Modifying Home and Work Settings
Environmental access (EA) is a term used to broadly define processes associated with modifying existing home and work environments to remove architectural and other barriers to access. It also defines the process of universal design--a design concept intended to achieve environments universally accessible to people of varying ages, abilities and disabilities. The primary goal of environmental access is to provide changes to the home, work or social environment that promote independence, safety and personal comfort.
The enactment of the Americans With Disabilities Act (ADA) more than 10 years ago fueled a better understanding of EA in society, as the ADA continues to be the single most significant piece of federal legislation implemented to protect the rights of disabled people. Yet, the provisions of the ADA pertaining to environmental access govern only commercial or public buildings and environments, leaving a large gap in regulations and in common practice guidelines among those performing environmental access services.
Through the years environmental access has evolved into a large trade in the United States that is somewhat associated with the health care industry, less associated with the construction industry, and rarely identified within one entity or as a single professional practice. Within the health care industry, environmental access most comfortably fits within the broad spectrum of products and services associated with HME, post-acute home health, rehabilitation and long-term care. Yet, these same providers of services and products have been slow to recognize the opportunities that exist in environmental access.
This lack of recognition can be attributed to many factors. Environmental access is not a covered benefit under Medicare or group health payers, pay systems that are important to the bottom line in industries like HME and post-acute health care. It is, however, a well established benefit under many types of expansive payer services, including workers' compensation, vocational rehabilitation, some long-term care insurance policies and certainly in several delivery models of social services, including elder and aging agencies, children's medical services, low-income housing subsidy programs, and a variety of county and municipal match-funding programs.
The cool reception of environmental access in the post-acute world also can be attributed to a general lack of knowledge and understanding about the process of modifying or adapting home and workplace environments to achieve access. This is largely due to the orphan syndrome of environmental access--not being claimed and regulated by any one industry to date.
Industry Response
In 1994, a study group consisting of health care professionals, construction and building specialists as well as insurance and financial representatives, began meeting to discuss how the disparity in defining and delivering environmental access services could be lessened. As stakeholders in environmental access, the study group focused on the large variations in pricing, practice and specialty background demonstrated by those professing to deliver environmental access services and products. The study group also explored mechanisms to develop standardized guidelines constituting best practices in environmental access.
Through research, use of advisory boards, modeling of existing health care certification programs, industry participation and volunteerism, the end result of this study group was the establishment of certification in environmental access in 1998. Environmental access specialists have met strict eligibility criteria, have successfully passed a national written examination, and have participated in continuing education to achieve and maintain certification in environmental access. These certified specialists are identified as Certified Environmental Access Consultant and Contractors (CEAC)--and constitute a varied group of health care practitioners, social service professionals, grant administrators, design experts and a host of other specialists. They are identified on a Web site voluntarily maintained by one of their colleagues at www.promoteaccess.com. Additional information on CEAC certification, or the CEAC annual conference in environmental access can be found at www.primeinc.cc.
Rapidly Growing Customer Base
There is a great need and a great opportunity for post-acute, HME, home health technology and other dealers and providers to understand more about environmental access and its evolution. To recognize the extraordinary predictable growth of environmental access, one only needs to understand the aging of America and its impact on available products and services. The Census Bureau continues to predict that by the year 2014, about 34 percent of the population will be ages 50 or older, and during the next 50 years, the number of people ages 50 and older will double. Of equal significance are the large number of frail and elderly people already requiring environmental access services and products, coupled with the rapid predictability of growth among the over-80 age group in the near future. Due to scientific and medical advances that redefine old age, predictions indicate that by as early as 2030, there will be more people over the age of 80 than under the age of 18.
Since physical abilities diminish with age, these growing populations will increasingly demand services and products to provide accessibility in the home, workplace and social environments. Also fueling this demand are the medical and scientific advances that are allowing people to live longer. Common services and products required of aging people include modified bathrooms and kitchens to accommodate the use of a wheelchair, scooter or walker; increased lighting and sensory tools; accessible entry ramps and walkways; high-technology devices, such as computer-driven temperature, lighting and security controls; and a myriad of other adaptations that can enhance independence, safety and comfort for people with changing needs.
Obviously, environmental access is a vast and varied practice. Providers of HME, home heath technology and home health care will want to first identify experts in environmental access to employ or establish consulting and contracting services. Once this has been established, the marketing of these services becomes a fundamental priority.
Marketing Environmental Access
There are many ways to market environmental access services and products. The simplest way will be for the provider to add environmental access to the existing menu of services already being offered. It will be important to market this service to health care professionals representing the common payer organizations already mentioned in this article. Other referral sources are health care professionals who work with aging or catastrophically injured/ill people, such as geriatric care managers, independent case managers, rehabilitation nurses or rehab case managers affiliated with local rehabilitation hospitals. Adult community living facilities and outpatient rehabilitation units also are excellent referral sources.
Acute care-based discharge planners, occupational therapists (OT) and physical therapists (PT) are important to the provider's list of customers. OTs and PTs work closely with clients to increase their independence and assist them in achieving a safe and early discharge. OTs often examine a client's home environment as part of the discharge planning process, in order to ensure a safe discharge from the acute care setting. Likewise, discharge planners are involved in working with the client, since it also is their responsibility to ensure that the client receives a safe discharge from the acute care setting. Safe discharges are often equated with removing architectural barriers in the home environment. If a pay source does not exist to provide this service, and patient cannot afford the services individually, the hospital's social worker may be a good resource to obtain funding options available in the community.
It also will be important to disseminate marketing materials to locations where appropriate consumers are likely to read them. These include community senior centers, rehabilitation centers, and disability organizations, such as the Paralyzed Veterans' Association or the Multiple Sclerosis Society. Physician offices also provide an excellent location. While most physician offices will not allow marketing materials to be readily accessible to patients, the physicians' staff can serve as excellent referral sources.
Providers also should track how large, influential organizations like the American Association of Retired Persons (AARP) are marketing members about environmental access. Currently, AARP is working diligently to educate its 50 million members about the benefits of aging-in-place, which will include the need to modify a home to achieve access. Aging-in-place is a shifting paradigm necessitated by the challenges in long-term care, and this paradigm is currently being explored and funded by several municipal social service agencies.
An excellent starting place for those wishing to examine products available to market in environmental access is at the Medtrade International Spring and Fall shows. The fall show in 2001 provided a backdrop for the first annual CEAC conference, where environmental access specialists gathered to network, explore best practices in environmental access and research new products. Annually, the Medtrade Spring and Fall shows are the location for the CEAC written examination.
Environmental access is certainly a lot more than stocking a few grab bars on the shelf or widening a doorway to accommodate a new wheelchair. It offers a whole new dimension in services and products for the provider willing to do some homework, broaden staff expertise, develop relationships and ultimately provide greater independence and safety for aging consumers.
This article originally appeared in the March 2002 issue of HME Business.