Pilot program for OTs working with Builders-December 21st AIM BIG Meeting

This meeting centered on developing a pilot program for occupational therapists working with builders, the first of hopefully many discussions, below is the video and below that is a summary.

This meeting focused on defining a pilot for working with builders.

Occupational Therapists working with Builders on Home Modifications

I am often asked what is the best way for occupational therapists to work with builders.  I'm not sure of what works for everyone but I can tell you what works for me and what I've heard from other OTs that are working with builders.  Of course every OT that has answered this question will have a different point of view.

I started my company Functional Homes, Inc. as a construction company.  I was a single mom of three and was looking for a business opportunity to bring in additional income to allow me to take my children traveling.  I was also a competitive sailor.  One of the other crew members on the sailboat owned a construction company and was renting wheelchair ramps which was quite lucrative.  We started talking and he told me he'd give me 25% of the take of every wheelchair ramp job I brought in.  At the time I thought, well I know plenty of people with handicaps so I started referring clients to him.  After a while he got a job remodeling a home for accessibility but did not know how to make a home accessible,  So we agreed on a 25/75 split and I did the design, chose the materials, and hired a few subcontractors and he did the construction.

AIM BIG Meeting on October 19th with Susy Stark on Home Modifications, Billing, and Evaluations

Great meeting with Susy Stark from Washington University

AIM BIG-Business Plan Development Meeting for OT Home Mod Business Part 1

We are beginning work on our business plans, we are in the incubation phase right now.  Here is our last meeting recording.

My Dilemma. Can it be a Marketing Device?

I was called in to provide a bid for an addition for a man with a LE amputation that is wheelchair bound.  The case manager and insurance company want our company to provide a bid for modifying a house for accessibility and a bid for building an addition.  We are competing against other construction companies for this project.   Putting together a good design for this project will take several hours of our design team.  If the client chooses our design and a different builder to do the work than that is several 'donated' hours by us.

I have done designs and construction for this case manager/insurance adjustor team before with very good results.  In fact the case manager was showcasing an addition we built to many of his other clients.

We typically get paid for our designs and provide a bid for free based on the construction specifications and the designs, that is how it has worked in the past with this case manager/insurance adjustor (on several jobs) until we had a job that went bad.

Job that went bad:  

Notes from Monetizing Home Mods Meeting June 15, 2015

MONETIZING HOME MODIFICATION BUSINESS

JUNE 15, 2015 VIRTUAL MEETING

MEETING NOTES

GUEST SPEAKER - SCOTT ANDERLE

Scott is a physical therapist who owned 13 PT clinics, then founded a business called Specialized Home Design, focused on universal accessible design.  In his journey to modify homes, he became a coordinator and consultant for home modifications.  In his role as a consultant, Scott evaluated homes and made recommendations for home modifications.  In his role as a coordinator, Scott worked with case managers and brought in contractors and architects. 

Scott then invented Comprehensive Home Evaluation Report (CHER) - an online tool for home evaluations.  This is a powerful home evaluation tool that supports information fill-in and embedded pictures and compiles a finished report from the data.  The CHER can be found at: http://www.shdesigns.net/cherreg

(Note from Karen:  Scott’s tool is more comprehensive than Carolyn Sithong’s tool.  Scott’s tool is appropriate for complex home evaluations that need to be very detailed for other professionals and even litigation purposes.  Carolyn’s tool is more appropriate for aging-in-place evaluations where your recommendations are more for lay people and you don’t have large amounts of time to spend.  Both are great tools for their applications.)

Apps for Organization

 

1Password

Raise your hand if you’re sick of trying to remember all of the logins and passwords that have been forced on you over the years. Keep those hands raised if you’d welcome a solution to this problem with open arms. Everyone has their hands raised, right? The founders of AgileBits apparently had their hands raised at one point, too, as their company’s team of developers produced an app (for Android, iOS, Mac, and Windows) that generates unique passwords for all the sites you visit and then remembers them so you can log in with a single tap. Oh, and it keeps them synced across all of your various devices, too.

 

Living Lab Possible Floor Plans

 Goal:  To convert 18.5’x 23.2’ space into a ‘Living Lab’ to teach occupational therapy students how to modify tasks and spaces to promote independence and to overcome disabilities to increase functional activities of daily living.  Ideally the Living Lab would be a flexible space that would allow for many different scenarios and set up so students would learn to utilize critical thinking and problem solving skills to overcome obstacles in many forms similar to the variety of situations they will encounter in the real world.

Concept:  In order for occupational therapy students to learn critical thinking skills to overcome the obstacles to function they will encounter in the real world they would benefit not from a perfectly wheelchair accessible space.  But instead a space that can be configured to be completely wheelchair accessible and reconfigured to present challenges to the students such as they will find when they begin practicing in the real world.  The living lab will be a place in which to learn transfers, how to modify tasks for independence with cooking, bathing, dressing etc.  Ideally the living lab will also have different types of adaptive equipment (low tech) and assistive technology (high tech) for the students to configure and utilize.

To create a 'Living Lab' for occupational therapy students to learn ADL's, and to learn home modifications via reconfiguring the space and having options for adaptive equipment etc.  No roll-in shower was planned for the bathroom originally because we were going more for problem-solving and critical thinking.

Current space:

 

 

Design 1:
This was the original Living Lab floor plan we submitted but the contractor did not want to have to move the water supply, which is to the left of the door and did not want to move the wall between the kitchen and bedroom.  The other issue is there is floorboard electric heat on the walls so this configuration was not going to work.

Kitchen:  Kitchen being difficult to reconfigure we are going for good universal, accessible design.

• Roll-under sink.
• Roll-under cooktop with above-the-stove mirror.
• Wall oven.
• Varying height countertops.
• Island on wheels.
• Touch faucet.
• Full extension drawers in base cabinets.
• Pull down shelving.
• Variety of adaptive devices for cooking in cabinets.
• Set-up for low vision with a variety of lighting options.

Bathroom:  Originally we were going for no walk-in shower and only a tub to trouble shoot mobility issues.

• Bathtub.
• Adaptive equipment (bath transfer bench, bathlift) for bathtub to overcome mobility issues.
• A variety of suction-cup grab bars to allow students to figure out best grab bar solution, although suction-cup grab bars should not be used in real-life situations for stability since they are unreliable.
• Standard height toilet or possibly an adjustable height toilet depending on budget constraints.
• Adaptive equipment for toilet (drop-arm commode, versa frame, elevated toilet seat.)
• Possibly a drop down grab bar or superpole next toilet, to demonstrate how drop down grab bars work.
• Roll-under sink with flipper-style doors or adjustable height sink.

 



Design 2:  Redesign after learning constraints with bedroom wall and researching other ADL Labs.  Decided to add a roll-in shower with flip-down shower seat to demonstrate roll-in shower design.  Would also like to have a functional bedroom for bed transfers and a ceiling lift installed between the bedroom and bathroom for lift transfers. 

Don't like the position of the tub in this design, only allows 3' between tub and toilet.  This design would work for side transfers onto toilet and for standing pivot transfers but prefer more space in front of toilet.

This design limits bedroom and storage space, will need to rethink adaptive equipment, may need to stick with fold-up and have photos of options.  Kitchen not addressed.

Design 3:  Bathtub position changed but limits space to enter roll-in shower to 36", which would work for most wheelchairs if user were independent with transfers will not work with standing pivot transfers.  

This design limits bedroom and storage space, will need to rethink adaptive equipment, may need to stick with fold-up and have photos of options.  Kitchen not addressed, flip down table not included.

 

Discussion with building contractor in progress to figure out limitations with water supply and moving walls.  Need to figure out best designs as well as adaptive equipment.

Living Lab Concept and Design

Living Lab Concept

May 16, 2015

Goal:  To convert 18.5’x 23.2’ space into a ‘Living Lab’ to teach occupational therapy students how to modify tasks and spaces to promote independence and to overcome disabilities to increase functional activities of daily living.  Ideally the Living Lab would be a flexible space that would allow for many different scenarios and set up so students would learn to utilize critical thinking and problem solving skills to overcome obstacles in many forms similar to the variety of situations they will encounter in the real world.

Concept:  In order for occupational therapy students to learn critical thinking skills to overcome the obstacles to function they will encounter in the real world they would benefit not from a perfectly wheelchair accessible space.  But instead a space that can be configured to be completely wheelchair accessible and reconfigured to present challenges to the students such as they will find when they begin practicing in the real world.  The living lab will be a place in which to learn transfers, how to modify tasks for independence with cooking, bathing, dressing etc.  Ideally the living lab will also have different types of adaptive equipment (low tech) and assistive technology (high tech) for the students to configure and utilize.

The Living Lab will be design based on principles of universal design and as much as possible many of the important elements will be able to be reconfigured to accommodate many uses of this space and to set up a variety of learning situations.

Current space:  The current space consists of a main room (18.5’x 10.9’) with a small cooking space in the corner, another room (12.5’x 12.25’), and a bathroom (5.1’x 7.8’) with a sink, toilet, and bathtub.  The current bathroom is not wheelchair accessible.

Living Lab proposed space:  The Living Lab would need to target the main areas of activities of daily living and home spaces that most often present obstacles to independence.  The areas of the home that occupational therapists are most often utilized for home modifications are the kitchen and the bathroom where much of the basic and higher level activities of daily living are performed.  Dressing is also a complex task and organizing the environment as well as utilizing various dressing equipment is an important aspect of occupational therapy.  The Living Lab should be composed of a kitchen, bathroom, bedroom, storage, and meeting area with a table if space allows.

Kitchen:  The kitchen should have a roll under cook top, a wall mount oven, a microwave at counter top level and plenty of storage.  The kitchen sink should be configured for a wheelchair to roll under. It could be set at standard sink height (36” above the finished floor) or it could be height adjustable depending on budget.  There should be information regarding what is required for space design of cabinets for handicap accessibility in regards to roll under spaces, clear spaces, reach ranges, heights etc. 

The kitchen should demonstrate design elements necessary for wheelchair accessibility such as high toe-kicks, pull out shelving, counter tops and lighting for visual disabilities, and pull down shelves.  The kitchen should also have a variety of kitchen equipment for people with a variety of disabilities, such as one-handed mixing bowls, cutting boards, storage containers, rocker knives, etc. 

The main cabinetry and appliances would be permanently placed but there should be a section of cabinets or possibly a long island on wheels that can be moved to reconfigure the space.   The ability for the space to be reconfigured will allow learning opportunities to present space limitations encountered in real world situations as well as to allow the space to be used for other purposes such as a meeting area or perhaps a hand therapy classroom.

Bathroom:  To be accessible (roll under sink, turn radius for wheelchair, clearance for wheelchair in front of toilet) with adaptive equipment as options to configure bathroom for different accessibility options.  Bathtub to be standard bathtub/shower configuration to allow for practice with adaptive equipment for accessibility.

 Current space: