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How Occupational Therapy fits into Universal Design

Friday, April 29, 2011


How Occupational Therapy fits into Universal Design
By Nicole A. Morgan, OTR
Universal Design (UD) is a term with which more remodeling professionals are becoming familiar. The definition describes an environment that is designed and created to be aesthetically pleasing and usable in the greatest extent possible for people of all ages and abilities. According to the Center for Universal Design, it is based on seven design principles:
1.       Equitable use: Design that is useful and marketable to various diverse abilities.
2.       Flexibility in use: Accommodating a wide range of individual preference and abilities.
3.       Simple and intuitive use: Easy-to-understand design, regardless of experience, knowledge, language and concentration level.
4.       Perceptible information: Design that communicates necessary information effectively, regardless of ambient conditions or the user’s sensory abilities.
5.       Tolerance for error: Design that minimizes hazards and the adverse consequences of accidental or unintended actions.
6.       Low physical effort: Design used efficiently and comfortably with minimal fatigue.
7.       Size and space for approach and use: Size and space provided for reach, manipulation and use regardless of user’s body size, posture or mobility.
Statistics from the Administration on Aging predict that by the year 2050, there will be an estimated 88.5 million Americans over the age of 65. Following the UD principles described above in your remodeling practice also will create an environment that would be appropriate for a person over the age of 65.
In addition, this environment would be appropriate for someone with a disability as a result of accident, unexpected injury or at birth. Universal Design does not constitute all characteristics of good, functional and safe design; however, it does provide a good foundation. Strategic, life-long design takes into consideration both the person and who they live with, whether it is family or a caregiver. Considerations about who they are, what they want, short term and long term needs, style, safety and function are woven into the design process. 
As our nation ages and people live longer, more productive lives, a primary goal of many Americans is going to be the decision to stay in their home for the entirety of their life. 
In the near future, standards of remodeling will change to be more accommodating to the changing needs of homeowners. Homes will be built utilizing principles of Universal Design as standard practice and as more Baby Boomers choose to stay in their homes, remodelers will have to redesign existing spaces using these principles. 
Designing for specialized needs
Still, there is much more to Universal Design then the design itself. Remodelers now face new challenges with the changing dynamic of the home.
Remodelers are challenged with familiarizing themselves with the aging process to determine current and future needs physically and mentally for a client and to take into consideration the daily occupational roles of the client and how the client interacts with their environment. Or, remodelers may be challenged with considering the dynamics of the client’s family, how the remodeling process will affect the client emotionally or physically or guiding the client to community resources that may help. All of these challenges are important to consider when remodeling for a client who is aging or has impaired ability. 
In addressing the needs of this specialized client, remodelers may seek out an Occupational Therapist that is specialized in Home Modification. An Occupational Therapist specializes in the evaluation of the client and their environment and provides your client with expertise that understands clinically what they are going through or will have to face in the future. 
An Occupational Therapist consultant assesses the physical, mental and social needs of the client in his or her environment. More specifically, they are trained to evaluate and assess not only the person, but the environment and how that person works and moves in that environment daily. They make recommendations concerning a client’s environment to help the client, caregiver and family members reach their goals. By drawing from their knowledge of various medical conditions or disabilities, an occupational therapist can establish present and future needs of the client.
A Home Modification Specialty involves additional training in making the home more accessible and safe for residents. My training included receiving an Executive Certificate in Home Modification from the National Resource Center on Supportive Housing and Home Modification and a Practitioners Certificate in the I.D.E.A.S. Home Modification program, both based out of the University of Southern California.
Remodelers can benefit greatly by utilizing this expert evaluation to lay all the ground work for what needs to be done and how it needs to be done to achieve the best outcomes. Through this assessment and evaluation process, you provide clients with the solutions to increase functionality and safety in the home. This collaborative effort helps homeowners gain independence, safety and enhance their overall quality of life. Adding an experienced occupational therapist to your team adds a more personal, client-centered point of view to the project and can give you as the remodeler insight to your client and their project that you would not have had.
Occupational Therapy goes to work
The best example of this kind of dynamic expert relationship is best given in a case study of one of my recent clients.
The client, at age 65, suffered a head injury while on the job 10 years ago.   I was referred to him as an Occupational Therapist, to evaluate the client and his home for power wheelchair accessibility. 
I spent time at the client’s home and interviewed his caregiver and wife. Through interviews and time spent at the home, I was able to get many questions answered about their environment, challenges they were facing, safety concerns with recent falls and the client’s declining physical abilities due to the progressive nature of Traumatic Brain Injury (TBI). 
I asked questions of the caregiver and client about routines, likes, dislikes and past and current hobbies. I determined level of function with daily living—f or example, ways of transferring to toilet, shower, bed and chair and how much assistance was needed. I also asked questions about specific characteristics that the client demonstrated because of the TBI, the extent and history of the injury and any pertinent medical issues they were currently dealing with as a result of the injury. Finally, I gathered information about community resources that were being utilized and expectations of the project outcomes.
After a series of questions combined with the knowledge I had gained about the client, I assessed the home room by room. I took pictures of each room and measured doorways, assessed the furniture layout and examined each entry- and exit way. Based on my measurements, knowledge of the client, his routines, and determining levels of function and goals of the project I wrote my findings in a report and reviewed it with the contractor. The report served as the guideline to the renovation that was about to take place. 
There were doors that needed to be widened and repositioned, ramps to be built, furniture repositioned and a master bathroom that needed to be more accessible for the caregiver and client. After learning how the caregiver and client performed shower and toilet transfers, I designed a new shower/toilet room consistent with his needs. I recommended necessary equipment to be added to the toilet for safety and transfer independence. I recommended a certain color grab bar for visual contrast because of a visual impairment. I suggested a specific height of countertop to accommodate both client and caregiver, seeing she had some back issues. I made recommendations for design of the storage drawer for the bathroom vanity in order to store the client’s medical supplies. 
I also educated the remodeler about the client’s condition of TBI. It just so happened that this client’s injury had made him very sensitive to loud noises. After learning this, the remodeler had to adjust his schedule in order to accommodate the client. 
The use of an Occupational Therapist consultant/Home Modification Specialist gave the project organized and appropriate solutions to help the homeowners both during and after the remodeling project.
In the end, the client and caregiver were pleased with the completed project and verbalized their gratitude of a specialist working with the remodeler. They expressed that the team work between the two professionals made them feel reassured that they had an advocate that understood exactly what they needed over what they wanted, but in the end were able to incorporate their wants with the needs.
I have told many clients who have had difficulty accepting the aging process as they approach the need for Universal Design in their home environment that making changes early rather than later is the smart thing to do, not a sign of old age. These improvements are more preventative and help prolong life and improve quality of life. Adding the expertise of an occupational therapist/home modification specialist to your team adds knowledge that can allow you as the remodeler help your client create a home environment that is reflective of their needs and wants. Adding this expertise to your team makes you stand out above the rest in the industry as a professional that really knows how to help your client.
Click here for Universal Design Remodeling prep course class schedules or click here to register. Contact Cindy at  cfoley@nari.org with questions.

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