Title: A Home Modification Research Agenda For Long Term Care
1A Home Modification Research Agenda For Long Term
Care
- Jon Pynoos, Ph.D.
- National Resource Center On Supportive Housing
And Home Modification - Andrus Gerontology Center
- University Of Southern California
- Los Angeles, CA 90089-0191
- homemods_at_usc.edu
- www.homemods.org
2Purpose
- Analyze Current Research Concerning The Home
Environment And Long-Term Care - Propose A Future Agenda That Will Benefit From
More Sustained Investment
3Nursing Home Bias
- LTC Bias Towards Nursing Homes Has Been
Accompanied By A Focus On Environmental Research
In Institutional Settings - It Has Crowded Out Research In Conventional
Settings Where Most Older Adults Live-- Their Own
Homes And Apartments
4Problem
- Even In Community-Based Care, Home Modification
(HM) Has Been A Sleeper Issue - It Has Taken A Backseat To The Delivery Of
Personal Care And Health Services - Part Of The Problem Has Been Issues Of
Measurement Conceptualization
5The Need For Research
- Consequently, Few Data Sets And
Investigator-Initiated Research Have Focused On
Home Environment
6Why Is The Home Environment Important?
- The Physical Environment Can Enhance Or Impede
Ones Functional Ability And Quality Of Life - Potential Mismatch In Fit Between Person And The
Environment (Powell Lawton) - Strong Preference Of Older Adults To Age In Place
- Psychological
- Familiarity
- Ties To Neighborhood
7Most Homes Peter Pan Housing
8What Are Home Modifications?
- Home Modification (HM) Refers To Converting Or
Adapting The Environment To Make Performing Tasks
Easier, Reduce Accidents, And Support Independent
Living.
9Examples Of Home Modification
- Ramps And Stair Glides
- Hand-held Showers
- Grab Bars
- Roll-in Showers
- Better Lighting
- Chair Lifts
- Widened Hallways
10Research Efforts
- Over The Last Decade, Considerable Strides Have
Occurred In Better Understanding The Home
Environment And Its Role In LTC - Discuss Main Research Questions And Initial
Findings
111. What Are The Problem Areas Of The Home?
- Outside Steps To The Entrance
- Inside Stairs To A Second Floor
- Unsafe Bathrooms
Source HUD (2001)
122. Can HMs Along With Assistive Devices Make It
Easier To Perform Tasks?
- Findings With Bathing
- 1. HMs Reduce Bathing Difficulty For Those With
High Levels Of Functional Impairment - 2. HMs, in Combination With OT Assessment and
Follow-up, Significantly Improved Bathing Ability
Among Frail Elderly - Source Matsuoka Pynoos (2000) Gitlin et al.
(1999).
133. Does HMs Prevent Falls?
- Contradictory Evidence
- For Example
- Gill et. al. (2000) Found Weak Relationship
Between The Presence of Environmental Hazards And
Falls - Cumming et al. (1999) Found Among Those With A
History of Falls, OT visits And Provision Of HMs
Reduced The Risk Of Falling - Source Gill et al. (2000) Cumming et al. (1999)
144. Are HMs Cost-Effective?
- In A Controlled Intervention Study
- HMs In Combination With Assessment And Follow-up
By An OT Reduced Health Care Costs And Delayed
Institutionalization - Source Mann et al. (1999)
155. How Do HMs Affect Caregiving?
- 1. Adequate Space Can Facilitate Caregiving
- 2. HMs May Help Reduce Challenges For Dementia
Caregivers - Caregivers in the treatment groups showed
enhanced self-efficacy - Source Newman (1985) Gitlin et al. (2001)
166. How Useful Are ADA Specifications For Older
Persons In The Home Environment?
- Findings
- Ergonomic Studies Indicate That ADA Specification
Are Often Inappropriate For Older Persons - (e.g., Ramp Slope, Transfer Grab Bars In Back
Of Toilet) - Source Sanford and Megrew (1999)
177. What Has Been The Trend In HMs Over Time?
- Significant Increases In The Use Of Assistive
Devices HMs over last decade - 45.3 Of Older Persons Live In Homes That Have
Special Features - Suggests That HMs Substitute For Personal Care
Services, But Mechanism Unclear. - Source Manton et al. (1993) American Housing
Survey (1995)
188. How Large Is The Unmet Need?
- 1.14 Million Elderly Households With At Least One
Functional Limitation Report Unmet Need For HMs -
- Source HUD (1999)
19SourceAmerican Housing Survey, 1995
209.What Do Consumers Consider The Barriers Related
To HMs?
Source Fixing to Stay (2000)
21How Does The Service Delivery System Impact HMs?
- Fragmented Service Delivery System Makes It
Difficult to Obtain HMs - Gaps In Services
- Cursory Assessments
- Source Pynoos, et al. (1998)
22What Have We Learned So Far?
- 1. The Home Environment Matters
- Makes Tasks Easier To Carry Out
- Facilitates Caregiving
- Can Reduce Health Care Costs And
Institutionalization - 2. Significant Unmet Need
- 3. Problems in Service Delivery
- Fragmentation, Gaps, Affordability, Assessment
- Only Scratched The Surface In Our Understanding
Of The Role And Potential Of HMs in LTC
23Issues Related To The Environment Will Only
Become More Important In The Future
- Increased Emphasis On Community Based Care And
Implementation Of The Olmstead Decision - Advocacy By Younger Persons With Disabilities
- Majority Of Housing Stock Not Subject To Fair
Housing Amendments Act
24(No Transcript)
25What Can We Do To Improve Research?
- 1. Insure That Longitudinal Data Sets On LTC
Include Items Related To The Physical Environment
- 2. Insure That Housing Data Sets Include Items
About Both Functioning And Home Modifications - 3. Coordinate LTC And Housing Data Sets To
Insure Consistency - 4. Provide Greater Specificity About The
Environment (e.g.,Types Of HMs.)
26- 5. Test The Most Effective Ways To Integrate The
Delivery Of HM Services With The Long-term Care
System - Develop Best Practices Models To Encourage The
Replication Of Successful Approaches
27- 6. Test What Types Of HMs Work With Which Groups
(e.g., Alzheimers, Parkinsons) - 7. Replicate Intervention Studies With Larger
Samples
28Overall, More Funding For
- 1. Nationally-directed Research Initiatives
- 2. Investigator-initiated Research
29- Recognize That Housing Is The Where In LTC