Show Notes:
Learning Community: Courses + Discussion Spaces
Alexis’ discussion space post. Three families tour an inaccessible home and an accessible one, then discuss the impact. You will need to log in with an email to see this post, but you’ll also get access to all the learning community courses and discussion spaces as well!
Home Modification Funding Resources
Good Fit / Poor Fit: Home Survey
Transcript:
Sarah: [00:00:00] You’re listening to Good Fit Poor Fit. Our podcast is part of The UD Project, a small business rooted in occupational therapy that looks at how the design of a home environment impacts how well people of different ages and abilities perform everyday activities. We chat about this unique perspective to boost your knowledge and help you consider what can be changed in communities like yours.
Learn more about our work at universaldesign.org.
Hi, Good Fit Poor Fit listeners and welcome back. If you’ve been with us for the last few episodes, you know that Alexis Girata has been with Rebecca and I and chatting about fun hobbies like indoor gardening and challenging topics like public transportation. Today she is going to be joining us in her last episode to discuss the project she’s been doing for her capstone to finish up her doctorate in occupational therapy. [00:01:00] I do want you to know that we’ll be discussing some fantastic resources that you’ll be able to use for finding funding, and assessing existing homes for basic home accessibility features. While she’s been interested in home mods and UD from personal experiences, she has some great opportunities in her capstone to shadow a contractor and produce some really great resources for the UD project.
So Alexis, why don’t you talk about the very first resource you worked on with us.
Alexis Girata: Hi everyone. I can’t believe I’m already at the end. I’m so excited to be here and to talk to you all about what I have been doing the past couple of months. Throughout the project I have been doing three different things. I’ve been posting on The UD Project’s website, assisting with developing the Home Modification Funding Resource, and gathering information on the Good Fit/Poor Fit: Home Survey. When you sign up for The UD Project courses, you [00:02:00] are automatically allowed access to six spaces that are connected to the courses and include a discussion area where people can share different products they like, ask questions or share their own accessible home. It is a great place for people to learn beyond the information in the courses. So throughout the capstone, I have contributed to various posts, including videos of different home designs and how products can be accessible for people with disabilities. One of my favorite posts that I did was a video that shows the impact of universal design on someone’s quality of life. It followed three people who had different disabilities as they viewed two different apartments. One without accessibility and universal design. And another, with both of those in mind. You can see how much happier the people were when they entered the second apartment and they realized that they could do their daily tasks without limitations. I go into a deeper dive of the video on the learning [00:03:00] community, so you can look there for more information if you’re interested. There are many other interesting finds that have been shared, and who knows, maybe it could give you some ideas for your own home.
Sarah: Yes, there’s a lot of great information in there. We would love to get more conversation going in there surrounding different topics. So please take a look. If you haven’t signed up for our learning community, which includes both the courses and the discussion areas, I’ll put that link in the show notes, or you can go to universal design.org/learn.
It is free unless you’re looking for CEUs for occupational therapy. And I do have to comment on your favorite post too Alexis about that video. It was so impactful having the input of those three different groups of people touring the same homes. I loved their commentary. I think you guys will too, so make sure you go check that out.
I can put a link in the show notes to that too, but onto another great free resource that Alexis made. Tell us about that.
Alexis Girata: Yeah. The next thing we can [00:04:00] get into is the Home Modification Funding Resource. If you haven’t seen this yet, it’ll be linked in the show notes, but you can also find it at universaldesign.org/funding. As many of us know, home modifications can be extremely important and can greatly impact how functional someone can be in their home.
Funding can be the limiting factor due to the required costs to make those modifications. So to address this, I’ve compiled over 300 organizations and resources that provide financial assistance for home modifications. It looks at different grants, loans, and assistance programs specific to each state. It also provides federal programs available nationwide, such as Veteran Affairs benefits and Medicaid waivers. And then lastly, it also looks at different nonprofits and foundations that provide funding resources across multiple states. Each funding option includes a small description of the services they provide and [00:05:00] any eligibility requirements that were available on their site. So with the help of Sarah and Scott, this information was all designed into one resource page where people can find the funding opportunities in their state. There’s also a link provided that will direct the user to that organization’s information page or the application page. Since information is always changing, please contact the organization for any questions about the program and application.
Rebecca: Wow, that’s a huge amount of work. Alexis bringing all that information into one place, but I can see where this would be extremely helpful. Making home accommodations alone is a huge project, so when you’re also having to figure out how to fund that project, it’s a really massive undertaking. So I can’t wait for people to start using this resource. Impressively, this isn’t all you did in your time here, Alexis. I know you’ve also helped wrap up another project that one of our students, two years ago, Anisha actually started. In [00:06:00] this project, you’ve helped us gather feedback about the home survey that Anisha created and began to develop it into an online tool. I love to see these kinds of projects get a little touch of several of our students. So can you share a little bit more about what you brought?
Alexis Girata: Yeah, I’m actually so happy that I could jump onto this project because I love the concept and I think it could be extremely helpful for many people . The goal of this was to create something that could generate results automatically based on the environmental factors and give occupational therapists a home modification resource to share with a patient when the education is needed, but time is limited. After Anisha and Sarah helped develop the home survey tool, Scott was able to then design it and build it onto their website. While I was tasked to complete different outreach and gather research on the usability of the tool and report information from both homeowners or renters and different therapists.
This tool was designed as an entry-level resource for people who are just beginning to understand how their home design [00:07:00] affects accessibility and independence. Whether you live in an apartment, a townhouse, or a single family home, whoever’s using the tool should be able to use it.
The questions were modeled after what inpatient rehab therapists routinely ask as they prepare patients to return to their home safely. These often include if there are any steps to enter the home, what are the features of their full bathroom, including toilet seat height, the style of the shower or bath, and if there are any handrails, where the bedroom is located, and the space available in the bedroom. These are all questions that will be used to help direct plan of care and make recommendations for any durable metal equipment that may be needed, including tub transfer, benches, bed rails, and grab bars. So the core questions in the survey mirrored those baseline inquiries.
Sarah: And we knew that we couldn’t do this in a long survey and it couldn’t be too [00:08:00] complicated, requiring families to measure every single thing in their home. So in this tool, we give people an option to measure if they want or they can kind of guesstimate based on the pictures we provide with text and measurements and the multiple choice questions.
Alexis Girata: And after you complete their survey, the results are populated automatically based on the design of the environment and provides recommendations for things that needs attention and statements that explain why each feature matters. It even gives the users a score and shows them what percentage of their home is a good fit and what percentage is a poor fit. OT would already be addressing the equipment and the technique on how to use those shower chairs and how to use assistive technology for dressing so the tool was designed to layer in that home environment piece and to pull people deeper into the topic over time. It directs the users to different resources, including the funding resource that I talked about before, in-depth courses made by The UD Project, and [00:09:00] lastly, the UD Style Guide and Specifications.
Rebecca: Now, listeners, I do wanna note that in the recommendations, there is no way to get into the specifics for every single situation because that’s impossible. Well, there’s no way we could foresee them all. Instead, I really like how you address the options in different domains like price ranges, for example.
Sarah: We were also considering all the use cases for their survey. Is it usable by therapists in treatment to get more info about homes? By OTs asking the questions, could they give it to their patients or the patient’s, caregivers or family members to fill out. Maybe it was just useful as a resource at discharge, or would people without any current needs find it online while they’re considering changes for their own home?
Rebecca: So basically what we’re trying to do with this resource is provide an entry point for people to gain knowledge of learning about home modifications. So I can imagine a situation where someone’s leaving the hospital or rehab and they’re getting so much information from so many [00:10:00] different service providers that it’s almost impossible to think of changing their home before they leave the hospital. But having answers to some of their questions and knowing the things that they could consider, they could think about making some of those changes in weeks, months, or years down the road. Just having this information opens a lot of doors for people.
Sarah: Yes, and that was really the gap that we were trying to fill. We knew that therapists were doing what they could to get people home safely and as independent as possible, and home health and outpatient therapists often have their own goals that they’re working on. We really wanted people to be equipped to any stage of life for addressing access in their home and to have that knowledge to advocate for their needs when that time came. Whether they were doing a project themself, or they wanted to get in contact with a contractor to do something more complex. Not only that, if they ever were in the position to start fresh and work with an architect to build something new that they had access to our courses to look at even [00:11:00] more features so they wouldn’t miss anything important.
Rebecca: That makes sense. Let’s get back into the methodology, Alexis. How did you get people to participate in this project?
Alexis Girata: There were two main demographics that we were interested in, and those included different homeowners or renters, and then therapists, specifically OTs. Sarah sent out an interest form to see if anyone would be interested in helping. I also posted on various social media platforms, including Facebook and the American Occupational Therapy Association’s community website, and from that outreach we got 95 people who stated that they were interested in participating. Then from those 95, we got 25 homeowners or renters and 29 therapists who actually completed the feedback form. So from those homeowners or renters participants, 36% were about between the ages of 60 years of age or older. 4% were between the ages of 50 [00:12:00] and 59. 28% were between 40 and 49. 16% were between 30 and 39. And 16% were between 20 and 29. For therapists, about 20% worked in home health. 13% worked in either acute care setting or in the community setting. 17% worked in inpatient rehab and about 6% worked in either outpatient adults or skilled nursing facilities. And then the last 20% were either in education or a retired therapist. So with all that information, I basically wanna say that there was a variety of ages and settings that completed the feedback form.
Sarah: Yeah, I know there are a lot of numbers in there, but I was glad to see that we had a really good variety and a pretty good response rate. If you are listening and you were one of those people who completed this survey, thank you so much for your feedback. So Alexis, let’s get into the responses. What are some of the things you gathered as you organized the [00:13:00] feedback?
Alexis Girata: The first thing we looked at was how much knowledge was gained after completing the survey and reviewing the report. So from that data we found that 21 of the homeowners or renters stated that they strongly agreed that knowledge was gain then three agreed and one person was neutral to that statement. Then for therapists, nine stated that they strongly agreed with that knowledge was gain. Six agreeing, 10 stated that they were neutral and then three people disagreed that they didn’t have any knowledge gain and one person strongly disagreed with that statement.
Rebecca: These outcomes all make a lot of sense to me. A lot of the content and recommendations are pretty aligned with what OTs are sharing with clients when they’re discharged and returning home after receiving inpatient care, for example. Not only does this somewhat explain these findings, it’s also a testament to how useful it could be to incorporate this tool into environmental design and discharge planning ’cause it addresses a lot of areas that need to be discussed. [00:14:00] It’s also obvious that homeowners and renters learned a lot that they hadn’t known before, which is evidence that education is needed among the non OT community for sure. So can you share a little bit more about the findings, Alexis?
Alexis Girata: Overall there was very positive feedback that was received between both groups. Many homeowners stated that the report helped them identify different accessibility recommendations in case any changes are needed to make their home more accessible, if there is any changes in health, or if as they started to age.
One person even stated, “This would be an amazing tool for a variety of populations. I just keep thinking of people in my personal circle who would benefit from completing this with therapist support to increase awareness and make plans in advance versus after an event has occurred. Even my younger friends who are having outpatient surgeries on hips, knees, shoulders, et cetera, or my friends who are in my situation with aging parents.”[00:15:00]
There are also a lot of feedback provided on the pictures included in the survey. There are pictures linked to each response option to help provide a visual representation of the features of the home for the users to compare. There are many people who stated the pictures were a great reference or that they were very helpful when picking an answer. But there was also some people who found that the pictures were difficult to follow due to the fact that every picture was different for each response option, and that they were sometimes confused on what the picture was trying to describe.
Sarah: Additionally, several felt that other housing styles weren’t represented, like townhome, apartment, mobile home, duplex, multifamily, and some felt that the homes looked expensive and picture perfect, which is not representative of many homes. I think our intent here, was to actually just depict the specific element to give people an understanding of what we’re asking. But we really hadn’t thought that people would resonate so [00:16:00] deeply with this specific style. We really do appreciate all of these comments and we do wanna take a deeper look into those images, but I will say finding free images to utilize was one of our greatest challenges in this tool, and we did try to vary it up in the home styles and price points, but it’s looking like we might need to do that a little bit more and to make sure our drawings and notations on the pictures depict what’s being asked in a way that makes the most sense to everyone going through the survey.
Rebecca: That’s all great and actionable feedback. I think very on par for the first iteration of this survey. It’s definitely a limitation to not be able to use images from real homes that reflect the actual diversity of the places that people live. What else do we learn from the feedback?
Sarah: We also learned a little bit more about the user experience and usability, so how people interacted with this tool. We did notice that many people gave feedback by looking at the pictures only and didn’t read the questions fully or the descriptions under the pictures. So [00:17:00] for example, many people noted that they used their garage to enter the home and not their front door, but felt like they had to answer the question about the front door because that is what the pictures represented.
Even though we had text noting, please assess your most accessible entrance, visually, their brain went to the front door because of the pictures.
So again, we’ll be considering that as we move forward.
Rebecca: Sounds like more good feedback. The generalizability of the images seems to be coming up a lot, and there seemed to have been some information that people simply weren’t engaging with maybe when they were clicking through because they saw the photos and just engaged with that. But this is all great for us to know as we keep iterating upon it. I will say the design of the survey, including images and written descriptions, like Sarah said, it was intentional. We wanted people to have several options of ways they could interact with the questions, right? So the images weren’t necessary to complete the survey. Someone using the screen reader could have completed the survey because the images had alt texts, and we [00:18:00] provided other texts in the questions as well, describing what we were asking. In addition to all of this, we also asked for feedback about home elements you may not have asked in the questions as well as things that we may have missed. So what was the feedback on that?
Alexis Girata: Yeah, we actually got a lot of this feedback from therapists, which we really appreciated.
Sarah: We did see some items we wanted to make room for including flooring inside possible stair lifts inside, and adding in comments to the report regarding clutter and a few more things as well.
Alexis Girata: Many of them recommended adding lighting and door handles and all these are great and these things are very important and can really impact someone functionally in their home, and it would be great to include them.
It would greatly increase the length of the home survey. To truly be a comprehensive assessment, there would be more than 150 questions and significant measurements for the users, and that level of depth is not [00:19:00] feasible for a self-administered tool. I now, I wouldn’t want to answer an assessment that has that many questions, and I doubt anyone else who is taking it would either. And so for this reason, some clarifications on the report are being made to help direct users to the courses available that actually do address these features in the home.
Sarah: Additionally, we do plan to add individual links to those courses in the report to direct people to information they may be looking for, including maybe specifics on grab bars, lighting specifications for bathroom measurements and more.
Alexis Girata: There is also some recommendations on having options for people to insert their own dimensions and pictures of their home to help address those other personal or environmental factors that impact daily function in their home that wasn’t addressed. And while this would increase the individualized recommendations on the result, it would also be impossible to count for every health condition in [00:20:00] combination with every possible home configuration and generate reliable automatic results. This tool is intentionally scoped to what OTs do best in discharge planning, identifying the most critical barriers to safe, independent function at home. And so instead, a comment or notes section is going to be added to the downloadable version so people can take notes of those factors that are not able to be addressed in the survey, so they can then discuss it with
their OT in the future.
Sarah: It’s also quite a bit more complicated from Scott’s perspective in coding all of this and adding pictures and individual comments into the survey, people would have to have their own logins and things like that.
We also wanna make sure it’s compliant with keeping everyone’s health information safe. And for now, that’s not something we’re going to address right away, but it could be something we do in the future.
Rebecca: Yep. That makes a lot of sense and I can see where that would get dicey, but it’s definitely worth exploring in the [00:21:00] future, if possible. What other interesting things did you guys find? Did the tool seem to be relevant for OTs, for example?
Alexis Girata: Yeah, it seemed like a lot of OTs actually really enjoyed the tool and thought that it could be really useful for them in their plan of care. So from the results that we gathered, 31% of responses stated that they would use this survey at eval. 48% stated that they would use it during a treatment session with their patient. 69 said that they would use it with their patient or have a family member complete it at home and then review the report in the treatment session. 24% stated that they would provide it as a resource at discharge, and 7% stated that they would use it some other time throughout the plan of care. So overall, it just varied based on what their setting was, at what point in the plan of care they would use it.
One therapist even stated, [00:22:00] “I’d love the tool for providing it as a resource to families and for suggesting that they do it to help with discharge to the home from either acute care, inpatient acute, or subacute rehab, and for outpatient as well. The families have to be motivated to want to change things for the better, but it’s a great conversation starter too, and helps to explain why someone might need a bedside commode since they can’t get to the bathroom because of the configuration.”
So overall there were many therapists who identified how the survey could assist their patient’s plan of care.
Sarah: I felt like overall we had a good mix of people from different settings, so it was really nice to see that they all could use it in some form in discharge planning and for resources for their patients. We also did get a lot of good feedback about the content and the report, which is why we wanted to put some effort toward making a more simplistic version.
Alexis Girata: Overall we understand the report [00:23:00] is very detailed. There are a lot of factors that go into making recommendations for home modifications, and it’s important to explain the reasoning behind those for individuals who don’t have that education like an OT. So a simpler version of the port is going to be made. In addition to keeping the one with more explanations, as everyone is coming from a different background and different understanding of this topic. This simpler version will include just the facts of the results and will take out the reasoning why to decrease the visual load of the report, but for the time being, since it will take a while for this version to come about, the courses, provide an alternative learning style through the use of videos, so until the shortened version is available, this could be a good option for people who find the report visually taxing due to the size and density. These videos actually break up each part of the home into shorter videos and provide recommendations as well.
Rebecca: Yes, please do dive into the courses. Sarah and [00:24:00] Scott worked tirelessly on them and they’re chockfull of actionable, approachable information. The courses are also free in the learning community, like Sarah said earlier, you should have to log in with your email. You can even preview some lessons before signing in. Along with the courses, you have the discussion board, to ask questions and get feedback from others in the group.
Alexis Girata: Yes, they have been doing wonderful work, but of course we have to tie this all back into universal design. The tool covers only a slice of what UD addresses in residential environments. It is not meant to replace a full home assessment or the guidance of a qualified professional.
Sarah: I think that this helps people realize how many features truly impact people in their homes to do their daily tasks. By working on items in this survey, people can manage in their home and do basic things or welcome people to visit, but to really look at the entire home and to allow people to use all of it without compromise, there are [00:25:00] lots of things to consider down to the detail, down to the inch, focusing on the reach range or, stylish functional products that can be added.
Basic access is great, and a lot of times that’s what people can do, but knowing that there’s an even broader perspective of UD that benefits everyone well, versus just changing one home to work for certain needs is a broader topic and I know that Rebecca and I are going to get into more of that soon on the podcast, so stay tuned.
Rebecca: Yes, thanks listeners and Alexis, congratulations on completing your capstone and thank you for everything that you’ve contributed over the last few months. We can’t wait to see what you do next, and listeners will be back soon with some more content from me and Sarah.
Sarah: Thanks for listening to Good Fit Poor Fit. If you want to learn more… first, find more episodes with transcripts and show notes at goodfitpoorfit.com. Don’t forget to subscribe! Second, check out our courses at universaldesign.org.
We [00:26:00] cover housing topics like advocacy, collaboration, home modification, universal design and task adaptations. Lastly, if you have questions or topics you’d like us to discuss, email us at [email protected]. Thanks for fitting us into your day.
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