Products & Technology

Home Access Opportunities

Building a foundation for new patient services and new revenues

• By David Kopf
• Mar 01, 2012

While providers are feeling like CMS is slamming the door in their face when it comes to Medicare funding, there’s one aspect of homecare that is putting out the welcome mat: Home access services. Offering services that ensure that patients can fully use and enjoy their homes lets providers tap into a market over which CMS has little dominion, while using the expertise they have built up over the years serving Medicare patients with various types of DME.

Massive cuts to Medicare funding through programs such as competitive bidding and the rental cap on oxygen, as well as CMS’s increase of both pre- and post-payment audits have narrowed provider revenues and cash flow so severely that they must search out new business opportunities. Providing accessibility services represents an excellent opportunity, given that most home access services are retail transactions, rather than funded, and because there is an expanding market for them.

There are many patient groups that need home access services. The classic scenario would be a mobility patient that needs his or her home overhauled to support his or her needs. But there are two key patient groups in need of home access services that are expanding by leaps and bounds that providers with an eye on home access should tap into: bariatric patients and the Baby Boom generation.

Bariatric patients have a variety of accessibility needs, especially in terms of bath safety and the bedroom, and they represent a growing portion of the U.S. population. There are now at least 72 million Americans that are obese, according to the Centers for Disease Control, and in terms of the number of patients that are morbidly obese, another study puts that figure at 9 million.

The Baby Boom generation comprises approximate 76 million people and has already started entering the age in which they need DME and home access services. Additionally, Baby Boomers are also caring for aging parents. Those two needs, combined with the relative wealth of the Baby Boom, means they are willing and able to pay for more expensive homecare solutions, such as home access devices. If there’s any doubt regarding their desire for home access, one need only look to a recent AARP study that showed that 89 percent of homeowners over the age of 45 prefer to remain in their homes, yet 80 percent of that population will require special housing and care needs.

Truly, those are key market opportunities that are hard to ignore for providers searching for new revenue opportunities that leverage their existing home medical equipment expertise and education. However, some providers might still approach providing home access services with a fair bit of trepidation, given that the discipline is often seen as the realm of specialty providers who have carved out a niche in a seemingly rarefied segment of the industry. Nothing could be further from the truth.

Another attractive element of home access services is that they offer providers a very scalable platform on which to build a business. Providers can start off by offering simple items related to their expertise, and then build from there. For instance, a provider serving bariatric patients could start by offering bariatric bath safety needs, then offer bath safety products that appeal to a wider spectrum of patients. Likewise, a provider specializing in mobility, could start by offering threshold ramps, then start offering access ramp installations, and then move into patient lifts. Additionally providers can start partnering up with contractors and design firms, as well as local loan specialists to provide turnkey bathroom remodeling services.

No matter how you slice it, there are many natural pathways that start from providing different types of DME and lead into home access services. To help you start charting a likely course for your business, let’s break down different home access considerations and opportunities in some key areas of the home:

The Entry

At the risk of sounding glib, the most important part of home access is actually accessing the home. For many mobility patients and others, actually getting into the home can be a tremendous obstacle. The typically American home is not very inviting when it comes to mobility patients and other patient groups.

Bearing that in mind, there are two key pieces of home access equipment that make that possible: access ramps and vertical platform lifts (VPLs). Deciding which access method, lift or ramp, best suits the patient’s need depends on a variety of criteria.

Determining which home access device is best for the patient begins with assessing the home with a special attention placed on space. The area must be large enough to accommodate a ramp if need be, and if there isn’t enough space, then a VPL might be the right choice.

Also, a patient’s mobility capabilities might be more compatible with one device or another. For instance, a manual wheelchair user might find having to roll up a gradually inclining 50-foot ramp a challenge.

Where ramp installations are concerned, there must be a foot of ramp for every inch of rise between the ground and the 5-foot-by-5-foot platform that is placed in front of the entryway (the platform provides a level spot for the patient to open and close the door. That said, the landscape where the ramp will go needs to be assessed as well. If the ground slopes away from the house, then the ramp will actually need to be longer.

Aesthetics are a consideration, as well. A patient might not like how a lot of aluminum ramps might look in the front yard. And a homeowners association might have rules governing the look and placement of home access devices, and obtaining approval for a ramp or VPL might be required. Likewise, if the patient is renting, then the landlord will need to approve.

Another consideration for access methods is whether or not the patient moves from time to time. Modular ramps do not require a building permit, assembled at the house, and, if the patient moves, the ramp can move with them. The platforms and ramp sections can be changed out to accommodate the new location.

Essentially a self-contained elevator, VPLs range in height from approximately
4 feet to 14 feet and sit next to the stairs leading to the patient’s home. A concrete pad for where the VPL will be positioned is required in order to safely anchor the device to the ground.

For power, VPLs are plugged into a dedicate outlet, which means some wiring could be involved. They also come in AC and DC version to provide an optional battery backup in the case of a power outage. (VPLs typically include a manual crank for emergencies, but many users’ conditions might limit them from using this option; especially the taller ones.)

For safety, VPLs include electronically locking gates to ensure that the gates remain closed to ensure no one could fall down from the top of the VPL’s “shaft” when the pad is in the lower position.

Similarly, durability is important. Ramps and VPLs should support heavier weights if the installation is for a bariatric patient. Materials should also stand up to weather and the elements. In fact, local weather conditions could dictate product choice. Salt air, high winds, frigid cold and constant humidity can all take their toll in unique ways that should be factored into the installation.

The Stairs

Helping patients negotiate stairs represents a tremendous opportunity for providers as the country ages. As many patients age, they become unable to safely climb and descend the stairs. Rather than be robbed of being able to use part of their home, patients can turn to providers that offer stairlifts. Stairlifts let patients continue living normally in his or home environment, having full access to each floor of the household, and there are a wide variety of stairlifts available to fit nearly every type of stairway.

Obviously, a key patient segment for providers considering offering stairs would be Baby Boomers. In addition to the fact that as the Baby Boom ages, many of its members will need stairlifts to negotiate their homes, many Baby Boomers are caring for older parents who have difficulty safely negotiating the stairs are naturally concerned about their parents falling down the stairs.

While installation can be a fairly straightforward process requiring some electrical and mechanical skills, as well as training in lift installation. They key easy installation depends on careful up-front preparation and assessment. And here is where a provider can truly differentiate from the competition.

Every stairlift installation is unique. While there are various safety codes for ensuring that stairs are built to standard specifications in order to ensure safety, every patient’s situation is going to be unique. Providers must go to the patient’s home to inspect and assess the stairway for consideration such as:

• The distance between the edge (or “nosing”) of the first step to the landing at the top of the stairs and the angle of that measurement.
• The width of the staircase to ensure the chair and rider will fit safely.
• The side of the staircase that the railway and chair will follow.
• The closest power outlet at either the top or the bottom of the staircase.
• Enough room at the bottom of the stairway to accommodate the end of the rail on which the chair is usual parked. This could create an obstacle that could cause someone to trip and fall, or simply obstruct movement around the bottom of the stairs.
• Does the stairway include a landing, or is it curved?

Curved stairways represent a particular point of expertise. Curved stair installations are essentially custom jobs. There are stairlifts designed for curved stairs, and the tightness of the curve will determine the unit. Some are designed for wider, sweeping curves, while others fit much tighter curves. Installation of curved stairlifts will be more expensive because stairlifts that can negotiate curved staircases cost more than units that run on straight tracks, and because tracks that follow the curves of the stairs requires more expensive, handson manufacturing. Essentially, the unit that arrives at the patient’s home is a one-of-a-kind solution.

In order to save space, many stairways are interrupted by a landing mid-way, and then double back on themselves before reaching the second floor. Or the stairs reach the landing and them form an “L” shape. These will typically require a double installation. This means that two rails and two chairs, one for the bottom of the stairs to the landing, and another from the landing to the top of the stairs. An alternative for L-shaped stairs and stairs that double back on themselves are pre-curved stairlifts that wrap around the landing.

In any case, a site visit also gives the provider an opportunity to do a spot assessment of the patient’s living situation and homecare situation. You might discover other home access or homecare needs that you can address. Also, the evaluation lets the provider build rapport with patients and ensure they see the provider as a key resource for their homecare and HME needs.

The Bath

The bathroom is one of the most heavily used rooms in the house — and one of the most dangerous. More than 80 percent of home accidents occur in the bathroom, which is considered to be the most dangerous room in the house according to the National Safety Council. Moreover, according to the Centers for Disease Control and Prevention, bathroom injury risk increases with age, with the most hazardous activities being bathing, showering and getting out of the tub or shower. Given that people 50 and older will represent 45 percent of the U.S. population by 2015, according to the AARP, this is a key home access opportunity.

Slips and falls on wet, hard surfaces are a true danger, and one that HME providers can prevent through bath safety products and services. And there are a variety of patient groups that need bath safety solutions as well. In addition to older patients, mobility patients and bariatric patients have specialized bath safety needs.

With older patients, falls are the big concern, so well-anchored grab bars strategically located in and around the bathing area, as well as around the toilet are critical. They ensure that the patient is supported and kept safe from a fall, but it also helps the patient gently lower and raise himself or herself while bathing or using the toilet. In terms of the toilet, ideally the patient would use a raised toilet so that he or she does not have far to travel when rising or lowering. Commode lifts are another option in this case.

For the bathing area, a bathing stool or bench that the senior can use in conjunction with a handheld shower will protect against falls. Also, the bathing area should have grab bars and shower floor should be lined with non-slip material or strips. Another bathing option could be a bath lift, which raises and lowers the client into the tub.

Bariatric patients are subject to the same fall risks as seniors, but the results of their falls can sometimes be more devastating given their weight. So, bariatric bath safety items must be even stronger than usual.

Grab rails that can support the patient’s weight should be strategically throughout the room. The toilet must be a special bariatric unit that supports their weight. Otherwise the risk of the toilet failing could be a major safety concern both because of the risk of fall and that of broken porcelain from older toilets. Bariatric toilets can support as much as 850 pounds and are typically taller so that the bariatric patient does not have to drop down on them. This is important given that it is difficult for very large patients to slowly lower themselves into a sitting position.

A shower chair or bench lets the patient bathe with confidence, and if the patient requires bathing assistance, having the patient at a sitting height will not only provide better access to the patient for purposes of bathing, but also protect the caregiver from injury, since he or she will not be leaning over at odd angles in a slippery environment. Again, grab rails and a non-slip pad or strips are critical.

Providing bath safety for mobility patients typically requires more remodeling and retrofitting. Much of that depends on the level of independence, the bathroom has to be large enough for the patient to move, which could mean modifying the bathroom.

Typical bath safety modifications for mobility patients include replacing the existing bathtub or shower stall with a roll-in shower stall or one that incorporates a special bathing chair. That can mean knocking out just the tub, and possibly expanding the bathroom itself. Also, many mobility patients might need to have their master bath relocated. For instance, if they are now living predominantly on the first floor, extensive work might need to be done.

The net-net is that major bath remodels for mobility patients (and others) will involve cost. A complete bathroom remodel can range from $15,000 to $30,000. This means that providers providing home access to mobility patients need to not only have a deep level of knowledge in the available product and remodeling solutions, but financial options, as well.

Typically, the tub is a major focal point in a bath safety remodel for a mobility patient, because it represents a central obstacle for the patient’s independence. In additional to replacing the bathtub or shower stall with a roll-in variety, there are other options. For instance, patients can use a special transfer chair that can be used in the shower, or they might relocate the shower altogether.

Also, it’s important to bear in mind that there are still many mobility patients that are unable to bathe on their own and need assistance from a caregiver. In this case devices such as bath hoists and special bathing chairs that take mobility patient seating and positioning into consideration can be an ideal solution.

In any case, when it comes to finding a foundation on which to grow a home access business, perhaps no category of home access products and services offers providers a better evolution path into accessibility than bath safety. Providers can start off small, offering items such as grab rails and then move up to bath transfers and bariatric fixtures, and then finally start partnering with remodeling specialist to completely overhaul a patient’s bathroom.

This article originally appeared in the March 2012 issue of HME Business.