Edited Home Assessment Melody and Kelsey

Home for Life Design
Home Assessment Report

Melody Klatt & Kelsey Puliafico of Touro University, performed the following occupational therapy home assessment to
determine the safety and current functional status of the client in the home. This report details clients feeling of safety
and measures the accessibility of important occupations that occur throughout areas of the home. Information was
gathered via professional interview with the client and/or family, activity analysis, objective measurements and
photography. This
assessment was performed on:
10/1/2015 Patient Information:
Patient Name:
Address:
Date of Birth:
Gender:
Special Considerations:
Inaccessible N/A
Areas:
If the client has fallen, did the most recent
fall:
Result in Injury: Yes
Result in Hospitalization: Yes
Result in Rehabilitation: Yes
Other Considerations:
Assistive Grab bars in bathrooms,
adjustable bed in Devices: master
bedroom
Consideration Type
Where did the fall

occur: Inside the
Home
What Room:
Kitchen
Other Concern
Las Vegas, NV 89117

Tennant Type:
Owner
Housing Type:
Single Family
No. Floors:
Fall Cause Type:

Environmental
Fall Cause Comments: Client experienced several falls both
inside and outside the house. One fall occurred on outside steps
due to loss of balance, resulting in a broken ankle. A second fall
occurred in the yard after a blackout episode, resulting in
lacerations to the client's face. A third fall occurred in the master
bathroom while the client was bending down to access a lower
cabinet and lost her balance, resulting in a right forearm
laceration that required an emergency room visit.
Home and Personal Findings:

Therapist Note
Has a History of Falls

Has Neurological Issues
Female
Client has experienced multiple falls both inside and outside

her home.
Client has a diagnosis of RSD in her left knee which affects
her balance while standing and walking. Client has a history
of hypotension which causes her to experience spells of
dizziness that also compromise her balance.
The following rooms assessed each indicate the Personal Safety Rating given by the patient and the Therapist
Accessibility Rating determined by activity analysis during skill performance:
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Home Recommendations Based on Findings:

Pre-Assessment
Bathroom, Main Level, adjacent to Master
Bedroom
Personal Safety
Rating %
Therapist
Accessibility
Rating %
70.00 %
55.56 %
Post-Assessment
Personal
Safety
Rating %
Therapist
Accessibility
Rating %
Recommended Modifications:
- Molded Tub Bar
- Towel Bar Grab Bar
- Grab Bar Right Side of Bathing Entry
- Vertical Grab Bar
- 12" - Textured
- Anti-Slip Floor Coating
Pre-Assessment Notes:
Client stated bathroom was recently remodeled; shower bench, grab bars, and adjustable shower head was added.
Client experienced a fall near the sink while bending down to open a lower cabinet; client stated she lost her balance
and didn't have anything to hold onto, so she fell. Towel Bar Grab Bar in the bathroom should be situated on the left side
of the sink so that client may hold onto it while bending down to access lower cabinets. Evaluators noted that client
would benefit from a non-slip mat being placed in the bathtub to increase transfer stability, as well as a step or stool
being placed outside the bathtub so client may have an easier time transferring into the bathtub.
Post-Assessment Notes:
Pre-Assessment
Bedroom, Master Bedroom, Main Level
Personal Safety
Rating %
Therapist
Accessibility
Rating %
90.00 %
90.00 %
Post-Assessment
Personal
Safety
Rating %
Therapist
Accessibility
Rating %
- Add Lighting
Client's bedroom was noted to be spacious, well-kept and did not seem to have any tripping hazards. The room was
equipped with an adjustable bed that assisted the client with bed mobility and pain management while sleeping.
However, it was noted that additional lighting may increase visibility.
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Pre-Assessment
Bathroom, Guest Bathroom, Main Level
Personal Safety
Rating %
Therapist
Accessibility
Rating %
70.00 %
60.00 %
Post-Assessment
Personal
Safety
Rating %
Therapist
Accessibility
Rating %
- Wall Mounted Grab Bar
Client stated that she does not usually use the guest bathroom for anything other than to use the toilet occasionally.
Client mentioned that transferring to and from the toilet would be made easier with a grab bar installed on the adjacent
wall.
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Pre-Assessment
Bedroom, Office, Main Level
Personal Safety
Rating %
Therapist
Accessibility
Rating %
70.00 %
66.67 %
Post-Assessment
Personal
Safety
Rating %
Therapist
Accessibility
Rating %
- Organize/Declutter Space
- Change Flooring
Room is currently being used as an office space by client and her husband. It was noted that there was a loose throw rug
on the floor that could pose as a potential tripping hazard; it is recommended that the client remove the rug or secure it
to the floor. It was also noted that the room was cluttered in certain areas, which could also pose a potential tripping
hazard.
- Add Hand Rails
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Pre-Assessment
Outdoor Space, Backyard
Personal Safety
Rating %
Therapist
Accessibility
Rating %
60.00 %
50.00 %
Post-Assessment
Personal
Safety
Rating %
Therapist
Accessibility
Rating %
- Create Smooth Pavement
It was noted that there was a gravel pathway with stepping stones used as a walkway throughout the yard, but it was
also noted that the stones were far enough apart that they could pose a potential tripping hazard. Client may benefit from
having additional stones added within the walkway, or having the walkway paved smoothly. It was noted that there was a
pool in the backyard, and client expressed that her husband helps her get in and out of the pool because it would be
difficult for her, otherwise. It is recommended that handrails be installed by the pool steps to make transitioning in and
out of the pool easier and safer for the client.
- Create 36 in. Wide Door
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Pre-Assessment
Kitchen, Kitchen,
Entryway,
OutdoorMain
frontLevel
area of the house
Personal Safety
Rating %
Therapist
Accessibility
Rating %
90.00 %
60.00
85.71 %
50.00
Post-Assessment
Personal
Safety
Rating %
Therapist
Accessibility
Rating %
It was noted that the first doorway into the kitchen was narrow compared to other means of entrance. Client may benefit
from this entryway being widened, especially if she comes to need durable medical equipment in the future.
- Add Visible Steps
- Add Hand Rails
Client expressed that she experienced a fall in the outside front entryway due to the fact that she lost her footing on the
front steps. It was noted that the steps were all similar in color, and therefore it is recommended that colored tape or
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Pre-Assessment
Personal Safety
Rating %
Therapist
Accessibility
Rating %
Post-Assessment
Personal
Safety
Rating %
Therapist
Accessibility
Rating %
"visible steps" be implemented on the stairway to improve visibility and safety for the client. It was also noted that the
front stairs had no railing for the client to be able to hold onto while navigating the stairway; it is recommended that a rail
be installed on at least one side of the steps to improve safety.
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Additional Service Recommendations (e.g. home health, medication management):

Additional Notes:
The home has an additional basement level with stairs leading down to it; however, the client expressed that she does
not frequently visit the basement, as all of the main, necessary rooms of the house are located on the main level.
Client also mentioned that the house was built to cater toward individuals with disabilities, so there were wide hallways
throughout the house and all essential rooms were located on the main level.
The client did not consent to photographs being taken of her home, so none were included with this report.
Submitted By:
Melody Klatt, , License #

3/11/2016
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Edited Home Assessment Melody and Kelsey

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Home for Life Design

Home Assessment Report

Where did the fall

Las Vegas, NV 89117

Fall Cause Type:

Home and Personal Findings:

Has a History of Falls

Client has experienced multiple falls both inside and outside

A Home for Life Design Solution

A Home for Life Design Solution

Home Recommendations Based on Findings:

A Home for Life Design Solution

A Home for Life Design Solution

Bedroom, Office, Main Level

A Home for Life Design Solution

Outdoor Space, Backyard

A Home for Life Design Solution

A Home for Life Design Solution

A Home for Life Design Solution

A Home for Life Design Solution

Additional Service Recommendations (e.g. home health, medication management):

Melody Klatt, , License #

A Home for Life Design Solution

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