Home modification practice for people with impairments of ability involves redesigning existing residential environments as distinct from the creation of a new dwelling. A redesigner alters existing structures, fittings and fixtures to better meet the occupant�s ability requirements. While research on case-based design reasoning and healthcare informatics are well documented, the reasoning and process of redesign and its integration with individual human functional abilities remains poorly understood. Developing a means of capturing redesign knowledge in the form of case documentation online provides a means for integrating and learning from individual case-based redesign episodes where assessment and interventions are naturally linked. A key aim of the research outlined in this thesis was to gain a better understanding of the redesign of spaces for individual human ability with the view to computational modelling. Consequently, the foundational knowledge underpinning the model development includes design, redesign, case-based building design and human functional ability. Case-based redesign as proposed within the thesis, is a method for capturing the redesign context, the residential environment, the modification and the transformational knowledge involved in the redesign. Computational simulation methods are traditionally field dependent. Consequently, part of the research undertaken within this thesis involved the development of a framework for analysing cases within an online case-studies library to validate redesign for individuals and a method of acquiring reuse information so as to be able to estimate the redesign needs of a given population based on either their environment or ability profile. As home modification for people with functional impairments was a novel application field, an explorative action-based methodological approach using computational modelling was needed to underpin a case-based reasoning method. The action-based method involved a process of articulating and examining existing knowledge, suggesting new case-based computational practices, and evaluating the results. This cyclic process led to an improvement cycle that included theory, computational tool development and practical application. The rapid explosion of protocols and online redesign communities that utilise Web technologies meant that a web-based prototype capable of acquiring cases directly from home modification practitioners online and in context was both desirable and achievable. The first online version in 1998-99, encoded home modification redesigns using static WebPages and hyperlinks. This motivated the full-scale more dynamic and robust HMMinfo casestudies prototype whose action-based development is detailed within this thesis. The home modification casestudies library results from the development and integration of a novel case-based redesign model in combination with a Human- Activity-Space computational ontology. These two models are then integrated into a relational database design to enable online case acquisition, browsing, case reuse and redesign learning. The application of the redesign ontology illustrates case reuse and learning, and presents some of the implementation issues and their resolution. Original contributions resulting from this work include: extending case-based design theory to encompass redesign and redesign models, distinguishing the importance of human ability in redesign and the development of the Human-Activity-Space ontology. Additionally all data models were combined and their associated inter-relationships evaluated within a prototype made available to redesign practitioners. v Reflective and practitioner based evaluation contributed enhanced understanding of redesign case contribution dynamics in an online environment. Feedback from redesign practitioners indicated that gaining informed consent to share cases from consumers of home modification and maintenance services, in combination with the additional time required to document a case online, and reticence to go public for fear of critical feedback, all contributed to a less than expected case library growth. This is despite considerable interest in the HMMinfo casestudies website as evidenced by web usage statistics. Additionally the redesign model described in this thesis has practical implications for all design practitioners and educators who seek to create new work by reinterpreting, reconstructing and redesigning spaces.

Home modification practice for people with impairments of ability involves redesigning existing residential environments as distinct from the creation of a new dwelling. A redesigner alters existing structures, fittings and fixtures to better meet the occupant�s ability requirements. While research on case-based design reasoning and healthcare informatics are well documented, the reasoning and process of redesign and its integration with individual human functional abilities remains poorly understood. Developing a means of capturing redesign knowledge in the form of case documentation online provides a means for integrating and learning from individual case-based redesign episodes where assessment and interventions are naturally linked. A key aim of the research outlined in this thesis was to gain a better understanding of the redesign of spaces for individual human ability with the view to computational modelling. Consequently, the foundational knowledge underpinning the model development includes design, redesign, case-based building design and human functional ability. Case-based redesign as proposed within the thesis, is a method for capturing the redesign context, the residential environment, the modification and the transformational knowledge involved in the redesign. Computational simulation methods are traditionally field dependent. Consequently, part of the research undertaken within this thesis involved the development of a framework for analysing cases within an online case-studies library to validate redesign for individuals and a method of acquiring reuse information so as to be able to estimate the redesign needs of a given population based on either their environment or ability profile. As home modification for people with functional impairments was a novel application field, an explorative action-based methodological approach using computational modelling was needed to underpin a case-based reasoning method. The action-based method involved a process of articulating and examining existing knowledge, suggesting new case-based computational practices, and evaluating the results. This cyclic process led to an improvement cycle that included theory, computational tool development and practical application. The rapid explosion of protocols and online redesign communities that utilise Web technologies meant that a web-based prototype capable of acquiring cases directly from home modification practitioners online and in context was both desirable and achievable. The first online version in 1998-99, encoded home modification redesigns using static WebPages and hyperlinks. This motivated the full-scale more dynamic and robust HMMinfo casestudies prototype whose action-based development is detailed within this thesis. The home modification casestudies library results from the development and integration of a novel case-based redesign model in combination with a Human- Activity-Space computational ontology. These two models are then integrated into a relational database design to enable online case acquisition, browsing, case reuse and redesign learning. The application of the redesign ontology illustrates case reuse and learning, and presents some of the implementation issues and their resolution. Original contributions resulting from this work include: extending case-based design theory to encompass redesign and redesign models, distinguishing the importance of human ability in redesign and the development of the Human-Activity-Space ontology. Additionally all data models were combined and their associated inter-relationships evaluated within a prototype made available to redesign practitioners. v Reflective and practitioner based evaluation contributed enhanced understanding of redesign case contribution dynamics in an online environment. Feedback from redesign practitioners indicated that gaining informed consent to share cases from consumers of home modification and maintenance services, in combination with the additional time required to document a case online, and reticence to go public for fear of critical feedback, all contributed to a less than expected case library growth. This is despite considerable interest in the HMMinfo casestudies website as evidenced by web usage statistics. Additionally the redesign model described in this thesis has practical implications for all design practitioners and educators who seek to create new work by reinterpreting, reconstructing and redesigning spaces.

Occupational therapists assess and make recommendations for modifying home environments to facilitate caregiving of children in their homes. Children who are profoundly and permanently physically disabled remain dependent for their care throughout their lifespan. As they mature, the physical demands on family members to provide care become more challenging requiring major modifications to ease caregiving. Qualitative interview data of ten educationally influential occupational therapists (EIOTs) were collected to examine what information the EIOTs collect and how they prioritize and organize these data to make modification recommendations. The data were analyzed using grounded theory methodology. The findings detail myriad information required by the EIOT to make recommendations for modifications. Findings suggest a future oriented and highly contextualized information gathering process. The themes were integrated into a process model that suggests how therapists may be developing recommendations. The findings highlight important implications for research, education, clinical practice and service delivery policy.

Occupational therapists assess and make recommendations for modifying home environments to facilitate caregiving of children in their homes. Children who are profoundly and permanently physically disabled remain dependent for their care throughout their lifespan. As they mature, the physical demands on family members to provide care become more challenging requiring major modifications to ease caregiving. Qualitative interview data of ten educationally influential occupational therapists (EIOTs) were collected to examine what information the EIOTs collect and how they prioritize and organize these data to make modification recommendations. The data were analyzed using grounded theory methodology. The findings detail myriad information required by the EIOT to make recommendations for modifications. Findings suggest a future oriented and highly contextualized information gathering process. The themes were integrated into a process model that suggests how therapists may be developing recommendations. The findings highlight important implications for research, education, clinical practice and service delivery policy.

As the U.S. population ages, there is a significant increase in functional impairment, chronic conditions and other age related health concerns. In later life, functional limitations and poor quality of health often lead to the utilization of skilled nursing care in institutional settings. However, older adults often report the desire to age in place even when experiencing health challenges. Therefore, identifying ways to promote aging in place at home as a long-term care option could enhance quality of life. The objective of the study is to examine the impact of home modification and other home and community-based services on the ability of Black older adults to age in place in comparison to Whites. The study utilizes administrative data from the Georgia Money Follows the Person program. The results indicate that race, the use of financial support and the utilization of many services were significant in attaining success in the MFP program.

Sammanfattning Syftet: Att sammanställa vad som fanns beskrivet i vetenskaplig litteratur om bedömningsinstrument som kan användas av arbetsterapeuter för bedömning av behov av bostadsanpassning för vuxna med främst fysiskt funktionsnedsättning.   Metod: Systematisk litteraturstudie med sökning på fyra sökord i sju databaser. För att få ytterligare information om de funna bedömningsinstrumenten gjordes en manuell sökning via artiklarnas referenslistor för att kunna besvara frågeställningarna.   Resultat: Författarna fann sju bedömningsinstrument som bedömde olika aspekter av miljön i relation till person och/eller aktivitet. Inget av bedömningsinstrumenten var avsett att enbart bedöma behovet av bostadsanpassning. Resultatet styrker behovet av bedömningsinstrument som innehåller både observation och självskattningsmoment för att få en helhetsbild av miljöns tillgänglighet och användbarhet.   Konklusion:  Arbetsterapeuter som bedömer behovet av bostadsanpassning behöver bedömningsinstrument som mäter både subjektiva och objektiva aspekter av hemmiljö. Fem av bedömningsinstrumenten innehöll antingen självskattnings- eller observationsmoment och om de kombineras med varandra får arbetsterapeuten en helhetsbild. Två av bedömningsinstrumenten innehöll båda aspekterna. / Summary   Purpose:   To compile what was described in scientific literature on assessment instruments that can be used by occupational therapists to assess the need for home modifications for adults with primarily physical disabilities. Method: Systematic literature search with four keywords in seven databases. To obtain additional information about the assessment instruments a manual search of article reference lists was carried out in order to answer the specific study questions of the study. Results: The authors found seven assessment instruments which assessed various aspects of the environment in relation to person and / or activity. None of the assessment instruments were designed to only assess the need for home modifications. The results proved the need for assessment instruments that contain both observation and self-assessment elements to obtain a complete picture of environmental accessibility and usability. Conclusion: Occupational therapists who assess the need for housing modification needs assessment instrument that measures both subjective and objective aspects of the home environment. Five of the assessment instruments contained either self-estimation or observation moments and when combined, the occupational therapist gets an complete picture. Two of the assessment instruments included both aspects.

The number of older Americans as a percentage of the United States population is growing. A majority express a strong desire to remain in their homes as they age; however, the physical and cognitive declines associated with the aging process often limit their ability to safely age in place. Social isolation and loneliness brought on by stay-at-home orders in response to the coronavirus pandemic of 2020 further limit this population’s quality of life. Evidence-based occupational therapy research has demonstrated that home modifications can be an effective and cost-efficient intervention for reducing falls and maximizing participation in community-dwelling older adults wishing to age in place. Still, varying levels of education and training in home modifications is needed for occupational therapy practitioners to help meet the needs of the aging-in-place population. Power of Place: Understanding and Advocating for Occupational Therapy’s Role in Home Modification is a web-based program in home modification for entry-level occupational therapy and occupational therapy assistant students that includes training to become an AARP HomeFit® volunteer. Designed to be embedded in an existing course, the supplemental curriculum includes both synchronous and asynchronous learning grounded in theoretical frameworks of person-environment-occupation, adult learning theory, design thinking and social learning theory. Training to become an AARP HomeFit® volunteer provides the foundation for experiential learning in home modification. Measured improvements in home modification competency and student self-efficacy through participation in Power of Place will drive further student learning, spark interest in becoming a HomeFit® volunteer within their local communities and promote greater recognition of the profession in the public arena.

The purpose of this dissertation research was to understand the decision-making process that well older adults use when deciding whether to make a home modification. The researcher also sought to understand the views of well older adults concerning the use of home modification to prevent injury and declines in occupational performance. The researcher used the Person-Environment-Occupation (PEO) model (Law et al., 1996) from occupational therapy and occupational science as the orienting framework. A qualitative grounded theory approach based on that proposed by Strauss and Corbin (1998) was used to structure data collection and analysis. Participants were obtained using purposive and theoretical sampling and were interviewed by the researcher. The 19 participants in this study ranged in age from 65 to 89. Findings from this study include a model of the decision-making process that well older adults used to plan for their futures related to home setting and modification and also a substantive grounded theory. The Theory of Home Modification Decision-Making: Well Older Adults is proposed and explained. Central to the theory are two decision-making processes, including the conditions that influence the decisions. These findings and the theory are discussed relative to the PEO model and existing occupational therapy and gerontology literature. The information gained from this study is beneficial to occupational therapists and Certified Aging-in-Place Specialists to improve and expand their services to the well older adult population.

I takt med att befolkningen lever längre och åldersstrukturen förändras har samhället genomfört en satsning för att äldre ska kunna bo kvar hemma så länge som möjligt, den så kallade Kvarboendeprincipen. Följden är att vårdrelaterade insatser har ökat i hemmet där bostadsanpassning är en insats som möjliggör kvarboende längre. För att få en bostadsanpassning krävs det att en arbetsterapeut, eller annan sakkunnig, intygar att behovet finns genom att bedöma personens funktionsnedsättning relaterat till det som utgör ett hinder för aktivitetsutförande. Syftet med denna studie är att beskriva arbetsterapeuters kunskaper och erfarenheter av sin roll i bostadsanpassningsprocessen samt hur arbetsterapeuten involverar klienten i denna process. Tio arbetsterapeuter med minst två års arbetserfarenhet inom bostadsanpassningsområdet intervjuades genom semistrukturerade intervjuer. Resultatet framhäver arbetsterapeutens olika roller gentemot klienten och bostadsanpassningsenheten. Resultatet belyser även etiska dilemman och vikten av den praxisbaserade kunskapen. Vidare skulle en tydligare processbeskrivning och ökad vetenskaplig grund bidra till en mer jämlik vård för klienten, där både vetenskap och beprövad erfarenhet används. / As people live longer and the age structure changes, society has carried through an initiative to allow older people to live at home as long as possible, the so-called principle remaining living at home. The consequence is that health care related activities have increased in the home where housing adaptation is an initiative that enables remain living at home longer. To get a home modification requires that an occupational therapist, or other expert, certify that the need exists by assessing the person's disability related to that constitutes a barrier to occupational performance. The purpose of this study is to describe occupational therapists knowledge and experience of its role in the home modification process and how the occupational therapist involves the client in this process. Ten occupational therapists with at least two years of work experience in the field of home modifications were interviewed through semi-structured interviews. The result highlights the occupational therapist has different roles towards the client and home adaptation unit. The result also highlights the ethical dilemmas and the importance of the practice-based knowledge. Furthermore, a clearer process description and increased scientific basis would contribute to a more equitable care for the client, where both science and proven experience in use.