A simple and concise Housing Adequacy Checklist (HAC) is beneficial for case managers in assessing home care eligibility for seniors in their place of residence. The results of a systematic literature review and a focus group, involving representatives from stakeholder groups, determined that it is important that the HAC assess four factors: the physical and material infrastructure of a care recipient's place of residence; the range of amenities; the household geography; and the cohabitation arrangements and supports. Focus group discussion also distinguished areas that might be usefully assessed by other health professionals.

Background: One of the main concerns with home care is that many homes do not permit the delivery of safe and effective care. Housing can be a hazardous environment for care recipients and their caregivers. This report outlines a two-staged process used to develop a simple and concise housing adequacy checklist (HAC) for seniors receiving long-term care in their place of residence.

Method: In Phase One of the study, a systematic review of the research literature concerning the functional status of housing was conducted. This review led to the development of a draft Housing Adequacy Checklist (HAC), which assessed five factors: the physical and material infrastructure of a care recipient's place of residence; the range of amenities; the household geography; the cohabitation arrangements and supports; and the functional behaviour of the client. During Phase Two, the draft HAC was evaluated regarding its overall utility and feasibility to inform decisions that pertain to in-home eligibility and service planning, through a focus group comprised of representatives from various stakeholder groups. The participants reviewed the five factors used in the development of the HAC; weighed the factors against evaluative criteria (usefulness, feasibility, validity and reliability); and came to a consensus on the key variables within each factor to include in the HAC.

Findings: In the first focus group exercise, participants found the first four factors (the physical and material infrastructure of a care recipient's place of residence; the range of amenities; the household geography; the cohabitation arrangements and supports) to be of great usefulness and should be considered in the HAC. The second factor scored in the moderate range for feasibility, validity and reliability, the third factor received a higher score for these three criteria and the fourth factor scored in the low range for the three criteria. The fifth factor was deemed unimportant, therefore omitted from the HAC. In the second group exercise, participants commented on ways to improve the HAC by critiquing the key variables derived from the literature review. Participants distinguished areas that might be usefully assessed by case managers and areas that should be left to health professionals. A more efficient and effective assessment tool was created through this analysis.

Conclusions: The focus group participants raised many issues worthy of considering in the HAC. First, assessing health hazards, such as water leakages, mold and rot, to include in the HAC, as they may pose huge health risks to individuals. Second, there are many aspects to housing assessment, such as the need for assistive devices, which may best be assessed during an in-home visit by a health care provider. Finally, many seniors may refuse to pay for home modifications and thus be faced with limited access to home care. Many of these considerations were difficult to include in the HAC.

Reference: Coyte, P.C., Mitchell, A., Zarnett, D. Development and Assessment of a Housing Adequacy Checklist for Elderly Individuals in Receipt of Home Care. Ontario Ministry of Health and Long-Term Care, Hospital Management Research Unit, July 10, 2003 (www.hcerc.utoronto.ca)

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