Housing Enabler

Even if accessibility problems in housing is an issue that have gained much attention during recent years, professionals and authorities involved in management of individual housing adaptation cases as well as in housing provision for senior citizens and persons with disabilities still lack efficient methodology for problem identification and needs assessment. Starting 15 years ago the Housing Enabler, an instrument intended for assessment of housing accessibility based on Lawton’s notion of person-environment (P-E) fit and occupational therapy practice and research has been successively developed. A unique feature of the instrument is that it takes the individual profile of functional limitations and use of mobility devices in a person into account, juxtaposing it against the environmental barriers present in the person’s home. Also, it should be emphasised that the Housing Enabler can be used in individual cases (housing adaptations or relocation cases) as well as on group level (housing provision strategies). The instrument has been revised and tested for use in research, teaching, and practice and is relevant for disciplines such as architecture, rehabilitation, occupational therapy, societal planning, and environmental gerontology. The methodology has potential to make housing adaptation case management more efficient and has great potential for housing planning at municipality level, but still co-ordinated and systematic efforts are needed to support practice implementation.

The Housing Enabler is administered in three steps:

1.Assessment of functional limitations and dependence on mobility devices (personal component of P-E fit), 13 + 2 items.

2.Assessment of physical environmental barriers (environmental component of P-E fit), 188 items.

3.Calculation of P-E fit score: Based on steps I and II, using a matrix comprising predefined severity ratings 1-4 the profile of functional limitations and use of mobility devices identified in each person is juxtaposed with the environmental barriers found present in the home environment. Thus, the degree of objective, norm-based person-environment fit problems in the home is calculated; higher scores mean more P-E fit problems. For reliable and valid data collection (by means of palm computers) and analysis, instrument-specific software is recommended.

The instrument has been continuously developed, tested and applied in a wide range of studies, in Sweden as well as cross-nationally, but also in the practical everyday work of occupational therapy. The instrument is reaching sufficient content validity, construct validity, and inter-rater reliability. It is currently being used in undergraduate education of occupational therapists in several countries, and besides application in interdisciplinary empirical research projects, its potential for full-scale implementation in a Swedish municipality context has been explored. Currently the Housing Enabler is available in six languages (Swedish, English, German, Latvian, Hungarian and Finnish).

A reduced version, meant for screening the accessibility in housing is under development, based on full-scale analysis of the barriers which cause the biggest problems.

Screening Tool Housing Enabler

In order to present a reduced version of the instrument Housing Enabler, useful as a screening tool in research and practical activities we carried out during 2006-2007 a scientific study. In this study (Carlsson, G., Schilling, O., Slaug, B., Fänge, A., Ståhl, A., Nygren, C., & Iwarsson, S. (2009). Toward a screening tool for housing accessibility problems. A reduced version of the Housing Enabler. Journal of Applied Gerontology, 28, (1), 59-80) the main assessment points in the instrument environment component were identified, i.e. the assessment of points that are most important for identifying accessibility problems, while the validity of the instrument was maintained.

A combination of statistical analysis and expert knowledge were used to identify the assessment points. While the full instrument environment component contains 188 evaluation points comprises the reduced version of 61. Since the list of the 61 most important environmental barriers is based on large amounts of data on both personal and environmental components of the accessibility concept (Step 1 and 2 in the full instrument) the list itself works as a checklist that can be used to identify environmental barriers to be addressed.

In a subsequent project, we took the list of the 61 most important starting point for creating a screening tool (Fänge & Iwarsson, 2009). Based on our accumulated experience in working with the methodology a few changes was made in the sequence between the assessment points, formulas, etc. The pilot version of the screening tool was then tested in collaboration with Lund Municipal Property AB (LKF). The people who tested the tool in the practice was area responsible, i.e. persons with property technical background. The project led to further revisions of the screening tool. The results showed that the screening tool is reliable and useful in practical activities and that it can be used by people with real estate technical background, provided that they receive a short introduction training including the opportunity to follow up with the support of experienced users.

Unlike the full instrument requires an assessment of screening tool, no assessment of the person component (i.e., Step 1 in the full instrument), it is shown built into the appliance by the 61 assessment points from the environmental component (i.e. Stage 2 in the full instrument) identified as the most important, based on large amounts of data collected with the full instrument. The assessment is thus that, during a visit to the home,observing and documenting the environmental barriers that exist. The assessment covers 61 items relating to the dwelling and its immediate environment. The results of an assessment of the screening tool is a list of the environmental barriers that exist in the current dwelling. This type of data is analysed and presented using descriptive statistics.

The Screening Tool is currently in a preliminary version that will shortly be published in a full version on this site and in a report published by Hjälpmedelsintitutet (financier of the practical examination of the screening tool).