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Enabling Home Environments: Identifying Barriers to Independence

Research Goals

The goal of this research was to test assessment methods and identify priorities for home modification services. We obtained descriptive data about the extent and type of barriers to independence found in the homes of a sample of older people with disabilities. A barrier was defined as an environmental feature that reduced functional capacity or put a person at risk. We identified 4 categories of barriers. They include features that affect activities of daily living, safety, security and the structural integrity of the dwelling. A free home assessment service was offered. Assessments of homes occupied by older disabled people were completed.

Recommendations were prepared and discussed with each client. A priority ranking of recommendations was then prepared for each person based on this discussion. The clients are being tracked to identify which recommendations are implemented. Data from the assessments, recommendations and initial tracking is presented in this paper.

The research has many specific hypotheses. For the purposes of this paper only a limited set will be discussed. They are as follows:

  • H1. Presence of barriers will be under-reported by respondents.
  • H2. Barriers associated with climbing stairs are the most prevalent handicapping environmental conditions in the homes of older people with disabilities, followed by use of bathtubs and transferring to toilets.
  • H3. The physical condition of the dwelling plays a major role in establishing priorities for each individual.

The first hypothesis is based on previous research. Very small proportions of older people who dwell in the community report unmet needs related to health and functional problems (Soldo and Longino, 1988). It has been argued that older people adjust their expectations to losses in functional ability (Jackson et al., 1991.). In addition, technical training is needed to understand the presence of many barriers.

The second hypothesis above was derived from an analysis of functional assessment data collected through the Uniform Data Systems Project at the Rehabilitation Medicine Department, University at Buffalo. This data indicates that the three most prevalent functional limitations in a sample of 1400 older disabled people were, in order of prevalence, using stairs (81.2%) transferring into a tub (73.6%) and transferring to a toilet(55.6%). One might assume from this data that H2 is true, however, there is a relationship between the individual's limitation and the presence of barriers in the environment. Barrier-free environments do not "handicap" the individual who has limited function. Moreover, if the UDS data on communication, cognition and social interaction abilities are added together they add up to a larger incidence of functional limitation than any of the other scores. Thus, it could be that environmental conditions related to security and safety are more critical than those related to access and use.

Our third hypothesis focuses on the relative importance of different housing related problems. Steinfeld et al, (1977) discovered that emergency repairs, weatherization and deferred maintenance were a major emphasis of programs providing residential repair and renovation services for older people. The literature on home modification services has generally slighted the importance of these construction issues. The focus on accessibility, usability and safety by health care providers is consistent with their therapeutic mission. Service providers that operate under a "construction model," on the other hand, recognize that basic shelter needs are often higher priority issues. We anticipated that many of our participants would reject investment of resources into removal of barriers of other types because they recognize the need to devote any available resources toward deferred maintenance of their dwelling or to future unknown shelter related problems. Clearly, shelter issues must be examined in relation to the health and function related concerns.

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