A Holistic Approach

Reprinted from Dealer Provider


A Holistic Approach 1
Home modification consultant Adam Fine says breaking the barriers to comfort, convenience, safety, security, and accessibility requires
delivering more than just traditional HME.


By Julie West

For independent living specialist and home modification consultant
Adam Fine, the concept that the home health care supply field is
limited to prepackaged hardware and other products to make mobility
and other basic functions of daily living possible for otherwise
sedentary people is an invalid and antiquated concept.

A Holistic Approach 2Consumer demands, changing demographics, the introduction of innovative products and new technology, and added comprehensive services designed with active and independent lifestyles in mind are transforming the
HME industry, he says. As a result, the perception that the primary role of HME suppliers is to provide canes, crutches, braces, reachers, wheelchairs, scooters, hospital beds, and lift chairs is passé.

In his company, the Los Angeles-based design firm Accessible Design and Consulting Inc., he puts into practice the belief that HME dealers
need to stock more than just the basic equipment they traditionally provide. They also need to offer devices that simply make life easier,
safer, and more accessible. The goal is to provide greater comfort, convenience, and security to customers.

“I offer a ‘one-stop-shop’ approach to my customers in the privacy of their own homes,” Fine says. “Delivering comprehensive service is the
way business should be conducted. I’ve had customers who are so thrilled with the positive impact that a product made in their lives that
they have hugged me.”

Hands-On Style
Home modifications have taken on new meaning at Accessible Design and Consulting under Fine’s direction. To him, any floor plan can be
modified, and only structural beams need to remain as they initially appear. Breaking down barriers for easy access is the bottom line, and
accommodating and overcoming physical challenges does not end with supplying appropriate DME. Acquiring true independence in daily
living takes a more holistic approach to assistive technology. It becomes an affirmative mind-set and a comprehensive way of life.

Typically, Fine starts with a thorough needs assessment with the consumer and/or an occupational therapist who works with the
customer. He begins his overview of the customer’s needs at the front curb of the home and extends it to the back yard. He studies every
aspect of the customer’s life and every room of the home so he can compile a complete list of assistive products.

“Every home is different and each customer has different abilities, requests, and financial means,” he says. “Thus, each project that we do
is very customized because I want my work to reflect my customer’s comprehensive needs and improve their overall quality of life without
compromising the aesthetic appearance or value of their home. I seek to increase the functionality, appearance, and ultimately the possible
resale value of any home that we modify.”

Common services include custom bathroom and kitchen modifications, accessible shower and bathtub installations, personal elevator and
stairlift installations, accessibility ramp construction, doorway widening, grab bar installation, and adjustable work station setups, as
well as adding shower chairs, portable bidets, and mobility aids (such as power chairs) to the home.

“I listen to my clients’ desires and I’ve learned to recognize their needs,” Fine says. “I attempt to immerse myself in their daily living
routine while simultaneously attempting to see things from their perspective and ability level.”

For Fine, this means taking a hands-on approach. When he started working in home health care, he used a wheelchair for a day so he
could begin to understand and recognize many of the unnecessary barriers that his clients encounter-and he puts an emphasis on
listening to clients. “There are many ways to help a customer, but good old-fashioned sitting down with them, taking a good look at their
situation, listening to their needs (both obvious and hidden), and then finding a solution that fits with their budget seems to work best for us,” he says.

A Holistic Approach 3Inspired Ingenuity
Fine is unique in the home modification field because many of his adaptations are anything but typical home health care aids. Through necessity and inspired ingenuity, he has incorporated some unusual modalities into his repertoire for construction. Some of the state-of-the-art devices that Fine uses include moving sidewalks, folding ramps, pools hidden below living room floors, skid-proof Italian tiles, heated floors, rising and sliding walls, retractable and hydraulic countertops, extendable shelving, individual sound chambers and home theaters that are incorporated into surround-sound vibrating
chairs, personal simulated motion machines, cantilever lofts, mezzanines, verandas, touch-activated stimulation and relaxation rooms, hydraulic lift chairs, stairlifts and glide systems, and private elevators.

But major or elaborate home modifications are not the only means to increased comfort, convenience, safety, security, and enjoyment in a home. There may be several ways to improve the overall quality of life
for any customer. “The smallest modifications, such as grab bars in the bathroom and devices or strategic positioning of units that simplify the
use of light switches and telephones, can be the key to safety and independence,” Fine says. “The length of time an individual can live
independently at home with a high quality of life is increased through these relatively simple home improvements.”

While many HME suppliers use standard ready-made products, Accessible Design and Consulting’s approach is to custom fit and/or design products to meet each consumer’s individual needs to best
accommodate their own specific environment. Properly implemented, HME and many assistive technology products can serve as alternatives
to expensive home additions. For example, a wall-bed armoire that resembles an entertainment center can take the place of adding an accessible first-floor bedroom onto a house. And if a wall bed is not an option, mobile room dividers can create some degree of privacy.

“All of our designs and augmentations are custom-made or altered to fit each customer’s own personal lifestyle, physical abilities, and health
requirements,” Fine says. “There may be several options to meet any one set of challenges. Because this business is so customized, there is not a cookie-cutter approach, and sometimes customers might have to
try several different products until they find the product that best suits their specific need or challenge.”

When they do, the results make all the challenges of providing health supplies and home modifications worth it. “The gratification that I get from helping my customers is one of the main reasons why I love my job so much.”

Julie West is a contributing writer for Dealer/Provider.

Ramping Up

On the surface, ramps appear to be one of the simplest of home modifications, making them attractive to both HME providers seeking to expand into this area and building contractors seeking to expand into home health care. The problem is that there is a lot more to them than just putting down some plywood boards.


“I have seen some ramps that are jokes,” says Adam Fine, an independent living
specialist with Accessible Design and Consulting Inc., Los Angeles, who has been doing ramps for the past 4 years. People with good intentions often put up makeshift solutions that actually end up being a safety hazard, he says. Some ramps are built without curbs on the side so the user could fall off, others are not properly weather treated so they sag after it rains, and most improper ramps are far too steep. When problems develop, Fine is called in.

So, where does one begin when installing a ramp? With a little basic high school geometry, says Ella Chadwel, company vice president of Life@Home, Nashville, Tenn., which has provided ramps for the past 5 years. As a general rule of thumb, there should be a foot of ramp for every inch of rise, she says.

And while in many parts of the country you do not need to comply with the Americans with Disabilities Act (ADA) guidelines for ramps for private homes, and you do not need a contractor’s license for jobs under $500, learning the guidelines and getting licensed can be valuable in marketing your company as a superior ramp provider.

The next step is learning how to carefully assess a client’s situation and listen to their needs. Factors that come into play include:

1. The environment the ramp will be put into. Is there enough space in front of the steps to create a ramp that is not too steep, or will the ramp need switchbacks to create an appropriate incline?

2. The needs of the user. If the person is in a power chair, he or she may be able to use a slightly shorter ramp with a steeper incline because the chair provides the power to get up the ramp, Chadwel says. On the other hand, an elderly person with balance problems and a walker may be unable to safely walk down even a gently sloping ramp and instead would do better with steps that are only half the height of normal steps and twice the depth.

3. The needs of others who come to the home. For example, a quadriplegic in a power chair has no use for handrails, but the person’s caregiver or elderly friends may need the handrails to use the ramp. “With our customers there are usually two household members who are aging, and they have elderly friends who like to visit,” Chadwel says.

4. The wishes of the homeowner. If he or she plans to eventually sell the house, installing a ramp that is hard to remove can lower the value of the property by impacting the home’s aesthetics, Fine says.

5. Cost constraints. When a patient has limited funds, coming up with a ramp that fits his or her budget and is still big and sturdy enough to be safe can be a challenge. “I might recommend a 10-foot ramp and the customer will say, ‘I don’t want to spend $1,000,’ and I will say, ‘You can get an eight-foot ramp, but I’m not going to be responsible for its safety,'” Fine says.

Instead Fine works with customers on alternative solutions, such as less expensive portable aluminum ramps. “A lot of people don’t know that these little aluminum ramps exist,” he says. “For every wood ramp I sell, I will sell 20 aluminum ramps because they are cheaper and they are portable.”

For more information about ramps, contact Accessible Design and Consulting at
www.accessibleconstruction.com, (310) 215-3332 or Life@Home at www.lifehome.com, (800) 653-1923.

– Lena Lindahl