Becoming “At Home” in Home Modifications

Most, if not all, occupational therapists have dipped their toes in home modifications at some point in their careers. Even for those working in traditional “physical” settings, there is often a level of environmental re-design or adaptation required to improve their experience of home. It comes as no surprise that there is an immensely positive impact that home modifications can have in benefiting the client, their caregiver and quality of life. Harris, Andrews, Logan and Lee (2016) conducted a scoping review to identify the key factors that influence best practice in home modifications. Below, we break down the major themes which were identified as essential to best practice home modification service delivery:

1. Re-ablement: a focus on utilising the strengths of the client and reducing the demands of the environment to find the optimal person-environment fit to enhance independence and safety. There should be an emphasis on client-centredness and to involve them throughout the process, and to not discount the caregivers needs.

2. Accessibility: with the ever-changing demographic and increasing cultural and linguistically diverse populations, it is essential to accommodate and ensure accessibility for the differing circumstances. There also needs to be an emphasis for what goes on the behind the scenes to be cohesive and centralised, further improving access.

3. Assessment and Review: An initial screening based on their current function has been identified as best practice. Occupational Therapists need to utilise robust, formalised assessments which are holistic and ensure they have capacity for follow-up and re-evaluation to check for usability and effectiveness of the home modifications.

4. Communication and Collaboration: Through effective collaboration with all parties involved, especially the client, the process becomes more streamlined and the results are a more effective use of resources. Different countries have different models and arrangements for the home modification process, all consisting of a multi-disciplinary team working together to enable informed decision making and effective uptake of home modifications.

5. Education and training: All members of the home modifications process and those involved in the care of the client require training to ensure familiarity with the latest available products, as well as disability awareness and the home modifications processes. In particular, there needs to be an effort to address any gaps in understanding to ensure good practice.

6. Service Evaluation and Improvement: For continuous home modification service improvement, there needs to be a measurement of client outcomes and an evaluation process of service performance against agreed targets. There needs to also be compliance with government and legislative requirements.

Overall, OT’s should consider thes important themes across all practice areas to help inform a best practice framework for the assessment and prescription of home modifications.