Date Presented 4/1/2017
We assessed the home safety of formerly homeless adults ages 40–65 yr residing in supportive housing. Nineteen of 20 participants fell at or above the 95th percentile of an elderly reference group, indicating greater home safety concerns compared with adults 20 yr older.
Primary Author and Speaker: Sharon Gutman
Additional Authors and Speakers: Jan Berg, Kevin Amarantos
Contributing Authors: Ethan Chen, Zachary Schlugar, Richard Peters
PURPOSE: Premature aging is a serious health problem in formerly homeless adults. Years living on the street with few opportunities for sanitary bathing, poor health care and nutrition, and assault risk are linked to premature aging in this population. Little is known regarding how this population’s chronic health conditions impact their ability to function safely once in supportive housing. The purpose of this study was to identify home safety concerns that may interfere with supportive housing maintenance.
DESIGN: In this exploratory study, quantitative and qualitative data were collected through a standardized home safety evaluation and set of supplemental questions. The study was approved by the institutional review board, and participants provided consent. Participants were residents of a supportive housing agency. An agency director identified possible participants meeting inclusion and exclusion criteria. Interested residents met with the researchers to learn about the study, provide consent if desired, and set a home safety visit. Inclusion criteria were current housing agency resident, homelessness history, age 40+, own legal guardian, and English speaking. The exclusion criterion was anger management disorder.
METHOD: The 2-hr home safety evaluation consisted of the Safety Assessment of Function and the Environment for Rehabilitation (SAFER) and a set of 177 supplemental questions about the resident’s home function. The research assistants were five occupational therapists (OTs) who received 5 hr of training from the principal investigator (PI) in the use of the SAFER and supplemental questions. Interrater reliability between the PI and research assistants was established (intraclass correlation coefficient = .94, p < .001). Descriptive statistics were used to summarize the SAFER and supplemental question data. Narrative responses were categorized to identify data trends.
RESULTS: Twenty residents participated in this study (16 male, 4 female; age range = 48–66). Participant race/ethnicity included African-American (n = 12, 60%), Hispanic (n = 6, 30%), and White (n = 2, 10%). The most commonly reported physical health problems were diabetes (n = 13, 65%), arthritis (n = 10, 50%), hypertension (n = 8, 40%), and cardiac disease (n = 6, 30%). Mental health problems included depression/anxiety (n = 14, 70%), substance abuse (n = 11, 55%), bipolar disorder (n =7, 35%), posttraumatic stress disorder (n = 5, 25%), and schizophrenia (n = 4, 20%). Fourteen of the 20 participants used mobility devices, including straight canes (n = 9, 45%), walkers (n = 7, 35%), and wheelchairs (n = 3, 15%). The most prominent home safety concerns involved inadequate lighting (n = 19, 95%), lack of nonskid flooring (n = 17, 85%), lack of grab bars in the shower and toilet area (n = 18, 90%), clutter and hoarding (n = 14, 70), unsafe meal preparation (n = 16, 80%), and lack of medication management (n = 15, 75%).
When compared to a SAFER reference group of 563 clients with a mean age of 78 and primary diagnoses of dementia (27%), stroke (8%), depression (5%), frailty (4%), and hip fracture (4%), 19 (95%) participants in our study fell at or above the 95th percentile—meaning that they had more safety concerns than 95% of the SAFER reference group. That 19 of the 20 participants fell at or above the 95th percentile indicates that our sample had more home safety concerns as a result of disability compared with adults approximately 20 years older.
CONCLUSION: OTs have a critical role in supportive housing services for the formerly homeless population. We must make legislators, administrators, and housing staff members aware of both the link between homelessness and premature aging and the ways in which OTs can decrease fall and accident risk in the home. We must become part of the primary care team so that needed occupational therapy services can be identified to help this group maximize safety and maintain supportive housing.
References
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Gilmer, T. P., Stefancic, A., Ettner, S. L., Manning, W. G., & Tsemberis, S. (2010). Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Archives of General Psychiatry, 67, 645–652. https://doi.org/10.1001/archgenpsychiatry.2010.56
Helfrich, C. A., Chan, D. V., & Sabol, P. (2011). Cognitive predictors of life skill intervention outcomes for adults with mental illness at risk for homelessness. American Journal of Occupational Therapy, 65, 277–286. https://doi.org/10.5014/ajot.2011.001321
Metzler, C. A., Hartmann, K. D., & Lowenthal, L. A. (2012). Defining primary care: Envisioning the roles of occupational therapy. American Journal of Occupational Therapy, 66, 266–270. https://doi.org/10.5014/ajot.2010.663001
