006: Mail & Macular Degeneration

Kati recounts a story about a patient who broke a hip and had struggles with a common yet meaningful task.

006: Mail & Macular Degeneration
Good Fit Poor Fit

 
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[00:00:30] Welcome to episode six. We’re sharing about how the design of outdoor pathways impacts the ability of people to get their mail. This will help you understand how individual needs and the design of the environment result in either a good fit or a poor fit. It’s the little things that make a big difference.

[00:00:47] It’s Kati and today I’m going to tell you a story about a woman that I treated during my fieldwork experience at an inpatient rehab facility.

[00:00:56] We’re going to call her Denise. Denise was a really awesome woman, and she had, unfortunately, fell while getting her mail, broke her hip and had to get a hip replacement surgery. Denise was 85 years young and had poor vision because of macular degeneration, so getting around her house and walking around outside was really difficult for her.

[00:01:16] For those of you who might not know what macular degeneration is, I will give you a quick explanation. So macular degeneration is caused by the deterioration of the central portion of our retina, which is called the macula. The macula is responsible for focusing our central vision and controls our ability to read, drive a car, recognize people and faces, and to see objects in fine detail.

[00:01:42] So when you have macular degeneration, you basically have a dark spot or a black spot right in the center of your vision. So it can be very difficult to see things clearly and to see obstacles and steps and things like that. So Denise told me that she was often bumping into things, she couldn’t see her front steps clearly, she couldn’t really judge distance, so her balance was off. And so all of this kind of is what caused her to fall. She told me that she was walking down her front steps to go get mail from her mailbox. She ended up missing a step and fell down and broke her hip. And like I said, she had to get hip replacement surgery.

[00:02:19] So after the surgery, she came to our rehab hospital to get therapy, and that’s where I met her. And while she was there, we talked a lot about what occupations were meaningful to her and how she would be able to complete those tasks safely once she got back home.  Denise told me that getting to her mailbox was something that she needed to do every day, but now that she had a pretty bad fall, she was really fearful of that. So it was really important to Denise that she would be able to get to her mailbox so that she could pay her bills. And she really enjoyed writing letters to family and friends, so we needed to figure out how to either modify the activity or change the environment to make it easier for her.

[00:02:56] My initial recommendation was for Denise to pay her bills online and email or text her family and friends. And I thought I could teach her how to use the voice messages on her iPhone, or I could teach her how to use her technology. But, uh, Denise was not a fan of that option. She said, “No way! I am not dealing with all that technology. I don’t understand it. I don’t want anything to do with it.”  Denise was pretty set in her ways, so I was like, okay, that’s fine.  

[00:03:24] I educated her on various ways that we could possibly change her environment at home so that it was safer and would work better for her.  

[00:03:32] The first suggestion that I had made was instead of using her front door entrance, which had these steep steps that were made of stone, she could instead use her side door entrance.

[00:03:43] However, she would need a professional to come in and pave a walkway from that side door to the mailbox because it was an uneven surface of grass and dirt and rocks, and it just looked very unsafe.  I recommended that that walkway that would go from the side door to the mailbox be wide enough for her to use a walker and smooth enough so that she didn’t trip on anything.

[00:04:05] Additionally, it would be beneficial if they were able to stamp the edges of the walkway with some kind of texture so that she would know and be able to feel when she might be stepping off of the path. And this is also important for someone who is completely blind and is using a cane to feel where they’re going.

[00:04:24] If they were able to feel that texture on the side of the walkway, or if they were even able to feel maybe mulch that came up to the side of the walkway, just feeling two different textures would be able to help them stay on the path so that they didn’t encounter any unsafe areas of the yard or something like that.

[00:04:44] I also recommended to have decent lighting because she could be using this pathway in the early morning or in the evening. It would be beneficial to have the walkway lit as well. 

[00:04:54] The last thing that I recommended was to install a different mailbox. They actually make mailboxes with a front and a back opening. So instead of having to walk around all the way to the front of the mailbox, which typically means you have to stand in the street, you’re now able to stand behind the mailbox and open it from the back so she can access the mail that way. And then they would also need to maybe pave a little platform around the bottom of the mailbox so that she wouldn’t have to step in the grass to get the mail.

[00:05:24] All in all, it would be a lot safer for Denise and she would be able to do her occupation of getting the mail, paying her bills and writing letters to friends and family. Denise was very thankful that I was able to make these recommendations and told me that she was going to talk to her son to see if he could hire someone to come out and make those changes.

[00:05:42] So this is just another example of how the design of a home can be a barrier to someone after they’ve encountered or experienced a health impairment. This happens very, very frequently. It happens all the time where someone will go to the hospital and they’ll go to a rehab facility and they’ll come home and the house just doesn’t work for them and they’ll have to make all these expensive changes.

[00:06:04] So that’s why it’s so important to consider the needs and abilities of all people prior to construction so that houses can be functional for everyone forever.

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