As part of my fieldwork at the Adult Day Health Program this summer, I get to perform home assessments for new clients who are admitted to our program (I lead them but my supervisor comes with me). At first, I really liked doing home assessments. I felt like I got to apply some of the knowledge that I had learned in my first year of OT school, like when to recommend different types of adaptive equipment, how to use empathy as a therapeutic tool both for the client and the caregiver(s), and how to interact with clients in a respectful and professional manner. As of today I have conducted six home assessments.
I don’t really like doing home assessments anymore.
Whenever I walk into clients’ homes, I know that I am walking into their sacred space. This is where they spend most of their time and, for many clients, this is where they have created several decades worth of memories. This is also where they are used to conducting their daily routine in the same way, day in and day out.
Enter occupational therapist.
During a home assessment, our job is to inspect the home for potential issues of safety and accessibility, and then we do our best to help the client and caregiver make those modifications by educating them about home safety issues and connecting them to resources that will help them make the changes they need.
Occupational therapists are usually the optimistic ones who see the best in everyone. But in this case, we often have to be the bearers of bad news. No matter how you spin it, telling someone that their home is unsafe for them or their loved one is not an easy task.
It makes me think of this clip from my favorite movie of all time, Father of the Bride, starring Steve Martin. Listen to what is said between 0:09-0:12.
Franck the wedding planner walks up to this beautiful, amazing dream home that has been saturated with decades of memories, and his first response is:
“Oh it’s very nice. We change it all though.”
That’s how I feel when I do these home assessments. “These rugs are so beautiful,” I’ll say. “Unfortunately, they are a tripping hazard for your mother so we really recommend that you remove them.” Or, “This shower that you just remodeled is absolutely stunning. However, in order for your husband to be able to safely get into and out of it, you are going to need to hire a contractor to drill grab bars on each of these walls.”
Sometimes it makes people cry.
And even though they’re crying, as you’re empathizing with them, you have to stand your ground and help them understand why the changes in equipment and lifestyle that you have recommended are really to help them be safer and more successful in their own home. I think the hardest recommendation to make and to receive is the one where the OT tells the client that he or she really needs to bring in some outside help to assist with their bathing because it’s just too unsafe to do it by themselves and their family isn’t able to provide the type of help they need.
That really makes them cry.
I don’t know that it will ever get easier, especially since I only have four weeks left of fieldwork. But at least I am aware of how difficult it can be for clients and caregivers to receive recommendations like these, and I know that this is an area where I must tread with caution because I really don’t like to see little old ladies cry.