Health Care Comes Home The Human Factors (2011) / Chapter Skim
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6 The Home Environment
6 The Home Environment
Pages 141-166
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From page 141... ...
This is also true for people with low incomes, multiple chronic illnesses, limited social supports, and health disparities as well as those who live in unsafe neighborhoods or poor-quality housing. A majority of vulnerable individuals do not receive effective health care for their chronic illnesses and live in housing that does not support their independence or functioning.
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From page 142... ...
Home environments can either help or hinder the ability of individuals to perform physical functions, carry out personal care tasks, or use health technologies. Individuals and families also differ in their willingness to change the home environment to facilitate health care, their preferences for where they perform basic activities of daily living, and their willingness to use health technologies (Albert, 2010)
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From page 143... ...
143 THE HOME ENVIRONMENT TABLE 6-1 Environmental Factors That Affect Medical Care and Life at Home Physical Environment Types of homes (detached single-family house, duplex, townhouse, apartment, mobile home) Age and condition Layout including location of bathrooms and bedrooms Accessibility in, out, and around the home Supportive features Communications/Internet access Adequacy of utilities Presence of children and animals Social Environment Immediate family Extended family Friends Religious affiliates Colleagues Cultural community Neighborhood community Clubs/associations Charitable activities Leisure activities Community Environment Safety conditions Weather conditions Presence and condition of streets and sidewalks Presence and condition of parks and recreation opportunities Presence and condition of meeting centers/locations Availability of goods and services Availability of public transportation Health Policy Environment Housing policies Zoning policies Building codes Social services policies Medical insurance company policies Medicare policies Medicaid policies Health care and long-term care reimbursement policies
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From page 144... ...
Housing Barriers The physical layout of homes can put individuals at greater risk of accidents, make daily living activities more difficult to perform, and even necessitate moving to a different home, assisted living, or nursing home (Fänge and Iwarsson, 2003; Iwarsson, 2005; Lau et al., 2007; Stark, 2008)
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From page 145... ...
Telehealth is the delivery of health care services or information via telecommunications technologies. Often is it used to link care recipients and caregivers to external health care providers, but it can also be used for communications between care recipients and caregivers.
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From page 146... ...
Barbara assists her husband with activities of daily living in the evenings and on weekends when she is home from her job and Sam's home health aide is unavailable. Sam spends the majority of his time in their second-floor bedroom because he doesn't like going up and down the stairs on his artificial limbs.
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From page 147... ...
. Many care recipients benefit from both low-cost home modifications and training in their use to enable them to engage in their daily activities more safely and efficiently (Gitlin and Corcoran, 2000; Gitlin et al., 2009)
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From page 148... ...
, features a product listing to help locate product manufacturers or distributors.1 Occupational therapists who specialize in home assessments are particularly skilled at helping to identify what will work for a particular individual and how to install home modifications to maximize an individual's abilities. A systematic home assessment by a trained occupational or physical therapist can help identify potential problems and solutions in the home 1 The AbleData database of assistive technology contains objective information on almost 40,000 assistive products.
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From page 149... ...
These include motion monitors that send alerts for people at risk of falling, video monitoring for activities and well-being, and interactive telehealth systems that encourage communication among care recipients, informal caregivers and formal caregivers. Although these technologies are promising, strong evidence is not yet available for the effectiveness of any particular remote monitoring technologies in achieving specific health outcomes.
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From page 150... ...
The Home as a Work Environment The home can be a challenging environment for both residents and their formal caregivers, such as registered nurses, physical therapists, occupational therapists, physicians, or personal care aides (Piersol and Ehrlich, 2009)
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From page 151... ...
For example, the ability to obtain formal daily supportive services for care recipients would also allow informal caregivers time to attend to their own needs. The availability of instruction on proper care techniques, such as how to assist with transfer in and out of the bed, would help informal caregivers reduce their own risk of injury (Sörensen et al., 2002; Pinquart and Sörensen, 2006)
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From page 152... ...
. The local community can influence whether care recipients can carry out daily living tasks, participate in social activities, and engage in healthy behaviors, such as walking safely in their neighborhood and shopping for healthy foods.
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From page 153... ...
This would require payment incentives to fund providers who coordinate care across settings and time.2 Also, informal caregivers would benefit from services that increase their skills in managing the complex health conditions and functional disabilities of their care recipients. These services require payment mechanisms to support their delivery (Gitlin, Jacobs, and Vause-Earland, 2010)
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From page 154... ...
The Patient Protection and Affordable Care Act (PPACA) includes elements that could promote care coordination at home for high-need populations.
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From page 155... ...
. Other care recipients, like Mrs.
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From page 156... ...
Finally, although the recently adopted long-term care insurance program (the Community Living Assistance Services and Supports Act, known as the CLASS Act) included in the Patient Protection and Affordable Care Act will pay eligible persons a daily amount that they can use for care and home adaptations, it is not yet clear how payment for expensive modifications will be covered.
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From page 157... ...
. For example, fully realized homes with universal design could include such features as a no-step path to a no-step entry, doorways that are at least 34-inches wide, at least one accessible full bathroom on the main floor, kitchen countertops and cabinetry that allow a person to work in the kitchen in a seated position, nonglare surfaces, a curbless shower in the bathroom, anti-scald faucet devices to avoid burns, nonslip flooring, variable height counters, doors and faucets with single-lever handles, and a bedroom on the main floor.
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From page 158... ...
nor homes that allow for aging in place or that meet the needs of persons with disabilities. However, it is encouraging that some builders, such as those in the planned community of Irvine, California, have provided prospective buyers with brochures and information about universal design features that can be included in homes to be constructed.
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From page 159... ...
Smart Homes Although not necessarily an essential feature of universal design, the "smart house" concept involves a home that is outfitted for telehealth services and other computer-based technologies to support people, including those with cognitive impairments (Sanford, 2010)
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From page 160... ...
These efforts will be buttressed by the CLASS Act, as noted earlier also part of the PPACA, that will build a reserve of funds for long-term care services to assist younger persons with disabilities and older persons who are frail. Delivery of daily supportive services, complex medical care, and mobile technology can lower costs and improve the experience of people who are living at home.
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From page 161... ...
. Physical housing characteristics for occupied housing units data set: 2005-2007 American Community Survey 3-year estimates.
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From page 162... ...
. Conducting research on home environments: Lessons learned and new directions.
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From page 163... ...
. Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders.
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From page 164... ...
. Occupational therapy in home health care.
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From page 165... ...
. The home environments of older people: A description of the psycho social processes linking person to place.
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From page 166... ...
. Fair housing: Toward universal design in multifamily housing.
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