Architects Architects are trained and licensed to plan, design, and supervise the construction of buildings and living spaces. They manage coordinating building codes, ADA regulations, and design to create a home that is both functional and aesthetic. There are two reigning schools of thought within architecture. One is that form and function go together, meaning that people must be able to utilize the space designed. The other is that form comes before function, meaning a provocative design is what is most important; therefore, it does not matter if people can utilize the space (Chabot, 2017). Fortunately, most architects who work in the aging-in-place market believe that form and function go together. They will start their assessments and ideas with the built environment first, working their way down to the person living within the space, making the occupational therapy perspective integral at the start of the design process. Builders and contractors Contractors are construction professionals who complete larger- scale projects that can last over several weeks or longer. They are typically the people who will perform the actual construction of the building and will work with architects to ensure that the facility is being built properly, within the confines of the landscape, and is in compliance with building codes. Licensure varies by state and specialty area. Builders are specialty contractors who specialize in the actual construction of the home itself. They often coordinate and manage all other workers on site. Other contractors can be subcontractors to the builder Clinicians should always begin any home modification project with a thorough home safety assessment and client evaluation. The client evaluation would be a typical occupational therapy Techniques for proper completion Regardless of the type of assessment chosen, completion should include a medical history review, examination of client factors, and observations of the client performing tasks in the problematic environment. Clients should always be asked about their concerns and areas of difficulties within their home. When observing a client performing activities in those problematic areas, the clinician should inquire further about which specific portions of the task are most difficult. The four main problem areas of the home are entering/exiting, moving around in the home, and completing bathing and toileting tasks. Older adults may not mention all the areas of difficulty. A good technique to observe the entire home is to ask for a tour. As the client escorts the clinician through the home, the clinician should pay attention to the following: ● Client factors such as client mobility through all areas of the home, overall safety awareness, and ability to use physical features in the home. Commercially available assessments Home safety assessments can be difficult to standardize; however, there are several valid and reliable assessments available. Some can be purchased; others are freely available on the Internet. There is also a recent movement toward electronic assessments, which are available for a price. An evidence-based assessment is superior due to its ability to identify problem areas and inform practical solutions. Formal assessments also allow for a more thorough and comprehensive evaluation of the living environment with little room for error. In no way is the author or the publisher promoting or endorsing any assessment mentioned below. Information is being provided for the reader’s awareness of its existence. Other assessments may be available and not mentioned at this time. A clinician should examine all available materials and choose the one that would work best for the clinician and client. Checklists Home safety checklists are available online. Rebuilding Together and the CDC both offer a free checklist (CDC, 2005; Rebuilding
for elements such as plumbing and electrical work (Chabot, 2017). Municipalities will have varying regulations regarding the licensure and certification of these professionals. Interior designers Interior designers are trained and licensed to address the layout and aesthetics of spaces. They focus on the functionality of an area, incorporating lighting, room colors, flooring, and furniture choice/layout. Interior designers have the option to specialize in healthcare, residential, and kitchen/bath design, among other specialties. They concern themselves with the human element of interacting with a space in every project they encounter (Chabot, 2017). Physical therapy As previously mentioned, home modifications and aging in place are emerging areas for physical therapists. Becoming part of the team will require much education on a physical therapist’s contribution and networking with design professionals. Physical therapists have the medical background but also understand the relationship between independent functioning during daily tasks, medical conditions, prognosis and the aging process, and the wants and needs of the individual. Physical therapists may review designs and advocate for either an alteration of ADA features or extra safety features beyond ADA guidelines in order to individualize and enhance the environment as necessary. Physical therapists bring the person back into the environment.
HOME ASSESSMENTS
evaluation, with a medical history and examination of client factors, habits, roles, and routines.
● What is the upkeep of floors, walls, appliances, lighting, etc.? If poor, is it due to the age of the items or because the client may be having difficulty with maintenance? ● How much lighting is available in all areas of the home? ● How wide are doorways and hallways? Are all pathways clear? The clinician should have a small measuring tape available. ● Are there other people or animals using the same spaces as your client? You may choose to discuss your observations during the tour as you inquire further into any areas you identify. It is also acceptable to discuss your observations after the tour, although it can be easier to discuss during the tour, asking the client to demonstrate performance in various spaces. Often, a client interview/observation in addition to an assessment will provide the most comprehensive evaluation. Together, 2017); other checklists are available on the Internet. Checklists are quick and easy, and can be completed as a self- report. They often provide modification suggestions on the form. However, they rarely have reliability and validity studies completed on them. They also focus more on hazards, rather than the actual use of the environment. Standardized assessments Other home assessments are available, often for purchase. These include: ● Craig Hospital Inventory of Environmental Factors (CHIEF). ● Housing Enabler. ● Comprehensive Assessment and Solution Process for Aging Residents (CASPAR). ● Home Falls and Accident Screening Tool (HOME FAST). ● In Home Occupational Performance Evaluation (I-HOPE). ● Safer-Home v. 3. ● Home Environment Assessment Protocol (HEAP). ● Home Safety Self-Assessment Tool.
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