Home for Life Design

Home Assessment Report

Lauren Hawkins of Touro University, performed the following occupational therapy home assessment to determine the
safety and current functional status of C in the home. This report details geoff Cs 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: 9/4/2015

Patient Information:
Patient Name:

C, geoff

Date of Birth: 1/1/1984

Address:

1111 touro street

Gender:

Male

las vegss, Nv 89074

Tennant Type:

Renter

Is Veteran:

No

Housing Type:

Apartment/Condo

Has HOA:

No

No. Floors:

Lives With:

Spouse

Special Considerations:
Inaccessible None
Areas:

Assistive Cane-does not use in the home

Devices:

If the client has fallen, did the most recent fall:

Where did the fall occur: Outside the Home

Result in Injury: No

What Room:

Result in Hospitalization: No

Fall Cause Type: Physiological

Result in Rehabilitation: No

Fall Cause Comments: Client lost balance when getting out of

car.

Other Considerations:
Consideration Type

Therapist Note
Has fallen in shower at least one time. Wife has to help him
in and out of the tub/shower combo.

Has a History of Falls

Home and Personal Findings:

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:
Pre-Assessment
Personal Safety
Rating %

Therapist
Accessibility
Rating %

Bathroom, Front of apartment

60.00 %

58.33 %

Living/Family Room, Down the hall from front

entrance

50.00 %

50.00 %

Kitchen, across living room

90.00 %

91.67 %

Entryway,

80.00 %

50.00 %

Room Assessed

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Post-Assessment
Therapist
Personal Safety
Accessibility
Rating %
Rating %

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Home Recommendations Based on Findings:

Bathroom, Front of apartment

Personal Safety Rating

Accessibility Rating

60.00 %

58.33 %

Recommended Modifications:
- Angled Grab Bar
- Grab Bar Left Side of Bathing Entry
- Vertical Grab Bar
- 18" - Textured
- Raised Toilet Seat
- Hand Held Shower
- Tub Transfer Bench

Living/Family Room, Down the hall from front entrance

Personal Safety Rating

Accessibility Rating

50.00 %

50.00 %

Recommended Modifications:
- Organize/Declutter Space
- Add Furniture Risers

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Kitchen, across living room

Personal Safety Rating

Accessibility Rating

90.00 %

91.67 %

Recommended Modifications:

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Entryway,

Personal Safety Rating

Accessibility Rating

80.00 %

50.00 %

Recommended Modifications:
- Add >1/4 in. Threshold

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

We recommend client gets the following A/E and DME:
Tub transfer bench
Grab bars for the bathroom
Reacher
Additional Notes:
Clients home was small and easy to maneuver. However there was a lot of clutter in the living room. In addition, his
cushions for the chair and couch were sunken in and would make a sit to stand transfer difficult. The other room of
concern was the bathroom. The client had no DME to assit with transfers into his tub shower combination. Unable to
assess client's bedroom as wife was sleeping from overnight shift. Client stated minimal issues with that room.

Submitted By:

Lauren Hawkins, , License #

9/17/2015

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