Occupational therapists enable many different groups of vulnerable people to grow, heal and enjoy life, but their role as frontline staff in disability care is perhaps their most prominent.
OTs help people with intellectual, physical and sensory disabilities successfully engage in occupations – in many circumstances, this can help these individuals lead semi- or wholly autonomous lives.
In this article, we’re going to examine why living at home is so important for people with disabilities, and how occupational therapy can help facilitate independent living situations.
Why is living at home important for people with disabilities?
Imagine: You’ve achieved a Masters in Engineering, you have a highly successful, well-paid career, you’re blessed with a loving partner and you’re in a wheelchair.
Now ask yourself this: would you want or need to live in disability housing? Would it make any sense to live away from your partner, your pets and your house, just because you have a disability?
The answer, of course, is no.
For many people with disabilities, nursing care facilities and shared disability accommodation is neither wanted nor needed. Ordinary homes can, with a few strategies and modifications, become equally accessible.
Even when completely independent living isn’t possible, supported living (where disability support workers and specialists provide regular at-home services) is an excellent option. It provides a sustainable balance between freedom and assistance that offers more chances to forge social, professional and intimate relationships.
Here’s what some people with disabilities think about living at home :
“I feel better about myself … making my own decisions … when to get up, what to eat, what to wear … what to listen to on the radio, what doctor to attend … that kind of thing.”
“I am a person with a disability … but first of all I’m a person [with my own identity] … I should be able to decide on how I lead my life.”
“I had always wanted to be independent … to have my own place … to look after myself … to come and go as I please and not have to check in with my parents about every little thing … like where I am going, when I will be back home, that kind of thing.”
Now we know why it’s important for people with disabilities to be able to live at home, let’s look at the role OTs play in making it happen.
For people with physical or sensory disabilities, therapeutic exercises can help improve functioning, as can management strategies and techniques. Interventions may include :
- Self-help practice sessions, like meal prep, wheelchair transfers or personal care tasks
- Energy conservation and work simplification techniques for activities of daily living (ADLs)
- Installation of and training in adaptive equipment, like driving aids
- Workplace assessment and training
- Environmental modifications (which we’ll talk more about in a minute)
- Education of employers, family and friends
It’s important to note that although some of these interventions can be successfully applied to people with intellectual disabilities (ID), limited awareness of their own difficulties with ADLs and trouble processing feedback can mean people with ID sometimes require slightly different interventions . These may include :
- Simplification of processes and tasks
- Teaching and practicing more effective ways of doing things
- Environmental adaptions that help with recollection and understanding (like using pictures instead of words as labels)
Home modification – the act of making a home accessible for someone by changing layouts or adding adaptive equipment – is essential for helping people with disabilities live at home. By modifying a home space, the difficulty of navigating awkward physical environments is reduced, ADLs become easier to accomplish and general safety and security is improved [4, 5].
Home modifications can occur across different dimensions of the home, which include :
- The physical dimension
- Structure, materials and finishes
- Services and facilities
- Ambient conditions (lighting, airflow, shade, impact of weather and climate)
- Location of the home
- The social dimension (relationships with family, friends and neighbours)
- The personal dimension
- Safety and security
- Freedom and independence
- The temporal dimension (order and routines)
- The occupational dimension (leisure, rest, relaxation, self-care, domestic and work activities)
Most home modifications revolve around privacy, safety and independence . Some examples of common modifications include lifts, ramps, more spacious bathrooms, grab rails and removal of trip hazards.
OTs will often act as consultants for home modifications, designing and recommending specific modifications that help achieve their clients’ goals.
For example, an OT might recommend the installation of therapeutic sleep system, like Revitalife’s Cloud Luxury beds, for a person with a disability who also suffered from chronic pain. The Celliant technology used in Cloud Luxury mattresses can help reduce chronic pain and fatigue, leading to improved occupational performance, and remote-controlled positioning can reduce the difficulty of getting in and out of bed. It’s also a low-impact modification, both spatially and financially, making it appropriate for clients with limited space or funding.
Safety. Privacy. Freedom. They’re three things every Australian wants in their lives, and we take the guarantee of them for granted.
Occupational therapy interventions help ensure that people with disabilities have them too. By recommending the right strategies and modifications, OTs can enable Australians with physical, sensory and intellectual impairments to enjoy the independence and dignity that accompanies living in their own homes.
 O’Connor, H., Gilbert, M. & McGrath, B. (2012) Living in your own home with a disability – the experiences of people with disabilities of support from their community. OCS Consulting, on behalf of the National Disability Authority. http://nda.ie/File-upload/Living-at-Home-with-a-disability-the-experience-of-people-with-disabilities-of-support-from-their-community-PDF-Format.pdf
 Blight, M. (1990) The Role of Occupational Therapy in Adult Physical Dysfunction. Canadian Journal of Occupational Therapy. 57(5), 2-4. DOI: 10.1177/000841749005700501
 Hallgren, M., & Kottorp, A. (2005) Effects of occupational therapy intervention on activities of daily living and awareness of disability in persons with intellectual disabilities. Australian Occupational Therapy Journal. 52(4), 350-359. DOI: 10.1111/j.1440-1630.2005.00523.x
 Petersson, I., Kottorp, A., Bergström, J., & Lilja, M. (2009) Longitudinal changes in everyday life after home modifications for people aging with disabilities. Scandinavian Journal of Occupational Therapy. 16(2), 78-87. DOI: 10.1080/11038120802409747
 Pynoos, J., Tabbarah, M., Angelelli, J. & Demiere, M. (1997) Improving the delivery of home modifications. Technology and Disability. 8, 3-14. DOI: 10.3233/tad-1998-81-202
 Aplin, T., de Jonge, D., & Gustafsson, L. (2013) Understanding the dimensions of home that impact on home modification decision making. Australian Occupational Therapy Journal. 60(2), 101-109. DOI: 10.1111/1440-1630.12022