Home for Life Design

Home Assessment Report

MelodyKlattofTouroUniversity,performedthefollowingoccupationaltherapyhomeassessmenttodeterminethesafety
andcurrentfunctionalstatusofDoeinthehome.ThisreportdetailsMarianneDoesfeelingofsafetyandmeasuresthe
accessibilityofimportantoccupationsthatoccurthroughoutareasofthehome.Informationwasgatheredvia
professionalinterviewwiththeclientand/orfamily,activityanalysis,objectivemeasurementsandphotography.This
assessmentwasperformedon:10/1/2015

Patient Information:
PatientName:

Doe,Marianne

DateofBirth: 1/15/1948

Address:

2110HomeviewCourt

Gender:

Female

LasVegas,NV89117
TennantType:

Owner

IsVeteran:

No

HousingType:

SingleFamily

HasHOA:

Yes

No.Floors:

LivesWith:

Spouse

Special Considerations:
Inaccessible N/A
Areas:

AssistiveGrabbarsinbathrooms,adjustablebedin
Devices: masterbedroom

Iftheclienthasfallen,didthemostrecentfall:

Wheredidthefalloccur:InsidetheHome

ResultinInjury:Yes

WhatRoom:Kitchen

ResultinHospitalization:Yes

FallCauseType:Environmental

ResultinRehabilitation:Yes

FallCauseComments:Clientexperiencedseveralfallsboth
insideandoutsidethehouse.Onefalloccurredonoutside
stepsduetolossofbalance,resultinginabrokenankle.A
secondfalloccurredintheyardafterablackoutepisode,
resultinginlacerationstotheclient'sface.Athirdfalloccurredin
themasterbathroomwhiletheclientwasbendingdownto
accessalowercabinetandlostherbalance,resultinginaright
forearmlacerationthatrequiredanemergencyroomvisit.

OtherConsiderations:

Consideration Type
HasaHistoryofFalls
HasNeurologicalIssues
OtherConcern

Therapist Note
Clienthasexperiencedmultiplefallsbothinsideandoutside
herhome.
ClienthasadiagnosisofRSDinherleftkneewhichaffects
herbalancewhilestandingandwalking.
Clienthasahistoryofhypotensionwhichcausesherto
experiencespellsofdizzinessthatalsocompromiseher
balance.

Home and Personal Findings:

ThefollowingroomsassessedeachindicatethePersonalSafetyRatinggivenbythepatientandtheTherapist
AccessibilityRatingdeterminedbyactivityanalysisduringskillperformance:

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Pre-Assessment
Personal Safety
Rating %

Therapist
Accessibility
Rating %

Bathroom,MainLevel,adjacenttoMaster
Bedroom

70%

56%

Bedroom,MasterBedroom,MainLevel

90%

90%

Bathroom,GuestBathroom,MainLevel

70%

60%

Bedroom,Office,MainLevel

70%

67%

OutdoorSpace,Backyard

60%

50%

Kitchen,Kitchen,MainLevel

90%

86%

Entryway,Outdoorfrontareaofthehouse

60%

50%

Room Assessed

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Post-Assessment
Therapist
Personal Safety
Accessibility
Rating %
Rating %

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Home Recommendations Based on Findings:

Pre-Assessment
Bathroom, Main Level, adjacent to Master
Bedroom

Personal Safety
Rating %

Therapist
Accessibility
Rating %

70.00 %

55.56 %

Post-Assessment
Personal
Safety
Rating %

Therapist
Accessibility
Rating %

Recommended Modifications:
-MoldedTubBar
-TowelBarGrabBar
-GrabBarRightSideofBathingEntry
-VerticalGrabBar
-12"-Textured
-Anti-SlipFloorCoating
Pre-Assessment Notes:
Clientstatedbathroomwasrecentlyremodeled;showerbench,grabbars,andadjustableshowerheadwasadded.
Clientexperiencedafallnearthesinkwhilebendingdowntoopenalowercabinet;clientstatedshelostherbalanceand
didn'thaveanythingtoholdonto,soshefell.TowelBarGrabBarinthebathroomshouldbesituatedontheleftsideof
thesinksothatclientmayholdontoitwhilebendingdowntoaccesslowercabinets.Evaluatorsnotedthatclientwould
benefitfromanon-slipmatbeingplacedinthebathtubtoincreasetransferstability,aswellasasteporstoolbeing
placedoutsidethebathtubsoclientmayhaveaneasiertimetransferringintothebathtub.

Post-Assessment Notes:

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Pre-Assessment
Bedroom, Master Bedroom, Main Level

Personal Safety
Rating %

Therapist
Accessibility
Rating %

90.00 %

90.00 %

Post-Assessment
Personal
Safety
Rating %

Therapist
Accessibility
Rating %

Recommended Modifications:
-AddLighting
Pre-Assessment Notes:
Client'sbedroomwasnotedtobespacious,well-keptanddidnotseemtohaveanytrippinghazards.Theroomwas
equippedwithanadjustablebedthatassistedtheclientwithbedmobilityandpainmanagementwhilesleeping.
However,itwasnotedthatadditionallightingmayincreasevisibility.

Post-Assessment Notes:

Pre-Assessment
Bathroom, Guest Bathroom, Main Level

Personal Safety
Rating %

Therapist
Accessibility
Rating %

70.00 %

60.00 %

Post-Assessment
Personal
Safety
Rating %

Therapist
Accessibility
Rating %

Recommended Modifications:
-WallMountedGrabBar
Pre-Assessment Notes:
Clientstatedthatshedoesnotusuallyusetheguestbathroomforanythingotherthantousethetoiletoccasionally.
Clientmentionedthattransferringtoandfromthetoiletwouldbemadeeasierwithagrabbarinstalledontheadjacent
wall.

Post-Assessment Notes:
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Pre-Assessment
Bedroom, Office, Main Level

Personal Safety
Rating %

Therapist
Accessibility
Rating %

70.00 %

66.67 %

Post-Assessment
Personal
Safety
Rating %

Therapist
Accessibility
Rating %

Recommended Modifications:
-Organize/DeclutterSpace
-ChangeFlooring
Pre-Assessment Notes:
Roomiscurrentlybeingusedasanofficespacebyclientandherhusband.Itwasnotedthattherewasaloosethrowrug
onthefloorthatcouldposeasapotentialtrippinghazard;itisrecommendedthattheclientremovetherugorsecureitto
thefloor.Itwasalsonotedthattheroomwasclutteredincertainareas,whichcouldalsoposeapotentialtrippinghazard.

Post-Assessment Notes:

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Pre-Assessment
Outdoor Space, Backyard

Personal Safety
Rating %

Therapist
Accessibility
Rating %

60.00 %

50.00 %

Post-Assessment
Personal
Safety
Rating %

Therapist
Accessibility
Rating %

Recommended Modifications:
-AddHandRails
-CreateSmoothPavement
Pre-Assessment Notes:
Itwasnotedthattherewasagravelpathwaywithsteppingstonesusedasawalkwaythroughouttheyard,butitwas
alsonotedthatthestoneswerefarenoughapartthattheycouldposeapotentialtrippinghazard.Clientmaybenefitfrom
havingadditionalstonesaddedwithinthewalkway,orhavingthewalkwaypavedsmoothly.Itwasnotedthattherewasa
poolinthebackyard,andclientexpressedthatherhusbandhelpshergetinandoutofthepoolbecauseitwouldbe
difficultforher,otherwise.Itisrecommendedthathandrailsbeinstalledbythepoolstepstomaketransitioninginandout
ofthepooleasierandsaferfortheclient.

Post-Assessment Notes:

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Pre-Assessment
Kitchen, Kitchen, Main Level

Personal Safety
Rating %

Therapist
Accessibility
Rating %

90.00 %

85.71 %

Post-Assessment
Personal
Safety
Rating %

Therapist
Accessibility
Rating %

Recommended Modifications:
-Create36in.WideDoor
Pre-Assessment Notes:
Itwasnotedthatthefirstdoorwayintothekitchenwasnarrowcomparedtoothermeansofentrance.Clientmaybenefit
fromthisentrywaybeingwidened,especiallyifshecomestoneeddurablemedicalequipmentinthefuture.

Post-Assessment Notes:

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Pre-Assessment
Entryway, Outdoor front area of the house

Personal Safety
Rating %

Therapist
Accessibility
Rating %

60.00 %

50.00 %

Post-Assessment
Personal
Safety
Rating %

Therapist
Accessibility
Rating %

Recommended Modifications:
-AddVisibleSteps
-AddHandRails
Pre-Assessment Notes:
Clientexpressedthatsheexperiencedafallintheoutsidefrontentrywayduetothefactthatshelostherfootingonthe
frontsteps.Itwasnotedthatthestepswereallsimilarincolor,andthereforeitisrecommendedthatcoloredtapeor
"visiblesteps"beimplementedonthestairwaytoimprovevisibilityandsafetyfortheclient.Itwasalsonotedthatthe
frontstairshadnorailingfortheclienttobeabletoholdontowhilenavigatingthestairway;itisrecommendedthatarail
beinstalledonatleastonesideofthestepstoimprovesafety.

Post-Assessment Notes:

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

Additional Notes:
Thehomehasanadditionalbasementlevelwithstairsleadingdowntoit;however,theclientexpressedthatshedoes
notfrequentlyvisitthebasement,asallofthemain,necessaryroomsofthehousearelocatedonthemainlevel.
Clientalsomentionedthatthehousewasbuilttocatertowardindividualswithdisabilities,sotherewerewidehallways
throughoutthehouseandallessentialroomswerelocatedonthemainlevel.
Theclientdidnotconsenttophotographsbeingtakenofherhome,sononewereincludedwiththisreport.

Submitted By:

Melody Klatt, , License #

3/11/2016

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