Abstract
OT practitioners conduct home evaluations to assess living environments, eliminate potential environmental barriers, and empower clients to actively engage in meaningful occupations. Compliance with home-modification recommendations is a problem area. This study aimed to identify the barriers to home-modification recommendation compliance through qualitative insights from OT practitioners, community-dwelling elderly clients, and caregivers in order to facilitate productive aging in place.
Primary Author and Speaker: Alisha Ramos
Additional Authors and Speakers: Justin Oakley
Contributing Authors: Randal Fedoruk
This study addresses OT’s distinct value on productive aging in place by identifying the disconnect between therapist recommendations and client/caregiver implementation. This study will be valuable to the OT profession by improving home modification discussions and therapeutic relationships.
Using a Qualitative Phenomenological Design, face to face semi structured interviews helped obtain an in depth understanding of each participant’s insight regarding home modification recommendations in the home health setting. Elder adults who had OT services within the last year, their caregivers, and OT practitioners with home health experience participated in the study using a snowball effect.
The MMSE was used during client recruitment to rule out those with moderate to severe cognitive impairments. Demographic information was collected to ensure adherence to the inclusion criteria. Each person participated in a 15 to 30-minute interview that was audio recorded, transcribed, and then analyzed using triangulation to identify common themes. Three themes emerged: Therapeutic rapport, modifications, and cost.
Establishment of a therapeutic rapport is vital. It is the foundation of a therapeutic relationship that involves the therapist’s ability to be empathic, trustworthy, and respectful to the individual receiving OT services (Tarlow, 2019). Characteristics were identified that foster the basis of a successful therapeutic rapport including communication, a mutual trust, and respect. Additionally, the therapist’s attitude, approach, and expertise influence the therapeutic relationship. When the therapist listens and is considerate of clients/caregivers wants and needs, the client/caregiver feels acknowledged, understood, and respected, allowing the client/caregiver to be open and honest. Trust is then developed which impacts recommendation compliance.
Modifications are not limited to installments or renovations. Education on new ways of doing daily living tasks to enhance independence and safety is also included. Modifications ranged from scatter rug removal to ramp installations and bathroom renovations. Regardless of significance or cost, insight was a notable component. Educating clients/caregivers on the benefits of modifications and resources available can improve compliance.
Interestingly, cost appeared to be an influential component for adherence according to therapists; however, it did not appear to be a factor for clients/caregivers. Therapists shared that a major barrier to compliance was the financial piece as major insurance companies that serve the elderly population do not provide coverage for equipment. A very low percentage of elderly clients have financial assistance from insurance programs (Freedman & Agree, 2008). Therapists reported that they strive to help clients/caregivers via education on community-based resources available.
Based on the data collected, therapeutic rapport, the modification process, and cost were identified as barriers to home modification recommendation compliance. The OT practitioner’s ability to approach, understand, empathize, respect, and build trust with clients/caregivers is essential in the OT service delivery process. Failure to effectively build the therapeutic relationship at the start of OT services can be detrimental to the achievement of positive therapy outcomes. Additionally, the process in which modification recommendations are conducted, as well as equipment attainment and cost, are important to consider. OT practitioners must reflect on their own professional and clinical practice methods while also taking into account client/caregiver’s perspective in order to help to bridge the service delivery gap and overcome barriers to home modification recommendation compliance.
Freedman, V.A., & Agree, E.M. (2008). Home modifications: Use, cost, and interactions with functioning among near-elderly and older adults. Retrieved on September 2, 2019 from https://aspe.hhs.gov/system/files/pdf/75676/homemod.pdf
Tarlow, A. (2019). Rapport and the therapeutic relationship. Retrieved on July 24, 2019 from https://bocarecoverycenter.com/rapport-and-the-therapeutic-relationship/