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Enabling Home Environments: Identifying Barriers to Independence


The research sample was selected using screening data obtained through a larger comprehensive interview survey conducted through the University of Buffalo's Rehabilitation Engineering Research Center on Aging. Participants were recruited through referral from a wide variety of organizations serving older people with disabilities. All the participants were over 62, had a disability and lived in community housing, not institutions. An initial quota sampling plan proved to be infeasible due to shortages of willing participants in several categories. In the end, we sought as many participants as possible in all the cells of the original quota sampling frame (see Table 1). The sampling frame was based on type of disability and type of housing tenure. We assigned people with more than one disability to the group reflecting their primary disability.

Disability Own Rent Total %
Visual Impairment 7 5 10 24
Dementia 10 10 20  
Non-Ambulant 3 5 8 16
Semi-Ambulant 11 10 21 41
Totals 31 20 51 100
% 61 39 100  

Table 1. Sampling plan

The sample was split into owners and renters because we wanted to examine the differences in needs and priorities between the two forms of tenancy. Four categories of disability were addressed as well: visual impairment, dementia, non-ambulant (use of wheelchair) and semiambulant. By sampling based on impairments, we could insure that a full range of problems would be encountered.

In the interview survey a series of questions were asked related to difficulties that the respondent had using parts of their home. This self report data was compared against data obtained through a thorough assessment completed by a trained observer. For each participant, we prepared a report listing the barriers identified through the assessment and our recommendations for eliminating barriers. We also visited each household to explain the recommendations and help the participants to establish priorities. Although not completed at the time of this writing, follow up visits will be made to all individuals in order to track the implementation of recommendations.

After a review of existing materials we developed five focused assessments:

  • ADL (includes accident safety),
  • Fire Safety,
  • Security,
  • Behavior Problems,
  • Building Condition.

Participants are also interviewed to determine if they have made modifications to their home and how effective those actions have been.

The ADL assessment was based upon previous work from Department of Community Health, Montreal General Hospital, (Maltais et al., 1989). We adapted their assessment form for U.S. conditions. It covers general accessibility of dwelling and site, bedroom activities, bathing and personal hygiene, using the toilet, preparing meals, doing the laundry, cleaning the house, using the telephone, enjoying leisure/doing business and taking medication. Participants are asked if they have difficulty with these ADL'S. We probe for details and examine the dwellings to determine whether those difficulties are in some way related to environmental conditions. The Fire Safety Assessment and the Security Assessment are based on existing publications as well (Newman, 1973; HUD, 1977). Both begin with a series of questions for the participant or caregiver on security and safety practices. The rest of the items are in checklist form which is used during a "walk through" of the dwelling. The Construction Assessment was developed by our research team. A survey or completes a circuit through the interior of the house and around the outside of the building using a checklist of building elements. Any construction problems are identified and evaluated. The Behavior Assessment is adapted from the Caring Home Booklet (Pynoos et al, 1988). It consists of an interview with a caregiver with questions about symptoms of dementia that may be alleviated through environmental interventions. The initial home assessment takes from 1-2 hours.

After the initial assessment visit, we prepared written reports for each household. The reports listed the problems identified and recommended solutions. The written reports were sent to the participants with a note indicating that we would soon schedule a home visit to discuss the recommendations. At that time, we helped them identify priorities and showed them illustrations of assistive technology and environmental design ideas.

If an individual had needs that required the assistance of rehabilitation therapists, we consulted and involved other staff at the RERC before making recommendations. In such cases, an occupational therapist would attend the follow up visit.

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