1

Hong Kong Sheng Kung HuiKowloon City Integrated Home Care Services

Non-compliance with home modification or assistive devices in elderly:

causes and management

Norris Lai (Occupational Therapist)

4th October 2008

2

Home Mod Classification

Three categories :

major architectural modification -demolish the bathtubminor home modifications - installation of handrails on-site alternation – installation of simple aids such as non-slip mat

3

74%

26%

compliance

noncompliance

Comply Vs Non-comply

4

External factors

Age - older age group complianceGender – men complianceLiving arrangement – living with familycomplianceFinancial issue - no supplementary insurance in HK complianceLiving space in HK - too crowded compliancethe ease to access home mod resource -constructive difficulty compliance

5

Internal factors

Knowledge of environmental risks decision making process not necessary Chronic illness

Self-care ability 70% of non-compliance cases were categorized as slightly dependent or independent

6

Internal factors

Individual meaning of home did not want to change home settingWant to have some control on their own

Habit think home mod does not work

7

Social factor

Caregivers acted as facilitators but sometimes acted as barriers during the decision making. The relationship between the caregivers and the older adults decision making process.Carer knowledge/habit decision making process.

8

Aim of Management

Increase the belief in home modification can reduce fall / improve ADL tasks

Improve caregivers’ support

9

Management 1

Education for clients and carersincrease their knowledge about home mod.

Community talk

Provide leaflet

10

Management 2

Financial support

apply funding

donation

11

Management 3

Self management technique self evaluation

Empower the clients to find out the risk by their own.

Plan a solution by themselves.

12

姓名: 家居環境 第一次評估 改善計劃

及方案

已改

善

第二次

評估

日期： 客廳: 個案 HCW 個案 HCW

光線/照明充足 地毯固定 電線/氧氣喉管放置妥當

通道暢通 傢俱擺放整齊 室內空氣流通 睡房: 床的高度合適 床的擺放位置合適 光線/照明充足 地毯固定 室內空氣流通

13

浴室: 扶手穩固 廁板穩固 浴缸有防滑墊 照明充足 空氣流通 廚房: 地面沒有水或油

污

電線放置妥當 地毯固定 食物存放位置適

當

煮食器皿安全 空氣流通

個案簽署 :

家居照顧員(HCW)簽

署：

社會工作員簽署:

- 表示安全 - 表示有問題, 需跟進 o – 表示不適用

14

Peer Learning

15

Management 4

Experiential learning approach

Learning by doing

Provide demo

Arrange rehab center visit

16

Management 5

Coaching approach

Accompany client to try/use the aid

Increase client’s confidence

Provide +ve feedback from carers.

17

Management 6

Cognitive-behavioral technique

18

Case Study 1

An old man with OA knee seriously and has hx of frequent fall during toilet transfer.

OT advised him to install handrail and raised toilet seat.

He rejected because he thought fall is not a problem and he insisted to take risk.

19

Case Study 1

Situation: fall risk during toilet transfer

Thoughts: fall is not a problem and it will not take his life. OT’s advice is meaningless.

Feeling: rejected

Action: rejected the suggestion.

20

Case Study 1

SW arranged volunteers to have a visit to him and shared the experience of fall.

OT and nurse reinforced the consequence of fall.

Frequent counseling and tried to make him thinks positively.

21

Case Study 1

Thoughts: he realized that fall will not take his life but it will hurt him and caused immobility. “installing handrail”is just a safe measure only

Feeling: become more positive

Action: agreed to install handrail in the toilet.

Situation: toilet transfer becomes safe.

22

Case Study 2

An old lady lived alone and suffered from Parkinson Disease for years.

She rejected to use rollator for walking because she said the aid is too expensive and bulky.

She has a son who will visit her every week and he agreed that rollator is useful for her mother.

Son convinced her mother to use.

23

Case Study 2

But the old lady still rejected to use it because she did not want to waste her son’s money.

After a week, OT brought a rollator to her and said that it was donated by a “funding”. Actually, this rollator is bought by her son but did not tell her the truth.

Then this old lady tried to use the rollator.

24

Case Study 2

This old lady did not have build up a habit to use it initially.

OT trained HCW to monitor her compliance of using rollator.

3 times/wk training, train her to walk with rollator indoor and outdoor until she build up a habit to use it.

25

Case Study 3

An old lady suffered from osteoporosis and lived alone.

Her home environment was very poor. Lot of old and unused furniture placed in the living area. The light is dim.

She had a fall history 3 months ago. When she tried to put the plug in the socket and switch on the radio, she lost balance and then fall at home.

26

Case Study 3

Then SW invited her to join an educational talk about home safety.After the educational talk, SW followed up her and encouraged her to identify the risk by herself.After she identified the risks at her home. SW facilitated her to plan a solution.SW provided resource to help her to implement the solution.

27

Before After

28

Before After

Tips

Timing

Action time

Team work

29

30

Thank you

Hong Kong Sheng Kung Hui�Kowloon City Integrated Home Care ServicesHome Mod ClassificationComply Vs Non-complyExternal factors Internal factorsInternal factorsSocial factorAim of ManagementManagement 1Management 2Management 3Peer LearningManagement 4Management 5Management 6Case Study 1Case Study 1Case Study 1Case Study 1Case Study 2Case Study 2Case Study 2Case Study 3Case Study 3 Before After Before AfterTipsThank you