EXCLUSIVE: How to achieve best value and overcome the barrier of steps and stairs

Peter Wingrave, Director at stairclimber specialist AAT GB, looks at how alternative prescription can expediate adaptations and hospital discharge.

The delay in delivery of home adaptations has been much in the news of late, even featuring on primetime TV.

The industry is trying to respond with a raft of new tools, including revised UK Government guidance on Disabled Facilities Grant (DFG) implementation, Foundations’ Adaptations Triage Tool, and Foundations’ latest offering: a report into the social value of aids and adaptations provided by Home Improvement Agencies (HIAs).

The situation is not new. Indeed, back in 2019, the Royal College of Occupational Therapists produced its guidance, ‘Adaptations Without Delay’.

Occupational therapists themselves admit it is not due to lack of available funds particularly, more about use of resources and reluctance/resistance to change from the conventional. Yet one thing covid has taught us is that there are different – and often more efficient – ways of working to achieve the best result.

Stairs – one of the most common adaptations

A survey by Habinteg Housing Association/YouGov found more than 50 percent of people questioned felt inability to deal with stairs would necessitate their moving home if they became disabled. Say stairs, and we think of a house; 20 percent of the population live in flats, the majority of which are three storey blocks or less, and for which there is no legal requirement to provide a lift. Therefore, up to 4.7 million people could become trapped in their homes if their mobility becomes impaired.

Addressing stairs is one of the four most common adaptations and actually is one of the easiest to resolve, even when involving “common parts”.

While dealing with stairs is perceived as a major adaptation in that it requires a professional assessment, implementation of a solution can be a minor adaptation, requiring supply of an aid from stores that requires no physical alteration to the building fabric (making good when no longer needed etc).

Front and centre – the ubiquitous stairclimber

It’s a dichotomy. Almost every local authority in the UK has some in its stores; we alone have supplied thousands in our 20-year history. Yet a large proportion of OTs and adaptations professionals are unfamiliar with the concept.

Let me first explain what a stairclimber is.

It’s a battery-powered device that can either include an integral seat or be attached to a wheelchair, and versions feature wheels or tracks. It features kinematic technology to smoothly – at a rate set by the operator – power up and down stairs and to another room. For safeguarding, there is no need to transfer on or off at the top/bottom of the flight, thereby eliminating a potential high-risk process; a substantial range of harness options and accessories are also available. These further ensure optimum comfort and safety, and facilitate re-issue. When not in use, it folds away.

As the stairclimber can be easily adjusted to each user, the one piece of kit accommodates recipients irrespective of age or size and can be altered to address longer-term prognoses.

It is not structurally fixed to the property, nor does it involve creating new penetrations through the building structure, so it requires no structural survey and does not impact on the rest of the household living daily life without impediment.

All that is needed is a capable carer and a couple of hours’ training them to ensure optimal safety for them and their loved one.

Even if only intended as a short-term solution, it’s a proven prescription to minimise risk while a more substantial adaptation is processed or a family rehomed, as in the way stairclimbers are used by authorities including Essex and Hertfordshire County Councils.

In appropriate circumstances, it avoids the usual short-term solution of bringing a bed downstairs or moving one into the lounge. It avoids the usual longer-term scenarios.

Installation of a stairlift impedes other members of the household’s ability to use the stairs with ease, or part of both floors is lost for a through-floor lift to be installed. If the client lives in a townhouse, conventional options of a stairlift or through-floor lift could be multiplied by two, doubling the cost.

Peter Ellis, whose family was supplied with a stairclimber for daughter Rhian when the through-floor lift broke down a decade ago, explains: “The design of the staircase means it’s not practical to fit a stairlift, and to be honest, we prefer the stairclimber to the through-floor lift we had, as it frees up space with is in short supply anyway.

“The design of the stairclimber, with arms that swing out of the way to aid transfer, also makes moving Rhian from it to her specialist hospital bed much easier for us. It reduces the strain on us physically, and reduces the number of transfers, as we can just slide her across. Before, we had to transfer her from the through-floor lift to an H hoist and then from the hoist to bed.”

If you live in a flat, how do you get outside if there’s no lift? You face becoming trapped in your home. You can’t usually fit a stairlift in common parts, unless you get the landlord’s permission, but you can use a stairclimber.

Charlotte Backshell’s mum, Pam, lives on a first floor flat in Scarborough; she had to bottom-shuffle down the stairs to get out, until North Yorkshire County Council re-issued a stairclimber from stock.

Comments Charlotte: “The stairclimber’s been a real problem-solver. It means so much to us. The stairclimber is so quick and easy to use, it’s just a couple of buttons to operate. It has been a life-saver. It was so dangerous how we used to get mum out and back home. This way is much more dignified.”

Opening the doors to accessing the wider community

Often, the recipient family has asked to keep the stairclimber in place of a bigger, more expensive adaptation of a through-floor lift. Unlike a through-floor lift or stairlift, the stairclimber opens the wider community to them: it can go with them up and down garden steps (no need to build ramps), shopping, on holiday, moving home…

Certainly, with regard to Foundations’ new report on social value, a stairclimber ticks the boxes. It reduces risk, it helps maintain normality, is has less impact on others, it addresses poor mobility in and outside of the home, and it delivers positive primary and secondary outcomes.

It’s a small change that has a disproportionately significant benefit, that helps the recipient remain in, and access, all areas of their home and their wider community such as church, mosque, or social group. That has positive outcomes for their mental wellbeing – outcomes that would not be achieved by a fixed alternative.

Achieving best value, best use of resources

If there’s a stairclimber available in equipment stores, the re-issue process can be expediated in a matter of days, removing the danger of leaving someone unsupported in inter-level transfer, and can be implemented for less than £1,000.

Even purchase of a new stairclimber can be effected for under £5000 – the ‘no DFG required’ point set by some local authorities. That stairclimber can be taken into stores when no longer needed by the original recipient and re-issued to another user.

Local authorities have access to the mechanisms to facilitate such processes under their Regulatory Reform Orders (RROs). The new DFG guidance recommends use of appropriate professionals. Manufacturers and suppliers are usually fully trained in supporting OTs with assessments to help accelerate the process, often providing detailed assessment notes and clinical reasonings.

Leeds City Council demonstrates the point, using AAT to support the assessment process and manage its stock of stairclimbers.

Leeds City Council Occupational Therapy Team Manager Jane Fisher commented: “Funds and time are under pressure now more than ever. This means we can quickly empower clients to still be able to access all levels of their home, with the peace of mind that the right kit is being supplied, maintained and serviced, and in full working order. It takes a pressure off the already busy stores team, and enables effective delegation and employment of specialised resources so we can make best use of our time and expertise.”

Visit AAT’s website to find out more about stairclimbers, their value to OTs and users, and the supply options available.