The Effectiveness of a Comprehensive Home Health Program for Functional Independence of Older Adults in the Home

PURPOSE: As people continue to live longer, occupational therapy plays a critical role in facilitating aging in place and safety for individuals who desire to remain in their homes. Additionally, it is estimated that one out of every three older adults living in the community experience a fall yearly, with the numbers increasing as adults grow older. Fall-related injuries affect a person’s functional performance in areas of activities of daily living (ADLs) and instrumental activities of daily living.

Home health care programs can allow this growing population to live as independently as possible within their home environment. Home care occupational therapists identify barriers and provide strategies, including provision of assistive technology, to enable individuals to maximize participation in daily activities. This study evaluated the effect of a home health program on functional independence of older adults in the home, including its impact on pain, falls, and functional independence in self-care tasks.

DESIGN: This retrospective study included 47 clients who received occupational therapy services and purchased assistive technology for use in the home. Participants were required to have a written order for therapy services from a physician and to live in the home environment, an assistive living facility, or a senior apartment. This study included clients with single and/or dual diagnoses. All participants were older adults age 50 or older at the time of therapy services.

METHOD: Therapists used a site-based assessment form to perform initial and discharge evaluations. The assessment form included an eight-point scale to measure functional independence in ADL tasks including self-care, transfers, bed mobility, and functional ambulation. Falls were tracked using the following question: Has the client had any falls since the last visit? Data were analyzed using IBM SPSS Statistics Version 23.0. Wilcoxon signed-rank tests and McNemar analyses were used to analyze differences between initial and discharge data for the outcome variables. Since multiple Wilcoxon tests were conducted, a Bonferroni correction was applied, and significance was set at p < .006. Field’s d values were calculated for effect sizes, which were interpreted as small, .10; medium, .30; or large, .50.

RESULTS: For ADLs, including lower-extremity bathing, upper-extremity dressing, lower-extremity dressing, bed mobility, sit-to-stand transfers, toilet transfers, and tub transfers, significant differences were found from initial to discharge assessment (p < .006). All significant differences had medium to large effect sizes ranging from .42 to .57. However, no significant difference was found in upper-extremity bathing, although only 6% of participants reported difficulty with this ADL at discharge compared with 60% at initial assessment. A McNemar test determined no change in falls from initial evaluation to discharge; however, at discharge, no falls were reported, compared with 11% falls at initial evaluation. Similarly, although there were no significant differences in pain levels from initial to discharge assessment, at the end of treatment 20% of participants reported less pain.

CONCLUSION: The results of this study indicate that home health care programs can have a positive impact on functional independence in ADLs for older adults in the home. Although some areas such as pain, falls, and upper-extremity bathing did not have a statistically significant difference, by the time of discharge patients reported less pain and falls and improvements in upper-extremity bathing.

IMPACT STATEMENT: This type of program allows older adults to remain in their homes independently, especially with occupational therapy involvement.

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