Role of Home-Modification Training for Care Managers

With the aging of society, the long-term care insurance system -which includes home modifications to continue living at home- was established in 2000. However, the quality of home modifications has been persistent issue, and effective training is expected to conclusively solve this problem. To this end, the purpose of this study is to clarify the rational for training care managers who plan home modifications. A survey comprising two sets of questionnaires was conducted; one set encompassed is all 62municipalities in Tokyo, whereas the other involved care manager who participated in training program. The results of the first questionnaire showed that, out of 62 municipalities, 9 (14.5%) provided training on home modification, of which 8 (88.9%) provided training on administrative procedures. In one municipality that provided training on practical aspects of home modification, we provide questionnaires to 59 care managers participating in the training. -Lectures on administrative procedures, physical conditions of invalids, and reading drawings were conducted by administrative staff, occupational therapists, and architects, respectively. Afterwards, the participants attended a planning workshop. According to the questionnaire conducted after the workshop, 80.4% of the participants could understand home modifications in the system, 85.5% understood how to modify homes based on the occupants’ symptoms and physical conditions, 81.6% could interpret drawings, 90.2% could plan modifications, and 81.6% found the training useful. These findings indicate that the training of care managers has indeed been effective in actual practice. Improving the quality of home modifications through multidisciplinary cooperation is significant in maintaining home life.

Understanding Multidisciplinary-team Practice in Developing Home Assessment Tools: A Systematic Review

As widely used instruments to identify risk factors and lay out preliminary plans of how to improve the built environment, home assessment tools play an important role in the process of modifying homes for older adults. Developed by a variety of disciplines and tailored to meet various needs, home assessment tools focus on features in homes and how they meet or hinder an older person’s ability to accomplish tasks — in other words, person-environment fit. Based on a comprehensive review of ten evidence-based home assessment tools identified by researchers at the USC Leonard Davis School of Gerontology and the National Council on Aging, we found that a common assessment strategy is the use of multidisciplinary teams (MDTs) in developing and testing the assessment tools to ensure the reliability vs validity of different home modification programs. To understand the nature of MDT practice and derive a set of generalizable protocols for developing person-centered home assessment tools, we conducted a systematic analysis of the ten evidence-based home assessment tools and 41 peer-reviewed journal papers about how the tools were developed, used, and modified. In addition, we applied the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to examine the use of MDTs in developing the tools and carrying out the programs. Based on our analysis, we propose a set of preliminary protocols for developing home assessment tools and a logic model for conducting person-centered home modification programs.

Advancing State and Local Home Modification Practice and Policy: Findings From Aging Network Surveys

Home modification (HM) can promote older adults’ functioning as their needs change, reduce fall risks, and support caregivers. A supportive home environment is increasingly important as homes become healthcare delivery sites for home and community-based services (HCBS). HM is funded and administered by disparate agencies, often hindering access to HM services for at-risk older adults who need them the most. The Aging Network (State Units on Aging (SUAs), Area Agencies on Aging (AAAs), and Title VI organizations serving Native American older adults) plays an important but not well understood role in HM. To address this lack of research, the USC Leonard Davis School of Gerontology, ADvancing States, and the National Association of Area Agencies on Aging in cooperation with Scripps Gerontology Center conducted three national surveys, with support from the Administration for Community Living: 1) directors of the 56 SUAs with an 89% response rate; 2) directors of the 618 AAAs with a 79% response rate; and 3) directors of 276 Title VI programs with an 84% response rate. Exemplary practices included HM advocacy through interagency coalitions; state and local plan priority setting; creative HM financing with housing, disability, and health care sectors, including partnerships with Medicaid agencies; and integration of HMs into state and local HCBS, including nursing home transition and caregiver support programs. Findings on the types of HM activities, service delivery barriers, funding sources, collaborations, and targeted populations will inform HM policy and practice for the Aging Network’s critical state and local agencies serving low-income older adults.

Use of Virtual Reality Technology to Support the Home Modification Process: A Scoping Review

Healthcare is a field in which the benefits of virtual reality (VR), such as risk-taking without consequences, direct experience, and service outcome prediction, can be utilized. VR technology has been used to help clients face environmental barriers by implementing a home environment in virtual reality without a home visit by an expert. This scoping review was conducted to identify the areas and implementation methods of the home modification process supported by VR technology. Twelve studies met the research criteria. The following three types of tools supported by VR technology for the home modification process were identified: educational tools for clients or specialists, home environment measurement tools, and intermediaries for decision making and collaboration between clients and specialists. Most of the studies reported positive results regarding the usability and acceptability of the technology, but barriers have also been reported, such as technical problems, inappropriate population groups for technical use, cost-related issues, the need for training, and fear that the technology could replace home visits. Thus, VR technology has potential value in the home modification process. However, for future clinical applications, additional studies to maximize the benefits of these VR technologies and address the identified problems are required.

Smart home modification design strategies for ageing in place: a systematic review

This research explores current strategies and approaches directed to integrate innovative technologies in the home modification process to support independent living and ageing in place. The systematic review considered studies conducted from the perspective of architecture, smart technology, and gerontology. Scientific databases of related disciplines (e.g. Scopus, Web of Science, Engineer village, Google Scholar, Crossref) were searched and supplemented by hand search method. Thirty-three out of 2594 articles were analysed from three perspectives: the framework of the smart home environment for ageing in place, the smart home modification process, and problems and countermeasures of independent living. The result shows that both home modification and smart technologies can support older adults’ independent living, especially with fall prevention and indoor accessibility. Technologies deployed in older adults’ homes are transiting from manual assistive technology to more intelligent devices, and the notion of the robotic home has emerged. According to existing practices, universal design is an extensively adopted strategy for smart home design and modification. However, in most cases, universal design is used as a retrofitting guideline for general home settings rather than specifically for smart homes. The fundamental requirements in smart home modification phases are customisation, minimum life interference, and extensible technologies to cope with the ageing process.