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Enabling Home Environments: Strategies for Aging in Place

Research Goals and Background Issues

Potential barriers to the accessibility, safety, security and usability of home environments for older people with disabilities are well known (see Pynoos, 1987 and Watzke and Kemp, 1992). As older people "age in place", these barriers present serious threats to independence and increase caregiver burden. Many methods for eliminating barriers and creating enabling environments have been proposed. However, the needs of individual households vary significantly and they differ from those of younger people with disabilities. There is a need for information on the types of barriers that "handicap" older disabled people, the specific interventions that should be high priorities and the level of acceptance of interventions among the older population. Such information can be used to identify priorities for policy, innovative design concepts, service programs and design of assistive technology. It can help to prevent disability among the older population and increase autonomy. This paper presents findings from the second phase of a multi-year research study concerned with the identification of barriers to aging in place and consumer acceptance of actions to remove those barriers. A previous publication reported on the first phase of the research (Steinfeld and Shea, 1993). The research reported here focuses primarily on the reasons why participants do not implement recommendations of professionals, particularly those that they themselves agree are a high priority.

In an earlier phase of this study we could not explain the priorities consumers gave to recommendations on the basis of cost alone. By analyzing consumer priorities and from informal interaction, we obtained insight into the decision making process (Steinfeld and Shea, 1993). From a cost-benefit perspective, interventions are valued if their benefit outweighs the cost compared to other alternative methods of coping, such as changing behavior. In a risk assessment model, the perceived risk associated with some barriers may be greater than with others, and may be misplaced. Barriers perceived as having low risk are not viewed as real problems. In a cognitive dissonance model, some problems are perceived to be unsolvable and, thus, expectations for resolution are lowered in order to accept the situation more easily. In a social construction model, accepting the need for an intervention is a "reconstruction" of self image, an acknowledgment to others that one can no longer function effectively without adjusting relationships with the everyday world. Denying the need for intervention, on the other hand, presents a courageous image - "It's tough, but I can handle it." As we began the next phase of our research, we realized that there are differences between establishing priorities and actually committing resources to action, thus we considered two other decision making models. The economic constraint model acknowledges that some individuals simply do not have the ability to pay for an intervention, even if they place a high priority on it. Furthermore, in certain cases, an item might be perceived as too expensive when in fact it is affordable. The stress management model is based on the premise that making a change requires some expenditure of psychic resources and energy; some things are perceived as "too much trouble," despite their obvious value. Because of the effort involved, however slight, a change is unacceptable regardless of the impact it might have on their life in the future.

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New York-Presbyterian. The University Hospitals of Columbia and Cornell