, and keeping pathways free of clutter. Adding lifts or risers to chairs and sofas can make transferring easier and more comfortable. If children are present in the home, having a designated room for play will help keep toys off of the floors and out of the way. Homes with smaller doorways or stairs create special problems. Doorways narrower than 32 inches will need to be widened if the patient uses a wheelchair, and stairs may require two railings or a stair lift. Smaller changes of elevation at entrances or within the home, such as sunken living rooms or step-ups to recreational areas, may be manageable with the use of ramps.
Affording Home Modifications
Many of the items required for home modification can be purchased at home medical supply stores, on Amazon.com, or at secondhand stores, such as Goodwill. Some organizations may offer borrowing programs for temporary equipment needs. Volunteer, loan, and grant programs are often available for major home modifications, including ramp installation and kitchen and bath remodeling. Contact your local stroke organizations, and agencies on disabilities and aging, for a complete list of resources.
Here at Saebo, we are committed to stroke support and recovery for all survivors and their families. Saebo offers a wide range of products that combine cutting-edge technology with evidence-based rehabilitation techniques. Our offerings and network of Saebo-trained therapists can help you or a loved one to obtain all the necessary tools to maximize stroke recovery.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.