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| Rebecca Dutton Home After a Stroke |
Home Sweet Home is the title of an article about an innovative program in home-based rehab (1). This program differs from traditional home rehab in three important ways. First, traditional home rehab provides little or no coordination among different staff visiting the home. The program in Baltimore ensures coordination of care among therapists, nurses, and handymen who repair homes. For example, the nurse evaluates pain, suggests medication changes if needed, and reports the pain issue to the OT. The OT determines if pain interferes with ADLs, if assistive devices would reduce pain, and if environmental factors while sitting or standing are making the pain worse. If modifying the home would reduce pain, the OT reports this to a handyman who makes changes in the home.
Second, traditional home rehab has handymen install medical durable equipment, like putting grab bars in the bath tub. The program in Baltimore also has handymen do home repairs that make the home dangerous. For a client named Mrs. V., the handyman repaired the floor in her bathroom that was collapsing and repaired basement flooring that was loose and torn. As Bridges says, few programs address both housing and health issues (1).
Third, traditional home rehab is client-centered. The program in Baltimore is client-directed. At the 1st visit the OT evaluates the client and the client shares his or her concerns. At the 2nd visit the OT evaluates the home environment and helps the client pick three goals the client identifies as important. For example, Mrs. V. wanted to increase her walking endurance, attend church to receive social support, and safely reach for items on the floor and over head. At the 3rd visit the OT helps the client find two things the client will implement to solve problem #1. Two more visits are devoted to solving problems # 2 and 3.
This innovative program in Baltimore is continuing thanks to a grant that is part of Obamacare (Affordable Care Act). A pilot program conducted in 2010 found that 94% of the clients reported their quality of life had improved.
1. Bridges, A, Szanton,, S, Evelyn-Gustave, A, Smith, F, Gitlin, L. Home sweet home. OT Practice. 2013;18(16):9-13.
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