HOME ASSESSMENTS
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 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).
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. ● Safer-Home v. 3. ● Home Environment Assessment Protocol (HEAP). ● Home Safety Self-Assessment Tool. They all differ from each other in setup, populations, and focus on the home assessment. Most of these assessments have reliability and validity studies with a focus on the functional abilities of the client. However, they do require a skilled professional for completion and may not specifically address/ evaluate the environment (Siebert, Smallfield, & Stark, 2014). Electronic assessments There are two electronic assessments at the time of this publication. Given the movement toward electronic medical records and use of apps in daily life, this number is expected to increase over the upcoming years. Electronic assessments can be useful; they save information in a database, and depending on the assessment, provide different reports. Both available assessments work on tablets. One assessment, the Home for Life app, has features that allow the clinician to rank the safety of the room and the person’s performance, and show pictures of the recommended modifications within the application (Home for Life Design, 2017). The other, the Home Accessibility and Safety Checklist, allows the clinician to rank modifications by priority through determining a desired time frame for completion (Living in Place Institute, 2017). Both allow for pictures to be taken and drawn over. Both are valuable depending on the desired features due to the ability to save information, take pictures to be printed out immediately on reports, and rank modifications without needing to carry paper and pen. Unfortunately, neither is free. Both require an annual fee for use; however, the Home for Life app is available to anyone willing to pay the annual fee. The Home Accessibility and Safety Checklist is only available if the Certified Living in Place Practitioner certification has been obtained.
OVERVIEW OF SPECIALIZED CONCERNS RELATED TO AGING IN PLACE
There is also some evidence that supports the cost effectiveness of home modifications and aging in place for the older adult and the health industry. The use of home modifications and assistive technology has been found to reduce hospitalizations and rehabilitation unit stays, therefore decreasing health- related costs (Graybill, McMeekin, & Wildman, 2014). Falls are one of the leading causes of injury, death, and forced relocation for older adults; home modifications have been proven very effective in reducing falls, related injuries, and
associated healthcare costs (Keall et al., 2015). These home modifications were not necessarily expensive. At times, they could be considered simple home maintenance. Materials for most modifications are available in local hardware stores, big- box stores, and online retailers; it is not necessary to purchase from durable medical equipment companies. When considering solutions, being current on possible products and equipment is important, as well as creative problem solving.
Page 122
Book Code: PTNY3622B
EliteLearning.com/Physical-Therapy
Powered by FlippingBook