How to Assess Your Home as Healthcare Ready

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As a person ages, everyday activities often become challenging. This results in a lower quality of life on many levels, from the physical to the psychological. The results of a unique home intervention study showed that individualizing home evaluations and involving the patient in decision-making can have a dramatic positive effect on functional abilities. The following interview with Laura N. Gitlin, Ph.D, a research sociologist and professor in the Department of Occupational Therapy and director of the Center for Applied Research on Aging and Health at Thomas Jefferson University in Philadelphia is presented by Philips Lifeline. She has published extensively in gerontology and occupational therapy on family caregiving, dementia care, physical function, and co-authored numerous books.

1. How does a home safety assessment play into the overall health care planning for an older person and how does it help prevent falls?

An effective home safety assessment plays a critical role in identifying ways to use the environment to support continued participation in an activity and minimize the risk for falls.

As people become older and experience functional difficulties due to chronic illness or health problems, they commonly adapt by changing their behavior rather than their environment. Typically, a person will stop or decrease their participation in an activity that is becoming difficult to perform. But this can have a negative and cascading effect. Decreasing participation in a valued activity may result in less physical activity, isolation, and feeling depressed. It is also associated with the risk for falling. On the flip side, adapting strategies such as modifying the environment or energy conserving techniques such as pacing oneself or sitting instead of standing, can enable a person to continue in an activity that he/she values.

2. What modifications to the home safety assessment would you recommend to healthcare professionals who conduct these assessments as part of their treatment plan?

I would say observe a person within the home environment in order to consider the person’s actual performance, preferred ways of carrying out everyday tasks and personal safety goals. We know now that for an assessment to be successful we have to include a person’s own goals and functional difficulties and make our recommendations without infringing on that person’s personal choices and goal for autonomy.

3. When the patient is going directly home from the hospital, what is the best way for a hospital discharge planner to communicate the importance of home safety assessment to family members?

We recommend that families be provided a home safety checklist and be given a referral to an occupational therapist.

4. At what stage in the aging process do you recommend a home safety assessment be done?

Anyone who is having difficulty at home such as getting into/out of the tub, getting in/out of bed, climbing stairs, going outside, or buttoning a shirt — as small as it might seem — should consider the role of the environment in supporting their efforts to carry out the activity safely and efficiently. If these functional difficulties are brought to the attention of a doctor, he/she could refer the person to receive occupational or physical therapy in the home. Our research, as well as others, suggests that this can prevent a lot of problems down the road.

5. What is the role of medical alert service in a home safety assessment?

The medical alert system is important because it can save a life. In addition there is a great psychological benefit because it provides a valuable security measure, particularly for the person who lives alone or in an isolated area. If a person knows that they have the ability to contact someone, much of their concern and fear of falling can be alleviated.

Fear of falling is very important to address. It represents a real geriatric syndrome with pernicious psychological and physical consequences that affects people’s ability to engage in activities. Having a fear of falling can lead to physical decline, depression and social isolation. A medical alert service can help overcome fear of falling for many people.

From Connections: A Newsletter for the Healthcare Professional, provided by Philips Lifeline.

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