Physical Therapy for Seniors Living at Home

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A new standard in environmental design

Occupational therapists work closely with clients who may require an individualized, comprehensive home assessment to maximize their independence, safety or level of accessibility. This client could be a child with a disability or an older adult experiencing physical and cognitive challenges.

Most individuals want to stay in their homes as long as possible. However, many recognize that their home is not well-suited for them to live safely and independently.

As practitioners, we must respond to the “silver tsunami.” Every day, 10,000 Americans turn 65, and by 2030, one in five will be over 65. We all know that as we age, a variety of changes occur — some of which are life-challenging.

Aging in Place

According to AARP, nearly 90 percent of people over age 65 indicate they want to stay in their homes as long as possible. Four of five in that age bracket believe their current home is where they will always live.

However, according to the Administration on Aging’s study “Aging In Place: A State Survey of Livability Policies and Practices,” from 2007 to 2008 only 3.7 percent of older people moved, as opposed to 13.1 percent of those under age 65.

Unfortunately, most homes were not designed with appropriate accessibility and safety knowledge. Likewise, we have learned that building codes were designed for healthy 35-year-old males. Many older homes, even those that have been remodeled with added features, do not make it easy or safe for everyone to live comfortably.

Adult children often oversee the modifications of their parents’ homes. In many cases, they live a considerable distance away and may have significant concerns that something might happen to their loved one. There is also the possibility of a visitor to the home sustaining a fall that could have been avoided with the proper attention to accessible and safe environmental design.

Meeting Client Needs

A new national certification called the Certified Living In Place Professional™ (CLIPP) was recently created by the Living In Place Institute. This program focuses on the needs of older individuals, but the emphasis is on everyone.

For OTs, CLIPP training provides a comprehensive outlook on home evaluations in addition to the education we already have in universal design, home modifications and adaptive equipment. CLIPP training provides increased education and useful tools to help clients live in place and grow our business.

The program recommends creating a team to meet clients’ needs and promotes the importance of non-healthcare professionals partnering with occupational therapists. OTs have specific training to recommend appropriate home modifications and adaptive equipment that pertain to ADLs, routines, roles and habits. When working with persons of size, whose weight is over 250 pounds, the program advises therapists to select appropriate products and partner with knowledgeable contractors and structural engineers to ensure that items will be properly selected and installed.

Many non-healthcare individuals do not understand the medical, pharmaceutical, physical and cognitive issues of aging, and how they inhibit daily tasks. The CLIPP program educates attendees on how design can better help people live in place.

One enlightening example is preparing lunch with a temporary disability. Some attendees experienced what it would be like to cook a meal with a vision impairment. Others experienced limited-to-no use of an arm. This raised awareness of the needs of our clients as well as the importance of making appropriate adaptive and ergonomic design recommendations.

Because the Living In Place Institute is an independent educational organization, one benefit of the program is learning about appropriate products that could be added to our “toolbox” as well as who makes them and what they cost.

Electronic Assessment

One aspect of the CLIPP program is an electronic assessment app: the Home Accessibility and Safety Assessment Checklist™ (HASAC). It is a comprehensive, standardized checklist available only to professionals certified through the CLIPP program. This allows a detailed home assessment to be conducted quickly, efficiently and thoroughly for accessibility and safety.

This checklist can be tailored to each client’s needs. It identifies hundreds of items to consider when making appropriate recommendations. It allows a systematic approach to considering every question, minimizing the risk of not addressing issues in the home and thus clinician liability.

Occupational therapists have roots in a client-centered approach with a focus on promoting the health and well-being of people through occupation. One of our primary goals is to enable people to participate in activities of everyday life. This often begins in their home.

The tool allows therapists to embed notes and photos directly into the final report. Users can view solutions from a large database of accessibility and safety products. Assessments can be sent electronically or a printed copy can be presented to the homeowner. The CLIPP program and HASAC assessment allow OTs to provide a comprehensive home assessment and help individuals live in place.

Training Takeaways

One of the most significant training takeaways, apart from the new professional relationships fostered during training, was the confidence to better serve our clients in recommending solutions that encourage a life-enhancing environment to live with dignity, safety and comfort.

The class included a wide variety of other professionals, including designers, home builders and remodeling specialists, as well as several manufacturers. The course encouraged a new direction in communicating solutions to accessibility and safety aligned with good design, well-made products and careful implementation.

As occupational therapists, it’s exciting to become an integral part of this new team of designers, builders, and real estate professionals whose aim is to create home environments that are accessible, comfortable and safe for everyone, regardless of their age or needs.

For some therapists this will become a new business service that may provide an additional source of revenue. For others it’s a wonderful opportunity to expand current practices while following our passion of helping clients across their entire lifespan.

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About Author

Sabrena McCarley, MBA-SL, OTR/L, CLIPP, RAC-CT

Sabrena McCarley is director of clinical operations for RehabCare and chair of advocacy and government affairs for the Occupational Therapy Association of California.

Kylie Sleeth, MS, OTR/L, CLIPP

Kylie Sleeth is an occupational therapist at Powerback Rehabilitation and chair of professional development and education for the Occupational Therapy Association of Colorado (OTAC).

Lisa White, OTR/L, CLIPP

Lisa White is an independent contractor in the Denver area and conference chair of OTAC.

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