By Erin Zablocki, CDME, CEAC, ECHM, Executive Director, Rehab Technology, ATF Medical
Insurers, third-party administrators and employers run a big risk if they do not pair a rehab specialist with a contractor when adapting a home for an injured worker. It takes a team with special skill sets to select the most appropriate equipment and home modifications for an injured worker.
While some contractors have experience retrofitting homes for disabled people and those aging in place, few fully understand the needs for workers’ compensation patients. That’s not to criticize contractors. They typically don’t encounter workers’ compensation home modifications every day.
Many have taken an ADA-compliance course or two and some earn the certified aging-in-place specialist (CAPS) accreditation from the National Association of Home Builders. However, aging-in-place modifications are quite different from those needed by an injured worker whose condition will likely change over several decades. In addition, these courses don’t cover the medical equipment side of adaptive housing.
There’s a lot of buzz about ADA compliance and universal design, but what many people don’t understand is ADA is based on creating a space that the largest portion of the disabled population can use regardless of the disability. It is not specific to a single injured individual, nor is it intended for houses. Rather, ADA provides guidelines for public spaces, like libraries, offices, shopping centers, schools, and similar facilities.
In workers’ compensation, home modifications need to be customized to a specific individual, their home, physical condition and abilities, and lifestyle. ADA calls for a countertop height of 34 inches, but that won’t work for an individual in a wheelchair who has a tall seat-to-floor height.
Without collaborating with an Assistive Technology Professional (ATP) or Occupational Therapist (OT), contractors tend to take a generic approach to the project. They may automatically expand the width of all doors, install grab bars in every bathroom and lower all the kitchen cabinets.
These changes are not always helpful or necessary and can add unnecessary cost to the claim. One injured worker said, “Why did they make all those changes in the laundry room? I’ve never done laundry in my life.”
Including a specialist such as an OT or ATP on the adaptive housing team produces the best renovation and equipment recommendations and ultimately the best outcomes.
The first step is a thorough assessment, including:
- Medical record review
- Clinical evaluation of the injured workers’ physical condition
- In-depth conversations with the injured worker and their family to explore how they use the spaces and their lifestyle, including activities pursued before the injury and might be able to do again.
- A home assessment, with photos and detailed measurements
- Discussions with treating physicians, physical and occupational therapists and other providers at the hospital or post-acute care facility
- Contact with the employer regarding return-to-work possibilities and ergonomic accommodations
The interview with the injured worker and family lays the foundation for a practical and efficient adaptive housing plan. What did the injured worker do around the house before the accident, what can he do now, and what is he likely to be able do in the future?
Is she an outdoorsy type who needs heavy-duty wheels on the chair? Did he just make sandwiches or was he a creative chef? There’s no point in renovating a kitchen if the workers’ compensation patient doesn’t use it.
The goal of medical equipment and adaptive housing is to facilitate maximum functionality and independence and foster recovery by providing appropriate equipment and home modifications. We want to restore the injured worker to as much of his pre-accident life as possible.
That’s the goal but getting there is complicated. Numerous factors go into adaptive housing decisions, and this is no easy task because there so many different construction techniques and medical equipment products.
For example, there are dozens of power chair types with hundreds of features. Some come with front-wheel drives, others with rear-wheel and mid-wheel drives, and the drives all have different turning radiuses. Front-wheel drives need a large turning radius, requiring widening of doors.
Plus, the size and weight of the equipment impact construction decisions. Every current and potential use must be carefully considered, and rehab specialists help contractors understand equipment features and performance to design a plan that accommodates the equipment and its use.
All changes need to be customized to the injured worker’s condition, present and future abilities. A person who cannot transfer themselves from a bed to a shower chair needs some kind of lift. But which kind? With a Hoyer lift, caregivers need to roll the patient onto a sling and push a button that activates the lifting of the patient. Then, they manually roll the lift to the bathroom to transfer the patient in a shower chair.
The Hoyer lift wasn’t the best solution for a case in which a high quadriplegic needed two care givers to maneuver him into the lift. Replacing it with a ceiling lift enabled a single caregiver to move the patient into the sling and use a remote to handle the lift and transfer. More efficient, the lift also reduced the cost of the claim by approximately $100,000 a year by eliminating the cost of the second caregiver.
Rehab specialists also examine disease progression, functional limitations and plan for the future to maximize construction changes. At some point, the injured worker may be able to transfer into a built-in shower seat, so the shower needs to be larger than originally spec’d. When spending $10,000 or more retrofitting a bathroom, it needs to work for the long haul.
With workers’ compensation home modifications, the rule is to replace like with like. A contractor visited an injured worker’s home and recommended replacing all kitchen cabinets, appliances and granite countertops for an injured worker.
When our ATP visited the home, he saw that pull-down shelving could be used in the existing upper cabinets and roll-out shelving in the lower ones. The only appliance issue was that the stove’s knobs were in the back. The solution was a long-handled knob turner along with a mirror over the stove to show the contents in pots.
And, it turned out the existing countertop was a nice laminate, not granite. Following the “like for like” rule means if you had laminate tops before, laminate will be used in the modification. The goal is to create a functional, safe and easy-to-use environment. Payers are not required to upgrade the standard of living.
You don’t want to make modifications that causes more problems for the injured worker. In one case, a contractor modified a bathroom, changing a tub into a walk-in shower. However, the powerchair did not fit through the bathroom door, so the injured worker had to transfer to a smaller wheelchair to enter the bathroom and then transfer into the shower chair. Additionally, the therapist at the post-acute care center recommend a shower chair that was so large that caregivers could not move around the man to bathe him and it hung outside of the shower, causing water to spill on the floor.
An early engagement with the therapists at the center could have resulted in a smaller shower chair. Or if the large one was essential, a rehab technician could have worked with the contractor on the size of the shower.
When working on adaptive housing solutions, consider a phased approach. The first phase is to address the immediate needs. The essentials of sleeping, eating, getting to the bathroom, and showering should be in place when they come home from the hospital or post-acute care center.
These injured workers are usually leaving an environment that is wide open and fully accessible. Once home, they face the limitations of their home and physical abilities. As they come to grips with the psychosocial aspects and think about what they hope to be able to do, rehab specialists can help decide what further changes will facilitate their goals.
Sometimes carriers try to get all the changes made at once, but the injured worker isn’t in the home to explain how he will use the space. Contractors may provide full access to the backyard, without realizing the injured worker never cared about going outside. It’s good to let them settle in at home and figure out how they’d like to use the space.
Successful adaptive housing solutions come from experience, combining the knowledge and skills of very different professions, and focusing on the injured worker’s precise needs. Partnering a contractor with a rehab specialist is the way to go.
About Erin Zablocki
Erin Zablocki serves as the Executive Director of Rehab Technology for ATF Medical. She leads the company’s skilled teams of complex rehab equipment and adaptive housing coordinators as well as its Rehab Technology specialists.
With more than 13 years of experience with complex rehabilitation and adaptive housing solutions, Zablocki has mastered the art of balancing the needs of injured workers against the cost-containment requirements of insurers, employers and third-party administrators.
Zablocki was one of the first people in the country to receive the Master Certified Environmental Access Consultant certification. She also holds the designations of Certified DME Specialist (CDME), Certified Environmental Access Consultant (CEAC), and Executive Certificate in Home Modifications (ECHM) through the University of Southern California and is a Medicare Set-Aside Professional.
About ATF Medical
ATF Medical is a medical equipment and supply company that provides comprehensive, clinically based equipment and adaptive housing solutions to fulfill workers’ compensation claims. It is dedicated to improving the lives of injured workers—especially those with complex or catastrophic injuries—by equipping them for independence and the highest functional outcomes.
ATF Medical boasts a team of highly trained and experienced assistive technology and rehab specialists, occupational therapists, and adaptive housing experts who collaborate with adjusters and case managers to select the best solution for the case. The company orders and delivers the equipment, and educates injured workers and their caregivers on its use and stays involved for the life of the claim, maintaining and servicing equipment and monitoring the injured employee’s progress.
Known for its stellar service and clear, frequent communication – with customers and injured workers, ATF Medical delivers substantial savings to customers without compromising care, quality or service by balancing what is reasonable and clinically necessary. Clients include workers’ compensation insurance carriers, ancillary service providers, employers, and other payers. Headquartered in Woodbridge, Virginia, ATF Medical can be reached 877-880-4283 or www.atfmedical.com.