1. Training Facilitators to Conduct the Remembering When Home Visit
This presentation should be given AFTER participants have learned the Fire and Fall Prevention Messages
Materials Needed:
Large Print Home Safety Checklist, Large Print Prevention & Safety Tips handout (Found online; w/ customizable contact information box)
Fire and fall messages
Safety tip sheets
Review and refer to the “Enhancing Communication” handout (found online) to support conversations that reflect the spirit of Motivational Interviewing. (Motivational Interviewing is a communication technique that will help the older adult participants identify their own motivations for taking on safe behaviors). The handout will be a useful resource for anyone conducting home visits.

2. How to Conduct a Home Visit
By the end of these modules, you will be able to:
use the Remembering When resources to support an effective visit.
explain the components of a typical home visit.
infuse MI strategies into home visit conversations.
interact with older adults in a caring, respectful manner.

3. Remembering When Program Book: Home Visits
You will find information about:
Working with established agencies
Training for home visitors
Guidance on preparing for a home visit
Home presentation ideas
Smoke Alarm information
Other safety information

4. Handouts for Home Visits
Remembering When Flyers: regular or large-sized print
Fire Prevention & Safety Tips
Fall Prevention & Safety Tips
Fire & fall prevention behavior message cards:
Table-top paper display or e-tablet view
Safety tip sheets:
Home Fire Escape Planning, Fire Safety for People with Disabilities, Medical Oxygen Safety, High-Rise Safety… and others.

5. How to Use the Home Safety Checklists
During the home visit:
 Use to survey home hazards
 Use as a basis for conversation
 Point out corrective measures
 If corrective measure not immediately possible:
-Discuss problem with resident to heighten awareness
-Give referral sources if possible.
The home safety checklists should be used after the resident has granted permission. It serves as a tool to help residents identify potential hazards they may consider addressing. It is not a contract.

6. Use similar thinking during a home visit:
What is happening in this picture? What factors might be at the root of her fall?
Use similar thinking during a home visit:
Conduct an observational assessment when you arrive at the home.
Make mental notes to help you prioritize next steps.
Address obvious hazards first.
BRAINSTORM:
Skates on ice!
Poorly sharpened skates
Rough, bumpy ice surface
Sudden, loud noise took her by surprise
Spotlight shined in her eyes…
Her confidence is off
Inner ear trouble affecting balance
Costume not fitting correctly
She saw someone in the audience who took her by surprise
Her concentration was broken
She was moving too quickly
She is inexperienced – hasn’t performed this move often
Feeling the pressure of watchful eyes
Etc etc…
The point here is that when we go to a home, we will make observations immediately. We want to get into the habit of thinking about potential underlying causes of potential hazards. Sometimes the first issue that comes to mind may not be the most important one.

7. Activity:
View the image on each slide.
Discuss the hazards and how you could address them using Remembering When materials. Determine if there is a need for a referral.
Left Side:
Fire Hazards: candles with open flames on stairs, decorations near candles, candles could get bumped when someone walks by and get knocked over, dangling clothing could catch fire…
Fall Hazards: candles on stairs, stocking feet, no hand rail, treads and risers are same color…
Right Side:
Fire Hazards: space heater too close to blanket, rug, and person,
Fall Hazards: space heater cord is trip hazard, stocking feet, holding magazine far away – vision issue?

8. Home Visit Structure At the beginning of the visit:
Thank the resident for allowing the visit
Scan the home & make mental notes about obvious hazards
Use EPE to ask permission to use the home safety check list and share safety information
Seek collaboration & emphasize autonomy
Review the content in the “Enhancing Communication” handout
Practice EPE: Elicit Provide Elicit
Helpers should communicate a sense of collaboration to clients. Developing partnership early will prevent the helper from making assumptions that the client wants or needs the information. The EPE method guards against the notion that clients will magically change by virtue of the helper sharing information.
E- Elicit- The helper should ask clients what they already know about the topic being addressed. The helper will LISTEN to what the client has to share and reflect a bit on what is heard.
P- Provide- The helper will ask permission to share the information related to the topic. Once permission is granted, the helper will share the message about cooking safety, safe lighting, escape plans, etc.
E- Elicit- Check in and make sure the person understands what you said. AND check to see what they think about the information that you shared.
A scenario: Ms. Archuleta is a very independent 68 yr. old who lives alone in a small farming community. She loves to cook and garden. A perfect day for her is one when she is able to spend some time tending to her property. She's on a number of medications for her heart condition and sometimes gets drowsy, needing to nap throughout the day. She keeps a very tidy house, but you notice throw rugs throughout the home, even over her carpeting.
Here’s an example of how EPE might work with Ms. Archuleta:
Elicit: “Ms. Archuleta, what do you know about your medications and any side effects?”
Provide: You know quite a bit. You take those medications very seriously and you’ve made it a point to take them. Can I also tell you a little bit more about how they might be affecting your balance?
Helper- Elicit: What do you think about all of that information? What thoughts do you have about what I shared with you?
Seek Collaboration
Seeking collaboration is another way helpers can show that they see the people they are working with as partners. It helps eliminate the hierarchy in the relationship. When there is a hierarchy, people tend to get defensive and may argue against the behaviors the helper is trying to get them to change.
The following questions are examples of seeking collaboration with Ms. Archuleta:
“Ms. Archuleta, would it be OK if we spent some time today talking about some ways to make your home safer?”
“Ms. Archuleta, I have some information about common causes of falls, would it be OK if I shared that information with you?”
“Ms. Archuleta, what are your ideas for making your home safer?”
Emphasize Autonomy
Helpers put an emphasis on client autonomy by overtly stating that the client is in charge. This is a powerful part of the change process. When the helper reminds both parties that the client is 100% in charge of her own behavior, the change is much more likely to be made.
Here’s an example of emphasizing autonomy with Ms. Archuleta:
“Ms. Archuleta, no one is going to force you to do any on particular thing. You are in charge of your own life and no one can make you do anything you don’t want to do unless you are seriously endangering yourself. If that were to happen, we’d have to make a referral on your behalf.
“You’re the one who knows yourself best here. What do you think ought to happen to keep you safe in your home?”
“Engaging with me around home safety is a something that you see as both an opportunity and a challenge. You are weighing the options and figuring out what will work best for you.”

9. Open questions: Beginning of the visit
What do you like about living in your home?
What concerns do you have about living in your home?
What would be the worst thing that could happen in your home?
What do you have going for you that makes you capable of keeping yourself healthy and safe in your home?
IF you did decide to make changes to the overall safety of your home, what are some reasons that you’d do so?
IF you decided to change, what would need to do?
Open questions convey a sense of curiosity and a genuine sense of really wanting to know what’s going on with the client. Open questions are those that have many possible answers and often start with What, How, Tell me about, or Describe… (Questions that start with Have, Had, Has, Which, How many, Did, Do, and Does are usually closed questions leading to one specific answer.)
Being genuinely curious is a part of the change process. Open questions invite people into the conversation in a more meaningful way. The client is more likely to engage with the helper as they consider their responses.
Here are some examples of open questions to help people consider why they might want to participate in a home safety check:
“What about the way you live in your home now works well for you?”
“What are some of your worries about the way you live in your house now?”
“What would be the worst thing that might happen if you don’t change?”
“If you did decide to make changes in your home’s safety, what might be some of the things that would get better?”
“If you did decide to change, how would you go about doing it?”

10. Home Visit Structure In the middle of the visit:
Ask permission to use the home safety checklist to identify fire & fall hazards in the home. Assure the resident that it is their decision.
Review the Fire / Fall Prevention & Safety Tips. Ask the resident which areas of special concern they’d like to discuss. Highlight areas of special concern identified via the home safety checklist.
Work collaboratively with the resident to identify 3 action steps for fire and fall prevention in the home and review related safety messages. Use message cards, if desired.
Permission is important! It helps to ensure collaboration.
It is important that residents identify their own motivations for making change. If they see the home visitor as someone of power, there reason may simply be “I am doing it because this person wants me to.” This will not likely lead to sustainable change. If the resident see the home visitor as a partner rather than a “boss”, this is less likely to happen.

11. Home Visit Structure At the end of the visit:
Remind the resident of their own reasons for wanting to make change in the safety of their home.
Provide the appropriate handouts
Provide referrals if appropriate
Provide contact information for additional questions.
Invite and encourage follow up.

12. Core Behavior: Smoke Alarms Save Lives
Test smoke alarms to make sure they are working.
Demonstrate how to test smoke alarms and set a schedule for testing.
Ensure the resident can hear the alarms.
Check placement of existing alarms.
One on every level, inside & outside sleeping areas
Refer resident to a smoke alarm installation program if alarms are inadequate.
More detailed information on Smoke Alarm installation can be found on the smoke alarm training presentation.
If the resident is hard of hearing, share information about smoke alarm accessories such as strobe lights & bed shakers.
If appropriate, share the Safety Tip sheet about Smoke Alarms for People Who are Deaf or Hard of Hearing

13. Core Behavior: Create a Home Escape Plan
Help the resident identify two ways out of every room.
Make sure windows & doors open easily.
Stress: If the alarm sounds, get outside & stay outside.
Involve all household members in the planning.
Considerations for older adults:
Personalize the escape based on abilities.
Discuss “Sheltering in Place”.
Practice the escape plan to make sure it is realistic.
Keep a telephone & emergency numbers close by.
Practicing the home escape plan is an important step. Older adults may have had physical changes that limit their abilities to open windows or move briskly through the home. Practice will alert the older adult to any new challenges they may need to consider.
Consider subscribing to a medical alert system
Keep signaling device (flashlight, whistle) near bed in case of emergency
Discuss “sheltering in place”
Review the Safety Tip Sheet on Home Escape plans

14. Home Visits – Let’s Review
Why should you leave a resident with printed information?
Why are the procedures at the beginning of the visit so important?
What are the core behaviors you should include in a home visit?
Questions?
Consider subscribing to a medical alert system
Keep signaling device (flashlight, whistle) near bed in case of emergency
Discuss “sheltering in place”