Developing Best Practice

WA HACC Home Modifications and

Assistive Technology Project

An ILCWA AND WA HACC Partnership

Scope of presentation

• Context of project

• Benefits of HM & AT

– Outcomes for clients/carers

– Social/economic outcomes

• What do we know

– Current model

– Barriers

– What clients want

• Components of best practice

• Progress to date and next steps

– Model of practice

Home Modifications/Assistive

Equipment

• Need for Home Modifications and Equipment usually arises when the

features of the environment pose challenges or demands that are

incompatible with an individuals ability to address these safely and

effectively.

• Post-World War II philosophy, despite successful functional training,

individuals were not able to live independently outside the hospital

setting without environmental modification.

• Changes made to reduce the demands of the physical environment in

the home and its close surroundings, in order to enhance activity and

participation, promote independence and well being.

Background to Project

• Increase in referrals for HM & AT

(Wellness)

• Barriers to independence/safety in

existing homes

• Home modifications/equipment

undervalued in terms of contribution to

care provision

• RAS gateway to HM & AT for HACC

clients

– Irregularities in choice of referral

pathways, system bottlenecks,

choices, assessor knowledge

• AT pathways – fragmented, convoluted

siloed, not reflective of BP

• Federal aged care reforms emphasis

reablement/HM & AT more effective if

interfaced

• Informed consumer choices/DIY

• Best Practice sustainable model

Why the need?

• Older people wish to remain in their own homes/environment may not support this

• Often have difficulty identifying a need and are not aware of the options, choices or pathways

• Around (50%) of the difficulties with daily activities experienced by older people can be overcome by [modification]

• Future proofing home

“The house you are in at 65 is probably the one

you will want to be in at 85, but a lot can happen

to you in those 20 years. It’s a time of great

physical changes. The bathroom for example has

to be very adaptable."

What are our choices when

our environment is no

longer compatible with our

abilities?

• ?Relocate

• ?Stay put with assistance

• ?Stay put with environmental adaptations

Meaning of home - important to well being

More than bricks and mortar

It's vital to move from regarding adaptations as a building task to properly

considering them as an intervention designed to minimise the impact of disability,

enhance independence and enable people to continue living in their own home.

Meaning of home

• Sleeping in your own bedroom

• Tea in your own kitchen

• Sitting in your favourite chair

• Washing in your own bathroom

• Being able to get onto my front porch or back patio

• Staying in own community

Highest risk group

• History of falling in the last year

• Hospitalized in the last year

• Chronic diseases such as heart disease, lung

and OA

• Recent functional decline

• Visual impairment

Barriers – client perceptions

• Stigma – don’t want people to know they need them/see them ie ramps, rails, toilet frames, walkers

• Lack of awareness – don’t know how they can be supported

• Perceive that they have no need – put off doing anything even after a number of falls

• Too stressful – ie stress associated with any disruptions to routines

• Financial – worried about costs

• Desirability – how it looks

Benefits and outcomes

Impact/outcome extends beyond physical environment

• increased accessibility and improved participation/community access

• increased independence/engagement in daily living activities

• improving safety, particularly in relation to falls risk

• slowing the impact of age related disability

• facilitates caregiving

• positive overall impact on an individual’s health and well being

• may reduce the need for downstream care/likelihood of entering residential care

by facilitating self care practices

Home Modifications - impact from

consumer perspective

• taking a bath/shower (83.7 %)

• feeling safer (79.3 %)

• running the house (73.9 %)

• being able to go out of the house (66.3 %)

• using the toilet (69.6 %)

• needing less help from others (68.4 %)

• continuing with interests (55.4 %)

“Home modifications provide me freedom. Not needing

someone to open or close the door for me provides me the

possibility of doing what I want, when I want most of the time.”

Slide Title•

Economic argument

Provision of adaptations produce

savings to budgets – UK report

o An hour’s home care per day costs £5,000 a year.

o Annual savings from adaptations varied from £1,200 to £29,000 a year.

o People fall whilst waiting for adaptations. Average cost to the state of a

fractured hip is £28,665.

o This is 4.7 times the average cost of a major housing adaptation

(£6,000) and 100 times the cost of fitting hand and grab rails to prevent

falls.

Putting the economics aside– the

real value argument • Home modifications change everything. If I did not have all my

things adapted, I could not do anything and would need daily help.

• The rails have prevented me from hurting myself. I used to fall a lot.

• I think now that the bathroom mods have been done, I can look after

my husband a bit longer.

• After the adaptations, Oh my god it was wonderful. I could go up and

down stairs.

• It was just the independence – keeping your independence. Not

always asking other people and being dependent on them.

Enabling Homes Ron and Beryl

What happens now – system barriers

• multiple pathways, different referral sources/access points, documentation, eligibility criteria and philosophies

• waiting lists – dependencies can be created while waiting

• different levels of staff understanding and knowledge

• siloed responses

• different costs to client

• limited interface with enablement/ongoing support requirements

• limited follow up/impact on outcomes

• unmet need not captured

• limited client choice and control

• accessing non complex equipment

Assistive & ‘Soft Technology’ Pathways

for Mary

REF: Layton et al 2013

REF: Layton et al 2013

Mismatch with what clients want

• Single accessible point of access and contact

• Transparent and independent advise

• Assessment that considers options and lifestyle

• Better communication about options/choices including self

manage/purchase

• Speed of access/waitlists/basic and essential

• Retail/mainstreaming/prescription/top up

• Ease of purchase (Non complex)

• Supported through process/follow up and education

• ?Grants to do home mods

Assessment - Consumer perspective

Activity:

Appreciates the

tasks/activities I want

to be able to do in

the future

Person: Guided by

what I feel affects my

life

I am given suitable

solutions or information

on appropriate

pathways. Including

choices to self manage

Environment:

Understands the

Environment and

how HM and AT can

help

Enabling Cycle – HM & AT

Ref: ILC 2015

Best Practice Components

• Improved Accessibility: Equitable, seamless, supportive and informative.

• Excellence in service delivery: Responsive, innovative, swift, simplified and cost effective

practices. Focus on minor works with capacity for complex HM.

• Collaborative and co-ordinated services with all key stakeholders.

• Improved assessment processes: The use of standardised tools, focus on P-E fit. Self-

assessment will be incorporated. Follow up for all HM clients, re-assessment and review

occurs at specified times.

• Outcomes focused: Programmes that incorporate re-ablement/enablement and

preventative services (falls) and based on client centred approach – emphasis on

autonomy, control and informed choice for clients and their family/carers.

• Quality workforce, training and credentialing: Multidisciplinary approaches with the role

of the OT being central to the HM process. Cost-effective methods i.e. Trusted assessors

• Adoption of best value and current technology and design elements. With improved

interface between HM and AT.

Home Mods and Equipment

Client barriers • 68 year old lady. COAD, depression, painful OA

• Lives in two storey house

• Difficulty with walking due to shortness of breath. Pain from bending

• Falls

• Diff picking up things from the floor or pots and pans in low cabinets

• Problems getting in/out of bath

• Cares for husband who has had multiple strokes

• Rarely goes anywhere, difficulty with house access

• Poor maintenance of house, flooring unsafe in areas

• Difficulty reaching into washing machine

Wellness focused solutions

• strategies - falls, work simplification, strength and balance

• bath grab rails and bathroom flooring fixed

• non skid tread tape on the bath surface and non skid bath rugs on the floor

• long-handled sponge and reacher for easier access to overhead and floor items issued

• railing on the back steps

• front top step re-cemented to increase stability

• bilateral railings placed to make it easier and safer to climb the stairs

• dryer raised by a 4-inch platform to ensure proper body mechanics during use

• scatter rugs removed or double-sided taped to reduce fall risk

Ruth's story

Work to date/ongoing

• Literature review/data collation

• Strategies to support RAS

– advisory line

– resources/tool kit

– professional development

• Clinical governance framework

• Reablement interface

• Working with HM providers/tool kit

• Consumer resources/ILC website

• Streamlining pathways

• Workforce development

• Model development

(protocols/processes/assessment tool, roles)

• CHSP interface Ref: Goldsworthy 2014

Future model?

WA HACC HM & AT Service Delivery

Statewide /WAAF

Interfaced with Re-ablement

Partnerships with AAWA and VisAbility

Governance

•Policies and guidelines

•Standards

•Tools

•Funding optionsWorkforce

Development

•RAS, Home Support staff,

OT’s, technicians

Consumer education and

resources

User involvement framework

• ILC website Helpline,

information pack, workshops, self

assessment

Easy access to non complex equipment

Retail model development

HM & AT Service Providers

Guided by best practice

Supported by resources/tools

Competency framework

Access to professional development

Rural and remote services

Skype consults

Combined OT/Technician

team

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How modifications support carers

Questions?

“If a medicine was discovered with a similar cost-profile (to equipment),

it would be hailed as the wonder drug of the age.”

Contact us

Hilary O’Connell

Project Manager Independent Living Centre WA

Email: hilary.o’connell@ilc.com.au | (08) 9382 0277

www.ilc.com.au