Running Head: HOME EVALUATION REFLECTION

Michelle Wilson
Home Evaluation Reflection
Touro University Nevada

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Home Evaluation
A peer and I were assigned to complete a home evaluation on a patient who had sustained
a cerebrovascular accident (CVA) one year prior in September, 2014. I called the contact
information provided and scheduled a time with the clients wife to complete the evaluation. She
mentioned on the phone that her husband, Tom, would be undergoing a surgery three days prior
to the evaluation date and may be weak when we met him. She also stated that her daughter
would be at the evaluation to assist with any questions we may have.
Description of Context
Tom returned living at home with his wife a short period after sustaining the CVA. He
and his wife live in a single story home located in Sun City Anthem. Sun City Anthem is a
community designed for individuals 55 years or older. Homes are designed to support aging in
place. His home contains no stairs exteriorly or interiorly, however, does have a number of
thresholds to maneuver upon entering and exiting the home. Thresholds are found at the garage
door, the door leading to the backyard from the master bedroom, and the door leading to the
backyard from the dining room. Once outside in the backyard, there is a large built in Jacuzzi
taking up most of the patio space. Toms wife mentioned that he use to enjoy completing
occupational and physical therapy outside, but the landscape makes it difficult to do so. The
Jacuzzi lies on a cement patio space, taking up about one third of the yard. The rest of the
landscape is filled with rocks and flower gardens at the outskirts of the yard and there are pavers
in place to use as walk ways.
Once inside the home, the lay out is a nice, open floor plan. There is plenty of room to
navigate a wheelchair from the front door to the living room, master bedroom, and kitchen.
Rooms that often present Tom with difficulties include the master bathroom, dining room, and
entering and exiting through doors that have a threshold. The master bathroom has a very tight
doorway to fit a wheelchair through, the toilet is closed off in a separate area off of the shower

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and sink area, much too small for Tom to get in with a wheelchair, and the shower contains a
threshold, sliding glass doors, and not enough room to transfer Tom safely. Tom has not
showered in a shower in almost a year and has only participated in sponge baths due to these
barriers. The narrow doorways to the master bathroom and area housing the toilet also prevent
him from being able to utilize the toilet. He has been using diapers for almost a year and feels
extremely embarrassed.
Tom owns quite a bit of durable medical equipment (DME) to utilize in the home.
Equipment includes a hospital bed in the master bedroom next to his wifes bed, a hoyer lift to
assist with transfers, a geri chair in the living room, and a manual wheelchair. Although Tom has
numerous items of DME and lives in a home designed for aging in place, there are still many
barriers in his home preventing him participating in basic occupations.
Experiences and Reflections Following Home Assessment
Upon arrival to Toms home, his wife and daughter greeted us kindly and invited us into
their home. In addition to myself and my peer, there was also a caregiver and a new nurse
assisting Tom. They mentioned that they were very used to having new faces enter and exit their
home on a day-to-day basis. Toms wife asked us almost instantly when she was going to hear
back about the recommendations for home modifications someone from RAGE had already
provided her with. Both Tom and his wife are on social security and cannot afford to implement
these necessary modifications by themselves and are highly relying on RAGE. They are
currently borrowing a ramp from the community recreation center to assist safely transferring
Tom into and out of the home over the thresholds. The recreation center has been calling
frequently requesting that they return it, all that is asked of them in return is a small donation.
Toms wife is hoping to hold onto the ramp until RAGE can supply her with a new one.
After completing the evaluation, I felt as if Tom had slipped through the cracks and was
not receiving the necessary care needed to live comfortably and as independent as possible in his

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own home. It was heart breaking hearing how much trouble the family had gone through over
the past year and how little progress Tom has made. Being on social security puts up numerous
barriers for the family and they are unable to purchase needed items and equipment for Tom to
continue to get better. His daughter and wife agreed that if he were able to shower and return to
leisure activities such as gardening, they truly believe that progress would be seen.
Pertinent Recommendations
Three pertinent recommendations based upon completion of the home assessment include
a roll in shower, a ramp to enter and exit the home safely, and widened doorways in the master
bathroom. Toms daughter and wife spoke to us about the fact that Tom has not showered since
he sustained the CVA in September of 2014. Prior to the CVA they described him as being a
well-dressed, put together man who cared deeply about his appearance. Doorways leading into
the master bathroom and toilet area are too narrow for Tom to fit through in a wheelchair. It is
necessary to widen these doorways and allow Tom to use the toilet and shower. Being provided
with the necessary equipment to shower and use the toilet would make all the difference to him,
his family believes. Additionally, Tom cared deeply for his garden in his backyard prior to the
CVA and spent much of his time outside. He does not have the proper equipment to safely
transfer into and out of the home, having a ramp would solve this challenge.
Clinical Utility of Assessment & Relevance to Occupational Therapy
My peer and I downloaded the Home for Life evaluation tool onto an iPad to ease the
clinical utility. Depending on the functional status of the client, the time to administer the
evaluation may vary. Due to Tom being confined to the hospital bed, a dependent transfer, and
inability to ambulate, it did not take us long to complete. Much of our time was spent
interviewing his wife and daughter and they were able to show us around the home and where
they feel needs the greatest modifications. Scrolling through the app was very easy and we had

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little difficulty learning how to use it. Prior to the evaluation, we spent about 15 minutes
familiarizing ourselves with it.
This tool is relevant to occupational therapy for many reasons. Ultimately, where our
clients reside is extremely important to our practice and how we go about interventions and
goals. According to the Occupational Therapy Practice Framework, environment refers to
external physical and social conditions that encompass the client and is where daily life
occupations occur (American Occupational Therapy Association [AOTA], 2014). Toms home
needs to be well suited to support completion of basic activities of daily living. Additionally, one
of the approaches to intervention includes modify or compensation and adaptation. This
intervention approach focuses on implementing changes to the current environment or activity to
support performance in the natural setting (AOTA, 2014). Entering Toms home and completing
the home evaluation was done so in hopes of improving his current status through the use of
modifications.

References
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1),
S1-S48. http://dx.doi.org/10.5041/ajot.2014.682006

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