Understanding home modification outcomes from the perspective of older people and people with a disability: informing home modification evaluation

PURPOSE

There is limited evidence to guide therapists in home modification outcome evaluation. Involving consumers in evaluating home modifications is critical to progressing practice. This study investigated the home modification experience and outcomes most valued by older adults and individuals with a disability in Australia.

MATERIALS AND METHODS

An interpretive description approach was used. Twenty participants aged 24-93 who had received major home modifications were interviewed and transcripts were analysed thematically.

RESULTS

Two major themes emerged: life before and during modifications - "it was all hard," and life after modifications - "to have a life." People's prior experience of home, the circumstance of and time to plan modifications, the perceived value of the modifications, and the home modification process and funding influenced perceptions of outcomes. Valued home modification outcomes included those that enable people to experience emotional and physical health, and safety; do what they want; maintain the image of the home; and plan for the future. Experiences and perceptions of modifications ranged from supportive to disruptive.

CONCLUSIONS

These findings point to the need for therapists to deeply understand and evaluate their clients' experiences of home and life as an initial and critical step in the home modification process.Implications for rehabilitationMajor home modifications result in broad and meaningful outcomes of importance to clients.Occupational therapists need to partner with clients to understand their life before and during modifications to achieve positive outcomes.Evaluation of major home modifications needs to be integrated and prioritised in daily practice.

The Effectiveness of Local Authority Social Services' Occupational Therapy for Older People in Great Britain: A Critical Literature Review

Introduction:

Older people are the main users of adult social care services in Great Britain. Evidence suggests that occupational therapists employed by local authorities are providing interventions that promote and maintain older people's independence, and decrease dependency on other services. However, such evidence is disparate in nature and lacks synthesis.

Method:

This literature review systematically selected, critically appraised, and thematically synthesized the post 2000 published and unpublished evidence on the effectiveness and cost effectiveness of occupational therapy interventions for older people in social care services.

Findings:

Identified themes established: the localized nature of social care services for older people; organizational and policy impacts on services, and factors influencing effectiveness and cost effectiveness. Although occupational therapists are increasingly involved in rehabilitation and reablement, there is a continuing focus on equipment and adaptations provision. A high level of service user satisfaction was identified, once timely occupational therapy services were received.

Conclusion:

Overall, occupational therapy in social care is perceived as effective in improving quality of life for older people and their carers, and cost effective in making savings for other social and healthcare services. However, the complex nature of social care services makes it difficult to disaggregate the effectiveness of occupational therapy from other services.