Kim Furphy: Welcome. Today we are going to talk about home modification. The age of the client is not as important as the function of the client. Everything we talk about today can be used across the life span. Please consider that as we go along. My goal for today is to improve your ability to describe the process of selecting appropriate assessment tools for home safety or home modification evaluation. I want you to be able to list appropriate assessment tools and have them at your fingertips for when you are looking to evaluate outdoor and indoor environments for your clients. Also, I would like you to be able to take some of that knowledge and apply it to a clinical scenario or situation in your own individual practices.
Introduction
The home modification process is basically the same as the general process that we use for any intervention completed when working with a client (see Figure 1). We start with a referral and a screening. The referral informs us about the person. It tells us if the person has had a new injury or a new diagnosis. It tell us if the client is being referred to OT because they have experienced a change in function due to aging or any other factor.
Figure 1. Referral, screening, and evaluation.
Are they being referred because they are moving into a new home and the family members or the client themselves are concerned about their ability to function within this new home? Are there any changes in caregivers or any other factors that might impact their functioning? Once this information is gathered then consider the information from that referral.
Is there enough information from that referral that you can make a determination as to whether an evaluation is even necessary for a client? What about funding? Will our services be covered by a payer source or will the client be responsible for the cost? Funding is a consideration because without funding you and the client may determine that it is not appropriate to continue with the evaluation process because the cost of the evaluation may not be covered and the client will not be able to comply with any of the interventions or modifications that are recommended by OT.
Once we get past the referral and the screening and we determine that the client is actually appropriate for the evaluation, then we will schedule a visit with them. Preparation for this visit is extremely important. You do not want to go into a client's home and look like you do not know what you are doing or that you do not have everything that you need in order to perform a proper evaluation. Make sure to take all of your tools with you. If you are using measuring tools that require batteries then make sure everything is in working order. Make sure you have the correct paperwork. If you are using a tablet to do your documentation, then make sure it is charged and has all of the correct apps or programs ready. When you write up the report, part of that process is seeking assistance from other professionals. It may be that you need to talk to contractors or architects or so forth to make any of the recommendations that you might want to make based on the evaluation.
The intervention occurs when you complete the home modifications with everybody whose involved (see Figure 2). There are many people that may be involved in the intervention portion of the process, including but not limited to the client, their caregivers or their family members, contractors, building professionals, people who may be involved in the funding of the interventions. Make sure that you are including everybody who is going to be affected through this process. At this point in time, you do not want to make the recommendations for the modifications, make sure the client has the modifications done, and then leave them on their own. You want to perform training with the client using the modifications. For instance, if you recommend that a bathroom be renovated with grabbars and a walk-in shower, then make sure to complete training with the client to complete a shower transfer with use of grabbars. This training will assist the client so they know how to use the new equipment and it will give you information if the initial modifications are working for the client.
Figure 2. Intervention and follow up.
The last part of the process is the follow up, where you evaluate your home modifications. Follow up should occur a week, a month, and possibly two to three months after the modifications have been completed. It is important to ensure that the modifications completed are meeting the client's needs. Are they improving function? Has their falls risk been reduced? Are they satisfied with the modifications that are made? At the end of this presentation, I will talk about some tools that will help you gather kind of outcomes data for yourself in terms of the recommendations that you make.
Framework for Home Modifications
What is our framework? We must think about what framework we are using before we proceed with the evaluation process. This is essential for determining the decisions that we will be making in home modification practice. Also, we may use one framework for the evaluation process, and that framework could change for the intervention process. In my experience, I do not see much difference between choosing a framework for the evaluation and then also utilizing that framework for the intervention. I do see a little difference sometimes when I choose a framework or multiple frameworks for my evaluations. For example, if a client has cognitive issues then I will try to apply some of those frameworks for their intervention.
There are several frameworks that can be applied for home modifications (see Figure 3). Occupational therapy is a client-centered practice. It is important to look at the unique qualities of each individual. Even those clients with the same diagnosis can not be categorized together because every person has their own unique qualities. For example, each dlient has different caregivers, different roles and routines, and different ways that people approach particular activities. Each client has their own unique characteristics or unique qualities that we need to consider. Each individual has unique physical abilities, unique cognitive abilities. You must also take into considerations the persion's vision, sensory skills, occupational performance and participation attributes. The framework that you choose should address the individual's attributes.
