Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT

The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.     

Assistive technology and employment: experiences of Californians with disabilities

For people with disabilities, work remains the best route to independence and enacting one's own choices. Assistive technology (AT) is often crucial in removing barriers to employment, and in enabling workers with disabilities to work more productively. A participatory action research project known as Community Research for Assistive Technology surveyed people with disabilities using Independent Living Centers throughout California, in part to identify barriers to employment and study use of job-related AT to overcome such barriers. Across disability groups, disability itself was cited as the primary barrier to employment, with potential loss of benefits and lack of education cited as secondary barriers. A majority of working respondents reported using assistive technology (such as adapted telephones, wheelchairs, magnifiers, and adapted computer equipment) or services to perform job functions. The vast majority of those using job-related AT reported substantial benefits to their productivity and self-esteem. Employees' requests for AT as a workplace accommodation were granted more often than not, but many other employees had to pay for their own workplace AT.     

Putting technology to work: Users' perspective on integrating assistive technology into the workplace

This qualitative study examined the experiences of people with disabilities who use assistive technology in open employment. This study aims to describe and understand the factors the participants perceived as important in integrating technology into the workplace, as well as the barriers encountered in the process. Fifteen people with a range of acquired and congenital disabilities as well as their employers (8) or co-workers (4) were interviewed. The interviews were transcribed and analyzed. Nud*ist Version 4(R) was used for data management. Emergent themes related to the integration of assistive technology were software compatibility, Information Technology (IT) and product support, and the interaction between technology and the work environment. Participants also reported on the impact of technology on their performance and comfort at work, as well as dealing with people and processes in the workplace. By identifying the issues and support strategies for technology users in the workplace, appropriate measures can be implemented to ensure that the spirit of disability discrimination legislation is realized.     

Formative evaluation on a physical activity health promotion program for the group home setting

Physical inactivity and high rates of chronic conditions is a public health concern for adults with intellectual disability. Few health promotion programs target the group home setting which is the pre-dominant form of residential accommodation for persons with intellectual disability. A process evaluation of a physical activity health promotion program, Menu-Choice, was conducted with five group home sites for adults with intellectual and developmental disabilities. Menu-Choice assists group home staff in including physical activity goals within resident schedules. The physical activity program was designed based on theoretical frameworks, community-based participatory approaches, and established health promotion guidelines for adults with disabilities. Fourteen program coordinators (age M 39; 77% females), 22 staff (age M 39; 82% females), and 18 residents (age M 59; 72% females; 56% ambulatory) participated. Results from the fidelity survey and program completion highlight potential challenges with implementation. Findings will assist with the refinement of the program for continued implementation trials in the group home community.     

Correlates of Voting Participation of People with Intellectual and Developmental Disabilities

ABSTRACT

People with intellectual and developmental disabilities (IDD) vote less frequently than nondisabled people and people with other disabilities. This study explores what factors facilitate and hinder people with IDD’s voting participation. To do so, 1,341 people with IDD were surveyed using the Personal Outcome Measures®. Binary logistic regressions revealed significant relationships between voting participation, and support needs, residence types, guardianship statuses, and organizational supports. Along with the right supports, attention to barriers that might exist can ensure people with IDD are able to make use of their civil rights and participate in this crucial form of civic engagement.     

Community reintegration for people with psychiatric disabilities: challenging systemic barriers to service provision and public policy through participatory action research

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.     

The Impact of the Housing Environment upon the Ability of Disabled People to Live Independently

The independent living (IL) paradigm proposes that the presence of environmental barriers affects critically the level of independence of people with disabilities. This study refines the IL paradigm and evaluates empirically the role that the environment plays in independent living, especially the influence of home adaptations and other housing variables on disabled people and their families. The results of this research indicate that housing adaptations have a variety of impacts upon the productivity of disabled people. Other housing issues are very important to individuals with disabilities, particularly tenants. This paper concludes by presenting implications for theoretical development and recommendations for housing policies which are responsive to the needs of disabled people.     

TigerPlace,A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

ABSTRACT

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

Exploring gaps in the online economic inclusion of persons with disabilities in Korea

ABSTRACT

This paper explores the difference in the online economic activities of people with and without disabilities in Korea. We conducted a multiple regression analysis to investigate the impact of socioeconomic characteristics, internet access, and internet skills on online economic activities. Our sample, based on a 2016 dataset that included 1554 people with disabilities and 6004 people without disabilities, was developed using quota sampling based on gender, age, and residence. We determined that individuals with disabilities were more likely to engage in online economic activities if they had higher levels of education, lived in urban areas, were employed, or had greater internet skills. Individuals without disabilities were more likely to engage in online economic activities if they were women, had higher levels of education, were employed, lived in a two-generation or more household, or had greater internet skills. For both people with and without disabilities, the level of education, employment status, and internet skills positively contribute to online economic activites. We also determined that education level, participation in economic activity, living in a two-generation or more household, and internet skills had a statistically significant influence on online economic activity for people both with and without disabilities. These results highlight the importance of education and internet training for people with disabilities, as well as social support systems that help them learn to use the internet in diverse ways through both formal and informal networks. The study also underscores the importance of information and communications technology that adequately addresses people’s needs.     

Planning for Aging in Place: Incorporating the Voice of Elders to Promote Quality of Life

Abstract

Aging in place offers emotional and physical benefits; however, challenges associated with advanced age may make aging in place difficult. As communities across the country prepare for forecasted increases in the proportion of older residents, it is important to understand barriers that may prevent aging in place. Perceived barriers voiced by residents of a suburban county who completed an Aging in Place Needs Assessment Survey were categorized into four themes: need to downsize/home modification; need for assistance; family desire to reciprocate care; and isolation. A fifth group with no intent to relocate, but with concerns about having to, was also identified. Included among this group were persons with mental health or developmental disorders, such as anxiety and autism spectrum disorder. Results were examined through a person-centered lens to illustrate that aging in place may be the desired option even among residents who indicate that it is not. It is important that aging-in-place initiatives preserve identity by fostering a sense of autonomy, control, and well-being in older residents.     

‘It is like being put through a blender’: inclusive research in practice in an Australian university

Abstract

How can university-based researchers committed to a position of solidarity with, and activism alongside, people with disabilities maintain such a stance in the metric-driven environment of the modern university? How can the academy ensure there is the opportunity for people with disabilities to contribute to production of the knowledge in which they have most at stake, in a wider environment where access to basic services for people with disabilities is precarious? In this article we draw on our experience as a team of university-based and community-based researchers with and without disabilities to reflect on these questions, using a framework of reflexive solidarity to consider practical strategies for strengthening the relationship between disability activism and the academy.     

Toward a Holistic View of Health and Health Promotion in Social Work with People with Disabilities

Abstract

The individual medically oriented model of disability suggests that people with disabilities seldom achieve health and wellness because of their impairments and disabilities. This paper provides an alternative to the tendency in social work to focus on the medicalization of disability without a due consideration of the social context. It draws insights from the social model that asserts disability is a form of social restriction encountered by people with disabilities and that social barriers of disability must be removed through collective action. Also, this model posits that people with disabilities can be healthy if the barriers preventing good health are removed. However, medical aspects of a person with a disability should not be forsaken entirely. Therefore, this article proposes a holistic view that converges insights of the individual and social models toward a better understanding of health issues for people with disabilities. It shows the implications for social work that follow from the convergence.     

A Descriptive Study of Home Modifications for People with Dementia and Barriers to Implementation

This study describes home environmental features, safety issues, and health-related modifications in a community dwelling sample of 82 elderly people with dementia. Main barriers to the accessibility of the homes were steps both inside and outside the home. The majority of the caregivers had made home modifications that pertained mainly to physical limitations. Home modifications to support cognitive deficits were made to a lesser extent. The main barrier to the implementation of home modifications to accommodate the care recipient's memory loss was skepticism about their usefulness. Regarding the removal of physical barriers, financial constraints were most frequently mentioned.     

Assistive technology outcomes in work settings

Successfully documenting the outcomes of assistive technology (AT) interventions in the workplace benefits people with disabilities, service providers and agencies. However, no work related system currently exists that comprehensively collects the data needed to analyze such outcomes. Part of the reason for this absence of an outcome system is that, while the concept is simple, the process is complex and depends on the acquisition of data that represent many outcomes related variables. This article describes the exploratory work of the NIDRR (National Institute on Disability and Rehabilitation Research) funded ATOMS Project (Assistive Technology Outcomes Measurement System) and its efforts to identify existing data that might be used as the basis for an outcomes measurement system. Sample records from four assistive technology service programs were acquired and evaluated for the data they housed. This study discovered that AT service programs fail to collect consistent or sufficient data for outcomes analysis. However, discussions with AT programs that provided services to State vocational rehabilitation agencies revealed an interesting potential. Assistive technology service data in combination with data collected by State vocational rehabilitation departments might coalesce the needed data. The Federal Rehabilitation Services Administration (RSA) 911 Report aggregates many variables of outcomes related information including employment status and the success of the vocational rehabilitation investment. This combined database could answer a range of assistive technology outcomes related questions of interest to service providers, people with disabilities, and vocational rehabilitation State agencies. This paper describes the data needed in an outcomes system, reviews the data that appear to be available today related to AT outcomes, and projects how data from two diverse programs might be used together to create a significant outcomes database.     

Qualitative examination of rural service provision to persons with concurrent developmental and mental health challenges

Although there has been an international trend away from institutionalization to community-based care, this has not always been successful, particularly for the unique and vulnerable population diagnosed with both mental health and developmental disabilities. The challenge of meeting the needs of this population is increased in rural and remote areas. As a part of a larger study, this paper reports on the voices of service providers for people dually diagnosed as they maneuver through the considerable challenges of meeting complex needs while located in remote northern communities. The complexities of rural service provision for those with a dual diagnosis of mental illness and developmental disability is also highlighted and includes challenges of northern living, difficulties in diagnosis, and system level issues. This paper confronts the inequities in provision of effective community-based services to this population and draws attention to the need to support and develop local, integrated services in order to build inclusive communities for all.     

Community-based arts research for people with learning disabilities: challenging misconceptions about learning disabilities

This article presents some of the community-based artwork of a group of men with learning disabilities, who aimed to challenge some of the misconceptions associated with learning disabilities. People with learning disabilities regularly face many forms of direct and indirect stigma. The consequences of such negative perceptions may affect individuals’ social relationships and ensure that barriers are strengthened which prevent their full inclusion. The men in this project used a series of visual and creative methods to challenge some of these misconceptions by telling stories through art, demonstrating skill through photography, using poetry to talk about sexual identity and improvising drama and filmmaking to challenge stigma, and through sculpture expressed their voices. Thus, by doing so, they were able to challenge some of the stigma associated with learning disabilities, indicating that community-based arts research is a valuable way in which to promote the voices of people with learning disabilities.     

Involving People with Disabilities in Volunteer Roles

Abstract

According to the 2002 National Health Interview Survey, 33.7 million non-institutionalized Americans have limitations in usual activities. A recent poll on community participation found that, overall, people with disabilities have lower rates of community participation compared to those without disabilities. An analysis of that same poll concluded that people with disabilities continue to be treated as second class citizens by being excluded from the mainstream of everyday life. Social role valorization theory proposes creating and supporting socially valued roles for people who are kept at a social distance. It is through these valued social roles that they gain equal access to other opportunities that society has to offer. One such socially valued role is that of a community volunteer. Volunteer activities can foster a social environment where people with disabilities are seen as credible coping individuals. This paper reports the results of a survey of twenty-six community agencies which regularly use volunteers. The purpose of the survey was to identify barriers to volunteer opportunities for people with disabilities and to explore openness to methods to remove the barriers through community collaborations.     

Creating Disability in the Home: the role of environmental barriers in the United States

One thousand persons with disabilities were sampled to discover the types of barriers they encountered in their home while carrying out their daily activities. A 43 percent response rate was obtained. The open-ended questions were submitted to a process of analytic coding and suggested 27 different categories of barriers existed in the homes of persons who have disabilities. The findings have implications for rehabilitation practice. Performance of daily activities is greatly diminished by the presence of architectural barriers. Environmental supports can greatly improve performance in daily tasks. These findings are discussed in light of disability policy and implications for improving performance of persons who have disability.     

Voices of youths on engagement in community life: a theoretical framework of belonging

Little is known from the perspectives of youths with intellectual and developmental disabilities themselves about their experiences related to inclusion, engagement in community life and friendship, and their quality of life. The Voices of Youths research project used an inclusive approach to learn from youths about these experiences. Twenty-four youths (age 13–24 years) with a range of intellectual and developmental disabilities diagnostic ‘labels’ participated in three video-recorded, community-based interviews. Constructivist grounded theory data analysis revealed a theoretical framework comprising the core concept of belonging and four associated concepts: engaging with similar people, having social relationships, negotiating meaningful roles, and navigating norms and expectations – finding a good fit. The findings contribute new knowledge about the ways in which these youths experience a sense of belonging from their own perspectives and can inform development/enrichment of policies, programmes, and services for these youths.