HOUSING CHARACTERISTICS, HOME EXPERIENCES AND COMMUNITY ENGAGEMENT OF PEOPLE WHO REPORT

IMPAIRMENT

AUTHORS AND ACKNOWLEDGEMENTSAuthors: Craig Ravesloot PhD, Lillie Greiman MA, Bryce Ward,

PhD, Andrew MyersAcknowledgements: This project is a collaboration between the

RTC on Disability in Rural Communities at the University of Montana and the RTC on Community Living at the University of

Kansas.

Funding by: The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR)

LIFE STARTS AT HOME…. Community participation is a central outcome in rehabilitation and independent living research. People who report experiencing an impairment, participate less. Qualitative research has highlighted how the home experience is linked to participation.There is little quantitative research that examines home experience and community engagement.

HOME AND PARTICIPATION BACKGROUNDThe home should includes spaces that facilitate rest and rejuvenation (Mallett 2004)“disabled people [sic] often experience the home as a series of ‘disembodied spaces’, or places that are designed in way that are rarely attentive to their physiological and bodily needs and functions” (Imrie, 2004)Longitudinal research on disability and aging highlights that difficulties in the home may first be experienced in completing ADLs like dressing and bathing (Dunlop, Hughes, & Manheim (1997) Intervention research in the bathroom focuses on fall and injury prevention, but not on participation outcomes (e.g., Gitlin, Miller & Boyce (1999). Barriers in the home impact the broader participation of people with disabilities (Dunn 1990, Stineman et al 2007, Hammel et al. 2015).

OVERVIEWState of housing access (American Housing Survey)Time use at home and in the community (American Time Use Survey)Home experience and community engagement (Home Usability Survey)Discussion and Conclusion

STATE OF HOUSING ACCESS ACROSS THE UNITED STATES: 2011 AHS

Lillie GreimanResearch AssociateRTC: Rural

THE AMERICAN HOUSING SURVEY (AHS)Sponsored by HUD and performed by the US CensusProvides a current and continuous series of data on housing across the US. Conducted every two yearsWe used a sample collected for the 2011 AHS that included households with occupants between the ages of 18 and 75.Complete sample redesign with 2015 survey

DISABILITY AND ACCESSIBILITY VARIABLES IN THE AHS 2009 addition of the ACS (Census) disability indicators2009 addition of the NOSTEP variable (presence of steps at entrance of unit)“Outside, it is possible to enter this home/apartment WITHOUT climbing up or down any steps or stair? Please consider all entrances and ramps that could be used.”

2011 Housing Modification ModuleMobility equipment useFunctional limitationAccessibility features

RATES OF INACCESSIBLE HOUSING

FeaturesHousehold member

uses mobility equipment †

No household members use

mobility equipment

Stepped Entrance 57.2% 60.9%Up stairs with no

elevator* 71.6% 81.7%Inaccessible kitchen 66.8% 69.5%

Inaccessible bathroom 56.1% 60.2%No grab bars in

bathroom 62.3% 86.7%No entry level

bathroom** 18.5% 20.9%No entry level

bedroom** 32.4% 42.2%

† Cane, crutch, manual wheelchair, power wheelchair or scooter * Of apartments** Of units with more than one floor

Up stairs with no elevator*

Inaccessible kitchen

No grab bars in bathroom

Stepped Entrance

Inaccessible bathroom

No entry level bedroom**

No entry level bathroom**

91.0%

61.4%

59.5%

59.2%

52.4%

26.9%

14.2%

68.8%

68.5%

63.8%

56.4%

57.3%

33.6%

19.0%

Inside MSA (Urban) Outside MSA (Rural)* Of apartments** Of units with more than 1 floor

Rate of Inaccessible Housing: Urban Rural Comparison

(Of HH with individuals using a mobility device)

Northeast Midwest South West

69.7%64.0%

48.5% 51.3%

66.0% 63.0%58.8%

50.1%

Rate of Stepped Entrances(Of HH with individuals using a mobility device)

Inside MSA (Urban) Outside MSA (Rural)

Northeast Midwest South West

58.3%62.9%

67.2% 64.3%64.6%

54.0%62.4%

57.5%

No Grab Bars in the Bathroom(Of HH with individuals using a mobility

device)Inside MSA (Urban)

DATA LIMITATIONSDefining “accessible” No objective measurement (e.g.. 32” wide doorway, or outlets 15” off the floor)

Cognitive testing (DeMaio, T., & Freidus, R. 2011).“Many respondents reported that aspects of their home could possibly be utilized by those in a wheelchair…this resulted in over-report of wheelchair accessibility features.”

Rural/Urban dataInconsistent definitions: OMB definitions from 1980, 1990 and 2000 are used depending on the unit and when the unit was added to the survey.

Limited data available for rural areas

CONCLUSIONS AND IMPLICATIONSA large proportion of people with mobility impairments live in homes that do not meet their needs.We see some rural-urban and regional variation in housing accessibility. Significant numbers of households with individuals with mobility impairments have steps or even a flight of stairs at their home entrance.Over half of households with individuals with mobility impairments do not have grab bars in their bathrooms.

TIME USE AT HOME AND IN THE COMMUNITY

Bryce WardAssociate DirectorBureau of Business and Economic ResearchUniversity of Montana

DATA: AMERICAN TIME USE SURVEY (ATUS)

2008-2014 87,000 observations; 2,800 with mobility impairment3 Main questions: • What were you doing?• Where were you?• How long did you do this for?• (For some years for 3 random activities) How

did you feel?Data obtained from Sandra L. Hofferth, Sarah M. Flood, and Matthew Sobek. 2013. American Time Use Survey Data Extract System: Version 2.4 [Machine-readable database]. Maryland Population Research Center, University of Maryland, College Park, Maryland, and Minnesota Population Center, University of Minnesota, Minneapolis, Minnesota.

METHOD Compare time use for people with mobility impairments to time use for people without mobility impairments.

People with mobility impairments differ from people without mobility impairments (e.g., 90% of mobility impaired are out of labor force, 74% do not live with a spouse or partner, 67% are female, mean age is 63).

Thus we include controls for person characteristics (sex, age, education, employment, and school enrollment); family characteristics (number of kids, live with a partner, family income, own/rent home); location (region, MSA size); and interview (day of week, month, year, holiday).

Dependent measure (number of minutes in activity X) are skewed with lots of zeros, so we use GLM with log link and poisson distribution.

WHAT DO MOBILITY IMPAIRED DO MORE/LESS OF RELATIVE TO SIMILAR NON-MOBILITY IMPAIRED?

Leisure and sports

Eat and drinking

Work

Household activities

Educational activities

1.111.09

0.960.80.8

0.750.690.660.60.5

IRRs from GLM regressionLess More

NON-MOBILITY IMPAIRED SPEND ABOUT 50% MORE TIME (47 MIN/DAY) ON HH ACTIVITIES

Household managementFood preparation and cleanup

Animals and petsHousework

Travel related to household activitiesLawn and garden care

Interior maintenance, repair, and decorationExterior maintenance, repair, and decoration

0.80.760.750.730.670.460.410.3

IRRs from GLM regression

FOR THE MOBILITY IMPAIRED, HH ACTIVITIES ARE ASSOCIATED WITH MORE PAIN, FATIGUE, AND STRESS (BUT ALSO MORE MEANING)

Pain (z) Tired (z) Stress (z) Happy (z) Meaning (z)

HH Activities 0.06*** 0.07*** 0.01 -0.17*** -0.09***

(0.01) (0.01) (0.01) (0.01) (0.01)

Mobility Impairment 0.70*** 0.30*** 0.26*** -0.15*** -0.04

(0.04) (0.03) (0.03) (0.03) (0.03)

HH Activities * Mobility Impairment 0.07 0.08* 0.06 0.04 0.14**

(0.04) (0.04) (0.04) (0.05) (0.04)

Regression with individual random-effects of well-being measure (standardized) on indicators for doing a HH activity, mobility impairment, and the interaction of the two, plus controls for sex, age, education, employment, number of kids, marital status, how well they slept the night before, their cumulative exertion (MET) to that point in the day, interview day, interview month, interview year, holiday, metro/nonmetro, activity duration, activity start hour. Standard errors clustered on the individual in ( )’s.

MOBILITY IMPAIRED SPEND ABOUT 10% MORE TIME (55 MIN/DAY) ON PERSONAL CARE ACTIVITIES (AND 15%,121 MIN, MORE “RESTING”)

Resting (sleep, resting, low exertion relaxing/TV)

Health-related self-care

Sleep

Grooming

1.14

2.76

1.07

0.97

PEOPLE WITH MOBILITY IMPAIRMENTS ARE LESS LIKELY TO REPORT ANY TIME SPENT GROOMING, BUT THOSE WHO GROOM SPEND MORE TIME GROOMING.

All Out of LF

80%

73%

65% 64%

% who report any time grooming

No Mobility ImpairmentMobility Impairment

All Out of LF

51 51

5758

Mean minutes grooming, for those who groom

No Mobility ImpairmentMobility Impairment

PEOPLE WITH MOBILITY IMPAIRMENT ARE LESS LIKELY TO LEAVE HOME AND LESS LIKELY TO ENGAGE IN SOCIAL AND RECREATIONAL ACTIVITIES

All Out of LF

88%77%

55% 52%

% who leave the house

No Mobility ImpairmentMobility Impairment

All Out of LF

56%61%

48% 48%

% who spent some time in social or recreational activities

No Mobility ImpairmentMobility Impairment

THE VAST MAJORITY OF PEOPLE WHO GO OUT/ENGAGE IN SOCIAL ACTIVITIES SPEND TIME GROOMING; HOWEVER, PEOPLE WITH MOBILITY IMPAIRMENTS ARE MORE LIKELY TO GO OUT WITHOUT GROOMING.

All Out of LF

17%

22%26%

28%

% who left home and did not report any grooming time

No Mobility ImpairmentMobility Impairment

All Out of LF

17%21%

29% 30%

% who engaged in social/rec activity and did not report any

grooming time

No Mobility ImpairmentMobility Impairment

SO WHAT DOES THIS SUGGEST?The facts are consistent with (but not definitive proof of) a simple economic story.

People have a certain capacity for effort (i.e., effort is scarce).

Every activity has an effort price. Effort price is determined by personal characteristics and environmental characteristics.

People with mobility impairments may have less capacity for effort, may face higher effort prices for activities, or both.

As such, they spend more time resting and less time engaged in activities – particularly activities with higher effort prices.

To increase activity/participation among people with impairments, need to increase capacity or lower prices of activities. This may be done through increasing personal capacity or by modifying the environment.

HOME EXPERIENCE AND COMMUNITY ENGAGEMENT

Andrew MyersResearch AssociateRTC: Rural

INTRODUCTIONA large proportion of people with mobility impairments live in homes that do not meet their needs and abilities.People with mobility impairments spend less time washing, dressing, grooming and engaged in social activities.

How much do people with mobility impairments exert themselves in the home?How does exertion relate to community engagement?

HEALTH AND HOME SURVEYSelf-report survey to assess home usability, health, and participation developed with input from a team of CIL advisors •Demographics •Descriptive characteristics of the home•Exertion within the home (BORG Exertion Scale; % of maximum)•Number of social and recreation activities in the prior 7 days

PROCEDURESGeneral Population Sample:Look at home usability across three urban communities using a random sample of approx. 2,500 address from zip codes surrounding local CILs in: Atlanta, Georgia (33 Zips) Fresno, California (25 Zips) Indianapolis, Indiana (30 Zips)Total Design Survey Method (Dillman)Post cards to ID participants, surveys follow, reminder letters and priority surveys mailed

SAMPLE DEMOGRAPHICS (N=170)Sex

Female 62%Male 38%

Mean Age (Range) 60 (23-95)

Race and EthnicityWhite 62%

African American 25%Hispanic/Latino 13%

Asian 5%American Indian 3%

Other 6%

EducationLess than high school 19%

High school/GED 23%Some college/Assoc.

degree 36%Bachelors and higher 22%

EmploymentNot employed 81%Household Income

< $20,000 57%$20,000-$60,000 26%

$60,001-$100,000 11%>$100,000 6%

IMPAIRMENT AND HEALTH Impairment

Walking 69%Errands 45%

Dressing 38%Memory 36%

Grasping 27%Hearing 22%

Vision 17%No Impairment 15%

Time with limitations (mean) 11.2 yrs.

Number of limitations (mean) 2.5

EquipmentCane 40%

Walker 27%Manual Wheelchair 15%

Brace 14%Health Excellent 4%

Very good 13%Good 33%

Fair 39%Poor 11%

39%34%

28% 27% 24% 24% 20%14%

20%11% 15% 10% 8% 7% 9% 8%

Percent of Maximum Exertion by Activ-ity

Mobility Impairment (n=116) No Mobility Impairment (n=54)

BATHROOM CHARACTERISTICSCharacteristic Mobility

Impairment %

No Mobility Impairment %

Can enter bathroom 97% 100%Can open/close bathroom door

90% 98%

Can use/reach bathroom sink

95% 100%

Can get in/out of shower/tub 72% 93%Has toilet grab bars 28% 15%Has shower/tub grab bars 39% 32%Needs toilet grab bars 41% 17%Needs shower/tub grab bars 50% 22%

Yes No

39%

19%17%

7%

Percent of Maximum Exertion: Needs Shower Grab Bars

Mobility Impairment No Mobility Impairment

Variables IRR SE z p 95 CIBathing exertion 0.74 0.07 -2.97 0.003 0.613; 0.905Mobility impairment 0.62 0.11 -2.69 0.007 0.433; 0.877Subjective Health (excellent excluded)

Very Good 0.54 0.27 -1.21 0.226 0.203; 1.457Good 0.55 0.27 -1.21 0.226 0.211; 1.445

Fair 0.61 0.30 -1 0.318 0.233; 1.606Poor 0.39 0.23 -1.58 0.114 0.123; 1.253

White 0.76 0.13 -1.63 0.104 0.551; 1.507Partnered 0.64 0.16 -1.79 0.074 0.388; 1.044Lives with other people 1.40 0.26 1.81 0.07 0.973; 2.012Constant 10.90 5.51 4.72 0 4.044; 29.354Note: IRR= Incidence rate ratio; SE= standard error; Analysis completed using generalized linear model with a log link and a Poisson distribution

GLM REGRESSION OF BATHING EXERTION ON SOCIAL/RECREATION ACTIVITIES (N=159)

SUMMARY & IMPLICATIONSPeople with mobility impairments exert themselves in home activities more than people without mobility impairment.Exertion while bathing is related to perceived need for shower barsLevel of exertion bathing is related to the number of social and recreation activities

DISCUSSION AND CONCLUSIONS Many people with mobility impairment live in homes that are not accessible. People mobility impairment spend their time differently from people without mobility impairment. People with mobility impairment are less likely to bathe and less likely to leave home than people without mobility impairment. Level of exertion bathing is related to the number of social and recreation activities

FOR YOUR CONSIDERATION…

How might reducing exertion in the home increase opportunities and choices for participation?

How might exertion in the home be reduced?

CONTACTCraig Ravesloot, PhD52 Corbin HallUniversity of MontanaMissoula, MT 59812406-243-2992Craig.Ravesloot@mso.umt.edu http://rtc.ruralinstitute.umt.edu The Home Usability Network Intervention (www.useablehome.com)