Housing Adaptations and Home Modifications

Abstract

Worldwide, but subject to substantial variations across countries, housing adaptations and home modifications constitute important and common interventions in occupational therapy practice. Starting out from the notion that occupational performance is the outcome of person–environment–occupation (P–E–O) transactions, such interventions are applicable with all kinds of clients with occupational performance problems in the home setting. Housing adaptations entail alterations of permanent physical features in the home and the immediate outdoor environment, whereas home modifications typically are more complex interventions that often include the provision of assistive technology and related training, etc. Most clients are older people, and measures such as removal of thresholds, installation of shower stalls instead of bathtubs, and installation of handrails and grab bars are among the most common. A growing body of scientific evidence has the potential to strengthen this part of occupational therapy practice, with the ultimate goal of creating home environments that support occupational performance—and ultimately, health, and quality of life.

When I signed the contract for this apartment, they said that it was suitable for an older woman like me, with a husband who had had a stroke. But it wasn’t at all.

Client in Sweden

Appendices

The Case Study of Stina: Housing Adaptation

Keywords:Home modification, Housing adaptation, Objective aspects of home, Accessibility, Perceived aspects of home, Usability

Introduction

The theme of this case study is housing adaptation aimed at a person with multiple sclerosis (MS) .

The student task includes:

• Identifying valid information on typical occupational performance problems in MS and their progression over time, specifically related to personal and instrumental activities of daily living usually performed in the home environment.

• Identifying aspects of home and health that need consideration and related ­assessment instruments for data collection prior to the planning for a housing adaptation as well as for follow-up.

• Applying clinical reasoning following the steps in the housing adaptation process, and reflecting upon the content of an efficient intervention for the person described in this case.

As a starting point, students should use the following references to gather ­background information:

Ainsworth E, de Jonge D (2011) An occupational therapist’s guide to home modification practice. Slack Inc.,Thorofare

Fänge A, Iwarsson S (1999) Physical housing environment: development of a self-assessment instrument. Can J Occup Ther 66(5):250–260

Fänge A, Iwarsson S (2005) Changes in ADL dependence and aspects of ­usability following housing adaptation—a longitudinal perspective. Am J Occup Ther 59:296–304

Iwarsson S, Haak M, Slaug B (2012) Current developments of the Housing ­Enabler methodology. Br J Occup Ther 75(11):517–521

Iwarsson S, Ståhl A (2003) Accessibility, usability, and universal design—positioning and definition of concepts describing person-environment relationships. Disabil Rehabil 25:57–66

Lexell EM, Iwarsson S, Lexell J (2006) The complexity of daily occupations in Multiple Sclerosis. Scand J Occup Ther 13(4):241–248

Lyons RA et al (2003) Modification of the home environment for the reduction of injuries. Cochrane Database of Systematic Reviews, 4, CD003600.

Oswald F, Schilling O, Wahl H-W, Fänge A, Sixsmith J, Iwarsson S (2006) Homeward bound: Introducing a four-domain model of perceived housing in very old age. J Environ Psycho 26(3):87–201.

Stark S (2004) Removing environmental barriers in the homes of older adults with disabilities improves occupational performance. Occup Participation Health 24:32–39

Wahl H-W, Fänge A, Oswald F, Gitlin L, Iwarsson S (2009) The home environment and disability-related outcomes in aging individuals: what is the empirical evidence? Gerontologist 49(3):355–367

Overview of the Content

Major Goals of the Actual Intervention

The goals of a housing adaptation are to adapt the housing environment to the client’s needs, given her functional capacity, wishes for optimal occupational performance , and perceived aspects of home relevant to her and the family. Ultimately, the intervention should improve the client’s independence in daily activities.

Learning Objectives

By the end of studying this chapter, the learner will:

• Be able to use scientific and clinical methods presented in literature to solve the case study based on the case method.

• Be able to apply the case method in clinical reasoning to the specific case study and similar clinical situations.

• Understand the justification and ethical considerations related to housing adaptation, applying an explicit client-centered perspective.

• Write a scientific report on housing adaptations as an occupational therapy intervention.

The Background History of Clinical Case Study

Client Description

Stina is 52 years old. She is married and lives with her husband and a teenage daughter. Though she has been working full time until now, she is considering a reduction of her work time to 75 %. Her husband is working full time in a job that requires much traveling, and he spends at least five nights per month away from home. The family lives in an old private house that has undergone some renovation, but would not be considered high standard. The kitchen is the most modern part of the house, as it was thoroughly renovated 3 years ago.

Stina was diagnosed with MS 3 years ago. She is experiencing increased tiredness, and now and then, she has started to feel that her balance and endurance are not sufficient to allow for longer periods of heavier cleaning or cooking while standing, and she feels frustrated when her activity performance becomes compromised. Increasingly, she sometimes feels uncertainty when walking, in particular in the entrance staircase and during the short walk required to reach her car, usually parked in front of the house.

Occupational Therapy Interventions

At the time when Stina was diagnosed with MS by a neurologist at the nearby hospital, she briefly met with an OT and received some basic information about her possibility to get assistive devices , for example, for mobility , and assistance in how to apply for a housing adaptation . She also got a leaflet that described how the disease might impact on daily occupation and some guidance on how to adjust daily routines to maintain activity and participation . Until now, Stina has coped with her daily life situation and has not sought for any in-depth occupational therapy consultation .

The Student’s Report

The following guiding questions have been identified in developing possible solutions to Stina. These questions were generated from the references found in the literature search:

• What are the major definitions and concepts used in the case?

• Which assessments should be used to determine how the housing adaptation should be planned, effectuated, and evaluated?

• Which are the short- and long-term goals for Stina?

• How can Stina maintain activity and participation?

• What is the research-based evidence for a housing adaptation?