By Melissa M. Smith, OTR/L, ECHM, CAPS, CHAMP, Clinical Specialist, Adaptive Housing Solutions, ATF Medical
With a staggering 41% of the US adult population considered obese, researchers have analyzed its impact on workers’ comp. A Duke University Medical Center study demonstrated a clear relationship between BMI (body mass index) and the number of workers’ comp claims, increased medical claim costs, and increased time off work per injury.
There are several reasons why obesity leads to more claims. Decreased sleep causes fatigue, which contributes to more accidents. Muscle injuries result from increased loads on the body, and there are higher rates of slipping and falling.
Obesity cannot be ignored and must be treated throughout the continuum of care. It starts with identifying obesity as a pre-existing condition so the medical team can address it and minimize complications. People who have obesity commonly have other comorbidities that may complicate recovery, such as hypertension, diabetes, sleep apnea, stroke, and other musculoskeletal disorders.
Addressing this sensitive issue throughout the spectrum of a worker’s comp case includes increasing the accessibility of the home through home modifications. This scenario illustrates typical adaptive housing requirements.
Mrs. Jones sustained a back injury at work. She is now using a bariatric electric wheelchair and has been unable to return to walking household distances. The usable clearance at the door into her bedroom is 28”, her bathroom is 24”, and into the kitchen is 31”. She cannot access any of these rooms in her bariatric wheelchair. She has a bariatric hospital bed situated in the living room, has a caregiver eight hours a day to assist with sponge bathing, setup for grooming and dressing, and meal preparation. She has 2 stairs to exit the home and can’t leave for physical therapy appointments.
There are ways to tailor care for workers’ comp patients with obesity and improve claim outcomes by decreasing time off work and containing medical costs through activity modification, home modification, and use of equipment.
The adaptive housing solution begins with a clinical and environmental assessment. This should be completed by a home modification specialist, such as an experienced occupational therapist who understands the relationship between disability, function, and the environment. The OT’s holistic evaluation will generate proposals for the carrier to consider, outlining modifications that are reasonable or necessary for the worker in their home. There are many things to consider when generating the proposal. How does the injury affect injured worker’s ability to function? How much assistance do they need with their activities of daily living? How does their environment limit their independence? How does their weight affect all the above?
A bariatric wheelchair has a larger base and therefore a larger turning radius. This means the person needs more clear space in the bathroom to transfer into the shower and the toilet. A bariatric ramp may be necessary to provide added support to the worker in their scooter. Additional flooring or ceiling joists may be necessary to support additional weight and durable medical equipment. Doors may have to be widened to provide access and increase independence. Neglecting to consider all the details can present increased risk of injury to the worker or caregiver.
Emergency egress from the home can present a unique challenge for the bariatric client. The width of a standard exterior door is 36”, which will not provide clearance for many bariatric wheelchairs. An accessible egress will not only provide a safe exit in case of emergency but will also provide adequate space for emergency services to take the patient out of the home on a stretcher. It may be recommended that the front door be widened to 42” or wider, or an additional egress be installed to exit directly from the injured employee’s bedroom.
The experienced home modification specialist is knowledgeable in issues that are unique to this population. For example, what is the most durable type of flooring for this bariatric power wheelchair user? Can the person mobilize to necessary areas of the home? Can we and should we install a ceiling lift for our bariatric employee? What are the options for toilet hygiene? The environment can either limit the person or it can empower them toward independence. Let’s see how issues were addressed in our scenario:
Mrs. Jones’ home modification assessment was completed, and the following recommendations were implemented. The doors were widened, giving her access to her bedroom, kitchen, and bathroom. Adding a bariatric ramp and enlarging the front door to 42” wide accommodated her bariatric wheelchair and enables emergency egress. Grab bars, a handheld shower, and a bariatric tub transfer bench were installed in her walk-in shower. Mrs. Jones no longer needs assistance with bathing, grooming, or dressing and can now prepare her own meals in her kitchen. The ramp and wider front door enable her to attend regular physical therapy sessions. Mrs. Jones is pleased, and the carrier saves on long-term caregiving costs.
As with all home modifications, the best outcome is achieved through collaboration. Ideally, the home modification specialist works in conjunction with the Assistive Technology Professional or Complex Rehab Technology Specialist who identifies assistive technologies and mobility products and educates the worker in any assistive devices they need for increased function.
It is essential that home modifications and DME are tailored toward every client, and the bariatric client is no exception. Providing them with necessary equipment and modifications that will improve their independence will allow them to live their life to the fullest.
About Melissa Smith
As Clinical Specialist in Adaptive Housing for ATF Medical, Melissa Smith, OTR/L, CAPS, ECHM, CHAMP assesses injured employees and their homes and recommends ways to address barriers to accessibility, mobility and independence. Prior to joining ATF Medical, she was the founder and CEO of LiveAble LLC, which modified home environments to enable people who experienced disabilities to continue living in their homes.
During her career as an occupational therapist, she has worked in a variety of settings, including hospitals, rehab centers, skilled nursing facilities and as a traveling OT. Former employers include Kaiser Permanente Home Care Services.
She holds a decree in occupational therapy from the University of Puget Sound in Tacoma, Washington and another degree in psychology from the University of Iowa. Smith has taken supplement courses in architecture, interior design and building programs and earned several certifications. Among them are the Executive Certificate in Home Modifications, the Certified Home Assessment and Modification Professional, and Certified Aging in Place Certificate I and II.
About ATF Medical
ATF Medical provides all the medical equipment and adaptive housing projects required for a complex workers’ compensation claim.
Specialists assess injured workers and their homes and recommend and implement solutions to foster mobility, independence, and safety. Clinically driven, outcomes-oriented solutions include DME, such as complex rehab chairs, home access equipment, and hospital beds. ATF Medical stays involved for the life of the claim, fitting equipment to injured workers and educating them on its use and care and maintaining and servicing DME for the life of the claim. In addition, the company provides a pressure injury prevention program and efficient, cost-effective home modifications.
Known for its stellar service, ATF Medical takes work off the desks of claims representatives by handling the myriad details of ordering and scheduling and ensuring that work is done on time and within budget. Clients include workers’ compensation ancillary service providers, carriers, employers, and other payers.
Formerly known as After the Fall, ATF Medical was founded in 2001. For more information, visit www.atfmedical.com or call 877-880-4283.