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What is it about adaptive equipment that makes people either embrace its use or put up a fight when it is mentioned?
I don't really have an answer; however, I do have a few ideas of why people have such strong reactions to the thought of using something as simple as a sock donner to something a little more involved like a tub chair or grab bars.
I have had several instances where clients or their family members have refused equipment that would definitely benefit them and/or make it easier to provide care. In one instance I was performing an evaluation for our Area Agency on Aging. I made the recommendation to the consumer's nephew (who owned the house) that grab bars would benefit the consumer in the shower. These would be no cost to him.
He refused, stating that he was going to be renovating the bathroom and would put them in himself! From the general shape of the rest of the house, I had a hard time believing that this was going to get done in a timely fashion. Because the consumer did not own the house, he unfortunately lost out on equipment that could help him and keep him safe while making it easier for his niece to assist him with his ADL. In home care I see family members seemingly agree with recommendations but then drag their feet in purchasing equipment or getting bars installed. Often I will offer to call someone to install the bars to see if that makes the process move any faster.
Another case involved a home care client who needed a second rail to go upstairs to the second floor. Although she didn't want the rail, her sons had it installed anyway. The PT reported to me that when she took her up the stairs, the patient was practically in tears over the rail but used it to help her get to the second floor. This same woman is refusing to shower because she will have to use a transfer bench.
Over the years, I have had patients refuse everything from tub equipment to dressing equipment to railings, grab bars and Life Alert systems. Some of this equipment was free through the Area Agency on Aging and some of it had been self pay. I can understand (sort of) why people refuse equipment if they have to pay for it and can't afford it. However, doesn't it become a higher cost if they have an accident at home because they didn't have the equipment they needed? What I really don't understand is when people refuse equipment that is not going to cost them anything!
Here is what I've figured out about this refusal of equipment: people don't want their homes to look like a hospital or nursing home. If there is no equipment visible, in their minds they must not have any problems. How many times have you walked into a home and seen a commode hiding under a blanket or throw as if to hide it from anyone coming into the house? People who have lived in the same house for 30, 40 or 50 years don't want to start making changes to the home. They are afraid someone will crack their shower tile when installing grab bars.
I believe they are unwilling to see themselves as aging or with physical problems that require assistance or equipment.
Sometimes you can reason with the person and explain why a specific piece of equipment is beneficial, will make them more independent or safer and easier to care for. This is occasionally enough to get them to agree to whatever recommendation you are making. Often, however, there is no amount of reasoning in the world that will make that person agree to whatever piece of equipment you have recommended. At that point you document the refusal and the discussion so that if an accident occurs, you have covered yourself.
Personally, I will continue to make my equipment recommendations to keep people safe and commend those who accept adaptive equipment and their families that can see past the refusals to help protect themselves or their loved ones.
Phyllis L. Ehrlich, MS, OTR/L, CHES, has been an OT for more than 29 years and has been working in home health for more than 19 years. She currently works for Holy Redeemer HomeCare. She has specialized training in NDT and is a certified health education specialist. She has co-edited and is a contributing author to Occupational Therapy in Home Health Care, Second Edition. Readers may contact her by e-mail at pleotr1@verizon.net.
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