Senior Care Issue

Home Safe Home

How providers can keep their businesses safe by keeping senior patients safe.

• By David Kopf
• Aug 01, 2012

“There’s no place like home.” Dorothy’s magic refrain from “The Wizard of Oz” perfectly captures the American love affair with the home. Home ownership is the American dream, and we spend the majority of our lives achieving it and protecting it. Truly, there is no place like home, but what happens when living at the home becomes a danger?

There are a number of compelling reasons for seniors to continue living in their homes: they retain the independence that gives them continued life satisfaction and enjoyment; they live more active lives; and they enjoy lower-cost home healthcare and the improved care outcomes that accompany these benefits. The problem is that, while living at home offers many advantages, it can simply be risky for seniors.

The biggest home safety threat seniors face is falling. Falls for seniors can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Earlier this year, the Centers for Disease Control reported that each year, one in every three adults age 65 and older falls. Among adults aged 65 or older, falls are the leading cause of injury death, according to the CDC. In 2008, over 19,700 older adults died from unintentional fall injuries, and in 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized. And, probably most telling, 54 percent of all elderly fallrelated deaths occur in the home, according to the National Safety Council.

Still, despite those risks, seniors want to and should live at home, and their numbers are massive. According to data released this year by the Census Bureau, there were 40.3 million people age 65 and older on April 1, 2010, up 5.3 percent from 35 million in 2000. And with the 77 million-person-strong Baby Boom well into retirement, that number will escalate. In fact, the AARP reports that by 2030 one in every five Americans will be age 65 or older. And despite the health benefits, they simply want to live at home.

“There have been several surveys dealing with this very question,” says Jerry Keiderling, president of the VGM Group’s Accessible Home Improvement of America (AHIA) division, which provides education and a referral network for home access providers (see “Building a Senior Safety Skill Set” to read more). “Those most recently conducted and published state that nearly 91 percet of all seniors have indicated they want to live out their retirement in their own homes. An interesting additional statistic shows that of that same group, 49 percent want to stay in their current homes and 38 percent want to either move into a new home or remodel their existing home to suit their anticipated needs.”

And can anyone blame seniors for wanting to stay at home? Since they left their own parents’ home, they have fended for themselves and worked hard to put a roof over their own head. And, chances are, they’ve raised a family of their own in their home, and watched their children grow up, graduate and move out to start their own lives. Their homes are the living monument to a considerable portion of their life story. That’s a hard thing to give up.

“It’s where they’re happiest, most comfortable and therefore feel most safe and secure,” Keiderling says. “For many, their whole lives have unfolded and developed within those walls and in that neighborhood. Being comfortable with one’s surroundings is a very valuable asset as we age. We need that sense of security that comes from familiar surroundings.”

“They want to be able to be more comfortable,” says Cali Thomson, business manager of Bath Safety & Walking Aids for Invacare HomeCare. “They want their own furniture, their own surroundings that they’re comfortable in.” For seniors, moving out of their homes “would be like moving to a different state for them,” she says.

But what happens when that sense of wellbeing is undermined by the dangers that can arise when an older person lives at home? Fortunately, falls are a senior health problem that HME providers can help prevent.

Providers are placed in a pivotal position to help seniors live safely in their homes. Seniors are most likely already coming to those providers for home medical equipment and services, and there is a chance the provider is visiting them at their home for delivery of items such as oxygen or re-supplies of one type or another.

“Formulating a real solution to meet the independent living needs of any client takes a real understanding of their past, present and future prognosis,” Keiderling says . “Those most capable of doing that have real world experience in HME industry. Helping to solve accessibility issues and devise independent living solutions for their clients is already a part of the goals that HME providers strive for. It becomes a natural progression to expand their offerings to enhance that quality of an independent lifestyle for their clients. I believe that the two go together very well.”

All it takes is sitting down with the patient and reviewing his or her situation the next time the patient comes in.

“The ability for an HME provider to help their clients retain a sense of normalcy, comfort and safety in their lives as they age, creates a great opportunity for conversations with them and family members about any concerns they may have about independent living and the obstacles they may face,” Keiderling explains.

“Offering solutions to those needs definitely leads not only to new revenue streams via product offerings, but also client and revenue retention, as well.”

Even the customer service lines and delivery personnel can serve as an excellent starting point for a conversation on home safety with seniors, Thomson notes.

“The customer service number presents the perfect opportunity to introduce bath safety to the customers,” she says. “The customer service rep might be calling Mrs. Jones, and could say, ‘We’re delivering a bed today, would you like my delivery person to do a 10-minute bath safety assessment?’”

Well-Timed Opportunity

The opportunity to provide these sorts of home safety services couldn’t be more well timed. With the seemingly endless list of threats from CMS to Medicare funding for DME claims — competitive bidding Rounds One and Two, increased pre- and post-payment auctions, standard power mobility rental, the oxygen cap — providers have been desperately seeking new revenue opportunities. Providing home safety solutions for such a larger and growing population, such as seniors, is one of those opportunities, and perhaps a crucial one.

“Due to the existing senior population explosion, the need for disease state management of all kinds will also be on the rise,” Keiderling explains. “This bodes well for HME providers. The key to maximizing their benefits will come from diversifying their product and service offerings.

“While currently offering a high level of service and quality product offerings, HME providers earn the trust of their clients,” he continues. “This level of trust leads to their clients’ satisfaction of being able to make the ‘one call’ for all their needs, opening the door and allowing for conversations about the their total needs and how the provider can offer solutions. Even if these solutions involve the need to arrange or contract out certain services like remodeling or installation of specialty products, the clients’ trust in the provider remains safeguarded. The phrase ‘keeping a client for life’ is definitely taking on a whole new meaning.”

So where do providers get started in helping older patients live safely at home? It starts with understanding their needs and matching them to the right solutions.

“The first real solution comes in the form of an in-home assessment that identifies all the needs and evaluates any and all possibilities, ending up with a practical and affordable solution for the client,” Keiderling says. “Accessibility solutions are not always a full remodel of the home. Many HME providers are finding real success in offering a much broader line of aids to daily living products, ramps of all kinds, stairlifts, grab bars and mobility aids.”

Of course, the more in-depth the solution, the more in-depth knowledge that is required to install that solution. The more complex items on that list, such as stair lifts, will require installation and service training and is for the most part provided by the manufacturer of the product, he adds.

And manufacturers are trying to assist their providers in incorporating these sorts of cash-sales senior home safety products into their overall retail sales efforts, Thomson adds. “The thing that we’re trying to do is help providers get into that business,” she says. “We’re helping them learn how to set it up, how to maintain it, and how to get your customers in.”

The Bath: A Key Trouble Spot

With falls topping the list of home safety dangers to seniors, the main area where those falls happen is the bathroom. It’s a wet environment with hard surfaces where even a young, athletic person can easily slip and fall with an injurious outcome. It’s not surprising that a senior faces the same danger.

“We’ve all heard the statistics showing the very high rates of injuries due to slips and falls in the bathroom,” Keiderling explains. “This is consistently one of the major concerns that everyone has when considering the safety of a loved one living at home and alone.”

“Most people have some type of tile or slippery surface in their bathroom, and as soon as that gets wet it’s a disaster waiting to happen,” Thomson says.

Breaking down the threats in the bathroom, Thomson says there are a number of factors providers should examine:

• Can the patient sit and rise on the toilet unassisted?
• Can the patient support his or her body weight?
• Are faucet handles easy to reach?
• Is there a non-slip surface in the tub?
• Is the doorway wide enough for any mobility assistance device the patient might have, such as a walker or wheelchair?
• Is the path to the bathroom clear?

Assessing those factors can instantly help the provider determine which pieces of DME can best ensure that patient’s safety in the bathroom. There is a broad range of solutions for certain.

“Examples would be things like shower chairs; raised toilet seats, especially ones with arms so that patients can use it as a toilet safety frame to help them get on and off the toilet; grab bars are a definite must; anti-slip surfaces such as a bath mat; things that would help patients get in and out of the tub, because that’s where we see a lot of falling,” Thomson says, adding that all of these items are things that can easily be added to the bathroom and that are of low cost. A perfect example would be suction cup grab bars, which provide a safe support to patients without even having use a drill to install them.

And while there are more expensive items for bath safety, those devices can actually negate much higher remodel costs, Thomson points out.

“Where it costs tens of thousands of dollars to renovate a patient’s bathroom to go from a tub to a walk-in shower, the cost of a bath lift that is, perhaps $1,000 MSRP is much left significant,” she explains, adding that this perspective can be applied to other areas of the home. Case in point: ceiling hoists in the bedroom can save patients thousands of dollars. “Someone might not have room in a small, older home for a floor lifting device, so people who were renovating their bedrooms to make them bigger to have a floor lift, are now using ceiling hoists.”

Other key trouble areas for the home are the bedroom, stairs, entry and exit points and the kitchen, according to both Keiderling and Thomson. This presents a deep well of opportunities for providers to add home safety value as they assess a seniors home. Slippery fl oors in the kitchen, steep stairs, and high thresholds all represent a chance to provide better care and drive revenue.

And besides the actual home safety DME products that the provider can put in place, there are additional services that the provider can begin to integrate into its line of offerings.

“Beyond what’s typically considered accessibility products, other technologies and services are becoming available to satisfy the concerns that family members have about their loved ones, especially with busy lifestyles or distances apart,” Keiderling explains. “Activity monitoring and several forms of tele-health systems are emerging as important and useful tools when creating a solution to meet everyone’s needs, especially useful in satisfying the concerns of a family member about Mom or Dad living alone. As the market grows, so will new product and technology offerings.”

Picking up the Tab

One hurdle seniors and providers jointly face when it comes to ensure safe home access is how to pay for it. Home access and safety items are not funded by Medicare or private payor insurance, which means patients have to pay for them. The overwhelming majority of safety products are affordable, cash sales items that patients should be able to afford, but for more expensive home access solutions, such as stairlifts and bathing transfers, covering the cost can be a tough challenge for seniors. For instances where the price might be a little steep, providers need to be aware of additional funding sources.

“Without the any aid from Federal funding, accessibility solutions for the aging population are most often considered to be cash sales,” Keiderling says. “Unfortunately, many will fall into low-, or fixed-income brackets. In those cases, there are some avenues to explore: Medicaid waiver programs, area councils on aging, specific disease state advocacy and support groups, the VA, and family. Often there are family members willing to help insure the safety, comfort and wellbeing of their parents, relatives and loved ones.”

So, building up lists of funding sources that the provider can offer the patient as solutions is a key skill providers must develop when providing safe home access to seniors. And those options should expand over time. Keiderling says that he expects that situation to change as more seniors face home safety issues. When that happens, simple demographic shifts will force more financing opportunities to arise.

“As the market grows with opportunity, consumer credit programs will become more commonplace; much like those currently utilized by furniture and appliance stores,” he explaines. “Although hard to find today, several lending associations and banking groups are now taking notice of the pending need and are working on solutions to offer the general public.”

Protecting Patients and Businesses

Any challenges aside, the net-net is that strategically minded HME businesses should definitely see providing home safety to seniors as a key opportunity to keep afloat in CMS’s current difficult funding environment, while building a foundation for future growth. America is aging and needs providers’ help.

“With the onset of the rapidly growing population explosion, the future of HME (as a whole) looks bright,” Keiderling says. “HME is the only real solution to handling the growing need for healthcare services. ‘Independent Living’ and ‘Aging-in-Place’ are terms that are becoming very popular in our world. Wanting to live at home as we age is a strong message coming from our senior population and of those classified as ‘Boomers.’

“So let’s embrace the opportunity and set our sights on being all that we can be,” he continues. “Let’s educate, train, credential ourselves, and become the experts providing a wide spectrum of product and service that’s directly connected to the largest available marketplace that we’ve ever seen.”

This article originally appeared in the August 2012 issue of HME Business.