FORMAS EVIDENCE – Longterm effects of housing adaptations for client and society

In Sweden, housing adaptation is a common intervention, aiming at supporting an independent life in the own home by removing physical environmental barriers. Out of all housing adaptation clients, 75% are older than 65 years.

Housing adaptations can contribute to enhanced activity and participation, to reduce client health care consumption, to relocation, as well as to reduce falls and fear of falling.

Long term health care will take place in peoples’ homes, and unless adequately designed housing for people with disabilities are provided the costs for housing adaptations, mobility devices, social services staff etc., will increase.

Research based case management
The majority of housing adaptations are performed unsystematically and without the use of research-based strategies. One underlying assumption of this project is that systematic, research based case management will have short- and long-term effects on outcomes for clients and society compared to ordinary practice.

Long-term, high-quality data and research on the nature of disability are essential for providing a basis for policy and for efficient allocation of resources. Thus, the economic perspective is of great importance.

Long term effects
The overarching aim of this project is to investigate the effects of using a new, systematic practice strategy for housing adaptation case management, and to determine the long term effects of housing adaptations for clients and society.

Outcomes targeted are related to aspects of housing and health, including a health economic perspective. The ultimate goal is to improve the housing situation for people with disabilities and to provide policy makers with knowledge useful for planning public services.

Design
The project is a longitudinal, a two-armed controlled trial, applying both qualitative and quantitative methodology. Data is collected before housing adaptation (T1), and 3 (T2), 6 (T3), 12 (T4), 24 (T5) and 36 (T6) months afterwards, at home visits.

In the intervention arm the clients’ ordinary occupational therapist, employed by the municipality, collects data, while in the control arm data is collected by a project administrator. All data collectors have undergone specific training.

Additional interviews
In order to gain a deeper understanding of change processes involved in this kind of intervention, a strategic sample of N=10 single living and N=10 pairs of clients and cohabitants are selected based on age, sex, mobility device use, and interviewed using qualitative techniques before and after housing adaptation.

Additional interviews are conducted with occupational therapists and housing adaptation grant managers, and municipality register data are collected.

Significance for society
According to current Swedish policy, all citizens should remain living in their own homes in spite of declining health, and institutionalization should be avoided until no other possibilities are available.

Long term health care will take place in peoples’ homes, and unless adequately designed and monitored interventions are provided the costs for housing adaptations, mobility devices, social services staff etc., will increase.

Future planning of housing
Given the fact that people applying for housing adaptations have assessed problems in daily life due to barriers in the environment, much knowledge can be gained from studying this group that can inform future planning of housing as well as health care and social interventions

In this context, the economic focus is increasingly relevant as policy makers need further understandings of public services implications both in terms of cost and outcomes. In this respect, the project can improve health care and social services case management and the effectiveness of interventions, as well as inform the housing planning and building sector and public policy makers.

När är nyttan som störst av en bostadsanpassning? Både för individen och för samhället? Det ska projektet Formas Evidence ta reda på. Så väl ur ett kortsiktigt som långsiktigt perspektiv för maximalt utnyttjande av resurserna vid bostadsanpassningar.

Majoriteten av dagens bostadsanpassningar genomförs utan systematik. Vetenskapligt förankrade strategier saknas som möjliggör ett effektivt utnyttjande av resurserna. Men det skulle behövas. Bostadsanpassningarna kostar idag samhället närmare en miljard kronor.

Hålla kostnaderna nere
I takt med att andelen äldre i befolkningen ökar, och allt fler ska vårdas allt längre i hemmet, kommer kostnaden dessutom att öka. Om inte effektiva strategier kan utvecklas som håller kostnaderna nere. Det är vad projektet Formas Evidence syftar till.

Ny, systematisk strategi
En ny, systematisk strategi för handläggning av bostadsanpassningar ska jämföras med ordinarie arbetssätt i tre skånska kommuner. Nyttan för den enskilde kommer att relateras till kostnaden för bostadsanpassningen. Därigenom ska de mest givande insatserna utkristallisera sig och borgar för ett effektivt användande av resurserna, är tanken.

Ett centralt mål är också att kunna förse politiker, kommunala handläggare och byggherrar med ett gediget beslutsunderlag som de kan dra nytta av i sin planering.

Statistik över flyttmönster och dödlighet
Hittills ingår 190 deltagare i studien som drog igång våren 2013. Insamlingen av data inleds inför en stundande bostadsanpassning. En rad faktorer kartläggs. Det handlar om allt från den sökandes upplevelse av exempelvis tillgänglighet och rädsla för att falla till statistik över flyttmönster, dödlighet och ekonomiska kostnader.
Text: Erik Skogh