Modifications Reduce Need for Home Care, Study Reveals
Image by Sabine van Erp, Pixabay
Whether you call it home modifications, housing adaptation, assistive technology, environmental intervention, home adaptation, or something else, the practice of modifying living environments to increase quality of life, preserve independence, and let seniors “age in place” is an urgent need all over the world.
Reflecting that need, a 2019 study by Australian researchers Philippa Carnemolla and Catherine Bridge looked at the potential for home modifications to reduce caregiving in homes of elderly and disabled people. In our last post, we examined the authors’ summary of previous research from across the world on the impact of home modifications. That summary showed that, among other positives, home modifications seem to improve residents’ ability to complete tasks of daily living, boost quality of life, slow the “progression of frailty” as residents age, and reduce need for institutionalization and external caregiving.
However, those previous studies may have had other contributing factors that helped bring about some of those positive outcomes, Carnemolla and Bridge noted. Their study was an opportunity to “directly measure how housing practices impact health and care.” Specifically, they wanted to determine whether “substitution of care” occurred following home modifications; that is, whether the positive changes brought by the adaptations were so impactful that residents needed less care and support in their homes.
Carnemolla and Bridge analyzed self-reported care data from 157 Australian care recipients aged, on average, about 72. Each of the study participants had received home modifications within the past six months. The results of the study were impressive: “A before/after comparison of care provided revealed that home modifications reduced hours of care provided by 42% per week,” the authors wrote.
A more detailed analysis by Carnemolla and Bridge revealed that the positive association of home modifications with care reduction is stronger with informal care, which saw a 46% reduction in need for services. However, the reduction in need for formal care was also significant, at 16%. “These results suggest the role that home modifications, and housing design in general, play in reducing care needs in a community setting,” the authors wrote.
The study’s results are applicable across a range of seniors and life situations: study participants were 54% female and 46% male, and they had a variety of living situations: owning their residence, renting, and living with family members. While 27% lived alone, 54% lived with a spouse or partner, and the remaining 19% with family or friends. Most study participants relied financially on some type of pension, either age- or disability-related, but a few lived on their own savings or still worked.
The study also highlights the fact, long known to us here at Evolve, that while major changes like full bathroom modifications can make a big difference, other, smaller changes also carry a high impact. Most study participants received either bathroom or access modifications ranging from big jobs like bath remodels, front ramps or lifts, and widening doorways to smaller changes like grab rails, modifications to steps, and installation of handrails at entrances. A few participants also had their kitchen or laundry area modified with changes like counter height, lowering of upper cabinets, widening of work areas to accommodate wheelchairs and other assistive devices, and mounting of appliances to provide easier access.
“The research findings suggest that home modifications support a model of self-care and substitute for both informal and formal care provided in the home,” Carnemolla and Bridge wrote. They added that the relationship between home modifications and a reduced need for care is strongest in informal care settings and noted several reasons why this might be:
Informal care is more flexible and responsive to changes in the home, while the bureaucracy of government-funded care delays its response to such changes.
The study may not have fully captured variations in formal care because of the time lag between modifications being performed and official changes being made to formal care plans.
A shortage of government care services and difficulty in obtaining such care may result in people being unwilling to give up any such care, so they just use that access to care access in other ways after receiving home improvements. “This … implies a level of unmet need for care in the community, which has been acknowledged by previous studies,” the authors wrote.
Overall, Carnemolla and Bridge wrote, “This study further supports the evidence base of the home modification literature and provides the previously unmeasured effect of home modifications on direct hours of care provided within the home.” The strong consensus of research worldwide into the impacts of home modifications shows signifiant positive impacts, and this particular study confirms “evidence of a relationship across housing and care, and therefore support(s) the case for housing policy and health care reforms to be considered concurrently,” the authors wrote.
They added that other “expected benefits” of reducing the need for both formal and informal care in the home following a successful home modification include reduced cost of caregiving, the ability of informal caregivers to work outside the home, and a larger pool of human capital in the workforce. “These benefits warrant further research in the context of built environment effects,” the authors wrote.
Once again, we’re seeing that, in a complex world, complex solutions are required, but their human components can be surprisingly simple. If a few grab bars, some lever doorknobs, and an entrance ramp make a senior in any country happier, healthier, and longer-lived, we’d hope that governments, communities, and family members could work together in good faith and good heart to make that happen.
