9.03 Housing Adaptations and Equipment

March 2, 2020

Presented by: Iain Wilkinson, Jo Preston, Alice O’Connor, Tracy Szekely

Faculty: Jackie Lelkes

Broadcast date: 3rd March 2020



Social Media

Alice: “Rehab Matters” – a short film from the Chartered Society of Physiotherapy (CSP).

Part of the “Right to Rehab” campaign, supported by multiple organisations including CSP, Chest Heart and Stroke Scotland (CHSS) and the British Lung Foundation.

The following links have more information about it:

https://www.csp.org.uk/campaigns-influencing/campaigns/rehab-matters

https://www.csp.org.uk/publications/manifesto-community-rehabilitation


Learning Outcomes

Knowledge

  • To gain an understanding of what  home adaptations for older people are available
  • To gain an understanding of the roles of  the OT and other professionals in the provision of home adaptations for older people
  • To gain an understanding of  the financial support available for home adaptations for this client group

Skills

  • To able to support older people to access appropriate and safe home adaptations

Attitudes

  • To appreciate the importance of client centred practice within the statutory framework for home adaptation provision

CPD Log


Show Notes


Definition

Practical definition

Home adaptations are changes that can be made to the home. These make it safer and easier to move around and do everyday tasks.

Main Discussion

Overview

Local council offers a service that assesses the home and recommends changes to help. Having a home assessment is free.

These changes can be small or big and include:

  • Fitting a stairlift or a stair rail on the stairs
  • Adding a bath lift, walk-in shower or a rail you hold to pull yourself out of the bath (grab rail)
  • Widening doorways
  • Lowering kitchen worktops
  • Putting in an outdoor ramp or step rails
  • Security, such as an outside lights and intercom systems.

There is equipment available to help make everyday tasks easier: 

  • Going to the toilet → a chair with a hidden toilet (commode) if getting to the toilet is difficult, a push button to flush the toilet,a raised toilet seat.
  • Using the bathroom → slip mat for the bath or shower, a rail to help you get out of the bath or shower, easy to turn handles for taps.
  • Cooking and eating → a kettle with a holder to make it easy to pour, knives and forks with special handles to make them easy to hold, easy to grip jugs or graters, cups with 2 handles.
  • Getting out of bed or out of a chair →  a rail you attach to the bed (grab rail)
  • Straps to help you lift your leg (leg lifters), blocks to raise your bed, reclining chairs.
  • Getting dressed →  hooks to help pull zips, undo buttons and pull jackets on, gadgets to help put socks, tights and pants on.

Personal alarms and security systems (telecare) are devices that call for help if you  fall or have a problem at home.

Basic alarms are small, user-activated devices. They usually make a loud noise or send a signal to a carer or family member’s pager or phone. They can be worn (around the wrist or as a pendant) or they can be a button or pull cord in the home. These alarms are cheap but rely on someone being close by to help. You can buy them online or on the high street and prices start at around £3.

Some are automatically triggered if, for example, you fall over/ out of bed, have a fit, wander off, or if the room is too hot or too cold.

They range from basic alarms to intercom systems that allow family members to see who’s knocking at the door.

Key safes

A keysafe is a small, locked box that holds a key. This means carers, family or emergency services can get into the home if you can’t get to the door.

A key safe is fixed to an outdoor wall and is opened using a code. They can be bought online or on the high street and prices range from £20 to more than £100. The more expensive key safes work the same way but they’re stronger and heavier. Often the challenges with installing a key safe relate to:

  • Who can install it? E.g. handyman – AgeUK and some councils will organise for you for a small fee
  • Who has the right to agree to install it? i.e. who owns the property? If rented, will the landlord consent? Power of Attorney for those owning their houses but lacking capacity to consent to the installation. 

Home security

Home security helps you to stay safe at home. There’s a wide range of devices that alert family or carers if there’s a problem. They include:

  • Small devices (such as a watch) that use GPS to tell someone your location if lost
  • Intercom systems that can show someone else (such as a family member) who’s at your door and allow them to open it.
  • Gadgets that turn off electricity or gas mains if they detect danger.
  • Reminder systems for medication etc.

The Which? Later life care website has further information:

https://www.which.co.uk/later-life-care

For systems connected to a monitoring service you can contact the Telecare Services Association. 

Some councils provide monitoring services, but they’re usually basic systems. 

Practical considerations:

  • Is it realistic to wear a device?
  • Do batteries need changing and are you able to do this?
  • Who is going to fit the system initially?
  • Are there animals in the house that may trigger sensors etc?

Home assessment

If help is needed with everyday tasks, or there is a fear of falling, social services departments can provide a home assessment. 

An occupational therapist will visit the home, interview the client, assess the home environment and collaboratively make a plan.

Assessments usually take at least an hour and even the smallest things are looked at.

The council should pay for each adaptation that costs less than £1,000. 

For more expensive things, grants can be obtained from Independence at Home, or a Disabled Facilities Grant.

A Home Improvement Agency (HIA) can help you find schemes to help with the cost of adaptations. Sometimes local councils might be able to help with the cost of urgent home alterations.

There is good evidence that both minor and major home adaptations can improve a range of outcomes for people in later life, especially when they are done in combination with any necessary repairs, are delivered in a timely manner, and are in line with people’s personal goals.

https://www.ageing-better.org.uk/sites/default/files/2017-12/The%20role%20of%20home%20adaptations%20in%20improving%20later%20life.pdf

  • This report has made some recommendations to improve later life based on insight from a body of evidence.
  • Its conclusions are also based on population data demonstrating major structural inequalities in England.
  • Housing and growing older affects everyone, and it is important the value of prevention is central to debates about improving later life.
  • Most people would like to remain living safe and well at home and be able to continue to be independent members of the community for as long as possible. 
  • Getting later life right for individuals is important for the health and wellbeing of families, carers and the wider community, and a good home environment is central to achieving this.

The gatekeepers of home adaptations are occupational therapists who have launched a campaign to demonstrate that their service can ‘Improve Lives and Save Money’.  

The Royal College of Occupational Therapists (RCOT) have some excellent examples on their website of how home adaptations can improve lives, but there is sparse evidence for how much money can be saved.

When any cost savings are estimated, not all staff time is included.

 An underestimation of costs could lead to a shortfall in Disabled Facilities Grants (DFGs) allocations and result in longer waiting times for people having their homes adapted. This in turn could lead to falls and preventable hospital admissions.

Practitioners and academic researchers are being invited to put together proposals to support development of an evidence base for the link between well adapted homes and a healthier old age. In coming years we will hopefully see the outcomes of this as it is currently a bit of a gap in UK research.

https://www.architecture.com/knowledge-and-resources/knowledge-landing-page/home-adaptation-for-better-old-age

Housing for older people

FirstStop Advice Service ,currently led by the Elderly Accommodation Counsel (EAC), aims to provide holistic advice covering a range of issues relating to housing for older people:

  • Repairs, maintenance and adaptations (and access to funding for these)
  • Home improvement agencies (HIAs), handypersons, trusted traders
  • Housing options, including specialist housing

https://publications.parliament.uk/pa/cm201719/cmselect/cmcomloc/370/37012.ht

The consequences of falls at home, caused by often trivial hazards, can be catastrophic, precipitating serious decline in older people’s physical and mental health.

There needs to be a national and local drive to address falls and accidents in the home. This should include provision of advice on many of the things we have discussed already, such as accessing services and Disabled Facilities Grants.

In addition, integrated working between housing partners and health and social care may help to identify homes with accident risks earlier and remove them.

There is a well-evidenced link between housing, health and wellbeing, and the consequent costs of NHS treatment.

Poor quality, un-adapted accommodation can lead to

  • Reduced mobility
  • Depression
  • Chronic and acute illness
  • Falls
  • Social isolation
  • Loneliness
  • Depression

The DFG has a very important role to play in making older people’s homes accessible and enabling them to maintain their independence.

Private renting is an increasingly important housing option for older people, and they should feel confident in being able to adapt their home to meet their needs.  It is recommended that the review of the DFG should consider how to ensure that older tenants in the private rented sector secure the adaptations they need. In particular, it should consider the case for allocating government funding to local authorities to make discretionary payments to landlords for the costs of reinstatement or removal of the adaptation once the tenancy has ended.


Curriculum Mapping

NHS Knowledge Skills Framework

  • Core 2 Level 1
  • Core 3 Level 3
  • HWB2 Level 1
  • HWB4 Level 2

Foundation Programme

  • Sec 1:3 Vulnerable groups
  • Sec 1:4 Self directed learning
  • Sec 2:6 Interface with HCPs
  • Sec 3:10 Frail pt
  • Sec 3:10 Support for pts
  • Sec 3:11 Discharge planning

GPVTS 

  • 3.05 Clinical management
    • Know how to access support services for older patients
    • Know the different forms of day-care and residential accommodation available and be able to advise patients about them
  • 3.05 Working with colleagues and in teams
  • 3.05 Practising holistically and promoting health
    • Know the preventative strategies required in the care of older people
  • 3.05 Community orientation
    • Be aware of inequalities in healthcare provision in older persons
    • Consider the positive and negative ways in which socio-economic and health features inter-relate
    • Understand the key government policy documents that influence healthcare provision for older people
    • Know how to use the various statutory and voluntary organisations for support of older people in the community

Core Medical Training 

  • Managing long term conditions and promoting patient self-care
    • Health and social service provision
  • Management and NHS structure
    • Debates impacting on service provision
  • Geriatric Medicine
    • MDT assessment
    • Discharge planning

Internal Medicine Stage 1

  • Generic CIPs – Category 3:4
    • Prioritise patient safety
  • Generic CIPs – Category 4:5
    • Role of evidence in practice

Geriatric Medicine Specialty Training 

  • Managing long term conditions and promoting patient self-care
    • Health and social service provision
  • Management and NHS structure
    • Debates impacting on service provision
  • 27. Comprehensive Geriatric Assessment
    • Factors influencing health status in older people
    • Have knowledge of the major sources of financial support, especially attendance allowance 
    • Have knowledge of the range of agencies that can provide care and support both in and out of hospital and how they can be accessed
  • 29. Diagnosis and Management of Chronic Disease and Disability
    • Health promotion and preventive medicine
  • 30. Rehabilitation and Multidisciplinary Team Working
    • Roles and expertise of different members of interdisciplinary team
    • Aids and appliances which reduce disability
  • 31. Planning Transfers of Care, Including Discharge
    • A general awareness of the financial support available to patients and their carers
    • Role of the geriatrician and the multidisciplinary team in discharge planning
  • 35. Falls
    • Consequences and impact of falls
  • 36. Poor Mobility
    • Interventions to improve mobility
  • 40. Community Practice Including Continuing, Respite and Intermediate Care
    • Understanding of the various agencies involved in community care
    • Opportunities provided by assistive technologies eg Monitoring devices, technology assisted living
    • Role of Independent Sector within intermediate and long term care
  • 46. Falls and Syncope
    • Evidence-based interventions to reduce falls risk

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