Gotta Go, Gotta Go, Gotta Go Right Now

We're rounding out bathroom safety today. Obviously grab bars around the toilet are helpful, but some bathrooms are just not set up for that, if there's a tub on one side and a pedestal sink on the other side, so then what do you do?

You add something called a versa-frame. You can see here that this item is just an aluminum frame that fits to the existing toilet. The legs can be raised or lowered, and this provides arms the person can use to help push up from the toilet. This item costs around $50, but I've never seen them at a big box store. You'll have to order it online or get it at a medical equipment company.

Most toilets are low, sitting only about 15" from the floor, making it difficult to get up if you have a bum knee or hip. Replacing your toilet with a 17" model is one option, but an expensive option. You can get a toilet for around $115, but if you don't know how to install it yourself, you'll have to pay a plumber for the installation. One option is to add a toilet seat riser. This particular model locks (don't ask me how), and can also be purchased with arms. Not always the most stable option, and can be problematic if there's a man in the house. But at $50, it's less expensive than replacing the toilet.

For a lot of situations, a bedside commode is a solution. If a person can't walk to the bathroom, a bedside commode can be placed wherever the person needs it. The bucket is removable for ease of emptying. The bedside commode can also be used over the toilet. In this photo the bucket is removed, and the splash guard is left in place, so this could then be placed over the toilet. Then, if needed, the bucket can be replaced and the bedside commode placed by the bed at night. Bedside commodes come in wider widths than the one pictured here for wider people. There is still some Medicare coverage for bedside commodes, so be sure to check with your medical equipment provider for details. If you pay out of pocket, cost will be $150-200, depending on the type.

Raindrops Keep Fallin' On My Head

On to bathing safety!

If you're not able to safely get in the tub for a bath, or to stand to shower anymore, then you need to consider adjusting things to make showering safer. Grab bars are often the first line of defense in this instance, and the first thing I did in my house for my mother.

You can see that this grab bar is placed so Mom has something to hold onto as she is bending over to turn the water on. This is also the bar she uses when she actually lifts her legs over to get into the tub. Fortunately, the handyman who installed the grab bars was able to anchor this grab bar into the studs on both ends, so it is easily able to withstand a great deal of weight.

This bar is for stability while standing and showering. It is longer, allowing for something to hold onto from almost any point in the tub. Grab bars come in all shapes, sizes and finishes. I believe the ones I installed are 2 and 3 feet long, and are brushed nickel. They were fairly inexpensive, around $25 each.

You can get grab bars in white plastic, polished chrome, you can even find designer grab bars that match your fixtures, of course you'll pay more for these. Grab bars are readily available in stores like Lowe's or Home Depot, and you'll find them in the plumbing section. Medical equipment companies also carry them, and they are comparable in price to the big box stores. I was really fortunate to find a great handyman through the medical equipment company I used for some other things. He installed the grab bars in about 20 minutes, and it only cost $50.

There is a lot of variety when it comes to bath/shower chairs. This one is molded plastic. The legs snap in place, and they can be adjusted by turning them. There is an optional back, that we have chosen not to use. It's lightweight, but very durable, and can hold up to 400 pounds. Also note the tub mat in place, to provide a less slick surface for feet and chair legs.

When looking at a tub bench it is important to remember to measure your tub width. I knew my tub was on the narrow side, so I made sure to measure it, and I'm glad I did. The first bench I looked at, which was a little less expensive than this one was a little too wide to fit all four legs squarely and evenly on the bottom of the tub, which is crucial for safety. You want to make sure the legs aren't on the curve of the tub. And be sure to measure front and back legs, because the other bench I looked at had about a half inch difference in width from front to back.

Weight limit is another consideration. It does seem that most of the benches I looked at are now automatically super-sized, accommodating 300 pounds or higher. This was not always the case, because back when I worked in the hospital we usually had to specify when we needed something to accommodate more than 200 pounds.

When I priced the benches in the big box store, they were twice what I paid for this bench at the medical equipment company, and with nowhere near the selection of the medical equipment company.

The last item we got for the tub was the hand held shower. This type is inexpensive--only $18 at the big box hardware store, and even better, it just screws on to the existing pipe. No special tools, no plumber. It even came with a little aluminum tape. You can spend a lot more if you want, but if you think the need is only temporary, this is really all you need. It makes showering while sitting more pleasant, because you don't have to have the shower pounding in your face, and since you can't move to let the shower hit different body parts, the shower can do all the moving.

Hopefully this has given you some good pointers for making bathing a safe and still pleasurable experience. We'll tackle the rest of the bathroom next.

Can't Reach That

Thanks to Mom, who was discharged from rehab this week for inspiring this post.

After we left the hospital, we made a stop at an unnamed big box home improvement store so I could get a hand-held shower and to price a bath chair. Got the hand-held shower, but the bath chairs were more expensive than the ones I had seen online. As I was telling Mom this, she said, "You know, you should go to the Senior Centers and do talks about this. I know there are a lot of ladies at the Senior Center who need this kind of stuff, but they don't know about it."

So, since there's so much of this stuff, also known as adaptive equipment, out there, I'll probably break it down into several posts. Today we'll talk about a "hip kit", which pretty cool, although that's not why it's hip.

When folks have had hip replacement or surgery to repair a broken hip, they are often placed on hip precautions: no crossing the legs, bending more than 90 degrees, other things that I can't remember right now. The result is that you can't reach things on the floor, like things you've dropped, or your feet. That's where the hip kit comes in.

The item at the top is a reacher. Pretty self explanatory. One nifty feature, that's hard to see, is a magnetized pin near the tip, in case you drop a safety pin or some other small, metal object.

The next items are the yellow long-handled shoe horn and the long handled bath sponge. Pretty clear what those are for, and how to use them. The sponge makes a pretty good scratcher, too, as Mom has discovered since her incision itches.

The white cylinder looking thing is a sock-aide, and Mom loves hers. This one looks like a rigid one, made out of hard plastic, they also make soft ones out of fabric and probably cardboard or something. What you do is put your sock on the cylinder, then undo the straps (in this picture they're not fully extended) and hold one in each hand. Then you drop the cylinder on the floor, put your foot into it, and then pull the cylinder out with the cords, and oila! Your sock is on! (To my OT friend Denise, hard to describe in words only how this works).

The last item is called a dressing stick. I've never known many people who actually used them, but you can see that there are different types of hooks on each end, so useful for hooking things.

You can buy each item separately, but they are less expensive when you purchase them in the hip kit. They are readily available at multiple places online, and also at most medical equipment companies. Medicare will not pay for any of this, but a kit will cost anywhere from $30-40, depending on the store. My local medical equipment company charges a bit less than most of the ones I found online.

Next stop--the bathroom.

I'm Not Your Honey

It's always eye opening, being on the other side.

Mom had knee replacement surgery last Tuesday, so this week I've been the patient's daughter, not the professional medical social worker-geriatric care manager. I have to tell you, I haven't been so impressed with what I've observed. But, one thing that has been reinforced, is that the folks I worked with at the Osteopathic Medical Center of Texas RehabCenter were an exceptional lot--so a big shout out to all of you! I wish you were taking care of Mom.

One of my biggest complaints is all the "elderspeak" (In "Sweetie" and "Dear", a Hurt for the Elderly, New York Times, October 6, 2008).

I am not your honey/sugar/sweetie/dear. Neither is my Mother. We have names. You can call me Kim, her name is Mildred.

Unfortunately, the comments to the New York Times article aren't available, but back in 2008 when I originally found the article, I read the comments. This is a very divisive topic. People who use elderspeak feel very strongly about it. To them, they are being comforting and nice and pleasant. To the people who hate elderspeak, it's condescending, impersonal and lazy.

After this week I have become aware of how much more prevalent elderspeak has become. Almost every nurse and aide who I have observed interact with my Mother has used it. I can't really tell if it bothers her, but it bothers me. They don't know her. How can she be their "honey"? And I know I'm not your "sweetie".

So please, take that extra 5 seconds to look at the chart, and use our names. Don't depersonalize us, or assume an intimacy or affection that isn't there.

Wandering through the Wilderness of Dementia

A good article in the New York Times today, More With Dementia Wander From Home. I have known a few families who have been extremely proactive in dealing with wandering, placing door locks up high, making sure the person with dementia is registered with the Safe Return program, even placing alarms and cameras around the house.

More often, however, families never get around to doing anything. The burden of caregiving, especially for people with dementia, can be so great, it's impossible to think about more than the current crisis.

But we all need to be aware of this danger. When we have children, we spend a lot of time and effort baby-proofing our homes; now we have to worry about dementia-proofing our parents' homes.

Common Bonds

I had the opportunity to attend a college reunion this past weekend. Before I go any farther, I do need to point out that I was an undergraduate at UT Austin from 1978-1982. (I know that might shock those of you who think I am much younger than that).

So, many of the people I saw last weekend I have not seen in 30 years or more. Mostly everyone was a little grayer and/or wrinkled. A lot weighed a little more than they did 30 years ago, and a few weighed considerably less than they did 30 years ago. Amazingly, we've all pretty much grown up and become a decidedly respectable lot, with spouses, children, mortgages, good jobs, and still doing oodles of volunteer work, which is what brought us together 30 years ago in Alpha Phi Omega, a national service fraternity.

I also discovered another common denominator with many of my former school mates this weekend--many of us care for our aging parents. I heard variations throughout the weekend, "I moved back to Texas to take care of Mom" or "My in-laws had to move in with us" or "I had to put my Dad in assisted living because he has Alzheimer's."

It put the article from a couple of posts ago in even greater perspective--we are an often silent and unknown group. Employers don't often recognize us, even our friends don't always know the pressure we face, when we are pulled to the future by our children, nieces and nephews, and yet the needs of our parents keep us firmly rooted in the here and now.

I salute all of you who do this work, and now that we've found each other after all these years, I know that we'll support each other in this latest endeavor, just like we all supported each other 30 years ago through boy/girlfriends and break-ups and all the travails of young adulthood.