Reviewing Sarah’s needs
Following inpatient rehabilitation and support from a multi-disciplinary team, Sarah subsequently had support from a case manager to involve an independent, specialist occupational therapist to review the property. Sarah was unable to access her garden, first floor, bedroom and kitchen as she was a full-time wheelchair user (although over time it was hoped she would eventually be able to use prosthetic limbs).
A comprehensive assessment of the property and Sarah’s abilities was undertaken by the occupational therapist and Sarah was supported to understand and plan for further major changes to her home. Sarah was understandably reluctant to adapt the property further as she had installed a free-standing roll top bath, spiral staircase to the first floor and kitchen with a range cooker. She was now unable to reach into a wash hand basin from her wheelchair, access the first floor and would be unable to access the bath as she had done prior to her injuries. Before the road traffic incident, Sarah had no medical diagnosis or contemplated that she would be unable to utilise her home as she had dreamed of for a number of years. She had renovated it based upon aesthetics and ideas she had gathered together on mood boards. However, the home was now mainly inaccessible and this, together with her executive functioning problems, affected her independence and placed additional strain on her partner who now had caring tasks to undertake.
The Social Model of Disability (Oliver, 2013) is often used in wider society to understand the barriers imposed upon disabled people which prevent them from engaging in occupation or accessing facilities or buildings. It is an antithesis of the Medical Model which looks at what is ‘wrong’ with a person and uses medical intervention to treat this. Conversely, the Social Model of Disability can be used by occupational therapists when assessing and evaluating a person’s home. The person is not seen as a ‘problem’ that needs changing, but the built environment is viewed as not being designed in such a way to enable a disabled person to access the same things non-disabled people can.
Redesigning her environment
The occupational therapist worked alongside an architect to redesign Sarah’s home to allow her access to her usual occupations: the things she needs to do, wants to do, or is expected to do (WFOT, 2012). The architect was able to share knowledge of the structure of the building, planning and building regulations and evaluate the feasibility of suggestions. The occupational therapist was skilled in understanding the function of the client, taking into account her wishes, as well as management of the barriers within the home environment. Together, they were able to design a scheme for the entire house that would afford Sarah the independence she craved and reduce the impact of her impairments on her everyday life.