Understanding clients experience of home

Home modifications are widely used for the purpose of increasing safety, security and accessibility within the home. However, in this definition we have limited the scope of home modifications to only consider the occupational function of the individual. In reality, research suggests that there are wider outcomes impacted by home modifications, including relationships, social engagement, privacy and identity (Alpin, Jonge & Gustafsson, 2015). Occupational therapists working in this space need to consider all aspects to prevent clients associating a negative experience to the home modification process. 

 An individual’s experience of the home is an essential aspect to consider, which has no way of being formally assessed to date. This article comprehensively identifies and explores the different dimensions of the home, to inform the development of such instruments. Alpin, Jonge & Gustafsson (2015) identify five dimensions of the home environment that are negatively and positively impacted by home modifications:

 1. Personal – Participants expressed an increased level of safety and security, and reduction of fear and anxiety as a result of the modifications. They valued their regained independence and freedom. Others identified modifications that made their home more unsafe and were frustrated by the lack of control they had over the process.

 2. Occupational – As the dimension most heavily considered, participants were often pleased with their ability to return to their valued roles and easily access the home. It also reduced the physical demand on carers, making their role easier. On the contrary, some participants identified everyday tasks as becoming more difficult.

 3. Physical – Was often reported as being negatively impacted by the modifications. Participants had to install their own roofing or described that it was difficult to keep warm in their open plan bathrooms. 

4. Temporal – The future was an important aspect under consideration for participants, and the ability for their modified home to accommodate their ageing and/or deteriorating needs created a sense of permanency in their home. 

5. Social – Although not very heavily impacted, it was only impacted in a positive way. Their homes were able to accommodate family and friends, with them also benefiting from the modifications. 

In addition to the dimensions, the experience of the home modification process also impacted the participants' views, including: 

• the respectfulness of the builder

• their involvement in the decision-making process

• the restrictions imposed by service providers and the Australian standards

As occupational therapists, the collaborative nature of our work, forces us to consider the different dimensions of the home modification process including those that may be restricting the process, so that we may provide the best possible solutions within that scope. Being aware of these barriers can help us better prepare our clients for the process as well as to manage their expectations.

~ Written by Suleka Hersi, OT intern, 2022-23 Summer Internship

Reference:

Aplin, Tammy & Jonge, Desleigh & Gustafsson, Louise. (2014). Understanding home modifications impact on clients and their family's experience of home: A qualitative study. Australian Occupational Therapy Journal. 62. 10.1111/1440-1630.12156.