If you choose home care for an elderly loved one, it is very important to ensure that your home is safe. Below, two elder care experts explain how you can make your home a safer place for the elderly.

What is the most common home injury among the elderly?
CHRISTINA BALDASARI, LPT: Falling. Rugs are the primary cause of falling for elderly in-home patients.

The most frequent injuries due to falling are head injuries, vertebral fractures, and hip fractures. These problems can lead to a long rehabilitation process and sometimes even to permanent disability.

Why are the elderly more susceptible to falling?
CHRISTINA BALDASARI, LPT: One reason is that they have loss of balance, which is sometimes caused by the medications that they are taking and sometimes caused by vision trouble. Also, osteoporosis leads them to be more susceptible to hip fractures than younger people.

Why are hip fractures so dangerous in the elderly?
WILLIAM BULMAN, MD: There is a very high mortality rate associated with hip fractures. It can cause blood clots and cardiac problems. Hip fractures are a major source of disability and there are very simple things that you can do to prevent the, like promoting strong bones early, to prevent osteoporosis.

But preventing fractures once an older person is in your home is often simply a matter of making your home safe by making it trip-free and fall-friendly.

What are some of the assessments you make in determining whether or not a house is safe?
CHRISTINA BALDASARI, LPT: The first thing I consider is whether the patient can get in and out of bed safely. Is a railing needed to help them roll over and sit up in bed? Sometimes we recommend putting a grab bar right on the wall next to the bed so that they can pull up onto the rail and then stand. Is the path from the bed to the bathroom clear and free of obstacles? This is especially important for nighttime trips to the bathroom. Is the rug in the bedroom too fluffy? Is it a shag carpet, which can lead to tripping? If they have a rolling walker, will they be able to navigate across the rug? We look at all these things in the bedroom.

The bathroom is probably one of the most dangerous rooms because of the combination of water and slippery surfaces.
CHRISTINA BALDASARI, LPT: Right. A lot of bathrooms are narrow, and it is very difficult to get a wheelchair or a walker through. We determine if there is amply room to turn with a walker-are they going to be able to sit on the toilet or get into the tub?

The tub is a big predicament, because a lot of older people can't climb over the rim, sit down, or get back up again. A lot of times we recommend a tub bench or a shower chair. A tub bench is just a bench that you put inside the tub. Sometimes it has a railing with it that they can sit down on and then swing their legs over the edge. They can shower or bath this way. A shower chair usually has a back to it, so they won't fall over or fall backwards.

WILLIAM BULMAN, MD: A shower stall is preferable, but you need to work with what you have in your home.

What are the difficulties involved in using the toilet?
WILLIAM BULMAN, MD: The strength required to stand from the sitting position from a low toilet is significant-it takes a great deal of strength in your legs to do that. If you have arthritis in your hips or your knees, going from a sitting to a standing position is painful. If you have muscular weakness in either one or both legs, it can be very difficult to stand using your legs alone. There are modifications that you can make to the toilet that make that easier.

What modifications?
CHRISTINA BALDASARI, LPT: There are different kinds of raised toilet seats that you can buy, or toilet chairs with rails that help the person to push up from a sitting position. And grab bars can be useful too.

WILLIAM BULMAN, MD: Very often with older persons with significant disabilities, getting from the bedroom to the bathroom is very important, especially since older persons often go to the bathroom in the middle of the night.

Sometimes we recommend a bedside commode so that they can get out of bed, use the commode next to their bed, and then use the bathroom for toileting during the day.

What are some safety considerations in the kitchen?
CHRISTINA BALDASARI, LPT: It is important to assess how they move about in the kitchen, especially if they have a walker or a wheelchair and they need to carry a plate of food from the counter to the kitchen table. We have to assess their mobility carrying, maneuvering the walker, and moving around. Sometimes, we recommend putting food on a tray if they are in a wheelchair or sliding the tray along a counter closer to the kitchen table.

We also look at how the patient is reaching for items in their cabinets. If the items are too high, then we suggest that they be moved closer to eye level or waist level so that they become easier to reach.

WILLIAM BULMAN, MD: Not everyone requires a wheelchair or a walker, but even older persons who are otherwise very independent and very healthy can have difficulties that present significant problems in the kitchen.

Somebody with very bad arthritis in the hand is going to have a lot of difficulty operating even a simple sink faucet. You can make easy modifications, such as replacing small twist knobs with large levers that make the faucet easier to turn off and on. There are special appliances that are made for people who have difficulty gripping and grasping. Things with large handles are certainly much easier to use for a person who has problems with dexterity or arthritis.

CHRISTINA BALDASARI, LPT: Something else to remember is lighting, because sometimes older people can't twist the little knob on the lamp. You need to have a switch.

What danger does poor vision pose in the home?
WILLIAM BULMAN, MD: One of the most significant contributors to accidents in the home is either bad vision or bad lighting, which can both cause someone to trip over something because they didn't see it. It's important that things be bright in the home to make things safe.

What kind of home modifications will insurance pay for?
CHRISTINA BALDASARI, LPT: I know that most major insurances won't pay for a tub bench or a toilet. Sometimes, insurance will pay for the toilet seat if it is medically prescribed by the doctor.

WILLIAM BULMAN, MD: Usually, the best first step is for the patient and/or the family members to discuss the in-home needs with the person's doctor. Some of these things, if written on a prescription filled in a medical supply store, will be covered by Medicare. But it is important to discuss it with your doctor and try to ascertain what modifications will be covered beforehand.

It can be an expensive proposition, but it is probably money well spent if you consider what you are preventing in terms of injury.