Home for Life Design

Home Assessment Report

Talia Bartolotta of Touro University, performed the following occupational therapy home assessment to determine the
safety and current functional status of Constantine in the home. This report details Rick Constantines feeling of safety
and measures the accessibility of important occupations that occur throughout areas of the home. Information was
gathered via professional interview with the client and/or family, activity analysis, objective measurements and
photography. This assessment was performed on: 9/4/2015

Patient Information:
Patient Name:

Date of Birth: 1/1/1

Constantine, Rick

Address:

Gender:

Male

Henderson, NV
Tennant Type:

Renter

Is Veteran:

Yes

Housing Type:

Apartment/Condo

Has HOA:

No

No. Floors:

Lives With:

Self

Special Considerations:
Inaccessible
Areas:

Assistive Client owns FWW, 4WW, quad cane, SPC,

Devices: TTB, raised toilet seat, and motorized scooter

If the client has fallen, did the most recent fall:

Where did the fall occur: Outside the Home

Result in Injury: No

What Room: Kitchen

Result in Hospitalization: No

Fall Cause Type: Environmental

Result in Rehabilitation: No

Fall Cause Comments:

Other Considerations:
Consideration Type
Has a History of Falls

Therapist Note
Client fell several weeks ago while showering in a hotel room
in San Diego. Client did not report any falls within the
apartment, but did say he has had approximately 5 near falls
throughout his time living in this apartment.

Home and Personal Findings:

The following rooms assessed each indicate the Personal Safety Rating given by the patient and the Therapist
Accessibility Rating determined by activity analysis during skill performance:

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Pre-Assessment
Personal Safety
Rating %

Therapist
Accessibility
Rating %

Bedroom, Master bedroom

100.00 %

100.00 %

Bathroom, Master bathroom

100.00 %

80.00 %

Kitchen, Kitchen

80.00 %

75.00 %

Entryway, Entryway

100.00 %

75.00 %

Room Assessed

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Post-Assessment
Therapist
Personal Safety
Accessibility
Rating %
Rating %

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Home Recommendations Based on Findings:

Bedroom, Master bedroom

Personal Safety Rating

Accessibility Rating

100.00 %

100.00 %

Recommended Modifications:
- Add Lighting

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Bathroom, Master bathroom

Personal Safety Rating

Accessibility Rating

100.00 %

80.00 %

Recommended Modifications:
- Toilet Paper Holder Grab Bar
- Grab Bar Left Side of Bathing Entry
- Grab Bar Opposite Side of Bathing Entry
- Horizontal Grab Bar
- 12" - Textured
- Add Lighting

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Kitchen, Kitchen

Personal Safety Rating

Accessibility Rating

80.00 %

75.00 %

Recommended Modifications:
- Organize/Declutter Space

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Entryway, Entryway

Personal Safety Rating

Accessibility Rating

100.00 %

75.00 %

Recommended Modifications:
- Add Lighting

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Additional Service Recommendations (e.g. home health, medication management):

Additional Notes:
The client stated that overall he felt very safe in his home. The only area he expressed concern was in the kitchen,
specifically during meal time. He said he frequently has difficulty balancing pans and dishes due to impaired right arm.
Despite the present deficits with bilateral coordination, the client completes all of cooking tasks on his own.
Only minimal recommendations have been made for the client's home environment, with nearly l of them being
related to the bathroom or increased lighting in various areas of the house.

Submitted By:

Talia Bartolotta, , License #

9/17/2015

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