11 M-CARE: Environmental control

Mobile Training for Home and Health Caregiver For People with Disabilities and

Older People

539913-LLP-1-2013-1-TR-LEONARDO-LMP

Module: Environmental control


How to adjust a home for your client’s needs?

This may include:

• Recommending widening doors and ramps

• Access to rooms and facilities –(i.e. a stair lift or a downstairs bathroom)

• Heating system that suits your clients’ needs.

• Adapting heating or lighting controls to make them easier to use

• Improving access and movement around the home to enable accessibility for your client and also for yourself


Unit 1

• Weather variations and adaptations

– Cold weather

– Hot weather

– Adjusting temperature

– Medication – hotter weather


Weather variations and adaptations

• There are certain conditions that are plainly influenced by weather: cold, heat, snow, rain.

– You as a caregiver should do your best to avoid aggravating these conditions by limiting the client’s exposure to certain types of weather.

Photo by digitalart,

http://www.freedigitalphotos.net/


Cold weather • Cold weather may promote

inactivity, something that also causes joints to stiffen.

• If possible ask your client to try some walking or low-impact activities which will provide some preparation of the muscles before going out.

Photo by Stuart Miles, www.freedigitalphotos.net


Warm weather • This affects elderly and

disabled people e.g. those with paraplegia and chronic health conditions such as vascular disease or diabetes. Photo by samarttiw,



Medications taken for a variety of diseases and symptoms can also interfere with one's ability to manage hotter weather.

These medications include antipsychotic drugs commonly given to Alzheimer's patients to:

• control agitation

• anticholinergic drugs

• tranquilizers

• sedatives (including over-the-counter sleeping pills)

• amphetamines

• diuretics and drugs to control blood pressure

• antihistamines

• some antidepressants

http://www.alz.org/

http://www.medscape.com/viewarticle/769985

http://www.thoracic.org/clinical/copd-guidelines/for-patients/what-kind-of-medications-are-there-for-copd/what-are-anticholinergic-medications.php



http://www.britannica.com/EBchecked/topic/602263/tranquilizer

http://www.news-medical.net/health/Sedatives-What-are-Sedatives.aspx

http://www.drugs.com/amphetamine.html

http://www.drugs.com/drug-class/diuretics.html

http://www.webmd.com/allergies/guide/antihistamines-for-allergies

http://www.medicinenet.com/antidepressants/article.htm


• A person with cognitive impairment may not be able to communicate distress.

• In some cases, they may not even "feel" the heat or discomfort because of changes in the brain's abilities to process sensory information.

Photo by Stuart Miles, http://www.freedigitalphotos.net/


Heat-related illness

• Poor circulation, heart, lung and kidney diseases, and high blood pressure increase the risk for heat-related illness.

• If the client is overweight or underweight also increases this risk. Photo by digitalart,



Adjusting temperature

World Health Organization recommends:

• a minimum indoor temperature of 18°C

• a 2‐3°C warmer minimum temperature for rooms occupied by sedentary elderly and persons with a disability

Don’t forget:

• Heating pads and warm baths can ease pain.

• Ice packs can reduce swelling.


Unit 2

• Humidity


• Keep humidity below 50%.

• Use air conditioning or supplement with a dehumidifier if needed.

Photo by Stuart Miles, http://www.freedigitalphotos.net/


Unit 3

• Clothing needs


Overall clothing approach

• increase clothing of client, particularly by wearing long underpants or tights with trousers, underskirts with skirts, jackets with overcoats, or all three of hat, scarf or gloves

• BUT: remove excess clothing when indoors


• Persons with reduced mobility that go outside should consider: – Most wheelchair users have a troubled “thermostat”.

• They get really hot in the summer. • They get really cold in the winter. • Cause: since they don't move their extremities a lot, the blood

doesn't circulate in a proper manner.

– Therefore: • Multiple layers of clothing to protect his/her body tissues and to

minimize rapid temperature changes between indoor and outdoor environments.

• Use of (bilateral) zip pants as they are very useful. – Also makes toilet transfers very manageable.

• If the individual cannot perform self transfers and cannot dress him or herself at all, the best wheelchair clothing items are the open back garments that are easy for the caregiver to use and that are comfortable for the wearer.

• Pushing gloves, sleeve protectors, cape with sleeves, etc.


Important!

• Be aware that some wheelchair users don't have sensation, hence they cannot feel their body or their extremities.

– This is very important when you dress them, especially when you put on their shoes.

– You have to ensure that the toes are straight and that the shoe fits well.

– You have to be careful because they cannot feel pain.


Source: http://www.essentialaids.com/


Older people • Older persons are less able to

maintain core temperature during a cold challenge: lower heat production and higher heat loss.

• When at rest in the cold, older persons have a lower metabolic rate and a higher skin thermal conductivity.

• They tend to overdress—they don't feel heat the same way like young people.

• Older skin also becomes thinner and offers less protection from the sun.

Photo by Ambro, www.freedigitalphotos.net


Unit 4

• The impact of weather on health

– Muscle cramps

– Lung diseases

– Lupus

– Osteoporosis

– Raynaud's Phenomenon

– Pulmologic diseases


Muscle cramps

• The risk of muscle cramping increases when an exercise activity is pursued without an adequate warm-up.

• It is very important to do warm-up stretches and get muscles of your client ready to work before s/he begin.

Photo by stockimages, http://www.freedigitalphotos.net/


Lung diseases

• Cold weather may also affect people with certain lung diseases.

• Asthma may be triggered in some people by physical activity in cold weather.

• Rheumatoid lung disease is characterized by shortness of breath, chest pain, cough and fever.

– For people with rheumatoid lung disease, winter air may aggravate issues with breathing.

http://www.webmd.com/lung/lung-diseases-overview

http://www.mayoclinic.org/diseases-conditions/asthma/basics/definition/con-20026992

http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/expert-answers/rheumatoid-arthritis/faq-20058245


Systemic Lupus Erythematosus

• Lupus can have a tendency to be activated by exposure to sunlight, a feature referred to as, 'photosensitivity.‘

• Since ultraviolet light can trigger and worsen flare-ups of lupus that may involve a person's skin or joints and other organs, people with lupus should avoid exposure to the sun.

• Sunscreens and clothes that cover the extremities are important.

Wikipedia


Osteoporosis

• Icy steps and walkways can present a particular danger to people with fragile bones.

• Slipping and falling can cause painful fractures that may be slow to heal, or even be disabling.

• Make sure there are handrails which keep sidewalks free of ice and snow and avoid wearing shoes with slippery soles.

• If your client takes medication that can affect his/her balance or stability, you may ask his/her doctor about the possibility of changing the medication or the timing of medication, so that they are less likely to interfere with his/her daytime activities.


Raynaud's Phenomenon

• People with Raynaud's phenomenon should minimize their exposure to extremes of temperature, especially cold, as well as rapid changes in temperature.

• They may also benefit by living in environments that are warmer.

http://www.mayoclinic.org/diseases-conditions/raynauds-disease/basics/definition/con-20022916


Pulmologic diseases

• If your client has difficulties with breathing, try a face mask when s/he needs to go out in the cold.

• The masks cover his/her mouth and then s/he may use the heat from his/her own breathing to warm air before it enters his/her lungs.

• Avoid alcohol, nicotine and caffeine because they have a drying effect on cartilage.

• Ask your client to get plenty of sleep, it restores his/her energy and can better manage pain. It also rests his/her joints to reduce swelling and pain.


• It is important that your client stays hydrated by drinking plenty of water, juice and other liquids.

• Water is a good replacement therapy.

• It helps to flush out toxins that can cause pain in joints with arthritis for example.

• Keep a Pain Diary: Write about the level of pain your client experiences at different times, how s/he is feeling, as well as what activities s/he can and cannot do.


Unit 5

• Security

– Anti-theft

– Fire safety


Before you leave the house with the client: • Windows

– Secure all accessible windows with secondary blocking devices – Block accessible windows so they cannot open more than 6 inches for

ventilation – Make sure someone cannot reach through an open window and unlock the

door – Make sure someone cannot reach inside the window and remove the blocking

device; – Use anti-lift devices to prevent window from being lifted out

• Lights – Interior lighting is necessary to show signs of life and activity inside a

residence at night. – Consider light timers or photo-cells to turn on/off lights automatically.

• Alarms – Alarm systems are effective deterrents with visible signage. – Alarm systems to be properly installed, programmed, and maintained.

• Neighbours – Get to know neighbours on each side of the clients’ home. Communicate

often, and establish trust.


Fire safety • Warning

– Are there smoke detectors and are they working? The batteries should be checked periodically.

• Emergency plans – Know the emergency plan for how to exit the home in an

emergency. – Plan an alternative exit route.

• Prevention – Is there a fire extinguisher? – Never leave cooking unattended on the stove. – Encourage appropriate smoking habits. – Never allow smoke in bed. – Smoking should NEVER be allowed around oxygen bottles.


In case of fire (“RACE formula”)

• Remove any people in direct danger

• Alarm by calling the fire department (112)

• Contain the fire by closing doors and windows

• Extinguish the fire if possible or evacuate if needed


Unit 6

• Set Assistive technologies ready for usage

– Overview – Hearing aids

– Overview – Mobility aids

– Overview – Healthcare aids

– Overview – Household aids

– Overview – Assistive Technology

– Interesting sites on supportive/assistive technologies

– Useful Assistive technologies


What to consider? • As a caregiver, you should be aware of the range of products and

services that exists and that can help the client to improve his/her daily life

• Be aware of the local stores that have aids in following areas – Mobility – Hearing – Vision – Hygiene – Bedroom – Household – Dressing – Home Healthcare – Work & Leisure – Comfort – Orthopaedic

You, as PCG, might identify an issue your client faces, which could be easily addressed with a supporting aid.


Overview – Vision aids

• Watches • Magnifiers • Clocks & Timers • Magnifying Lamps • Calculators/Record

Keeping • Writing/Money

management • Canes & GPS • Braille & Blindness Aids

• Labelling & Marking • Reading

Glasses/Sunglasses • Bibles & Dictionaries • Games & Education • Electronic

Magnification • Systems • Telephones • Telephone Accessories


Overview – Hearing aids

• Bluetooth Cell Amplifiers

• Telephone Headsets

• Telephone Ring Amplifiers & Visual Alerts

• Personal Amplifiers

• TV Amplifiers

• Voice Amplifiers

• Hearing Aid Dryers

• Vibrating Clocks & Watches

• Timers

• Tinnitus & Hearing Aid Batteries

• Hearing Aid Maintenance

• Amplified Telephones


Overview – Mobility aids

• Canes

• Rollators

• Walkers

• Support/Transfer Aids

• Bathroom Aids


Overview – Healthcare aids

• Blood Pressure Monitors

• Scales/Thermometers

• First Aid/Massagers

• Pill Accessories

• Medication Reminders

• Diabetic Aids


Overview – Household aids

• Lamps & Lighting

• Reading Accessories

• Kitchenware

• Daily Living Aids


Overview – Assistive Technology

• Computer Accessories & Software

• Recorders/Players

• Reading Machines/Scanners


Interesting sites on supportive/assistive technologies

• Aids for usage in the home environment: www.essentialaids.com / www.thuiszorgwinkel.be

• European Assistive Technology Information Network - www.eastin.eu

• Institut Der Deutschen Wirtschaft Köln - www.iwkoeln.de

• Flemish Agency For Persons With Disability - www.vaph.be

http://www.essentialaids.com/

http://www.thuiszorgwinkel.be/

http://www.eastin.eu/

http://www.iwkoeln.de/

http://www.vaph.be/


Useful Assistive technologies

• Independent living aids (easy-to-grip cutlery, reaching tools, elastic shoelaces and long-handled brushes)

http://www.independentliving.com/



• Medication aids like pill organizers and timers to remind people to take their medicine

Source: http://www.containerstore.com/



Safety and security devices:

• intercom systems,

• occupancy monitors that activate when the person using them gets up from a chair or bed

Onsetcomp.com occupancy/light logger



• For those in the early stages of dementia there are memory aids, like jumbo, analogue wall clocks and voice-activated phone dialers.

Memory Game- Modern Menagerie


Unit 7

• Vacuum cleaning

• Dusting


Vacuum cleaning

• Once or twice per week, preferably when client is not present.

• Wearing a mask may help if client does vacuuming him/herself.

• Preferably use vacuum cleaners with HEPA (High Efficiency Particulate Arrestance) filters or high filtration bags.

Photo by artur84, http://www.freedigitalphotos.net/


Do’s and don’ts of vacuuming

• Do vacuum regularly. Once a week is the minimum, but twice a week would be best.

• Do move furniture.

• Do vacuum under beds.

• Do vacuum both ways: up and down and side to side.

• Do also the edges.

• Do use the vacuum tools to reach those tiny spots.

• Don’t rush.

• Don’t let the bag get too full, a bag that is overfilled loses suction and effectiveness.

• Don’t just vacuum the floors.


Do’s and don’ts of dusting • Use damp method one or two times per week. • Before you begin dusting, it’s important to remove all items from

every surface. • There are several different cleaning tools you can use to dust

your office. – A damp dust rag can be used to wipe down counter tops and desk

top surfaces. – A feather duster is good for reaching high areas such as the ceiling,

tops of shelves or filing cabinets, overhead ceiling vents, etc.

• Start dusting the high surfaces of your room first. • If you are having a hard time dusting those inconvenient spots,

try using different dusting tools such as a vacuum or paint brush. • Don’t move onto another room until you’ve finished dusting

every surface in the room you started in.


References:

• Aging families and caregiving / Sarah Honn Qualls; Steven H Zarit 2009, English Book xiii, 338 p. : ill. ; 25 cm. Hoboken, N.J. : John Wiley & Sons, ; ISBN: 9780470008553

• The real truth about aging : a survival guide for older adults and caregivers / Neil Shulman; Michael A Silverman; Adam G Golden2009 ,English Book p. cm. Amherst, N.Y. : Prometheus Books, ; ISBN: 9781591027195

• Aging Families and Caregiving by Sara Honn Quall, Steven H. Zant, Eds. 2009, English Book , (338 p.) Wiley: (January 27, 2009) ISBN: 10: 0470008555

• http://www.nfcacares.org/who_are_family_caregivers/

• http://www.nfcacares.org/pdfs/AARPSurveyFinal.pdf

• http://www.womenshealth.gov/faq/caregiver-stress.cfm#a

• http://www.womenshealth.gov/faq/caregiver-stress.cfm#a

• http://aspe.hhs.gov/daltcp/reports/ltcwork.htm

• http://www.healthcalculators.org/calculators/caregiver.asp

• http://www.co.rock.wi.us/Dept/Aging/CaregiverBooks.htm

• http://seniorliving.about.com/od/lifetransitionsaging/a/agingwellbooks.htm

• http://www.caregivingcafe.com/blog/wp-content/uploads

• http://seniorcarepartners.wordpress.com/our-caregivers/

http://www.nfcacares.org/who_are_family_caregivers/

http://www.nfcacares.org/who_are_family_caregivers/

http://www.nfcacares.org/pdfs/AARPSurveyFinal.pdf

http://www.nfcacares.org/pdfs/AARPSurveyFinal.pdf

http://www.womenshealth.gov/faq/caregiver-stress.cfm








http://aspe.hhs.gov/daltcp/reports/ltcwork.htm

http://aspe.hhs.gov/daltcp/reports/ltcwork.htm

http://www.healthcalculators.org/calculators/caregiver.asp



http://www.co.rock.wi.us/Dept/Aging/CaregiverBooks.htm

http://www.co.rock.wi.us/Dept/Aging/CaregiverBooks.htm

http://seniorliving.about.com/od/lifetransitionsaging/a/agingwellbooks.htm

http://seniorliving.about.com/od/lifetransitionsaging/a/agingwellbooks.htm

http://www.caregivingcafe.com/blog/wp-content/uploads




http://seniorcarepartners.wordpress.com/our-caregivers/


