Home Modification Services Research Articles

Examining Older Adults' Home Functioning Using the American Housing Survey.

Identifying individuals at risk of experiencing functional difficulty at home would support timely home safety assessment and modification services, which could lead to reducing home incidents such as falls. The objective of this study was to calculate older adults’ functional difficulty at home scores using the 12 physical function items in the American Housing Survey National and Metropolitan Data (AHS). Among the 28,474 older adults selected for this study, we used 19,932 for measurement model development and 8542 for model testing. Confirmatory factor analysis confirmed an adequate fit of the one-dimensional model with all AHS 12 items loading on one latent construct (functional difficulty at home) (RMSEA: 0.034, CFI: 0.990, and TLI: 0.988). Based on our model selection process, we determined that the Graded Response Model was an optimal model for our analysis and separated two detected differential functioning items for each sex. Using the testing dataset, we validated that the estimated functional difficulty scores showed an expected item hierarchy and statistically significant differences in their association with housing and demographic conditions (p < 0.001). Our results demonstrated the process of using the 12 AHS physical function at home items to produce validated scores of older adults’ functional difficulty at home.

Perception of autonomy among people who use wheeled mobility assistive devices: dependence on environment and contextual factors

Purpose To evaluate and compare the perceived autonomy of people using wheeled mobility assistive devices (WMADs) in five community-based environments. To evaluate how personal, environmental, and assistive device-related factors impact the perceived autonomy of WMAD users. Method A study-specific questionnaire was used to evaluate perceived satisfaction of WMAD users with their autonomy in five environments: the Home Environment, Buildings Outside of the Home Environment, Outdoor Built Environment, Outdoor Natural Environment, and Transportation. For each environment, participants rated their satisfaction with autonomy about 15 personal, environmental, and assistive device-related factors. Qualitative perceptions were also collected with open-ended questions. Results Participants included 123 full- and part-time community-dwelling WMAD users. Participants’ overall satisfaction with autonomy in the Outdoor Natural Environment was statistically significantly lower compared to the other four environments (p < 0.05). In all environments, the top factor respondents were most satisfied with was WMAD ease of use. Their least satisfaction was when negotiating stairs, curbs, or obstacles in the Home, Buildings Outside of the Home, and the Outdoor Built Environments. In the Outdoor Natural Environment, the most dissatisfaction was with manoeuvring on different terrains. Responses to open-ended questions supported the quantitative findings and highlighted the effects of various factors on autonomy (e.g., subject-environment familiarity). Conclusions WMAD users reported the greatest restriction to their autonomy in outdoor environments. Different context-specific factors were found to impact autonomy in different environments. Understanding how environment-specific contextual factors contribute to overall perception of autonomy may inform the development of future strategies to overcome identified limitations and challenges. Implications for Rehabilitation Wheeled mobility assistive device (WMAD) users experienced the highest autonomy in their home environments, specifically, when having access to home modification services. WMAD users had the lowest autonomy in the outdoor natural environment, with manoeuvrability on different terrains being the main predictor of the overall satisfaction with autonomy in this environment. Environment-specific contextual factors with significant impacts on perceived autonomy were identified that can inform the design and development of future WMADs (e.g., distance travelled, safety).

Home Modification and Health Services Utilization by Rural and Urban Veterans With Disabilities

ABSTRACT Inaccessible home environments that create barriers to the enjoyment and the approachability of the living space impact some U.S. Veterans. Injuries acquired while serving in the military or developed through the aging process complicate matters for Veterans with disabilities. Home modifications (HM) afforded by the Home Improvements and Structural Alterations (HISA) program can increase accessibility. We examine the difference between urban and rural Veterans in their health service utilization (hospitalization versus outpatient encounters) 12 months before and 12 months after their HISA use. All the study patients were Veterans with disabilities who use the HISA program. There is a significant decrease in hospitalization post-HM as compared with pre-HM provision for all HM users. There is a significant increase in outpatient encounters post-HM as compared with pre-HM provision for all users. Rural vs. urban status was only significant in outpatient encounters 12 months pre-provision of HM. Provision of HM is associated with favorable clinical outcomes such as decreased hospitalization and increased preventative outpatient care visits. Our findings suggest some subset of hospitalizations could be prevented or delayed if timely and appropriate outpatient care is accessible to patients along with HM. Increasing the provision of HM services such as HISA can free up hospital beds, reduce cost to both individuals and institutions, decrease the risk of hospital acquired morbidity, and promote community integration.

Sustainability perceptions of home modification service providers for older Australians

PurposeThe majority of older Australians prefer living in their own home. Home modifications support older adults' ageing-in-place through mitigating environmental hazards of their home, and there is an increased interest in modifying older adults' residential environment in sustainable ways. However, an in-depth understanding of sustainability perceptions of home modification service providers (HMSPs) is lacking in Australia. Thus, the study aims to address this research gap.Design/methodology/approachQualitative content analysis was adopted to identify sustainability perceptions through analyzing the retrieved home modification business information from the selected HMSPs' official websites. The results of qualitative content analysis were further analyzed by using independent-samples t-test and chi-square contingency table analysis to investigate the relationships between HMSP type and sustainability.FindingsIn total, 54 sustainability perceptions were identified, with the crucial ones being safe living environment, independent living and service diversity. Overall, there are no significant differences in sustainability perceptions between charitable and non-charitable HMSPs. Nevertheless, charitable HMSPs place more importance on social sustainability in comparison with non-charitable HMSPs.Originality/valueThe study results facilitate understanding about HMSPs' sustainability perceptions and sustainable home modifications in the ageing society, which facilities theory advancement and industry practice in the home modification area.

Do home modifications reduce care home admissions for older people? A matched control evaluation of the Care & Repair Cymru service in Wales.

Background home advice and modification interventions aim to promote independent living for those living in the community, but quantitative evidence of their effectiveness is limited.Aim assess the risk of care home admissions for people with different frailty levels receiving home advice and modification interventions against a control group who do not.Study design and setting matched control evaluation using linked longitudinal data from the Secure Anonymised Information Linkage (SAIL) Databank, comprising people aged 60–95, registered with a SAIL contributing general practice. The intervention group received the Care & Repair Cymru (C & RC) service, a home advice and modification service available to residents in Wales.Methods frailty, age and gender were used in propensity score matching to assess the Hazard Ratio (HR) of care home admissions within a 1-, 3- and 5-year period for the intervention group (N = 93,863) compared to a matched control group (N = 93,863). Kaplan–Meier curves were used to investigate time to a care home admission.Results the intervention group had an increased risk of a care home admission at 1-, 3- and 5-years [HR (95%CI)] for those classified as fit [1-year: 2.02 (1.73, 2.36), 3-years: 1.87 (1.72, 2.04), 5-years: 1.99 (1.86, 2.13)] and mildly frail [1-year: 1.25 (1.09, 1.42), 3-years: 1.25 (1.17, 1.34), 5-years: 1.30 (1.23, 1.38)], but a reduced risk of care home admission for moderately [1-year: 0.66 (0.58, 0.75), 3-years: 0.75 (0.70, 0.80), 5-years: 0.83 (0.78, 0.88)] and severely frail individuals [1-year: 0.44 (0.37, 0.54), 3-years: 0.54 (0.49, 0.60), 5-years: 0.60(0.55, 0.66)].Conclusions HRs indicated that the C & RC service helped to prevent care home admissions for moderately and severely frail individuals. The HRs generally increased with follow-up duration.

Home Modification Service Delivery in Australia

In Australia, a patchwork of services provide home modifications, each with varying approaches and service guidelines. This context is rapidly changing with consumer directed care models impacting the aged care and disability sectors. A study investigating satisfaction with service delivery for 31 clients of major home modification services is presented to illustrate home modification practice in Australia. The findings indicate overall satisfaction with home modification services, but also revealed areas for improvement and inequalities in service provision. This included the need for more choice in design, materials and products and the impact of housing tenure, where renters reported lower satisfaction.

Feasibility and Effectiveness of Telehealth Home Modification Interventions to Improve Safety and Perception of Performance

Abstract Date Presented 4/21/2018 It is feasible to provide telehealth home modification interventions using participant-owned devices to improve home safety and perception of performance. Telehealth has the potential to improve access to home modification services, and therefore large-scale studies are warranted. Primary Author and Speaker: Marnie Renda

Study protocol for investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage

IntroductionThis study will evaluate the effectiveness of home adaptations, both in preventing hospital admissions due to falls for older people, and improving timely discharge. Results will provide evidence for services...

Clinical utility of the In-Home Occupational Performance Evaluation (I-HOPE) for major home modification practice in Australia.

The use of standardised measures in home modification practice is rare, in part due to a lack of suitable tools. One promising outcome measure designed for home modification practice is the In-Home Occupational Performance Evaluation (I-HOPE). This study aimed to investigate the clinical utility of the I-HOPE for major home modification practice in Australia. The I-HOPE was trialled in one major home modification service by five occupational therapists who participated in two focus groups. Feedback using a purposefully developed questionnaire was also collected from 25 adult clients who completed the I-HOPE. Data from the focus groups were thematically analysed, and the questionnaire responses were analysed using template analysis. The analysis revealed four themes: client experience, training and resources, suitability to major home modification practice and improvements and future use. Therapists valued the person-focused nature of the I-HOPE; however, there were some clinical utility issues identified including confusion of the rating scales for clients, length of time to complete the tool and the need for more training and a clearer instruction manual. It is suggested that the I-HOPE is a person-focused and valuable tool for community occupational therapy practice in the Australian context but may not be suited to specialised major home modification services. An app or online version of the tool for client use, and the availability of training resources which are accessed online would enhance the clinical utility of the tool.

The Development of a Design and Construction Process Protocol to Support the Home Modification Process Delivered by Occupational Therapists.

Modifying the home environments of older people as they age in place is a well-established health and social care intervention. Using design and construction methods to redress any imbalance caused by the ageing process or disability within the home environment, occupational therapists are seen as the experts in this field of practice. However, the process used by occupational therapists when modifying home environments has been criticised for being disorganised and not founded on theoretical principles and concepts underpinning the profession. To address this issue, research was conducted to develop a design and construction process protocol specifically for home modifications. A three-stage approach was taken for the analysis of qualitative data generated from an online survey, completed by 135 occupational therapists in the UK. Using both the existing occupational therapy intervention process model and the design and construction process protocol as the theoretical frameworks, a 4-phase, 9-subphase design and construction process protocol for home modifications was developed. Overall, the study is innovative in developing the first process protocol for home modifications, potentially providing occupational therapists with a systematic and effective approach to the design and delivery of home modification services for older and disabled people.

Have They Done what They Should? Moral Reasoning in the Context of Translating Older Persons’ Everyday Problems into Eligible Needs for Home Modification Services

This study explores how moral reasoning is expressed in matching health care with the problems older persons experience in their everyday life. Narrative data were collected from older persons who had applied for home modification services and from professionals involved in these services in Sweden. A theoretical framework, based on theories on the anthropology of morals, was applied to explore how the participants made conclusions about "what should be done." Moral reasoning was found to be guided by ideologies related to the historical and cultural context of the Swedish welfare state. Different interpretations of how these values should be expressed in specific situations led to different conclusions about what should be done. The study highlights the importance of understanding how values are enacted rather than what values different social agents have in order to understand how health care services can be designed and provided to support older persons' everyday life.

Long-Term Functional Outcome of Older Adults After a Traumatic Brain Injury

To identify factors associated with long-term independence in mobility and self-care activities of daily living of older adults after traumatic brain injury (TBI). One hundred thirty-six TBI survivors 55 years or older were assessed 2 to 4 years postinjury (mean of 3.2 years). Level I or level II trauma centers in Quebec, Canada. Personal, injury-related, and environmental factors were gathered from hospital records or by telephone interview; a telephone version of the Functional Independence Measure motor scale was collapsed to 4 levels. Logistic regression analyses identified factors associated with independence in mobility and self-care. The strongest and most consistent factors associated with independence in mobility and self-care were fewer comorbid conditions, no difficulty of access to home modification services and home support services, male gender, younger age at time of injury, and shorter acute care length of stay. Factors associated with long-term functional outcome should be considered in the development of practice guidelines for rehabilitation of older adults who sustained a TBI.

Policies concerning assistive technology and home modification services for people with physical and cognitive disabilities in Sweden

The purpose of this paper is to describe policies, laws and regulations regarding the procurement of assistive technology and home modifications for individuals with disabilities in Sweden. Children up to ages 17-21 are entitled to free access to assistive technology. For adults the access is substantially subsidized with public funding. We will discuss the issues and implications of new technology, with an emphasis on assistive technology for cognitive impairment. Today, the social security system is financially burdened due to increasing demands and limited economic growth. However, the basic doctrine of the "Swedish model" remains, evoking structural and ethical issues.

Balancing the good – a critical discourse analysis of home modification services

Today an increasing number of people with functional limitations are ageing in their homes. Although the home has become an arena for assessment and implementation of services, little is known about how the interrelationships between ideological and practical circumstances influence the allocation of such welfare services. This explorative study applied a combination of critical discourse analysis and a narrative approach to closely examine such relationships in home modification services to older persons in Sweden. Data consisted of focus group discussions with street-level bureaucrats from two institutional contexts in the organisational field of home modification services and official documents related to such services. Findings showed that the attempts of street-level bureaucrats to allocate resources in accordance with the good were complicated by competing local definitions of 'the good'. The process of forming local perceptions of the good included complex balancing acts between hegemonic discourses within the organisational field which influenced and shaped how 'the good' was practised. Understanding the moral dimensions that enter into the complexity of allocation of home modification services across institutional settings has implications for the policies of and practices for the allocation of welfare resources.

Older persons’ navigation through the service system towards home modification resources

Home modifications are part of the occupational therapy interventions provided to persons with functional limitations in the home environment. Home modification services often involve many different actors, and persons experiencing a need for home modifications have to navigate through a network of service organizations and professional actors. The aim of this study was to explore and describe how older adults in one Swedish municipality tried to find their way and navigate through the service system in order to receive home modification services that could meet their experienced needs. A case study design was used, including four older adults with different experiences and expectations of home modification services. The relationship between the participants’ expectations, experiences, and their ways to navigate through the service system was described through the metaphor of a “geographical map”. Satisfaction with the service process was found when there was a match in understandings of responsibilities and eligibility between what could be read from the older persons’ map and the professionals’ perspective. The findings have implications for client-centred occupational therapy practice, indicating that this match can be achieved when professionals translate clients’ experienced problems in everyday life into a terminology that fits into the service system.

Creating possibilities for action in the presence of environmental barriers in the process of ‘ageing in place’

ABSTRACTThe need for an understanding of ‘ageing in place’ as a progressive process has emerged among researchers in the field of environmental gerontology. The aim of this study was to explore this process, in relation to home modification services. Four older adults who had applied for home modification services in one Swedish municipality were included. Data were collected by open interviews with the participants in their homes on subsequent occasions, from before the modification had been installed until recognised stability in the situation relating to the home modification. In the analysis, the concept of place integration was used as a tool to explore the active relations that connect people and context over time. The main findings show that the participants used creativity and initiative to direct future situations towards increased possibilities for action. This indicates that services aiming to support people ‘ageing in place’ should be directed towards increasing possibilities for action rather than only facilitating activity performance. Furthermore, it can be concluded that if the service-users' creativity and efforts are recognised as resources in design and provision of services, services that aim to support individuals who are ageing in place have the potential to be empowering.

Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.

Impact of home modification services on ability in everyday life for people ageing with disabilities

To examine the impact of home modifications on self-rated ability in everyday life from various aspects for people ageing with disabilities. The study sample was recruited from an agency providing home modification services in Sweden and comprised 73 subjects whose referrals had been approved and who were scheduled to receive home modifications (intervention group) and 41 subjects waiting for their applications to be assessed for approval (comparison group). The subjects rated their ability in everyday life using the Client-Clinician Assessment Protocol Part I on 2 occasions: at baseline and follow-up. The Client-Clinician Assessment Protocol Part I provides data on the clients' self-rated independence, difficulty and safety in everyday life. The data were first subjected to Rasch analysis in order to convert the raw scores into interval measures. Further analyses to investigate changes in self-rated ability were conducted with parametric statistics. Subjects who had received home modifications reported a statistically significant improvement in their self-rated ability in everyday life compared with those in the comparison group. Subjects who had received home modifications reported less difficulty and increased safety, especially in tasks related to self-care in the bathroom and transfers, such as getting in and out of the home. Home modifications have a positive impact on self-rated ability in everyday life, especially on decreasing the level of difficulty and increasing safety.

The Client-Clinician Assessment Protocol (C-CAP): Evaluation of its Psychometric Properties for Use with People Aging with Disabilities in Need of Home Modifications

The objective of this study was to evaluate aspects of the validity and reliability of the Client-Clinician Assessment Protocol (C-CAP) Part I. C-CAP data for 103 people aging with disabilities in need of home modification services were analyzed using the Rasch rating scale model. The C-CAP Part I consists of a client self-report of ability in daily life tasks comprising three scales (independence, difficulty, and safety). The analysis demonstrated support for internal scale validity, person response validity, and person separation reliability of the C-CAP Part I, although the results differed among the three scales. The results of this study indicated that the C-CAP Part I has psychometric strengths and limitations. The instrument has the potential to be used in the home environment with people who are aging with disabilities. The C-CAP could complement already existing tools that are used to assess functioning in activities of daily living, especially regarding the focus on the clients' self-report of difficulty and safety in daily life at home and in the community.

Performance of activities of daily living in a sample of applicants for home modification services

Home modification services are provided to support persons with functional limitations to live independently at home. It is not well known what causes individuals to apply for home modifications, or in what kind of life situation this need appears. The aim of this study was to examine the relationship between performance of activities of daily living, housing and living situation, and the home modification applied for in a sample of home modification applicants. Further, the aim was to examine differences in performance of activities of daily living between subgroups with different social support. A total of 102 participants were included in the study. Data on performance of activities of daily living was collected through interviews in the participants’ homes, using structured instruments. The participants reported high levels of independence in activities of daily living, and were using assistive devices to a large extent. However, the applicants clearly experienced difficulties in performing activities related to the applied home modification. The study indicates that the main reason for applying for Home Modification Grants was perceived difficulties in performance of activities of daily living. This stresses the importance of including other aspects besides independence when trying to understand persons’ activity performance and planning for occupational therapy interventions.