Hands That Help · Seoyeon Kim
Chapter 5: A Home That Is Safe and Easy
A Common Situation
A man in his sixties notices a large bruise on his mother's arm when he visits her one weekend. She tells him, a little embarrassed, that she tripped on the rug in the hallway on her way to the toilet in the night. "It was nothing," she says. "I got up again by myself." Her son is frightened. On the drive home he makes a long list in his head: take away the rugs, move the furniture, put her bed in the living room, perhaps stop her from using the stairs at all. When he tells her his plans the next weekend, she becomes upset and says that this is still her home. They both end the day feeling misunderstood.
Both of them are right in their own way. The son is right that falls matter and that the home can be made safer. The mother is right that her home is hers, full of habits and memories, and that changes should not simply be done to her. In this chapter we will look at what care textbooks teach about making a home safe and easy to live in. We will start with falls, which are the most common accident in the homes of older people, and go through light, floors, furniture, the bathroom, the stairs and footwear. Then we will look at warmth and cold, fire and the kitchen, why it helps to keep things where the person expects them, how to make changes together, and what to do if a fall happens.
Light, Floors and Clear Paths
Care textbooks also explain why falls happen so often. With age, balance often becomes less steady, the muscles of the legs lose some strength, eyes need more light, and reactions become a little slower, so a small trip is harder to catch. Some people feel dizzy when they stand up quickly, and the doctor or pharmacist can say whether any of the person's medicines may affect balance. The encouraging part is that many falls can be prevented with small, simple changes in the home. It is also worth knowing that fear of falling can lead a person to move less and less, which weakens the legs further. So the aim of a safe home is not to stop the person moving. It is to make moving easier and safer.
Good light is one of the simplest changes and one of the most useful. Older eyes usually need more light than younger ones, and they take longer to adjust when a person moves from a bright room into a dark one. Bright, even light in the hallway, on the stairs and in the bathroom helps the person see edges, steps and objects on the floor. Light switches should be easy to reach at the entrance of each room, so that nobody has to cross a dark room to find them. By the bed, a lamp or switch should be within reach while the person is still lying down, before standing up. A bulb that has gone out is worth replacing the same day, because a dark corner is easily forgotten until someone trips there.
The path to the toilet at night deserves special attention. Many falls happen on this short journey, when the person is sleepy, the house is dark and there may be a feeling of hurry. Walk the path yourself in the evening and look at it with fresh eyes. Small night lights along the way, or lights that switch on by themselves when someone moves, can light the route from the bed to the toilet without waking the person fully. Leaving the bathroom light on, or the door open with a soft light inside, helps too. If the bedroom can be close to the toilet, that is a great help. Chapter 9 talks more about the toilet itself, including other ways to make night-time easier.
Floors should be clear and firm underfoot. Walkways become cluttered quietly over the years with piles of newspapers, bags, shoes and boxes, and it helps to keep the main paths through the home free of them. Loose rugs and mats are among the most common causes of tripping. The safest choice is to remove them, but if a rug matters to the person, it can be fixed firmly to the floor so that its edges do not curl or slide. Electric cables should run along the walls, not across the floor where feet go. Spills should be wiped up at once, and very shiny, polished floors may be slippery, especially in socks. Where there is a single step or a change in floor level, a strip of contrasting colour on its edge makes it easier to see.
Furniture can help or hinder. Many older people steady themselves by touching furniture as they walk through a room, a habit that is often quite safe as long as what they lean on is stable. A small table that tips, a chair on wheels or a lamp stand cannot take a person's weight, so it is worth checking anything the person might reach for. Chairs that the person uses every day should have firm seats, armrests to push up from and a height that lets the feet rest flat on the floor. The same is true of the bed: when the person sits on its edge, both feet should reach the floor comfortably. Low coffee tables and footstools in the middle of a walking path are easily missed, and moving them aside often makes a room feel more open as well.
The Bathroom, the Stairs and the Feet
The bathroom brings together many risks in a small space: water on hard floors, hard edges, and movements such as stepping over the side of a bath, sitting down and standing up from a low toilet. Non-slip mats inside the bath or shower and a non-slip mat outside it make a real difference. Grab bars beside the toilet, the bath and the shower give a firm hand-hold, but they must be fixed properly into the wall. Towel rails, soap dishes and the edge of a washbasin are not made to hold a person's weight and can come away suddenly. A shower chair, a board that sits across the bath or a raised toilet seat can make each movement easier. Chapter 8 describes washing itself in more detail.
Choosing the right equipment for a bathroom is easier with help. In many places, an occupational therapist, a therapist who helps people manage the tasks of daily living, or a nurse can visit the home, watch how the person moves and suggest what would fit, where the grab bars should go and at what height. Chapter 14 describes the kinds of help that may be available. A few other small points are worth thinking about. A bathroom door that can only be locked from inside can become a problem if the person falls and someone needs to get in, so a lock that can be opened from outside is safer. Hot water from the tap can burn older skin more easily than younger skin, so it helps to check the water before the person touches it. A light that is easy to find in the dark also belongs here.
Stairs need firm handrails, ideally on both sides and running the whole length, so that the person can always hold on with the stronger hand, going up and coming down. Good light at the top and at the bottom, with a switch at each end, means that nobody walks up or down in the dark. Nothing should be left on the stairs, not even for a moment, because a book or a pair of shoes on a step is easy to miss. Contrasting strips on the edges of the steps help tired eyes. Carrying things up and down the stairs is a common cause of falls, because both hands are busy and the feet cannot be seen; a small bag carried over the shoulder, or a basket left at the bottom for someone else to bring up, keeps one hand free for the rail.
If the stairs become very hard, families sometimes think about moving the bed downstairs or finding another arrangement. This is a big change for the person, and it is one to talk about together, slowly, rather than a decision for others to make in a hurry. Some people find it a relief; others feel that something important has been taken away. Feet and shoes, on the other hand, are an easy place to make a difference. Shoes or slippers should fit well, have a closed back, a firm sole that does not slip and a low heel. Old, stretched slippers that slide off, walking in socks on smooth floors, and long nightwear or trousers that trail on the ground all make tripping more likely. Painful feet, long nails or swollen ankles are worth mentioning to the doctor or nurse, because comfortable feet walk more safely.
A few habits complete the picture. Walking aids should be kept within easy reach and used as the professional who provided them advised; Chapter 6 says more about them. Glasses should be clean and worn while walking, and the person may need extra care on steps with glasses that combine lenses for near and far vision, because the edge of a step can look blurred through the lower part of the lens. Getting up slowly is a habit that care textbooks teach again and again: sit up first, wait for a moment on the edge of the bed or chair, and only then stand. This gives the body time to adjust and makes dizziness less likely. If the person often feels dizzy on standing, tell the doctor or nurse.
Warmth, Fire and the Kitchen
Older bodies are often less able to keep their temperature steady, and an older person may not notice cold or heat as clearly as a younger one. In cold weather, keep the rooms the person uses most, especially the living room and the bedroom, comfortably warm. Several thin layers of clothing keep in warmth better than one thick one, and warm drinks, a blanket over the knees and warm socks all help. The bathroom should be warmed before washing. Being cold is not only unpleasant; it can make muscles stiff and movements slower, which makes falls more likely. If the person seems unusually cold, sleepy or confused in a cold home, warm them gently and contact the doctor, and in a serious case call the emergency number.
Hot weather brings its own risks. As Chapter 7 explains, older people may feel less thirsty than they used to, so they may not drink enough when it is hot, and their bodies may cool down less easily. During hot days, keep curtains or blinds closed against the sun, open windows when the air outside is cooler, and help the person to wear light, loose clothes. Offer drinks regularly through the day rather than waiting for the person to ask, and help them to rest in the coolest room. Unusual tiredness, dizziness, headache or confusion on a hot day are signs to act on: move the person somewhere cool, offer a drink and contact the doctor or nurse. If the person becomes very unwell, call the emergency number.
Fire safety is another part of a safe home. Smoke alarms on every floor, tested regularly, are one of the most important things a home can have, and a carer can make testing them part of a regular routine. Heaters should stand well away from curtains, furniture and clothes, and clothes should never be dried on top of them. Old electric blankets and heaters with worn cables are worth checking or replacing. Too many plugs in one socket can overheat. If the person smokes, smoking in bed or in a chair when sleepy is a common cause of fires, and it is kind and wise to talk about safer habits together. Candles should be placed on a firm surface and never left burning in an empty room. Think about how the person would get out quickly: a clear path to the door and keys kept in the same easy place.
The kitchen is often the room that an older person most wants to keep using, and with a few changes it can stay safe. Things that are used every day are best kept between waist and shoulder height, so that there is no need to climb on a stool or a chair or to bend low to the floor. Pan handles can be turned inward on the cooker so that they are not knocked. A kettle that switches itself off and clearly marked knobs on the cooker help, and some families use a simple timer as a reminder that something is cooking. Where gas is used, everyone in the home should know what to do if gas is smelled: do not switch anything on or off and do not light a flame, open the windows, leave the home and call for help from outside. Gently checking the fridge from time to time for food that has gone past its best is a small and useful task, done with tact.
Keeping things where the person expects them is a quiet but important part of safety. A home that is familiar is easier to move through, especially at night or when memory is changing, as Chapter 3 described. When objects are moved, the person may search for them, climb to reach them or become anxious that something has been lost or taken. So the telephone, the glasses, the keys and the walking stick are best kept in the same places every day. A list of important telephone numbers in large, clear writing beside the telephone helps both the person and any visitor. Some people also find comfort in an alarm button worn on the wrist or around the neck that can call for help, if this is available where they live.
Changes Made Together, and After a Fall
Changes in the home work best when they are made with the person, not to the person. A home is more than a building: the rug in the hallway may have been a wedding present, and the chair by the window may be where the person has read every morning for years. Before changing anything, walk through the home together and ask where things feel difficult. The person often knows exactly which step feels uncertain or which corner is too dark. Explain why a change might help, and offer choices: the rug can be fixed to the floor instead of removed, or moved to a room where nobody walks at night. Make changes one at a time, so that the home stays familiar. Think of the son in the opening situation, who could start with one night light and one firmly fixed rug, and talk about the rest later.
Even in the safest home, falls can still happen, so it helps to know calmly what to do. If the person falls, the first thing is not to rush to lift them. Lifting someone from the floor alone can hurt both the person and the carer, and moving someone who is injured can make an injury worse. Instead, stay calm, kneel down beside the person and speak gently. Ask whether anything hurts and where. Look and listen for signs of injury: pain that is strong, an arm or leg that cannot be moved or looks out of its usual shape, a blow to the head, bleeding, or confusion that was not there before. A calm voice helps the person to stay calm too, and a frightened person needs that more than anything.
If the person is hurt, cannot move, has hit their head, seems confused or cannot get up, call the emergency number and follow the instructions you are given. While you wait, keep the person warm with a blanket or a coat, and stay with them. Do not try to lift them yourself. If the person is not hurt and feels able to get up with their own strength, you can guide them with words, without lifting. Care textbooks describe the usual way: the person rolls onto one side, then comes up onto hands and knees, moves close to a sturdy chair, puts both hands on its seat, brings one foot forward flat on the floor and pushes up, then turns and sits down. The carer holds the chair steady and gives calm instructions. If this is not possible, call for help rather than struggle.
Lying on the floor for a long time can itself be harmful, so it is worth thinking ahead with the person about how they would call for help if they fell when alone: a telephone kept within reach low down, a regular call from family at agreed times, or an alarm button. After any fall, even one that seemed small, tell the person's doctor. A fall can be a sign of something new, such as an infection, a change in balance or an effect of a medicine, and the doctor can look into the cause. Over the following day, watch for pain, swelling, unusual sleepiness, headache or confusion, especially after a blow to the head, and contact the doctor at once, or call the emergency number, if any of these appear. Writing down when and how the fall happened helps the doctor; Chapter 11 describes a simple care notebook.
Finally, talk with the person about the fall afterwards, without blame and without fuss. Many older people feel ashamed after a fall and keep it secret, just as the mother in the opening situation said that it was nothing. If the person knows that telling you will lead to help rather than to a lecture or to losing their freedom, they are much more likely to tell you next time. A fall often leaves fear behind it, and fear can make a person move less. Gentle encouragement, walking together, and small changes that the person has chosen help confidence to grow again. The goal is a home where the person feels both safe and at home.
A Question to Think About
If you walked slowly through the home of the person you care for, from the bed to the toilet at night, what would you notice, and which one change would make that path easier? You might take this walk alone with fresh eyes, and then take it again together with the person, asking what feels hard and what must stay just as it is.