the woman now requires the use of a walker. Her sister’s home has stairs at the entrance and narrow hallways that do not accommodate a walker. The lunches stop because her sister’s home does not support her abilities. Some might say, why not move the lunches to the other sister’s home? Perhaps the sister All clinicians are aware of the importance of the therapeutic use of self and the proper approach to achieve buy-in from their clients. The same concepts apply to aging in place and home modification recommendations. Changing the home environment can be unsettling for some; therefore, the proper approach is very important to receive an agreement to proposed modifications. There are four different kinds of people: “practical planner,” “rugged pioneer,” “where I belong,” and “rooted Addressing concerns A clinician can employ several strategies to communicate effectively with older adults and alleviate any potential concerns they might have about changes in their home and the entire process. First, the client should be involved in all conversations. Often, the client comes with other stakeholders, such as family members and interested friends. Staying focused on the client and/or powers of attorney are key in this situation. Pay attention to nonverbal cues, and allow them to have a chance to process all the information provided. There may be competing values from the various stakeholders, such as cost versus benefit, safety versus resale value, etc., that need to be addressed. Often, having several modification solutions for one problem can put competing values at ease. Much of handling concerns is open communication Handling refusals As the saying goes, change is hard. During the aging process, people lose mental flexibility and become even less adaptable to changes in the environment. Resistance to recommended home modifications and age-in-place features comes from a lack of information on the subject, fear of the future, or a belief in a personal inability to cope with a disruption in daily life or to new routines (Rioux, 2005). However, these are all factors that can be remedied through the proper therapeutic use of self, communication, and education on the side of the clinician. Open and honest communication without pressure works well. It is important to remember and acknowledge the emotional attachments to the home. Knowing which of the four types of person (practical planner, rugged pioneer, where I belong, and rooted in place) with whom the clinician is working assists in communicating appropriately with the person and understanding his or her values. Utilizing those values to frame the modification Monetary concerns It is not uncommon for charities and other organizations to require someone to own their home prior to home modification completion. Empowering clients with knowledge of the Fair Housing Act when speaking with landlords can help with some of these issues. Being knowledgeable of eligibility requirements for local resources helps with connecting clients to the appropriate Many people choose to self-pay or take out private loans to complete their home modification work. A clinician should always consider both present and future needs so as to prevent future work and costs, on top of maintaining function for a longer period of time. Some home modifications and repairs can be tax deductible. Homeowner insurance companies sometimes offer discounts to people who have proactively completed necessary home modifications. County sources The county may provide some assistance to people who wish to complete home modifications. Some counties provide loans that are repayable over the rest of their lifetime, then out of their estate upon passing. Other counties and sometimes cities have nonprofit organizations that will provide grants or work, though assistance. Financing
does not drive or has a significant health condition herself. Visitability considers the involvement of friends and family with their special health concerns so that social isolation does not inadvertently occur.
PRESENTING MODIFICATIONS TO THE CLIENT
in place” (Severinsen, Breheny, & Stephens, 2016). Practical planners consider the social supports and services available before considering the living environment. Rugged pioneers find strength in facing adversities in their environment. “Where I belong” people have a great emotional attachment to the home. Finally, people who are “rooted in place” see the home within the community, with a strong attachment to that greater community. and compromise with all invested parties. Many people may want to be involved who have no legal obligations, such as extended family members without power of attorney and friendly neighbors. As with handling these people in the clinical sense, it is best to acknowledge them gently but share information and solutions with the right stakeholders. Older adults take more time to process novel information. Coupled with the imminent change in routine, home modification work can be highly unsettling. Over communication can go a long way to settling anxiety around the entire process, and will allow all involved parties to have a clear idea of expectations and the sequence of events. can alleviate concerns and reverse possible refusals that come from fear of change. A discussion to delve into the reasons behind the refusal should also occur so that emotions and thoughts can be acknowledged. Compromise also helps with refusals; it allows the older adult to remain in power and have a voice in changing the home. Another useful technique is to frame suggestions as a story about someone else. Sharing the story of someone who had a certain modification completed might change someone’s mind. Along the same lines, discussing how certain changes would help other people who would come to visit also increases the chance of approval. Few people openly embrace change and acknowledge their aging, but they tend to be more willing to accommodate and help others. Storytelling is a very powerful tool in this process. these can sometimes have a waiting period of several years. The county’s area agency on aging should have information in this area for inquiring minds. Other county based resources include Habitat for Humanity and Rebuilding Together. Some Habitat for Humanity groups now offer home modification services; if they do not include a rehabilitation specialist such as a physical therapist on the team, it could be a valuable advertising opportunity for the clinician. With Habitat for Humanity, the client or family will be responsible for a portion of the cost, in keeping with Habitat’s mission to provide full ownership of the home. Rebuilding Together will complete home modification work free of charge to older adults of limited means. They typically do have a volunteer occupational therapist on the projects. If your client has a specific condition, such as multiple sclerosis, cerebral palsy, or amyotrophic lateral sclerosis, the respective association often has funds to assist with home modification projects. It is also possible to ask local charities, organizations, and neighborhood groups for assistance in some of these areas.
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