Older persons’ navigation through the service system towards home modification resources

Abstract

Home modifications are part of the occupational therapy interventions provided to persons with functional limitations in the home environment. Home modification services often involve many different actors, and persons experiencing a need for home modifications have to navigate through a network of service organizations and professional actors. The aim of this study was to explore and describe how older adults in one Swedish municipality tried to find their way and navigate through the service system in order to receive home modification services that could meet their experienced needs. A case study design was used, including four older adults with different experiences and expectations of home modification services. The relationship between the participants' expectations, experiences, and their ways to navigate through the service system was described through the metaphor of a "geographical map". Satisfaction with the service process was found when there was a match in understandings of responsibilities and eligibility between what could be read from the older persons' map and the professionals' perspective. The findings have implications for client-centred occupational therapy practice, indicating that this match can be achieved when professionals translate clients' experienced problems in everyday life into a terminology that fits into the service system.

Understanding home modifications impact on clients and their family's experience of home: A qualitative study

“…The pervasive influence of this dimension has been described elsewhere. In a Swedish study, older adults described difficulties with the home modification system, where standards, a lack of consultation and limited information provision from service providers resulted in unsatisfactory outcomes (Johansson, Borell & Lilja, 2009).…”

Client involvement in home care practice: a relational sociological perspective

“…It is further shown how relatives are caught between being actively involved in care tasks and decision-makings and being able to withdraw from such responsibilities (Hegli and Foss 2009;Stajduhar et al 2010). One study shows how home modifications unfold as a negotiation between the professionals (and their working place) and the client and his wishes for his home (Johansson et al 2009). There seems to be only one Danish study about how client involvement takes place in home-care settings, namely, in relation to dying at home.…”

The Development of a Design and Construction Process Protocol to Support the Home Modification Process Delivered by Occupational Therapists

“…Whilst home modifiications have been a traditional area of practice for occupational therapists, the home modification process protocol is the first time this practice been described as an occupational therapy design and constuction process. Through the development of the protocol, there is the potential to address the professional [ 50 , 51 ] and ethical need [ 40 , 41 ] for practitioners to better understand the intervention they are providing and to be able to express their role in the design and construction of a home modification.…”

“…Despite the professional [ 41 ] and ethical requirements [ 40 ] to make visible the core reasoning skills and process used within occupational therapy professional practice within the UK, there are concerns [ 50 , 51 ] that very few research studies have evaluated or attempted to describe the home modification process and make visible the practice involved. Protocols have been used successfully to improve the interventions provided by occupational therapists, for example, to improve the clinical reasoning of novice practitioners using a specific assessment to identify appropriate interventions to reduce upper limb hypertonia [ 52 ].…”