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Delaware Assistive Technology Initiative

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Volume 19, No. 1 - Winter 2011

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Home Is Where You Hang Your Hat

Debra Young, MEd., OTR/L, ATP, CAPS
Occupational Therapist, Founder/Owner
EmpowerAbility, LLC

Think about what environmental qualities help you feel safe, secure, and comfortable. Whether you are indeed hanging your hat in your home or using various facilities—bathroom, kitchen, office space, entrances, exits—it can be helpful to think about the design and layout of the space. This article explores the purpose and benefits of an evaluation of commonly used spaces for individuals regardless of their physical, cognitive, and/or emotional limitations. Essentially, the goal of a home accessibility evaluation is to promote independence and safe access to maximize participation in meaningful activities inside and outside the home. (A similar assessment, a workplace evaluation, can be performed at your place of work.)

The Daily Routine

Many people simply wake up, get dressed, eat breakfast, and have their morning cup of coffee to get ready for work and school. Typical routines can go awry—oversleeping, the car not starting, or the kids not being agreeable—which cause adaptations to occur on the spot. Not surprisingly, an illness, disease, or disability adds another level of complexity to daily routines. Adaptations to the environment may simplify these routines. Existing research on environmental interventions, including the use of assistive technology and devices, demonstrates that alterations to living spaces can reduce a person’s level of difficulty1 and dependence, thus increasing safety in everyday life.2,3

“Environmental Press”

According to the late Powell Lawton—a renowned research scientist and behavioral psychologist—a person has certain abilities at a given time and the environment has certain demands it places on a person’s abilities.4 By examining abilities and level of demand (also known as environmental press), behavior can be better understood. Developing the ideal environment, suitable for each individual, is the goal.5 Changes in a person’s physical skills impact the degree of environmental press that is tolerable. Such tolerance often decreases as age and illness progress. Therefore, it is important that the individual learn about potential changes within the home that can optimize their living. The home accessibility evaluation is an invaluable tool.

Environmental Modifications

Individuals vary greatly in how they experience their home, work, and community environments. There are many factors to take into account regarding how an environment will be experienced by an individual with physical, cognitive, and/or emotional limitations. The question becomes how to identify necessary modifications to a given environment. Successful environmental modification recommendations are the outcome of a comprehensive evaluation of an individual and his/her environment. It is wise to have an experienced professional—often an occupational therapist (OT)—conduct an evaluation of the environment under consideration. OTs who specialize in environmental modifications bring a thorough knowledge of illness, injury, disease, and prognosis, as well as how different impairments affect an individual’s functional performance. These professionals assess the wants, needs, and limitations of people in concert with the environment to determine how they will perform necessary tasks. Health, wellness, and participation in all aspects of each individual’s life are considered.

photogragh of the rear of a house with an attached deck that has a ramp that wraps around two sides.Second accessible egress point in rear of house
Home modifications, however, require a team approach. As an OT who specializes in environmental modifications, I bring a unique perspective to the team. Nevertheless, a group of professionals—OTs, contractors, builders, interior designers, product vendors, and architects—is necessary to completely meet the needs of the client concerning home accessibility.

Safety

A home accessibility evaluation will help determine safe, accessible options for entrance and egress from a home. It is optimal to have at least two safe egress points during an emergency in case one is blocked. When this is not feasible, other strategies must be considered and put into place to maximize safety. While making modifications to your home to allow for safe egress during an emergency is important, it is equally important to create and practice an emergency escape plan. Second accessible egress point in rear of house

Another facet of a home accessibility evaluation is to identify fall risks, with the goal of preventing injury. Most falls happen at home; every year approximately 33 million Americans are injured seriously enough to require medical attention. In fact, the most common cause of nonfatal injury in every age group is falling down. Furthermore, among people 65 years and older, falls are the leading cause of injury deaths, nonfatal injuries, and hospital admissions for trauma. Each year in the United States, nearly one-third of older adults experience a fall.6 The integration of environmental modifications can help decrease the risk of falls, creating a safer home environment.

Maximizing Independence

A home accessibility evaluation will provide recommendations to make a home more accessible to its residents, which increases independence in completing daily tasks. Being able to get in, out, and around one’s house ultimately affords easier access to the community.

Aging-in-Place

Aging-in-Place design takes into consideration a person’s current and potential needs and incorporates them into the design to allow people to remain in their homes for as long as possible. It considers the aging process and the impact of health on one’s environment, with the goal of safety and independence.

Is a home evaluation right for you? You may benefit from a home accessibility evaluation if:

If one or more of these scenarios applies to you, you may want to look into obtaining a home accessibility evaluation. Your physician should be able to offer a referral to an experienced professional who can perform the assessment.

References:

1. Gitlin, L. N., Winter, L., Dennis, M., Corcoran, M., Schinfeld, S., & Hauck, W. W. (2006). A randomized trial of a multicomponent home intervention to reduce difficulties in older adults. Journal of the American Geriatrics Society, 54, 809-816.

2. Roelands, M., Van Oost, P., Buysse, A., & Depoorter, A. (2002). Awareness among community-dwelling elderly of assistive devices for mobility and self-care and attitudes towards their use. Social Science & Medicine, 54, 1441-1451.

3. Sonn, U., & Grimby, G. (1994). Assistive devices in an elderly population studied at 70 and 76 years of age. Disability and Rehabilitation, 16, 85-92.

4. Lawton, M. P. (1986). Environment and Aging. Albany: Center for the Study of Aging.

5. Carstensen, L. L., & Edelstein, B. A. (Eds.). (1987). Handbook of Clinical Gerontology. New York: Pergamon Press.

6. Center for Disease Control and Prevention. Injury Prevention & Control: Home and Recreational Safety. Retrieved July 28, 2010 from http://www.cdc.gov/HomeandRecreationalSafety/Falls/index-pr.html. ■

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