Most older people would prefer to spend their final years in their own homes rather than in a nursing home, and occupational therapists (OTs) can help make that desire a reality. OTs with training in home modifications play a role in transforming a person's living space into a safe, accessible environment.
"OTs have tremendous potential in the area of accessibility features in housing and the related field of home-access modifications," says Richard Duncan, MRP, senior project manager for The Center for Universal Design at North Carolina State University's College of Design.
Clinicians and Carpenters
In rural Louisiana, OTs, along with RNs who have rehab or geriatric experience, are teaming up with builders, remodelers and even financial planners to help clients with life-limiting conditions adapt their homes so they can live there independently and comfortably for as long as possible. During a three-hour home assessment, teams from the Wendy Elliott Foundation (WEF) complete a seven-point assessment, develop recommendations and refer clients to qualified remodelers. For assessments and actual remodeling, the WEF relies on construction professionals who are Certified Aging-in-Place Specialists (CAPS), a designation offered by the National Association of Home Builders (NAHB).
"Joining OTs and medical professionals with CAPS professionals allows us to make the proper evaluation for providing a continuum of care for each person," says WEF executive director Jay Brooks, a CAPS remodeler who is also a Certified Graduate Remodelor and Graduate Master Builder. Services are provided free through the WEF and on a fee basis through Homes Without Barriers, the for-profit affiliate of the grant-funded WEF.
Software Aids Assessments
Several years ago, OT Margaret Christenson, MPH, parlayed her experience as a continuing-education instructor with a rehab institute into a consulting business advising nursing homes about how to enhance their environments so patients could be more independent.
Based on her experience with institutions, she used a grant to apply the principles she learned to the residential setting. The result: A series of software tools for OTs to assess environments, recommend changes and identify specific products and sources. "The software is based on the intersection between a person's capability and potential problems in the environment," explains Christenson, who was chair of the American Occupational Therapy Association's (AOTA's) Environmental Modification Specialty Certification Panel from 2004 to 2006.
OTs interested in exploring aging-in-place careers can take tips from their colleagues who have already plunged into this nascent field:
- Prepare Yourself: Read the AOTA's Occupational Therapy Practice Guidelines for Home Modifications, and obtain its forthcoming environmental-modification specialty certification. Another option is the University of Southern California's nine-week online Executive Certificate Program in Home Modification.
- Stock Your Toolbox: Tools such as Christenson's LivAbility and Buildease software or CASPAR, the Comprehensive Assessment and Solution Process for Aging Residents offered through accessibility contractor Extended Home Living Services, can help OTs assess a client's home-modification needs.
- Present Yourself: Develop a PowerPoint presentation showcasing your services and credentials, suggests Christenson, author of Aging in the Designed Environment.
- Target Your Markets: Because homeowners are not accustomed to hiring OTs directly, it's often easiest to access potential clients through other professionals or groups. Publicize your services to orthopedic practices, local chapters of the NAHB, chambers of commerce, hospitals, nursing homes, senior centers, aging organizations, remodelers and durable medical equipment suppliers.
- Create a Team: Taking the CAPS course is a great way to learn and rub shoulders with builders and remodelers who may recommend or partner with you.
OTs who work in the aging-in-place field may find employment with homeowners, builders, remodelers, agencies such as Homes Without Barriers or extended-care facilities, usually on a project, consulting or part-time basis.
"Most OTs have starry-eyed dreams of making this a full-time gig, but that's tough to do," Duncan says. "Don't make this your exclusive domain. Add it to your existing skill sets as an additional service you can provide."