Too Many Stairs

I’m wondering if the only physicians that think about how many stairs are in a patient's home are rehabilitation physicians.  While other doctors may be looking at a patient’s blood cell counts to monitor anemia, or blood sugars for diabetes management, or infection risk before deciding on medical clearance for a surgery, when I first assess a patient I’m thinking about whether she or he will be able to get into their house after their surgery.  It’s something new students or residents learn on rotations with me; that is, an essential part of the background information for a rehabilitation patient is the type of home they live in and how many stairs there are to navigate.  Is the home single level or two stories?  How many steps are required to get into the house, from the front, the back, or the garage? If a ramp was needed, is this feasible—not just is there the space required (one foot length for every one inch rise of step per the American with Disabilities Act), but more importantly, does the patient or family have the resources to get the ramp installed?  In Reno, due to the continual construction boom, it’s usually difficult to find builders to complete a ramp in the time a patient is doing inpatient rehabilitation, usually about ten to fourteen days.  What if a patient doesn’t have the money to build, buy, or rent a ramp?  What if they live in a second story apartment without elevator access? 

I remember once a young guy who had a car accident resulting in a broken femur, for which he was not allowed to bear weight on this leg, for eight to twelve weeks.  He was strong, and the therapists were able to show him how to use crutches to get upstairs, or how to scoot himself up backwards on his bottom.  But most patients with fractures on the inpatient rehabilitation unit are frail elderly women and men who absolutely cannot manage crutches or scooting on their behinds. So, where do these patients go after their rehabilitation?  

Some patients are able to do more rehabilitation at a nursing facility, though there is a limit as to how long they can stay there as well, and sometimes their weight bearing restrictions on their limbs last much longer than their insurance coverage.  What then?  I once had a patient who had broken her ankle, lived in a two-level home that had twelve steps to get to the main floor, where the kitchen, bedroom, and full bathroom were located.  Her husband was trying to see if he could scrape together enough money for them to move to a first floor senior living facility, which turned out to be cost-prohibitive, thousands of dollars over what their monthly social security could afford.  It saddens me that there are challenges for the elderly to find accessible housing they can afford.  Some are fortunate to have children who can house them for short time periods, but many aren’t so lucky.  

For the homes my husband and I have been blessed to purchase, one here in Reno, and a small townhouse up in Anchorage, stairs were on my mind, and one of the first things I told our realtors for our search criteria. "We must have a single level home with no steps to enter, or a two-story home that has a first-floor set-up," which means a bedroom and full bathroom with a shower or tub on the first floor.   That way if Ronando or I  have a hip fracture or some other orthopedic surgery—my knees and toes are not happy with all the miles I’ve put on them during my competitive athletic years—we will have an accessible home.  So yes, steps are always on my mind when I am taking care of patients.  It might not be as important as blood sugar or red blood cell counts, but a body’s ability to get inside a warm and safe home is a basic survival need.  With a place to lay one’s head in a bed as well as an accessible toilet and shower, healing can continue.