Dwellness^™ • Home Environment

Home Environment

Dwellness^™ customization for:

Your Patient

Input for All Senses

General Principles

Our customized home environment is designed to lower toxicity, facilitate medical procedures (routine and emergent), encourage safe physical activity/mobility, foster cultural activities, build social contacts, provide for caregiver comfort, and maintain infection control.

→ CAUTION: There are times when you need to use products with chlorine (bleach, scouring powder) for disinfecting in very difficult circumstances. Use these products only very seldom. Use products with chlorine only with plenty of ventilation, and not close to your patient in any way. Rinse thoroughly afterwards. ←
→ CAUTION: Do not use any of the common, chemical disinfecting products such as Lysol cleaners, wipes or any similar products. These can cause serious allergic reactions. ←

Home Environment Factors

• Seventh Generation Disinfecting Bathroom Cleaner
• For cleaning toilet surfaces (not the bowl)
• Clean bathroom floor for minor cleanups
• Store on the floor or under the sink — do not set on the counter
• Seventh Generation Disinfecting Multi-surface Cleaner
• For surfaces with which we have frequent contact — no toxicity
• Can be used for any surface, including surfaces that come in contact with food
• No need to wipe away after spraying
• Store on counters or tables, do not set on the floor
• Seventh Generation Toilet Bowl Cleaner
• Use instead of chlorine-based scouring powder
• Restore Natural Products EnzAway Spot Remover — or…
• Biokleen Bac-Out Stain and Odor Remover
• Both of the above are enzyme liquids
• For use on bodily fluid spills, every day on the wheelchair, and other places where you want to remove either a stain or an unpleasant odor
• Put the Biokleen product in a good-quality spray bottle for best results
• Seventh Generation Laundry Detergents
  → CAUTION: Never use chemical fabric softener — liquids or dryer sheets. Avoid allergic reactions. ←
• There are some good detergents that are equivalent
• Rug Doctor Oxy Deep Clean carpet shampoo
• For general carpet and upholstery cleaner
• Be sure to rinse after shampooing

• 2X Revolution Carpet Cleaner
• Be sure to rinse after applying and removing the carpet shampoo
• Winix 9500 Air Cleaner
• Vacuum the filter once a month
• Wash the filter once every three months
• Replace the filter once a year
• Aprilaire Model 224 central humidifier
• Ideal year-around humidity is about 50%
• Required only in winter months
• Adjust for seasonal changes
• Extreme cold weather needs more humidifier activity
• Ordinary cold weather needs less humidifier activity
• Spring and summer (air conditioning)
• Turn off the humidifier
• Replacement parts
• Annually, replace
• Water Panel
• 4004 In-line Strainer
• 4021 Red Orifice
• Adjust with the Aprilaire controller attached to the furnace
• Check the humidity regularly with a humidity measuring device in the living room
• Furnace
• Use the thermostat in the living room
• Generally, the best temperature in the house is around 72°F
• During hot months that need cooling, point the metal arm on the furnace vent to "Summer"
• Anticipate and adjust for seasonal changes
• Change the filter every six months

[Refer to "Seizure Monitoring" for more information about potential seizures.]

• Since starling can trigger seizures, avoid sudden loud noises when possible
• For example, before you cough or sneeze say, "I’m gonna sneeze (or cough)."
• If you’re turning on a machine (eg: blender or vacuum), announce it first

Home Spaces

• Three main choices for seating
• Rifton Activity Chair
• Quickie IRIS wheelchair, with custom molded supports for scoliosis
• Leggero REACH (Model #3004-1003) portable folding wheelchair
• The REACH is used mainly for outings that require a folding wheelchair
• The main source of recorded music is the Apple Macintosh Mini on the computer table
• Hardwired into the Bose Solo 5 sound bar
• Use remote control to operate
• Computer keyboard (Bluetooth) is kept on the shelf under the table, to avoid damage from food or water spilling on it
• If you want to connect a different Bluetooth device, press the Bluetooth button on the remote control and pair your device
• Secondary source of recorded music
• iPad, connected to Bluetooth speaker that hangs from the back of your patient's Quickie IRIS wheelchair
• The speaker is UltimateEars Wonderboom Bluetooth
• Live sources of music
• Guitars, winds, drums, cymbal, harmonica, etc…
• Piano
• Keyboards (Yamaha PSR E333)
• Your patient plays trumpet
• Encourage your patient to buzz lips
• If your patient's energy is up, try holding the trumpet to the lips and encourage playing
• Yamaha YDD-40 Drum Machine
• Whenever your patient is seated next to the caregiver chair, place chucks on the floor under the chair
• In case of briefs leaking
• In case of food or medicines spilling
• Online social connections
• Use the iPad, mounted onto the holder on the microphone stand
• Use a cable to connect the iPad to the Bose SoundLink Mini
• Set the SoundLink Mini to "Aux"
• Perform a level test: play music through the speaker and set a high volume level
• The clothes for everyday use are located in a small dresser in the living room
• Changing location of chairs
• If you will be working in the kitchen for a while, place your patient chair just outside the kitchen so you can keep a closer watch while you work

→ CAUTION: As your patient plays, crawls, and climbs alone in the bedroom, there is always a risk that your patient will get into an uncomfortable or unsafe body position. Do a visual check every few minutes. Listen carefully to any sounds your patient makes, being aware of your patient's sounds of stress. If your patient suddenly goes silent, go into the bedroom. ←
→ CAUTION: Even though the bedroom is set up to be safe, there are always risks to leaving your patient alone for too long during playtime. Be sure to listen very carefully to sounds your patient makes in the bedroom. Be sure to do visual check on your patient every few minutes. ←

• The bedroom is set up as your patient's safe domain
• Your patient loves to kneel on the floor, raise up arms, and tumble forward onto the floor
• This provides very good vestibular input
• This requires that you keep your ears and eyes on your patient to ensure safety
• Safety is the key to your patient using the bedroom alone, with frequent visual checks
• Bed
• A king-size bed is on the floor, with a low-profile frame holding the box spring
• The box spring mattress has a king-size Tempurpedic memory foam overlay
• The memory foam overlay helps your patient sleep better
• Discourages skin breakdown or "bed sores"
• Floor and walls
• The entire floor space in the bedroom is lined with SporTime TechnoMat interlocking athletic mats
  

  [NOTE: Any safe athletic mats can be used, but make sure they aren’t likely to shift. The interlocking mats are safest.]

• The walls next to your patient' bed are lined with thick athletic mats
• The edge of your patient's open bedroom door has an athletic mat pressed up against it
• Furniture
• The "table" is an athletic mat block made for toddlers to climb
• Wedges are used in two places, providing extra padding and space for objects
• Contents
• Avoid hard-surfaced toys and other objects in the bedroom
• Avoid any objects with edges, corners, or points that can damage your patient's skin or eyes
• Toys should be soft, stuffed animals or padded activities
• Toys should be multisensory, such as soft animals that talk or soft activities that talk and interact with your patient

[NOTE: As soon as your patient crawls to the doorway, the rule is that your patient will be helped to stand up and walk to a chair in the living room. See "Rifton Activity Chair Transfers" and "Wheelchair Transfers". He does not crawl anywhere outside of your patient's safe bedroom environment.]

→ CAUTION: Always keep a large bathroom rug that has a non-skid base on the bathroom floor. This provides adequate grip for your patient's stance and yours, and is a certain amount of padding in case he has to go to the floor. ←
→ CAUTION: NEVER MOVE AWAY FROM YOUR PATIENT IN THE BATHROOM. NEVER LEAVE YOUR PATIENT ALONE IN THE BATHROOM. ←
→ CAUTION: When your patient is standing in the bathroom, always stand behind your patient. If you have to reach for something or move sideways, then always keep at least one hand behind your patient. ←

• Keep the bathroom stocked with supplies that might be needed for Toileting
• Keep the bathroom sensory environment refreshed
• Always bag up any soiled briefs and supplies in the bathroom
• Dispose of soiled briefs and supplies ONLY in the bathroom — not any other room
• Spray surfaces with non-toxic surface sprays
• Use pure essential oils to make home air fresheners
• When changing briefs, put a few drops of essential oils on the baby wipes
• Much of the urine smell is retained by body hair, so be sure to wipe any body hair with the essential oil treated wipes

→ CAUTION: In winter, the ramp will get covered in snow and possibly ice. If you are going out — or anticipating someone coming over — use the push broom to sweep off the snow. If there is ice, use Splash Red-Hot De-Icer or Pretreat if you know ice and snow is coming. ←
→ CAUTION: When returning home in snowy/icy weather, be aware that the ramp might be slippery. Always maintain the supply of de-icer handy, and the broom at hand. ←

• Entry must have durable rugs for placement of the wheelchair when you come in from messy weather
• Take off shoes or boots when you come in, especially in messy weather