Recent trends in housing and remodeling indicate an uptick in more accessible living features, or what is termed “Universal Design,” but clinicians who work in home modifications should avoid a one-size fits all approach to home design. A client-centric, occupation based approach facilitates evidence-based practice in home modifications and will lead to successful outcomes of function and safety for the homeowner. Let’s read through a case example to understand how an occupational therapist can help with person-centered design.
Functionally Aging in Place
Mr. and Mrs. Sing have lived in their home for 35 years. They, like 90% of older adults, want to age in place; however, they live in a home environment that no longer works for them. A home equity line of credit can grant them the opportunity to remodel their home to meet their current levels of function. The Sing’s find a local design-build firm that specializes in aging in place. The company’s website indicates that the owner recently received the Certified Aging in Place (CAPS) Designation offered by the National Association of Home Builders.
Upon research of the designation Mrs. Sing learns that some physical and occupational therapists hold these professional credentials. She also recalls the OT she met when her husband was last hospitalized for his cancer surgery. Mrs. Sing recalled how the OT was deliberate and personal in her husband’s therapy treatments. The OT also helped her find the right magnifier for her recent visual deficit because reading was the most important hobby she had as a caregiver. Mrs. Walters smiled at that recollection but thought, “What would an OT know about home remodeling?”
The Value of an OT in Home Design
Person-centered and occupation-based interventions are foundational in occupational therapy home assessment practice. Environmental or home modifications are emerging areas of practice the profession is enhancing with evidence and outcomes. OT practitioners are working within the building and housing industries to ensure that homes remodeled for aging persons, do not succumb to codes and design trends but rather lead to function and occupational performance both now and later.1
OTs distinct value and skill set brings forth new perspectives to the remodeling industry. With universal design as the backdrop and the person as the focus, practitioners take a unique approach to home design. It begins with ‘working backwards’, keeping the home dweller’s occupational performance goals in mind, and involves considering important environmental contexts: temporal, cultural, personal and social. These contextual insights help shape future home designs uniquely to the person as practitioners consider how long the person has lived there, study important daily routines and habits, contemplate the roles of and relationships with other family members, etc. This critical and intentional method cannot be replicated by implementing universal design principles, but universal design principles can be the starting point.
Mr. and Mrs. Sing decided to make an appointment with the CAPS builder and an OT CAPS professional. The occupational therapist comes to the home and performs a home assessment which includes an occupational profile of the couple. The OT uses these tools to ensure the functional desires of the couple are met and that the home environment and all of its contexts support those desires. Here are some examples of questions that can gain insight into needed home modifications:
1. What occupations are important to you now?
Mrs. Sing: I love to walk in the morning, before the sun comes up. It is my personal time before I come home to help Mr. Sing get ready for his chemo. Mr. Sing: Yes, my morning shower is very important, I love the warm feeling. I wish I had the energy I used to but my wife is here and she takes care of me.
2. What hobbies do you have and where do you perform them?
Mrs. Sing: I love to read and I sit in my recliner chair by my window. I have a new magnifier that I use. It helps me to see. I also like cooking, but often the preparation can be overwhelming.
3. Besides ‘seeing’ is there any other difficulty you experience while reading?
Mrs. Sing: Well, it is hard to hold my magnifier for long periods of time and get out of my chair with my bad arthritic knees. If Mr. Sing calls to me from the bedroom, I am not always the fastest.
This assessment can help us begin to ‘work backwards’ in our design process and lead to recommendations that add to the universal design layout provided by the builder. The functional outcomes and experiences we want to achieve in the home environment are:
1) Safe walking in the dark.
2) Warmth, energy conservation and independence while taking a shower in the bathroom.
3) Safety and energy conservation in the kitchen.
4) Ease of reading in chair and ease of transfers from chair.
The CAPS builder designs a beautiful home with wider doorways and hallways, no-step entries, a full bathroom and bedroom on the first floor, levered handles throughout, easy to reach and use appliances, cabinets, pull-out drawers, pull-down shelves, etc. The OT adds value to the design by providing a list of recommendations based on assessment findings:
Front Porch & Outside the Home
- Sensor lighting on the front porch and along the pathway to the lit street where Mrs. Sing walks.
- An outlet near the main doorway for an automatic door opener in case Mr. Sing’s cancer progresses and he requires a wheelchair for community mobility.
- Color contrasted grab bars in the shower are recommended for Mrs. Sing’s visual deficits and Mr. Sing’s normal aging eyes.
- A shower seat with arm rests, a 72-inch hand held shower hose, and heating light in the bathroom will ease caregiver burden, and provide Mr. Sing warmth during a necessary daily occupation.
- A pull-out seat and knee space suggested and located in the kitchen encourages sitting.
- Lighting and magnification over meal prep counter spaces will increase safety.
Additional Safety Features
- A lift chair will reduce fall risk.
- A floor based magnifying device will increase safety and comfort around a desired occupation.
- Outlets in the floor can be strategically placed in the blueprints.
By thinking less universal and more personal, OTs can use research and best practice to personalize a home design to fit the homeowner’s medical needs and occupational priorities.
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For additional insights and techniques you can apply today, explore the MedBridge catalog of over 1,400 occupational therapy courses spanning specialties and settings. Advance your career and restore your patients to meaningful occupation with expert-led online OT CEU courses featuring interactive demonstrations that include real patients and up-to-date, evidence-based strategies.
- Lindstrom, D. and Sithong, C. (2015). An OTs perspective on healthy housing. OT Practice (19) 6, pg. 7-10.