Home Modifications

based on learning objectives from home modifications lecture slide deck

What are home modifications appropriate for?

to improve function (behavioral, cognitive, and physical), improve safety, decrease caregiver burden, and increase life participation

What is the role of OT in the multi-step process of home modification?

provide a comprehensive evaluation of personal and environmental factors, resolve the incompatibilities between the person and the environment, obtain/install the modifications, train individuals to use modifications

What are the 6 dimensions of “home”?

1. Physical - structure, services and facilities, space, lighting, location

2. Social - relationships in and outside of the home

3. Occupational - meaningful activities, doing, being, belonging

4. Societal - political and economic influences

5. Temporal - routines and order, past, present, and future

6. personal - safety and security, privacy, control, freedom, independence

Describe the “new” clinical framework that can be used by OTs to implement home modifications

• based on the PEO model

• designed for individuals who are "trapped” in their homes

• client-centered approach to remove barriers and build environmental supports

• intervention strategies (caregiver education, modifications, recommendations/training)

• organized around sustaining independence, community reintegration, and enhancement of well-being

What are some goals of a clinical application framework that support home modifications for a person with a disability living at home?

• improve occupational performance in the home

• improve the quality of life

• build family’s and client’s skills/knowledge of resources

• decrease the risk of premature institutionalization

• train on use of modifications

• increase capacity of caregivers to provide supportive care

• provide assessment and intervention in the everyday context

What is the responsibility of an OTP in an inpatient rehabilitation setting in regard to home modification?

therapist visits the client’s home prior to discharge from the hospital to determine the types of environmental barriers present in the home

What is the responsibility of an OTP in a home health setting in regard to home modification?

therapist observes the home environment and recommends equipment and modifications

What are some examples of environmental modifications?

• changes to the physical environment - add grab bars, remove rugs, renovate, etc.

• modification of the occupation - use emergency service w/ necklace for assistance (life alert)

• supports from people - join/visit a social group to gain knowledge and access community resources

What is “the meaning of home”?

more than just a physical structure, can include the physical space, objects within the home, meanings with the structure by those who dwell in it, etc.

What is the role of the client in the home modification interprofessional team?

• participates in evaluation of performance of ADLs in the home

• reviews the range of intervention options available and selects the preferred modification/implementation

• receives training in the use of home modification interventions after installation

What is the role of the family members in the home modification interprofessional team?

• provide additional input for changes, especially in areas of shared space

• understand the roles and occupations of the family members currently living in the home

• may receive training in the use of home modification interventions after installation

What is the role of the occupational therapist in the home modification interprofessional team?

• evaluates client’s occupational performance within the home

• identifies supports and barriers to occupational performance in the home

• identifies range of options for removing barriers and maximizing occupational performance in collaboration with other team members

• communicates recommendations

• implements interventions

• provides follow-up education and training to client and family

What is the role of the contractors in the home modification interprofessional team?

• understand building construction

• provide guidance to modification possibilities

• estimate the cost of home modifications

• install home modifications

• hire and supervise any subcontractors

• understand building codes

• coordinate complex teams of building professionals

What is the role of the interior designers in the home modification interprofessional team?

• assist with design of interior space

• collaborate with home modification team to identify potential intervention options

What is the role of the architect in the home modification interprofessional team?

• designs the physical layout

• prepares plans needed to obtain building permit

• understands local building codes and regulations

• coordinates complex teams of building professionals

What are the steps of the occupational therapy process for home modifications?

1. Referral

2. Evaluation - two elements are occupational profile and analysis of occupational performance

3. Considerations of Assessments - ownership/control, payment/reimbursement, consultation/direct service, home modifications/audits/accessibility

4. Interventions - prevent, modify, create/promote, maintain

5. Considerations during Intervention Planning - type/ownership of home, condition/layout, needs of all residents, cost/client preferences, culture

6. Targeting of Outcomes - occupational performance, prevention, health/wellness, quality of life, participation, role competence, well-being, occupational justice

7. Discharge - should occur when client achieves established goals, client achieves max benefit from skilled OT services, home modifications are no longer needed

What are some primary topics found in a systematic review of home modifications?

• fall reduction/prevention

• frail older adults

• improving functional performance

• significant functional impairment

• post-op hip repair

• low vision

• schizophrenia

• dementia