This article will give you tips for justifying a complex home modification recommendation in your reports.
In the body of your report, under the "Housing and Living Environment" section, detail the client's current home environment. You may want to recommend temporary home modifications until complex home modifications can be funded. You can break up the section into paragraphs with subheadings, such as:
Outdoor Access findings
Ensuite Bathroom findings
Kitchen findings
Here's an example for your reference
It is recommended that complex home modifications be explored by an occupational therapist to develop a scope of works in consultation with a builder for CLIENT to access all areas of their home as independently and safely as possible. Due to his limited mobility, CLIENT falls under the evacuation-impaired category and is at risk of being unable to evacuate his home in case of an emergency without assistance. Evacuation-impaired refers to individuals who have difficulty exiting a building or space quickly and safely during an emergency.
An extension of the study area to include an ensuite wet room (including a toilet and shower) and an emergency exit should be planned in the complex home modifications scope of works to accommodate CLIENT’s disability-related needs. The current study and downstairs bathroom are not suitable for CLIENT's physical needs and lack appropriate circulation space for his four-wheeled walker. The existing shower is extremely small and given CLIENT's height (X’ X”) he is unable to complete showering tasks in the small, glass enclosure with the physical assistance of his carer. The toilet and shower area of his current bathroom lacks the circulation space for mobility equipment.
Temporary home modifications (grab rails) are recommended in CLIENT's current toilet and shower area to increase his safety during these tasks. Planning of the build and modifications to the study and bathroom will require an occupational therapist with experience in complex home modifications. Temporary home modifications are advised until a more thorough assessment can be conducted for complex modifications.
Outdoor access findings
CLIENT has experienced several falls both indoors and outdoors, while navigating the door thresholds and uneven ground in his backyard. At the time of assessment, it was determined that to increase CLIENT’s safe access to his backyard, temporary home modifications of a ramp and handrail are required until complex home modifications of this area can be assessed further. CLIENT is unable to safely ascend and descend steps. He currently lacks appropriate mobility equipment and uses a walking stick for all indoor and outdoor mobility. CLIENT’s (INSERT DISABILITY)-related motor symptoms are expected to progress, necessitating a living environment with level access, ramps, handrails and grab rails with appropriate circulation space to accommodate his future mobility equipment needs.
Kitchen access findings
CLIENT is unable to participate in cooking tasks due to his lack of standing tolerance for more than two minutes at a time. He requires a height-adjustable stovetop so that he is able to sit on a portable chair in order to participate in this valued activity. Similarly, CLIENT is unable to access cooking ingredients in his pantry due to his limited reach and range of motion in his upper body. He would benefit from a pull-out pantry to promote CLIENT's goal to increase his capacity to participate in meal preparation activities.
Recommendations for immediate temporary home modifications
1. Installation of temporary grab rails in the current downstairs bathroom to support CLIENT during transfers and toileting tasks. The grab rails should be installed at a height of 800-810mm above the finished floor level and must withstand a load of 1100N in any direction.
2. Construction of a temporary ramp with a minimum clearance width of 900mm and a maximum slope of 1:12 for backyard access. The ramp should have one handrail and a non-slip surface.
3. Installation of a handrail to assist CLIENT in safely moving through the door thresholds using the ramp above and navigating the backyard terrain.
These immediate modifications will enhance CLIENT's safety and independence while plans for more complex home modifications are developed and executed.
Pictures (with consent) of the home environment are also encouraged to document the current home environment safety and access issues.
Then, in your "Clinical recommendations" section, you may reference your findings similar to this example:
Complex Home Modification Support
CLIENT currently experiences limitations in carrying out daily activities and navigating his home safely and independently due to accessibility challenges. While he has lived in his three-bedroom home in LOCATION for approximately Xyears and intends to remain there long-term, he is unable to access his ensuite toilet due to a lack of circulation space and is unable to access his backyard independently.
To improve CLIENT's functional capacity and promote his independence, several major home modifications are required. These include modifications to facilitate outdoor access, complex bathroom and bedroom modifications and kitchen modifications to enable CLIENT’s use of these facilities. These accessibility challenges have made it difficult for CLIENT to carry out daily activities and navigate his home safely and independently. CLIENT requires home modifications in the following areas of his home to facilitate forward planning and to maintain his independence long-term in his home. Refer to the photos in Appendix X.
Outdoor Access
1. Ramp, handrail and replacement of bricked patio with a concrete paved patio to access the patio area from his lounge so that CLIENT is able to access his backyard and reduce his risk of falls on uneven ground.
2. Paved pathway from grassed lawn and patio to hills hoist. This will enable CLIENT to access the hills hoist without getting his four-wheeled walker stuck during wet conditions and for CLIENT to perform gardening tasks more easily.
Major Ensuite Bathroom Modification The bathroom requires modifications to allow CLIENT to use his four-wheeled walker transfer to a padded shower chair for showering.
Appropriate recommendations may include the following:. 2. A wet floor and open shower configuration with additional grab rails 3. Restructuring of the wall adjacent to the current bedroom to allow CLIENT to access the toilet and installation of grab rails on the wall adjacent to the toilet.
Kitchen Modification Appropriate recommendations may include the following: 1. Installation of a height-adjustable cooking surface, meal prep surface. 2. Installation of a pull-out pantry to promote CLIENT's participation in meal preparation activities.
The funding should include a scope of works for the complex home modification to be explored by an OT (20 hours) in consultation with a builder and the equipment needed to enable Steven to access his kitchen facilities as independently as possible. These modifications would improve CLIENT’s quality of life and reduce his dependence on carers. This aligns with CLIENT's NDIS goal: “XXXXXX”
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Minor Home Modification Support CLIENT would benefit from installing four ramps to enable full access to all areas of his home. It is imperative that funding include installation of these fixtures to enable CLIENT to access his home as independently as possible. It was reported that the threshold step at each of these egresses has contributed to CLIENT experiencing falls in the past 12 months. Ramps will ensure his safety when entering and exiting his home.
If the above home modifications and AT do not proceed, there may be an increase in paid support staff costs associated with prolonged time to complete tasks or the need for additional paid support staff assistance to manage manual handling tasks.
For example, if just one hour of care were added to the daily routine to accommodate the lack of modifications, the following cost would be incurred per week.
· 1 hour of weekday care - $67.56 per hour x 5 days = $337.80 · 1 hour of Saturday care - $95.07 per hour x 1 day = $95.07 · 1 hour of Sunday care - $122.59 per hour x 1 day = $122.59 · TOTAL $555.46 x 52 = $28,883.92 annually
(Public holidays are not counted in this formula. Based on costings from the NDIS 2024-2025 Price Guide.)
Assumptions: · The above rates are basic rates and do not include after-hours, public holidays, CPI changes, and remote and very remote areas, which will cost more. · The provision of home modifications that create a safer environment and eliminate the need for additional care results in value for money. For example, there are cost savings if the modifications are provided rather than just an hour of attendant care.
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