016: Housing and Collaboration: Stories from the Field

Experiences as occupational therapists collaborating with building and design professionals.

016: Housing and Collaboration: Stories from the Field
Good Fit Poor Fit

 
 
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Show Notes

This episode is a bit longer than normal, but it is packed full of helpful information! We based this episode on a recent blog post: Occupational Therapy and Our Role in Housing

Here are a few other items we referenced in our discussion:

Transcript

[00:00:27]  Hey there! It’s Sarah and Kati and we’re doing a follow-up podcast to one of our most recent articles that we wrote on our blog titled “Occupational Therapy and Our Role in Housing”. You can find this blog post in the show notes of this episode if you haven’t read it yet. April is Occupational Therapy Month and we have decided that we wanted to chat a bit more about the three different practice areas we mentioned in which an occupational therapist could collaborate with professionals in the home building industry. So the three areas include working in a clinic, a practice area where OT act as consultants doing home modifications, and the third more unique area of work is where OTs focus on universal design. 

[00:01:15] Kati: Yes, we received a lot of comments and great feedback on that blog post and it seems like it got some good attention. So we wanted to supplement that with a podcast episode so that we could really dive a bit deeper and share our experiences from those three practice settings or practice areas. And with it being April, occupational therapy month, I think it’s the perfect time to really showcase OT’s role in the housing industry.

[00:01:41] So let’s start by explaining what occupational therapy is. Occupational therapists or OTs help people across the lifespan engage in meaningful occupations, especially after they’ve encountered an illness, disability, or injury that affects their performance in their daily tasks. OTs might help them relearn the activity in a new way or adapt the environment to enable them increased independence. And some activities that are typically addressed in OT include toileting, bathing, dressing, and grooming, which are all called activities of daily living or ADLs for short. And OTs can also help people achieve higher-level tasks, such as grocery shopping, cooking meals, paying bills, and even driving a car. And all of these activities are called instrumental activities of daily living, or IADLs for short. 

[00:02:34] The profession of occupational therapy is incredibly diverse. We can work with babies in early intervention. We can work with kids and teenagers in pediatric clinics or children’s hospitals or even school systems. We can also work with adults in hospitals or rehab centers, and then we can work with the older population in nursing facilities, long-term care, and even hospice. We even have a role in the housing industry, which is the focus of this podcast. 

[00:03:04] OTs are trained to consider how the physical environment influences someone’s performance in their occupations because the physical environment can either support or present barriers to participation in these meaningful activities. So OT’s commonly use the Person-Environment-Occupation Model, or the PEO Model to help guide their intervention and the design of home environments to enable a good fit for people. And we actually have a whole podcast episode dedicated to the PEO Model. So if you haven’t checked that out, be sure to. 

[00:03:37] So now that y’all have a better idea of what OT is, let’s go ahead and dive into the three different practice areas in which OTs could collaborate with professionals in the housing industry.

[00:03:48] OTs are qualified to provide input about how people function in a home environment when illness, injury, or disability are present. So they are the perfect people to collaborate with if you’re interested in building a home that is functional for all people. 

[00:04:03] So Sarah, you’ve actually worked in each of these settings over the course of your career. Would you mind giving us a quick rundown of your experiences? Then after that, we can focus on each area more specifically. 

[00:04:15] Sarah: Sure. Yes. I have worked in all three practice areas and I’ll give a little back story here. So right out of graduate school, I worked in a hospital setting in North Carolina on an inpatient rehab floor. I typically saw individuals after an illness or injury or a surgery, mostly with spinal cord injuries, but I also helped individuals who had had amputations, deconditioning from an illness as well as those with cancer. I was on a team and worked closely with a physical therapist, speech therapist, the doctors, nurses, case managers, and other specialists.

[00:04:48] After my husband graduated from grad school, we both decided that we wanted to do something together with our knowledge base and decided that working as consultants in home modifications and universal design would be a good path. So what we found was we were doing more home modifications to existing homes versus focusing on new homes, which were easier to implement universal design.

[00:05:14] As a consultant, I would go into my client’s homes and make recommendations based on their needs and the desires they had for their homes, and then partner with a builder or contractor to make those changes. We saw a great need for existing homes to have safer and more functional features, which I think a lot of OTs and other professionals do, but there still was  a more systemic issue of homes being built that were new and had very few functional features from the start.

[00:05:42] Many homes would still have to be modified for them to be used right after they were built. So I really enjoyed working with individuals in their homes and got to know them, but I knew that I had to differentiate myself as an OT from one of doing home modifications or doing universal design if we really wanted to focus on universal design.

[00:06:05] So after doing some consulting and home modifications for about four years, we decided to change up our model to start working primarily on universal design in the capacity of designing new homes. I am excited to dig a little deeper into these practice settings to help consumers, builders and architects really see the difference and similarities of what an OTs role is in each of these areas. Plus, share some stories about our experiences. 

[00:06:34] Kati: Thank you for sharing that, Sarah. I know I’ve had the pleasure of learning from you about these three different practice areas over the course of my doctoral project, so I’m really excited to dig deeper into this so that we can educate even more people about it. And you’ve really made it clear to me that there is a difference between each setting. Yet the common thread is that we are all recommending design or equipment that increases the safety and independence of our clients within the home environment. Because we know as OTs that if an environment is unsupportive, that can lead to greater dependence on others, they could miss out on valued activities and then there’s the safety concerns. 

[00:07:13] So let’s go ahead and dive into clinical settings specifically.  After a health event occurrs, some individuals will find themselves in hospital or after that they’ll go to a rehab center to recover. And in these settings, collaboration typically only occurs between the other healthcare team members, like doctors, case managers and nurses. And then the other therapy disciplines like physical therapy and speech therapy. 

[00:07:39] Sarah: Yes, exactly. So when I was working in the hospital, we were getting people back to the point where they could get home independently,  or they would actually need some help from a caregiver right after discharge. And we would do a lot of education on that. We were mainly focused on ADLs,  which Kati described before and would also recommend different adaptive equipment to get them dressed or bathed, as well as durable medical equipment, like shower chairs or seats to put over the toilet to make sure these tasks were easier. We also saw patients for a short amount of time, so it could be a week, but then up for longer for like a month. 

[00:08:15 ]Kati: Right. And then in these settings, you’re typically planning for the patient’s discharge on day one of their stay. So you’re trying to figure out where they’re going to be  discharged too, so that you can make the appropriate recommendations for all of the equipment that you mentioned earlier.

[00:08:31] So along with improving their overall function, we’re also going to interview the client to learn more about their home environment. And so an OT would typically ask a patient questions similar to this: 

[00:08:44] Do you live in a single family home or an apartment? How many floors are in your home? Are there stairs that you have to navigate or do you have an elevator?  Are there steps to enter or exit the home? Is there a railing you can use? In your bathroom, do you have a bath tub or is it a walk in shower? Do you have grab bars? Do you live alone or with family members? And if you live alone, is there anyone that can come assist you?

[00:09:10] Sarah: Yeah, these questions are spot on. And most of the time that’s all we really have to go from in the clinic because the answers to these questions are the exact things that we have to work on while they’re in the clinic. And so sometimes we may have a family member share pictures of the home, but , more often than not, it’s the patient’s report of their home design. We really don’t get to go see them in their home doing these tasks unless we do a home evaluation. And that evaluation is mainly to make sure the patient could be safe in their current home and it really wasn’t to assess them for major changes like a bathroom renovation, for example. 

[00:09:49] Kati: Right. So we commonly ask these questions because homes don’t accommodate someone after they acquire an illness, injury, or disability.  For example, the doorways might now be too narrow for a wheelchair to pass through, their only full bathroom might be upstairs and they might not be able to get there, or there might be steps to enter the home, and now that they’re in a wheelchair, for example, they can’t get in.

[00:10:12] So many of these things can be a barrier for that person to return home. So unfortunately, in a clinical setting, there’s only so much that an OT can do to help with environmental changes. Of course, we can recommend adaptive equipment to  adapt the environment to fit them better. We can also teach them how to do familiar tasks, but in a different way, so teaching them new techniques. And then we might be able to give them a handout on how to build a ramp or, you know, suggest that they install swing away hinges to widen the doorway.  But these are all recommendations at this point so that we can provide them with the things they need to be discharged home safely. 

[00:10:52] Sarah: Exactly. I had a client who did get to go home,  but he didn’t have the money to do any major renovation. So the bedrooms and bathrooms were upstairs and he would be using a wheelchair for the rest of his life. So they actually would go to a hotel for him to take a shower. And I’ve heard of people getting gym memberships to utilize more accessible shower options because it was more functional for them there then their home. So OTs and individuals with impairments really do have to think outside the box sometimes just to get their ADLs done. And I’ve also had many clients discharge home who have had to turn a dining room into a temporary bedroom until they were strong enough to go up and down the stairs safely.

[00:11:36] Kati: Yeah. I’ve actually also experienced a situation similar to that where a gentleman and his family had to convert their formal living room into a bedroom because he was no longer able to safely get up and down the stairs, and he’d probably need to use a wheelchair for the remainder of his life.  So while he was at our rehab facility, we had to recommend that he get a hospital bed for home, so that bed mobility would be a little bit easier for his caregivers, and we recommended a bedside commode for using the bathroom because he couldn’t safely get into the half bath that was located on the first floor because his wheelchair was too wide to fit through the doorway. And then we also recommended that he take sponge baths because he couldn’t get to the second story full bathroom, which is where the shower was. So luckily in this situation, his family was very understanding and they were able to accommodate him the best that they could. But that isn’t the case for some people and that really breaks my heart. But as OTs, we just try to make the best recommendations we can and adapt things the best that we can and teach our clients and teach our caregivers how to be as independent as possible and as safe as possible. 

[00:12:45] So we actually have discussed this topic in more depth in another podcast episode. So if you’d like to learn more about home evaluations and additional experiences about discharging home from a clinical setting, go check that one out.

[00:12:59] Sarah: Awesome. Yeah, so also I wanted to add for my experience, in a clinical setting it is rare that an OT gets to collaborate with a building professional at this stage. I think I only had one client when I worked in the hospital that actually had us consult on a new bathroom that was being built. But that was only because the family rallied quickly and funds were raised so that the person had a functional place to return home.

[00:13:23] And like you said, Kati, we can only do so much in the way of recommendations for new things to implement in the home. And we weren’t around to help with making sure the implementation was correct. It’s not because it wouldn’t be helpful, it’s just because most healthcare systems haven’t established a way for this to happen. I didn’t have a list of local builders approved by the hospital and recommend to my patients. And as an OT, when my patient is discharged, I stopped treating them as they are getting ready to go meet a new OT, either through home health or outpatient but sometimes they need to go to a skilled nursing facility if they needed more training or more help than their family could give them at that time.

[00:14:05] So overall, I think having direct contact with someone in the construction field at this point in the process would be extremely helpful for someone who has just  undergone a health event and is determining if their home is even safe to return to as most needs are immediate in nature. But in my experience, there really wasn’t a hospital process or protocol to follow for that.

[00:14:28] Kati: Yeah, you’re right, Sarah.  In the facilities that I’ve worked at through my fieldwork experiences, I have never witnessed any type of collaboration between a building professional and any of the fieldwork educators or OTs that I’ve connected with in past facilities. So I do think it would be incredibly beneficial to establish some way that hospital settings could be linked up with different construction companies or builders in the area, so that when there is a significant renovation that needs to occur for someone to get home safely, that these OTs can quickly give the family the information they need to contact these builders and I think it would just be so helpful. And I wish that there was a way to establish a system like that in our healthcare. 

[00:15:15] Sarah: When I was, I’m actually an OT student doing my research for my master’s I did a interview with some caregivers and they suggested the same thing.  They wanted like a pamphlet or a booklet or resource for local builders that they could contact cause most often or not, they had to have their homes modified and they just didn’t even know where to start. The emotions of having a family undergo this, major event and now they have to figure out what to do with their home. It’s extremely stressful  and so any way that we, as healthcare professionals and housing professionals could be a part of this process, I think it would only increase the outcomes for patients and their families.

[00:15:57] Kati: Right. And that’s a good leeway into the next area of practice for OTs. And that’s the area of home modifications and consulting. So there is a newer niche of OT beginning to form where OTs are branching out of clinical settings and developing their own consulting businesses. And these OTs specialize in home modifications and they can be hired as a consultant during renovations to help, for example, the aging population or people with complex disabilities or people who’ve had a traumatic event take place in their life. So some occupational therapists have even created partnerships within a builder or architect company and are employed by that company to modify existing homes for a specific family. 

[00:16:43] Home modifications are typically geared toward individuals living in a specific home with specific needs. And I just wanted to throw in a quick definition of home modifications and according to AOTA, which is the American Occupational Therapy Association, they say that home modifications are changes made to adapt the living spaces to increase usage, safety, security, and independence.

[00:17:08] So as an OT in this practice area, they would typically go in and evaluate their client’s abilities and analyze how well they perform their occupations in their natural home environment. If the OT saw that the environment didn’t work for them, then the OT would make recommendations for how the house could be improved and they would then collaborate with a building professional to make it happen.

[00:17:30] And I know Sarah, you have experience in consulting, so would you like to give us a little rundown of what it looked like for you. 

[00:17:38] Sarah: Sure. Yeah. So when I first started doing consulting, I had to really figure out what my process would be. Cause I didn’t learn this process in school. It’s kind of a new niche. So I really wanted to make sure that I did a thorough evaluation and I didn’t miss anything important. 

[00:17:53] So I eventually landed on an evaluation that I liked. It’s called, I-HOPE. And it stands for In-Home Occupational Performance Evaluation. And there’s a ton of different evaluations out there, but this one really made sense to me. And this evaluation only looks at the client. We actually created another checklist for the environment  and that can be found at safescore.org. So the big point of I-HOPE was to really assess the occupations that someone did in their home. So in this evaluation, it had the person rate over 44 different activities that they do or they could indicate that they didn’t actually do them and what their satisfaction was in doing them. And the big takeaway from this part was determined what was important for the client to address. We did pick their top 10 and how satisfied they were with performing that task. And this helped me to determine how to focus my time with them because I couldn’t focus on all 44 areas like that just isn’t possible.

[00:18:51] So I narrowed it down to 10 and then I observed them doing those 10 tasks  so I could see where those hangups were in their home. So some of the tasks on the list included things like getting in and out of the shower, washing dishes, caring for pets, getting in and out of the home, picking things up off the floor, paying bills, taking out the trash, and many, many more.

[00:19:14] And you can see that some of these are  daily essential things that have to be done, but some of these are also very meaningful tasks, like taking care of pets, which could go either way. So after leaving their home, I’d write up the recommendations. My recommendations included maybe assistive technology, like a video doorbell or adaptive equipment like sock aids or reacher to get things out of high places or off the floor. Durable medical equipment such as specific  shower chairs, or a lift to get someone in and out of the bath. And then I’d also make suggestions for structural changes to the environment. These types of modifications included installing grab bars around the toilet to help someone stand up and sit down safely, purchasing a stair lift so someone is able to access their second story bedroom, or building a ramp so someone who used mobility devices could enter and exit the home safely. And these recommendations were typically categorized into three options at three different price points with the lowest price point, doing some minor modifications to the third option being major modifications that could be things like the stair lift or a larger renovation that would  cost a lot of money and potentially time. 

[00:20:30] So after the evaluation, I would send a copy to the client and then to the builder, and then I come in again with the builder and we problem solve together how we could make some of these changes because the builder needed to be involved in that and see how that client moved.

[00:20:47] And ideally, I would also be present for the buildout to educate the client on how to use some of the new equipment. After the building was complete, I would redo my evaluation and hopefully their scores improved from the initial one. So hopefully they could complete their tasks with more satisfaction and they could complete them more functionally. And then I’d write up my discharge. 

[00:21:09] So each time working with a different builder was a little difficult because the process became a little fuzzy. Everybody does things a little differently. And some builders only wanted me to give the recommendations and then that was it. And they didn’t think I needed to be there for when things were built.

[00:21:27] Another thing that I really struggled with, and I know other OTs in this area have struggled with, was how, how do we get paid? I didn’t take insurance so I’d have to charge the client by an hourly rate and that usually just came out of their pockets. So it would be an hour for my visits, writing up recommendations, then the time spent with the builder, and then going back to educate and make sure all of those changes and products were installed correctly.

[00:21:55] But then I felt like getting paid by the hour, I was kind of getting the short end of the stick because I was only charging for the amount of hours. But no matter whether the construction costs were $5,000 or $20,000, I felt like it just didn’t work out well. So I’ve also heard of OTs charging the builder for a percentage of the total cost as well.

[00:22:21] So the thing with existing homes is unfortunately that some of these modifications, while they can increase function, can end up looking like an add on since accessibility was not considered in the original design of the home. Not all of them, however, it really does depend on the situation and the amount of money that people have to spend.

[00:22:41] Additionally, this area of practice you have to make some compromises because some of the time, people don’t have the time for the renovation and they don’t have the money for it. So it really results in the person with an impairment only being able to use a portion of their home if some of those compromises have to be made.

[00:23:00] So this was a situation in one of my consulting jobs. The individual had an amputation, she wore oxygen, and didn’t have full range of motion in one of her shoulders. She and her husband lived in a split level home where the bedrooms were up a short flight of steps, and then the laundry and other living areas were down another flight off the main level.

[00:23:21] So they were renting this space and the changes that they were needing to make either needed to hold their value and seem enticing to new renters, or they had to be changed and removed when they left. They didn’t want a walk in shower because of the bathroom the wife used was the only one with the tub and if a family were to move in afterwards, they were worried that the space wouldn’t be helpful without a tub if they had kids to take a bath. 

[00:23:51] So the biggest issue was that she had to ride up the stair lift from the main floor to get to the only bathroom that she could use. She then transferred into another wheelchair at the top of the steps. So she had a wheelchair at the bottom of the stairs and the top of the stairs. There were two entrances to the bathroom and both of those doors were too small to fit her wheelchair through. So picture this in your mind, she had to transfer again out of her wheelchair through the door to sit on another seat in the middle of her bathroom. Then she scooched herself over to the end of that seat, she stood up again and then she sat down on the toilet. So that’s a lot of up and down for someone who really has to go to the bathroom and who already uses oxygen, is managing those tubes, and is already out of breath.

[00:24:37] So when they had a builder come in to do an original bid, it was to change this bathroom. They were quoted $12,000 to $14,000 . But obviously the owners couldn’t spend that much. And so they had me come in to help problem solve some ways to make it more functional at a lower price. And I’ll tell you what we did for the project, but it was closer to $5,000 to $6,000 which was much more manageable for them.

[00:25:01] So we ended up widening one of the doors so she could move into the space in her wheelchair but we couldn’t widen it fully to fit  her wheelchair. So we installed some swing-away hinges just to give us another inch or two so the door could open and be in line with the frame and that got us to the right width. 

[00:25:20] We also changed the sink to a pedestal sink to help allow the wife to get  closer to the sink versus one with cabinets underneath. We also widened another door in the middle of the bathroom so she could roll right up to the toilet. So she didn’t have to hop around to different chairs like she was doing before.

[00:25:38] And then we also installed some grab bars. So before she was holding on to towel racks and swinging doors just to try to feel safe when she was transferring and obviously those things are not safe. They did have to change the flooring after removing the sink and widening the doorways because those pieces were gone now so there was a blank space there. 

[00:25:59] They also repainted the bathroom. And because they didn’t want to change the tub, we left it alone. But we did add some grab bars to help her easily get in and out when she wanted to use the shower chair.

[00:26:11] We only worked on the bathroom and I did see a lot of other things that could be done in the home to increase functionality. One of the biggest things she wanted to do was go downstairs and do laundry. So that was really one of those compromises that I talked about before  that wasn’t a main priority at the moment, so she still wasn’t able to help out with laundry. 

[00:26:28] And when I went back to look how the renos went, the wife told me that she was so excited to be able to roll her wheelchair into the bathroom, that she just sat in the bathroom for an hour because she could. And so that shows just how meaningful this area of practice is, cause it really helps people with some of those little things that they want to be able to do. 

[00:26:50]Kati: Wow. Sarah, that was such an amazing description of OTs role in home mods. I definitely learned a lot. I appreciate the story you told because it really painted a picture in my mind of how it can be tricky and you really need to problem solve and you really need to collaborate with not only the client and their caregivers, but also a building professional just to make this process run as smoothly as possible. So thank you so much for diving deep into that practice area of OTs and home modifications and consulting. I think our listeners will definitely learn a lot from that. 

[00:27:26] Sarah: Sure. Yeah, no problem. And I also wanted to mention that a lot of OTs in this practice setting do work on new additions as well. So it’s not just modifying current spaces but it might be adding to the current space. And so, it could be a bathroom or a kitchen to create increased independence. And these modifications can also increase the resale value of the home. 

[00:27:47]Kati: Yes, you’re right. And this actually reminds me of a opportunity I had while I was doing my doctoral project with you all  because I was able to sit in on a consultation that Sarah and her husband Scott had with a man who was interested in designing an addition to his home for his aging parents.

[00:28:06] So Sarah, Scott and I met up with this man at a local coffee shop, and we all sat down and reviewed the blueprints that he and his contractor had developed together. And we basically just went through each area of the addition. And the addition included a bedroom, a full bathroom, a living room, and a kitchen. So it was kind of like another little house attached to this man’s already built house where his parents could come and spend the weekends with him cause his parents were currently living in an assisted living facility. So he really wanted this addition to be as functional as possible for them.

[00:28:41] So during our meeting, we sat down with him and we kind of talked through the dimensions of the spaces and the way it was laid out and configured. And we talked about different features that we would recommend, including like doorknobs and faucets and countertops . And then we also asked him what kinds of activities his parents would be doing in that space so that we could kind of visualize that and make the best recommendations for him. And Sarah and Scott were able to give him different design recommendations that would make the space more safe and functional for his elderly parents. And he was so incredibly thankful and appreciative after that meeting. He commented and said that he hasn’t received help like that from any of the other OTs that his father has worked with in the past.

[00:29:28] So that was really, really cool to hear. But I think the reason for that is most likely because his father had been in and out of hospitals and rehab centers. And when you’re in a clinical setting like that, the OTs typically don’t have the time to go in this much depth with design. They’re not able to just sit there and review blueprints for a couple hours because they just don’t have the time to do it. They need to see more patients. They also probably don’t get reimbursed for that. So OTs in that clinical setting can give as many recommendations as they can. But sitting down and looking at blueprints and really looking at every inch of the home is really beneficial for people who are looking to create add ons for their home and renovations to make the space more functional.

[00:30:14] I was really grateful that I was able to sit in on that consultation with Scott and Sarah because  they’re experts in this field and we were able to help this man make a space that was going to be great for his parents. 

[00:30:28] Sarah: Yeah, I really am glad that you got to see that and you kind of got to see a side of like the home modification recommendations and because his family did have some specific needs. And so while we wanted to make it useful for a wide variety of people, it really had to be specific to that family’s needs. So I’m glad you really got to see that. 

[00:30:46] So before we actually leave this practice area, I do want to just share  when I first started doing home modifications, I was able to get connected to a great group of OTs working on advocating for this area of work.  If you are a builder or an OT actually looking into getting into this area in home modifications, you can check out the Home Modification Occupational Therapy Alliance. It’s also shortened as HMOTA and that might be helpful.  This was also helpful for me as an OT just to be able to talk with others who are trying to figure out what direction to go with their businesses and what evaluations to use. And that group has changed a lot over the years and working on some different processes.   

[00:31:28] And there does continue to be a lot of education that needs to occur  with builders and with consumers on why occupational therapists would be a great part of the team. Sometimes as an OT, I would be brought into a project after it was already built to give recommendations on changes, which really seemed backwards to me because it costs money to make changes.

[00:31:48] Another scenario would be where I was there at the beginning to make recommendations and then my part was done and I wasn’t asked to come back for the implementation. So however on my recommendations might not be implemented in this situation. Might not be implemented fully, or some of the features may have gotten lost in translation and so we realized that there needed to be communication between the builder and the OT and the homeowner from evaluation at the very beginning, throughout the entire build. Plus the consumer needed training on some of the features and the equipment added to the home. So just like I did an eval at the beginning, I would need to do that evaluation at the end and to make sure they were satisfied and they were able to use those products.

[00:32:32] So the best case scenario I really see for OTs in this niche is to be able to get connected with a builder or a contractor that believes in this work and values your opinion and wants to do this to increase their bottom line for clients. Some projects are small and yes, the implementation is going to look like an add-on because with split-level homes or multi-story homes, they just weren’t designed for accessibility.

[00:32:56] However, there are ways to add features to look beautiful and functional for individual clients. There just has to be a shared understanding and a way that that process will occur. The two professionals can’t work in their own little silos. Plus the need is so great for people to have safer features in their home. I was drawn to the idea of UD and working more on the design of new homes because from our personal experience, Scott,  my husband and I wouldn’t be able to move right in to some of these new homes that were being built. So we really saw an opportunity for universal design to be in the forefront of any new builds that were being started in communities and we wanted to adjust our business to help with that need.

[00:33:39] Kati: Awesome. So let’s go ahead and dive into universal design then. This is the last  practice area that we are going to touch on today. So universal design is an even more unique practice area where OTs participate in the design and build of new homes for a wide variety of use users.

[00:33:55] This means that the finished product is flexible enough to work for different types of needs and  not specific to just one person. So side note, universal design applies to a lot more than homes, but that’s what we’re going to be focusing on for this podcast. 

[00:34:09] Universal design is by definition, “design that’s usable by all people, to the greatest extent possible, without the need for adaptation or specialized design”. And universal design concept was created by Ron Mace. 

[00:34:24] Sarah: Yeah. And I think that the idea of universal design, it’s just a shift in mindset that people need to understand with UD. So in home modifications, you’re typically working with one client and one family who has very specific needs for their family.

[00:34:38] With universal design, the OT and designer are typically working on a structure that is new and they don’t have to add some of those quick fixes to the space because it is a blank canvas. It is much easier and less costly to implement functional features in this entire home from the start. Plus, the focus of universal design is on anyone who could use the space and not just one person with one type of impairment. 

[00:35:05] Kati: That’s right. OTs can contribute to the successful implementation of universal design by considering the abilities and needs of all people.  The Universal Design Project has developed a way to make sure we visualize the wide variety of impairments that need to be addressed during our design work. So we actually utilize an infographic during our collaborative design process that depicts 24 different categories of health-related human impairments. And we consider all of these when designing for all people. And many of these impairments are often overlooked by architects or builders when they’re doing the initial home design. So having this infographic really helps us illustrate  the complexity of universal design and the value of collaboration because we believe that collaboration between builders, architects, and health professionals is necessary to ensure that people of all ages and all abilities can function well within the same environment. So we consider things like limitation of sight or blindness, limitation of hearing or complete hearing loss, chemical sensitivity, difficulty interpreting or processing information, difficulty with balance , inability to use your arms. We have a huge list of human impairments and we make sure that when we’re designing something, every different impairment is able to function in that environment . 

[00:36:31] Sarah: Yeah. And a lot of people think universal design is just like a checklist of items. So check, I have a no step entrance. Check. I have lever door handles. So we as OTs are really looking at how are people going to use the environment, and do their occupations in that space without the use of their hands or without the use of their legs. So that’s a really good point Kati. 

[00:36:50] So based on what I learned during consulting, we developed a design process because there really wasn’t a process out there that could help guide the collaboration between myself and a building professional. It also really helps set a precedent for how we work. So our goal is to create designs that are a good fit for as many people as possible and our focus reaches beyond wheelchair access. And that’s why we look at those 24 different areas. 

[00:37:17] And the creativity of this area of practice really does lie within making the space flexible. The environment needs to meet a wide variety of needs that are out there and design must allow for easy adjustment if needed.

[00:37:31] One of the things to remember here is that UD, works to provide that flexibility to new homes so people can still use the equipment they need to  do their daily tasks. 

[00:37:40] So for example, if there is a shower that has no steps to get in and has ample room, the individual has the option of attaching a seat to the wall where they need it, or they can put in a shower seat or a bench that can be moved based on their needs. Or somebody could use one of the rolling shower chairs that kind of look like a wheelchair that can get wet. 

[00:38:03] That’s the beauty of universal design, that people can still use their equipment like they need to and the space accommodates it because everybody does tasks differently. Then if you don’t need any of those things, you have a really nice big shower, but if you need  something like that in the future, you can add it in easily.

[00:38:23] And this is also the challenge of universal design. You have to understand all these different types of people that could use the space being designed, and that’s why we use the content and infographic that Kati described, so we don’t miss impairments or situations that people may deal with on a daily basis. And collaboration is important because myself as one person does not understand how everybody does everything. 

[00:38:49] When we actually changed our work to do universal design, we knew that individuals with disabilities, designers, and healthcare professionals all needed to have an input in the design from the beginning to make sure everyone was on the same page and working on a similar workflow.

[00:39:05] We are stillworking on getting architects to work on plans with us to ultimately build a library of plans on our site for purchase. But I do have to say that the process we’ve created with our organization isn’t common. You don’t see the collaboration between  healthcare professionals, design professionals, and people who are impacted by disability. And we have a design advisor group of volunteers who actually have disabilities and can speak into those designs. 

[00:39:33]We have been doing this since 2012 and I do have to give credit to my husband for really focusing on all of the barriers we’ve run into  and he really helped change and formulate the direction we’re going right now. I feel like by having plans that we can have for builders to use to build more homes that are universal we can help increase the surplus of homes on the market. 

[00:39:56] Interprofessional collaboration with those in the building and design fields, although is difficult, it’s essential to implement these changes to an existing home or designing a new one. Designers and builders understand the science behind the build and OT understands the science behind the human function. All professionals at the table must see the value of each professional  skillset. And when that occurs, they can all work together to create something that has an impact on the way people use and live in their homes. 

[00:40:27] Kati: Yes. Thank you, Sarah for that great explanation. I know this is your passion. This is where you guys really strive to make a difference. And I’m sure it was very helpful for our listeners to know the big takeaways from this and why The Universal Design Project is so unique and that you look at many different human impairments and that you also have a collaborative process with builders, architects, and people with disabilities who all come together and all give their input to make sure that you create something that is truly universal design.

[00:40:58] So I know that I am so grateful to have completed my doctoral project in this practice area because it’s been so unique and I love being able to advocate for it and educate people about the benefits of universal design and specifically how universal design is not just for people with disabilities, but it’s useful by anyone and everyone, no matter the age, no matter their ability. And it’s just really great to have this experience under my belt. 

[00:41:26] So I know this episode was a little lengthy, so if you’ve stuck around to the end, thank you so much. I’m excited that we were able to discuss these different practice areas and discuss the differences between them because often times they can overlap a little bit and people might assume that OTs in each of these areas do the same thing. And that’s true to an extent, because as I mentioned earlier, there is a common thread between these practice areas and that is to increase the safety and independence of our clients. However, each practice area does it a little bit differently. And that’s the takeaway from this podcast episode and it was a really unique and thoughtful way of celebrating occupational therapy month too.

[00:42:06] Thank you, Sarah, again for sharing all of your experiences. Thank you all for listening to another episode of Good Fit Poor Fit and we hope you have a good day.

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