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 house. The majority of the caregivers had made home modifications, which 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.     

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.     

Environmental Evaluations and Modifications to Support Aging at Home With a Developmental Disability

ABSTRACT

Increasing numbers of people with developmental disabilities are living into old age and are now residing in community-based housing, largely due to the deinstitutionalization movement. The overlay of age-related impairments onto pre-existing, lifelong disabilities puts this population at a magnified risk for premature behavioral limitations and loss of independence. This article describes a demonstration project designed to enable people with developmental disabilities to age in place. Interviews and observational assessments with 45 older adults with developmental disabilities were conducted in their community-based homes to identify potential barriers to aging in place. An Individualized Environmental Intervention Plan was developed for each study participant, recommending ways to solve problems and eliminate potential barriers. Individualized Environmental Intervention Plans were implemented to the extent possible through home modifications and assistive technology. Pre- and post-modification task performance and self-report revealed the positive impact that home modifications and assistive technology can have. The study demonstrates the need for ongoing evaluation and assessment sensitive to the needs of people with developmental disabilities and the unique characteristics of supported living settings.     

Physical Home Environment as a Determinant of Aging in Place for Different Types of Elderly Households

The aim of this research was to investigate the relationship between physical housing features and home modifications to aging in place or precipitating a housing transition among elderly households. Data was taken from two waves (1998 and 2000) of the Health and Retirement Survey. Univariate, bivariate, and multivariate analyses were performed. Residing in a multi-family home without an elevator was a predictor for housing transition for couple households, while residing in a home with small interior modifications was a predictor for remaining in place for single households. Implications for policy makers, health care providers, housing industry and elderly are discussed.     

Reducing disablement with adequate and appropriate resources: a New Zealand perspective

This article presents the qualitative findings from a larger mixed methods study of the barriers and costs associated with disability in New Zealand. A social model of disability framework was integrated with an economic cost model using consensual budget standards to (1) identify key barriers disabled people experience in their everyday living and (2) develop consensus about the resources disabled people agree they require to reduce or remove them. Forty-nine people with physical, hearing, vision or intellectual impairment participated in a series of 8 impairment-based focus groups. The analysis identified inaccessible environments, negative attitudes, unreliable transportation and poor access to information as key barriers. However, lack of adequate and appropriate resources (e.g. equipment, modifications, support, transport and time) to address these barriers was the overarching obstacle to participation. The inclusion of time as both a barrier and a valuable resource is arguably the most important contribution of the study.     

Political and organizational barriers to satisfying low-income U. S. seniors' need for affordable rental housing with supportive services

A substantial share of the low-income older tenants who occupy U. S. government-subsidized rental housing has physical and cognitive limitations. These older tenants are often women living alone in their 70s and 80s, who need help obtaining community-based services, demand-responsive transportation, help with apartment housekeeping and maintenance, self-care assistance, and design modifications made to their dwellings. Other low-income and frail older persons who have large housing expense burdens or occupy physically deficient dwellings also need affordable rental housing with these supportive services. The unmet supportive service needs of these groups persist even as this country's major political and professional stakeholders are aware of their problems and have solutions. This paper examines five major political and organizational barriers that have restricted the availability of supportive services in affordable rental developments. It offers 12 policy recommendations.     

To live an ordinary life: resource needs and additional costs for people with a physical impairment

Disabled people face increased risks of living in poverty largely due to lower incomes and extra resource requirements compared to non-disabled people. This study incorporated the social model of disability with an economic approach to costing to estimate the additional costs required by people with a physical impairment to achieve an adequate standard of living in New Zealand. Budgets estimating the additional equipment, modifications, transport, support and time required to achieve an adequate standard of living were developed and validated through focus groups with community members. The findings suggest that reducing barriers involves substantial costs ranging from NZ$645–$2,348 per week.     

Restorative home environments for family caregivers

Caregiver stress negatively affects caregiver health and the overall quality of in-home caregiving. While environmental interventions such as home modifications help caregivers manage stressful functional aspects, interventions for managing stressful emotional aspects are unexplored. Frequently, caregiving responsibilities restrict caregivers' spatial and temporal range of restorative activities to their familial residential environment. In a first attempt to explore the restorative potential of a house in which caregiving occurs, this paper reports experiential attributes of restorative environments from environmental psychology and healthcare design research. It discusses the relevance of restorative attributes to the socio–physical residential context of caregiving using three caregiver needs: need for a temporary escape, meaningful social support, and a sense of control. This conceptual exploration of the restorative potential of the residential caregiving environment offers a base for investigating targeted architectural and functional interventions that might complement current advances in home modifications and respite services.     

Home-Making: Supports and Barriers to the Process of Home

The process of home-making changes over a lifetime. For many, including newly resettled homeless people, the home-making process is difficult, challenging, and sometimes unsuccessful. This paper draws on research concerning the experiences of homeless individuals and families in New York and studies of single homeless adults in London and Dublin. It argues that there are supports and barriers to the home process, which include social, physical, environmental, financial, and practical factors. Central conclusions are that home does not arrive with a roof over a person's head, but rather that home-making is a complex social psychological process. Developing supports to home-making may offer tangible ways to enable this process to flourish.     

Home-Making: Supports and Barriers to the Process of Home

The process of home-making changes over a lifetime. For many, including newly resettled homeless people, the home-making process is difficult, challenging, and sometimes unsuccessful. This paper draws on research concerning the experiences of homeless individuals and families in New York and studies of single homeless adults in London and Dublin. It argues that there are supports and barriers to the home process, which include social, physical, environmental, financial, and practical factors. Central conclusions are that home does not arrive with a roof over a person’s head, but rather that home-making is a complex social psychological process. Developing supports to home-making may offer tangible ways to enable this process to flourish.     

Mobile Home Park on the Prairie: A New Rural Community Form*

Abstract Mobile home parks are an increasingly common form of residence for the rural poor. A rural central Illinois mobile home park and its residents seemingly possess features—a distinct territory, a homogeneous population, and a collectively held rural ideology—that foster formation of a sense of community. Other factors, however, some unique to this relatively new rural residential form, present physical and social barriers that challenge park residents' construction of a sense of community. We use ethnographic data to describe daily life in a rural mobile home park and to determine who among its working‐poor residents are most able to construct a sense of community, and thus to gain access to the potentially beneficial community social resources that are crucial to making a difference in the quality of their lives.     

The Use of Boundaries by Self-employed,Home-Based Workers to Manage Work and Family: A Qualitative Study in Canada

This qualitative study used grounded theory methodology to explore the experiences of 30 self-employed, home-based workers in Canada. Using boundary and work–family border theories as central theoretical constructs, this research examined the extent to which workers used boundaries to manage work and family, the nature of these boundaries, and how they were negotiated by the workers and their families. The results indicated that self-employed, home-based workers used both conceptual and physical barriers to create and manage the boundaries between home and work and that these boundaries were reinforced by rules. Gender differences and similarities were observed in the ways that boundaries were constructed and managed. Based on these observations, several areas for further investigation are proposed.     

A qualitative study of attitudes, beliefs, and practices among 40 undergraduate smokers

OBJECTIVE: Because little is known about college-age smokers, the authors conducted a qualitative study to better understand this population. PARTICIPANTS: Forty college student smokers from 12 Pacific Northwest colleges participated in the study. METHODS: The authors identified themes and built models to ascertain important factors related to smoking and smoking cessation. Four models emerged: smoking facilitators, smoking barriers, cessation facilitators, and cessation barriers. RESULTS: The authors observed physical, psychological, and social influences across models, and social influences were strongly associated with both smoking and cessation. Many smokers were unlikely to define themselves as regular smokers. Most smokers had made prior quit attempts. CONCLUSIONS: College students are a unique category of smoker and colleges can play a role in helping them achieve cessation.     

Moving to and Living in a Retirement Home

Abstract

Bad health combined witii deteriorating physical functions force many elderly people to move to a retirement home. The primary focus of this study was to investigate the resident's experience of safety and security. From a sample of 57 residents, 12 persons volunteered to participate in the interview. Data were analyzed with qualitative content analysis. The standard and design of the participant's previous home made mobility difficult and this affected their sense of security. This motivated them to move into an environment where they felt more secure. The environment at the retirement home was predominantly described as secure and safe. The finding shows that the participants felt that safety and security were more important than independence.     

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.     

Impacts of Home Modifications on Aging-in-Place

The purpose of this study is to analyze the relationship between home modifications and aging-in-place. Using the ENABLE-AGE United Kingdom sample (N = 376), the authors hypothesize that seniors who have modified their housing are likely to have stayed longer in their current housing. There is a positive relationship between home modifications and aging-in-place. The results underscore the importance of supportive environment to prolong living in housing settings.     

Physical and social barriers to social relationships: voices of rural disabled women in the USA

Through exploring the lived experiences of disabled women, this study investigates how physical and social barriers affect their social relationships. In‐depth tape‐recorded interviews investigating a variety of social and interpersonal issues were conducted with 24 women with physical or visual impairments who lived in a rural region of the midwestern USA. Using content analysis, the researchers examined interview data for common themes and patterns relating to social relationships. The findings indicate that physical barriers, related to the physical environment and personal physicality, along with social barriers, involving preconceptions of others about impairment and restrictions in personal networks, hamper the initiation and maintenance of social relationships. Further, the experiences of this group of disabled women corresponded most closely with the premises of a social relational understanding of disability.     

Barriers and facilitators to implementing evidence-based health innovations in low- and middle-income countries: A systematic literature review

The unsuccessful implementation of health innovations occurs frequently, leading to missed opportunities where improvements could have been made on various aspects of a health system. The purpose of this study is to identify, assess and synthesise the facilitators and barriers to sustainably implementing evidence-based health innovations in a low- and middle-income country (LMIC) context. To identify the LMIC specific facilitators and barriers, a systematic literature review was conducted. 79 studies were analysed, and the implementation barriers and facilitators identified in each study were extracted. The extracted barriers and facilitators were categorised and synthesized into one of seven concepts: context, innovation, relations and networks, institutions, knowledge, actors or resources. There were no substantial variations between the frequency that each concept was identified as a facilitator or barrier to implementation. However, resources, which includes time, human, financial and physical resources, was the most frequently mentioned concept; emphasising the need to focus on the resource situation in LMICs. This study contributes to the growing literature that aims to inform health system planners and evaluators in LMICs on effectively and sustainably implementing evidence-based health innovations.