Home Evaluation For Seniors

An Occupational Therapy home evaluation can be performed when the person is having difficulty living independently and safely at home. The client can request this, but often it is a family member or caregiver who is more likely to look for outside assistance, when they are concerned about the person's welfare. There may have been a recent decline in self-care abilities, a history of falling, difficulty managing the home, or the person can no longer function without assistance. This could be due to a recent medical condition, declining health problems, or possibly due to cognitive deficits. And sometimes it is due to the recent death of a spouse or caregiver. Any of these conditions can limit the person's ability to function independently at home.

The Occupational Therapy home evaluation has three components:
1. The client is assessed for physical, cognitive and perceptual problems and limitations. Functional skills and ADL abilities are evaluated. The client’s medical status is also taken into consideration as part of the overall equation.
2. The therapist will perform a home evaluation with the client and family to see what the issues and concerns are. The OT will look at issues such as safety, accessibility, the home environment, etc.
3. A summary report and list of solutions and alternatives are provided to the client, family, and/or caregiver afterwards. Education and other resources are also provided. A copy of the final report can also be provided to the person's physician and other support agency if desired.

The Occupational Therapist who evaluates a client in the home environment will weigh the client's desire to be independent along with the current medical problems and safety concerns, and help formulate solutions to achieve a suitable outcome which will not compromise the client's health and safety.

The Occupational Therapist will provide the client and family options and alternative solutions to consider, as well education and practical solutions. This can include local resources and other contacts; such as home health agencies, local and state agencies, and DME companies that can provide adaptive equipment. Further consultative sessions may be requested, and this is entirely up to the client/family. Sometimes client and caregiver education and training is required in order to help the resident remain safe and independent at home.

When grab bars are being considered, proper placement for height and reach, as well as anchoring, are critical. (Illustration courtesy of Moen Homecare)

When a home evaluation is performed, the OT will look at not only the home environment, but will also assess the individuals's 'task performance' and interaction with the environment. An important component of this is analyzing proper 'body mechanics', which is needed when there is any kind of physical dysfunction. It is important that the individual with any kind of physical limitations demonstrate good judgement when performing ADL tasks in order to minimize the problem at hand.

For example, a senior who lives alone has recently become limited in her independence due to osteoporosis and vertebral fractures of the spine. She will need to avoid bending, twisting, and lifting in order to not exacerbate the current problem and to allow proper healing of the affected area, and to reduce the incidence of pain. Something as simple as putting on socks and shoes or picking up items off the floor can be an ordeal that causes increased pain and may cause further injury to the spine. Education on proper body mechanics and coming up with alternative solutions, such as using adaptive equipment, may be needed.

It was determined by the therapist that the stairwell was too dark for the client and a motion sensor light should be installed; as the basement lighting did not sufficiently illuminate the top of the stairs. The light will illuminate as soon as the door to the stairwell opens.

Some of the problem areas to be assessed?

• Ability to bath, dress and perform other basic self-care needs adequately?

• Ability to prepare and eat healthy meals daily?

• Ability to take medications on a regular schedule?

• If diabetic, can they check their own blood sugar level and dispense insulin?

• Can they navigate stairs and other obstacles in the home, can a wheelchair or walker be navigated in the home?

• Can the person safely get in/out of the bed, tub or shower, automobile, etc.?

• Will they know how to respond in an emergency situation?

• Do they need help with laundry, shopping, etc.?

• Are they staying physically and socially active?

• Do they have an adequate support system to help meet their needs?