By Jeanne R. Seliskar, MA, CCC/SLP
Corporate Director of Rehabilitation
Vrable Healthcare Inc
Home Evaluation completed by a Physical Therapist or Occupational Therapist is a necessary component of the treatment plan of care in a Skilled Facility. It is essential to ensuring a safe and successful return to the patient’s prior living situation. A home evaluation is usually scheduled 1-2 weeks prior to discharge and can easily be misunderstood by the patient and family as a signal that we are discharging. Careful education about the timeline and how goals can develop from seeing the person function at home, need to be reviewed. It is offered to everyone within a reasonable distance from the facility and helps to dispel the misconception that “when I go home, I will be able to things”. It presents a realistic picture of current levels of functioning.
The therapist covers various areas which can be divided into the following areas with the patient performing tasks and mobility in each part of the home:
Exterior and Access to the Home: This section covers lighting, steps, handrails, locking/unlocking doors, opening/closing doors, getting the mail and other outside obstacles, tasks or barriers. This allows the therapist to assess the patient’s ability to enter/exit the home and manage assistive device in case of an emergency. Recommendations may be made regarding the addition of handrails or other safety features such as a ramp.
Foyer and Hallways: This particular part of the evaluation assesses lighting, throw rugs, width of the hallways for walker/wheelchair, managing switches and other possible trip hazards.
Kitchen: In this area, the flooring condition, accessibility of items to cook or eat with, storage/counter space, operation of the faucets/garbage disposal, dining space, retrieval of items from the stove, oven, microwave and refrigerator are examined. Therapists may recommend that items be placed between knee and shoulder level to improve safety and decrease risk of falls during kitchen tasks/IADLs. Additional equipment such as a walker tray or basket may be recommended at this time.
Living Areas: the condition of the carpeting, any throw rugs present, sturdiness of the furniture as well as the height of seating for transfers are the foci of this part of the visit.
Interior Stairs or Steps: Important factors include height of the step, presence of handrails, clutter on the steps, and carrying items when navigating the stairs.
Bedroom: The therapist notes the condition of the carpeting or flooring, stability of the bed and other furniture, transfers on/off the bed, accessibility of clothing from drawers and the closet and the use of the blinds or window coverings.
Bathroom: Components include lighting/presence of a night light, throw rugs, presence of grab bars, availability of supplies and ability to safely navigate throughout bathroom with reduced risk of falls. Therapists will assess ability to get on and off the toilet and into/out of tub or shower, recommending equipment as necessary.
Basement/Laundry Area: Lighting, throw rugs, flooring and tripping hazards are assessed. Therapists observe the patients ability to reach and transport laundry items, retrieve clothing from washer/dryer and safely operate machinery.
Telephone: The therapist will assess the availability of telephones and other emergency devices to assure that the patient can get help from emergency response personnel if needed.
Fire Safety: During this portion of the home assessment, alternate exit routes are examined, fire sources are observed and smoke detectors are located. Recommendations are made to facilitate safety in case of a fire or other need to evacuate the home.
The importance of the home evaluation should not be taken lightly or dismissed. It can be the difference between a successful, happy and safe return to home life for a long period of time or possible re-hospitalization from a fall or inability to manage essential components around the house.