Installation of ramps at entrances is among the most common housing adaptation measures. (Photograph: S. Iwarsson; reproduced with the subject’s approval)
Housing adaptation as intervention places great demands on OTs, because they are acting upon the most private domain of a person’s living environment. Potential conflicts of interest are inherent in the process (see, e.g., Chiatti and Iwarsson 2014).
As the quite diverse systems across countries make comparisons between studies difficult, it is hard to evaluate the literature for scientific evidence regarding housing adaptations and home modifications . The majority of published housing adaptation evaluations lack theory-based definitions of core concepts and outcomes. According to the Cochrane reports (Gillespie et al. 2003; Lyons et al. 2003), the scientific evidence of the effects of housing adaptations and home modifications is limited. Yet, according to a literature review, including studies with mainly older people (Wahl et al. 2009) there is substantial evidence of positive effects. Positive effects were indicated on (1) functional decline (Mann et al. 1999), (2) fear of falling (Cumming et al. 1999; Heywood 2004), (3) pain and depression (Heywood 2004), (4) satisfaction and performance in daily activities (Gitlin et al. 2001; Stark 2004), and (5) costs of healthcare and social services (Mann et al. 1999). Most recent studies on housing adaptations and home modifications show promising results (see e.g., Sheffield et al. 2013). However, regarding health economy outcomes, the scientific evidence is nonexistent (Chiatti and Iwarsson 2014).
Housing adaptations and home modifications should be recommended as interventions that support the maintenance of independence in activities of daily living (Wahl et al. 2009) and occupational performance in general (Fänge and Iwarsson 2007). Still, there are critical methodological challenges for practice and future research (Malmgren Fänge et al. 2013). As the quotation at the start of this chapter demonstrates, another challenge is to present scientific evidence that would make some individual housing adaptations unnecessary. Applying such a health promotion approach, and using experience and knowledge generated from individual housing adaptation cases to be translated into recommendations for housing provision as part of the process of planning a society for all (Ainsworth and de Jonge 2011; Iwarsson 2005), is a challenging but important avenue for future development.
The Case Study of Stina: Housing Adaptation
Keywords:Home modification, Housing adaptation, Objective aspects of home, Accessibility, Perceived aspects of home, Usability
The theme of this case study is housing adaptation aimed at a person with multiple sclerosis (MS) .
The student task includes:
Identifying valid information on typical occupational performance problems in MS and their progression over time, specifically related to personal and instrumental activities of daily living usually performed in the home environment.
Identifying aspects of home and health that need consideration and related assessment instruments for data collection prior to the planning for a housing adaptation as well as for follow-up.
Applying clinical reasoning following the steps in the housing adaptation process, and reflecting upon the content of an efficient intervention for the person described in this case.
As a starting point, students should use the following references to gather background information:
Ainsworth E, de Jonge D (2011) An occupational therapist’s guide to home modification practice. Slack Inc.,Thorofare
Fänge A, Iwarsson S (1999) Physical housing environment: development of a self-assessment instrument. Can J Occup Ther 66(5):250–260
Fänge A, Iwarsson S (2005) Changes in ADL dependence and aspects of usability following housing adaptation—a longitudinal perspective. Am J Occup Ther 59:296–304
Iwarsson S, Haak M, Slaug B (2012) Current developments of the Housing Enabler methodology. Br J Occup Ther 75(11):517–521