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Home Modifications and Occupational Therapy

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Occupational therapy provides clients with the tools to optimize their home environments relative to individual abilities and promote full participation in daily life activities. As the population of older adults continues to grow, home modifications are a key factor in enabling individuals to “age in place,” or live in the place or home of choice. An AARP study found that more than 80% of people older than age 50 want to age in their own homes.1 Home modifications also can benefit clients of all ages with health conditions, sensory or movement impairments, or cognitive disorders by supporting the performance of necessary and desired daily activities (occupations), safety, and well-being.

Home modifications are “adaptations to living environments intended to increase usage, safety, security, and independence for the user. Home modifications are used in conjunction with assistive devices and home repairs” (p. 28).2 The home modification process includes evaluating needs, identifying and implementing solutions, training, and evaluating outcomes that contribute to the home modification product.2 The results of this process may be recommendations for alterations, adjustments, or additions to the home environment through the use of specialized, customized, off-the-shelf, or universally designed technologies; low- or high-tech equipment, products, hardware controls and cues, finishes, furnishings, and other features that affect the layout and structure of the home.3

The Role of Occupational Therapy in Home Modifications

Occupational therapy plays a key role in identifying strategies that enable individuals to modify their homes, thereby maximizing their ability to participate in daily tasks/activities. Occupational therapy practitioners are skilled at recognizing how the environment affects the ability to perform desired occupations. An occupational therapist evaluates balance, coordination, endurance, safety awareness, strength, attention, problem solving, vision, communication, and many other functions while the individual performs daily tasks. In addition to the individual’s performance abilities, occupational therapists also evaluate the home environment to identify barriers to performance. For instance, features can be identified that increase the risk of falls (e.g., loose banisters) or present other hazards (e.g., overloaded electrical outlets). Occupational therapists also review aspects of the home that may require modification to facilitate performance. For example, secure upper-body supports such as handrails or grab bars can assist someone who has difficulty balancing during functional mobility and self-care activities. As part of the evaluation, occupational therapists analyze how a person interacts with his or her environment to complete a task or activity. Through this process, modifications and intervention strategies are selected to improve the fit between these elements, with a goal of maximizing safety and independence in the home. The intervention plan may include but is not limited to strategies such as adaptive equipment, lighting, family caregiver training, or remodeling.

Occupational therapy services can be provided directly to clients who are experiencing a decline in safety or independence, or are planning for future needs.
Occupational therapy practitioners provide client-focused intervention to adapt the environment in order to increase independence, promote health, and prevent further decline or injury. For example, falls often result from home hazards in combination with declining physical abilities.4 One strategy to reduce the incidence of falls is to have an environmental assessment and recommendations for modifications completed by an occupational therapist.5 In this type of situation, an occupational therapist performing an environmental assessment can observe and evaluate all occupations (activities) occurring at and around the home, from activities of daily living (ADLs; bathing, dressing, other self-care activities) to instrumental activities of daily living (IADLs; preparing meals, doing laundry, and performing home maintenance chores) to play and/or leisure activities (playing cards, exercising, playing a musical instrument, entertaining friends, enjoying hobbies). Based on that evaluation, recommendations can be made for modifications or client training to promote safety in the home.

Occupational therapy services are available in many places in the community: hospitals, home health agencies, clinics, rehabilitation or community agencies, or through private practice. They may be reimbursable under Medicare and some private health insurance plans when coverage criteria are met, including a physician referral.

Occupational therapy practitioners provide a valuable perspective to a team of professionals (e.g., other health care workers, builders, architects), caregivers, and the client during the home modification process.

References
1. Bayer, A.-H., & Harper, L. (2000). Fixing to stay: A national survey on housing and home modification issues. Research Report. Retrieved June 23, 2006, fromhttp://www.aarp.org/research/reference/publicopinions/aresearch-import-783.html
2. Siebert, C. (2005). Occupational therapy practice guidelines for home modifications. Bethesda, MD: Author.
3. Sanford, J. A. (2004, May). Definition of home modifications. Included in L. A. Fagan & J. A. Sanford, Home modifications: Assessment, implementation, and innovation. Presented at the 84th Annual Conference & Expo of the American Occupational Therapy Association, Minneapolis, MN.
4. Lord, S. R., Menz, H. B., & Sherrington, C. (2006). Home environment risk factors for falls in older people and the efficacy of home modifications. Age and Ageing, 35(S2), 55–59.
5. Tse, T. (2005). The environment and falls prevention: Do environmental modifications make a difference? Australian Occupational Therapy Journal, 52(4), 271–281

Developed by Lisa Ann Fagan, MSD, OTR/L, and Dory Sabata, OTD, OTR/L, SCEM, for the American Occupational Therapy Association. Revised and copyright © 2011 by the American Occupational Therapy Association. This material may be copied and distributed for personal or educational uses without written consent. For all other uses, contact copyright@aota.org.