Publicly funded home modifications are a regular feature of My Aged Care and the NDIS schemes. NDIS participants seeking independence and desires to age in place are increasing, but our housing stock is not fit for this purpose. Consequently, homes need adaptation as people age or acquire a disability. However, there is a clash of values between what the client wants, what the funder wants, and what the occupational therapist (OT) deems functional. That’s a finding from researchers at the Hopkins Centre.
Our homes are not designed for disability and ageing. Consequently, modifications are essential for remaining safely and independently at home. They are an essential part of the NDIS and My Aged Care schemes.
The chart shows the key overarching themes from the research
Researchers interviewed OTs experienced in prescribing home modifications. They wanted to gauge their experiences in the assessment process. They found that clients (homeowners) value aesthetics and property values. On the other hand, funding bodies value the cheapest option, and OTs are looking for the most functional outcome. OTs are also confronted with different decision making criteria across the various schemes.
Consequently, it is up to the OT to balance the desires of the client with those of the funder using their professional knowledge. Not an easy task, and unlikely to lead to optimum outcomes. And OTs become de facto bureaucrats in this process, which can also be a challenge to their professional values.
But what is “value”?
The research paper discusses the various aspects of value from different perspectives. The best outcomes are achieved when there is open discussion between the client, the funder and the OT. This encourages a better alignment of values.
While this paper is focused on the OT professional, it links closely with the notion of disability and ageing stigma. The idea of having a grab bar or a ramp appears to be an affront to one’s dignity. Older people see this as the beginning of the “downhill run” of life. The new Livable Housing Design Standard will help minimise this stigma by providing a step free entry and better bathroom design. Until we have sufficient stock, OTs will continue to provide home modification assessments.
The title of the paper is, Valuing home modifications: The street-level policy work of occupational therapists in Australian home modification practice.
There is also a webinar on the Hopkins Centre website that discusses client perspectives of home modifications. In a nutshell, they see modifications as value for money if they meet their specific needs to a high standard. Also, the process of getting a modification has to be straightforward without wasting time and money.
Phillippa Carnemolla’s research showed the number of care hours saved and improved quality of life with appropriate modifications.
Future-proofing is best
For those who can afford to renovate their home now, it is worth considering future-proofing, rather than leaving it “until the time comes”. The Livable Housing Design Guidelines are a good reference for anyone updating their home at any point in their life. This Guideline is the basis of the mandated Livable Housing Design Standard, but has more useful information for homeowners.