with Parkinson’s disease will also freeze when confronted with a sudden change in color in flooring as they are attempting to Special considerations and challenges There are additional considerations and challenges to consider when making recommendations for older adults. These concerns should be factored into all decisions and are in addition to any special concerns related to health conditions. Housekeeping A recent study specifically examined the relationship between home maintenance and upkeep with the ability of people to age in place. It was found that excessive home maintenance demands cause stress and anxiety to older adults, which in turn damages their attachment to their home. The cost of maintaining a home can be a source of difficulty because many older adults are on a fixed income. Common concerns are maintaining the grounds, roof repairs, gutter cleaning, and other heavy work items. Minor repair work within the home also causes undue stress with having to handle hiring handymen and coordinating the repair work (Coleman, Kearns, & Wiles, 2016). The burden of housekeeping, feature maintenance, and possible repairs needs to be taken into consideration when making recommendations. For example, an electronic stair glide is useful for helping people move up and down stairs; however, when it becomes older and breaks, problems occur. Company maintenance people must come to repair it, which can be costly. In the meantime, if the stair glide takes up the majority of the space in a narrow stairway, people are unable to move around it. The older adult may become stuck on one floor or be at an increased risk of injury due to the new obstacle in the stairway. Social supports for the older adult should be sought for assistance in possible repair and maintenance problems to help determine appropriate Given the rise in multigenerational living situations, and the fact that many older adults may live with a spouse or companion, it is important to always take into consideration the needs of the other people of the household. An example of this is heights of counters. If your client uses a wheelchair or happens to be short, but the others in the household are a foot taller, a compromise on counter heights would be wise. Multiple countertop heights would ensure the ability of everyone to work at the recommendations. Multi-person use 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
process the change in environment. A consistent color helps support mobility as someone ages.
counter without injury or discomfort to either party. Another consideration would be space needed for caregivers as a current or proactive concern. Caregivers need space around toilets and bathtubs to properly care for their clients. Some family members will have no objection to recommended modifications and design features. Others may have great objections to your choices; it is important to remember the symbolism an object or design may hold for people. People may view grab bars as “old,” and become concerned about potential resale of the home after installation. Even the room itself might hold meaning. A client once refused to move her 3:1 commode to the second bathroom because it was the guest bathroom, and had to be kept clean for all guests coming to the home. The initial relocation recommendation was made because her husband had dementia, did not recognize the toilet with the commode on it, and was urinating in the sink. She had been using the 3:1 commode as a raised toilet seat after a hip surgery; no one had recommended a raised toilet seat to her, which ended up being the compromise. This is an example of why speaking to and observing everyone who commonly uses the same spaces are important; it would not be effective to make the home age- friendly but make it impossible for other people to use the same space. Also along the same lines is the consideration for visitability. Visitability is a growing concept in the design world and ties closely into UD principles. This story best demonstrates the aforementioned design concept. A woman used to visit her sister every week for lunch; however, as they both have aged, 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 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.
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
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Book Code: PTNY3622B
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