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Jun.19.2020View related content

Home Adaptations: Kitchen (Rehabilitation Therapy)

ALERT

Provide special consideration to patients who are at an increased risk for falls due to impaired cognition or vision or to decreased strength or balance.

OVERVIEW

The Occupational Therapy Practice Guidelines for Home Modifications defines home modifications as adaptations to environments that are intended to increase use, safety, security, and independence.6 Modifications may include, but are not limited to, the use of medical equipment or universally designed products; architectural modifications or major home renovations; and education of the patient regarding new strategies to use in the home environment.6

Therapeutic intervention that includes home modifications may prevent premature long-term care by supporting aging in the home,3 as well as improve the patient’s functional performance and reduce the risk of falls and physical demands on caregivers.6 Additionally, home adaptations may reduce costs while older adults age in the home.4

When considering home modifications, the patient's physical functionality is one of the main factors for the therapist to keep in mind.4 The therapist must also take into consideration the patient's perception of the home modifications, readiness to change the environment, and costs.7 The therapist must work with the patient or caregiver (or both) and have the patient’s consent before making any changes in the home.

In the kitchen, the therapist should assess the height of the counters and cabinets, amount and quality of the counter space, condition of the seating, type of flooring, and lighting. These contribute to patient safety in the kitchen. Reaching cabinets may be a challenge for patients due to decreased shoulder range of motion, use of a mobility device, and decreased balance when reaching overhead. Countertops need to be assessed for clutter or visual interference. Other considerations include the physical layout of the kitchen, including the layout of the appliances.

SUPPLIES

Click here for a list of supplies.

EDUCATION

  • Provide developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, and overall neurologic and psychosocial state.
  • Educate the patient and caregiver on home modification recommendations.
  • Educate the patient and caregiver on the use and installation of adaptive equipment.
  • Instruct the patient to report pain or dizziness experienced while completing tasks in the kitchen.
  • Encourage questions and answer them as they arise.

PROCEDURE

  1. Perform hand hygiene.
  2. Introduce yourself to the patient.
  3. Verify the correct patient using two identifiers.
  4. Explain the procedure to the patient and ensure that he or she agrees to treatment.
  5. Assess the patient for pain.
  6. Assess the patient's strength, balance, and vision.
  7. Review risk factors that predispose the patient to falls or accidents in the home.
    Take note of preexisting conditions such as visual or hearing impairment, neuromuscular dysfunction, fatigue or reduced energy, and postural hypotension.
  8. Assess the patient’s thoughts and perceptions on home adaptations.
  9. Partner with the patient and caregiver to conduct a home kitchen safety assessment.
  10. Have the patient complete simple kitchen tasks with assistance as needed. Observe and document his or her abilities and take note of special considerations such as poor lighting and the type of flooring. Kitchen tasks the patient can perform include:
    1. Preparing a light meal or drink
    2. Opening cabinets and accessing high and low surfaces
    3. Transporting items and setting them on the counter
    4. Turning the stove on and off
    5. Reaching into the microwave
    6. Sitting and standing from the chair in the kitchen
  11. Make specific kitchen modification recommendations based on the patient’s needs and comfort using the Americans with Disabilities Act guidelines as a starting point and then adapting the recommendations to the patient’s specific needs (e.g., the patient may be standing or sitting in a wheelchair to complete activities).
    1. Advise the patient on the layout and the recommended floor clearance for safety in the kitchen.
      1. For a pass-through kitchen, explain that the minimum clearance should be 101.5 cm (40 in) (Figure 1)Figure 1.1
      2. For a U-shaped kitchen, explain that the minimum clearance should be 152.5 (60 in) (Figure 2)Figure 2.1
    2. Advise the patient on the height and condition of the counters.
      1. Explain that the counter heights should be no more than 86.4 cm (34 in) above the finished floor.1
      2. Explain that there should be at least one 76-cm (30-in)-wide section of counter for workspace.1
    3. Advise the patient on the safest use of the kitchen counters.
      1. Recommend that the patient keep all counters free from exposed sharp or abrasive surfaces.1
      2. Recommend that the patient clear any unused items to eliminate clutter.
        Rationale: Having a clear counter space allows the patient to transport items along the counter.
      3. Recommend that the patient add color contrast between countertops and other kitchen elements such as dishware, utensils, sink, and stove. This can be achieved by using placemats or a nonslip material to stabilize items on the counter.
      4. Recommend that the patient have plain-colored countertops to make items easier to see. Explain to the patient that glossy or glaring countertops should be avoided.
      5. Recommend that the patient add shelving at the proper height if he or she needs additional counter space to complete tasks.
      6. Recommend that the patient have the microwave at counter height for easy access.
    4. Advise the patient to make items in cabinets more accessible by adding a turntable or pullout shelves as needed.
    5. Advise the patient to change knobs on cabinets to handles. D-ring handles are typically the easiest for patients to use.
    6. Advise the patient on the use of appropriate seating in the kitchen. Explain to the patient that chairs should not have wheels, should be at the proper height to sit in and stand from safely, and should have armrests to assist the patient with sitting and standing.
    7. Advise the patient on the safest sink setup.
      1. Recommend a motion faucet if the patient has any difficulty with the lever.
      2. Recommend a shallow sink if the patient has trouble reaching into the sink.
      3. Recommend that the maximum water temperature be set to a safe temperature to avoid burns.
    8. Advise the patient on the flooring in the kitchen.
      1. Recommend that the patient remove any throw rugs or make sure they are properly secured to the floor.
      2. Recommend non-glare flooring to increase safety.
    9. Advise the patient on lighting in the kitchen after completing a thorough vision assessment. Explain that lighting should not create glares or shadows.
      Rationale: Recommendations depend on the patient’s specific visual impairments and preferred lighting needs.
      1. Recommend that the patient install task lighting under cabinets to illuminate counters and workspace.
      2. Recommend that the patient add lighting to dark pantries.
    10. Advise the patient to use a cart with wheels to transport items in the kitchen if he or she is having trouble moving items around in the kitchen.
  12. Perform hand hygiene.
  13. Document the procedure in the patient's record.

MONITORING

  1. Observe the patient for signs and symptoms of pain. If pain is suspected, report it to the authorized practitioner.
  2. Observe the patient for signs and symptoms of orthostatic hypertension. If this condition is suspected, report it to the authorized practitioner.
  3. Observe the patient during kitchen tasks, such as reaching into cabinets and moving around the kitchen. If the patient is unable to complete the tasks safely, educate him or her and the caregiver on which tasks are unsafe for the patient to complete independently. Educate the patient and caregiver on the level of supervision needed and how the caregiver may assist the patient.

EXPECTED OUTCOMES

  • Patient participates in home safety assessment of his or her kitchen.
  • Patient understands and implements home modification recommendations.

UNEXPECTED OUTCOMES

  • Patient and caregiver do not acknowledge risks identified from the home kitchen safety assessment.
  • Patient or caregiver fails to implement modifications agreed upon during the evaluation and intervention.
  • Patient suffers a fall or injury in the home.

DOCUMENTATION

  • Education
  • Patient's progress toward goals
  • Unexpected outcomes and related interventions
  • Kitchen safety assessment and recommendations
  • Changes made within the environment
  • Assessment of pain

OLDER ADULT CONSIDERATIONS

  • Older adults are at greater risk for falls due to age-related physiologic changes.5
  • Orthopedic conditions (e.g., arthritis, joint pain) and decreased vision, sensation, balance, and mobility are conditions affecting older adults and their ability to function independently.
  • Housing needs can change as an older adult ages in the home.2

REFERENCES

  1. Department of Justice. (2010). 2010 ADA standards for accessible design. Retrieved May 19, 2020, from https://www.ada.gov/regs2010/2010ADAStandards/2010ADAStandards.pdf (classic reference)* (Level VII)
  2. Granbom, M. and others. (2016). Community relocation in very old age: Changes in housing accessibility. AJOT: The American Journal of Occupational Therapy, 70(2), 7002270020p1-7002270020p9. doi:10.5014/ajot.2016.016147 (Level IV)
  3. Lien, L.L., Steggell, C.D., Iwarsson, S. (2015). Adaptive strategies and person-environment fit among functionally limited older adults aging in place: A mixed methods approach. International Journal of Environmental Research and Public Health, 12(9), 11954-11974. doi:10.3390/ijerph120911954 (Level V)
  4. Powell, J. and others. (2017). The role of home adaptations in improving later life. Retrieved May 19, 2020, from https://www.ageing-better.org.uk/sites/default/files/2017-12/The%20role%20of%20home%20adaptations%20in%20improving%20later%20life.pdf (Level VII)
  5. Roy, N. and others. (2018). Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults. PloS One, 13(1), e0189266. doi:10.1371/journal.pone.0189266 (Level I)
  6. Siebert, C., Smallfield, S., Stark, S. (2014). Occupational therapy process for home modifications. In Occupational therapy practice guidelines for home modifications (pp. 11-40). Bethesda, MD: AOTA Press. (classic reference)* (Level VII)
  7. Stark, S.L. and others. (2015). Clinical reasoning guideline for home modification interventions. American Journal of Occupational Therapy, 69(2), 6902290030p1-69022900308. doi:10.5014/ajot.2015.014266 (Level V)

ADDITIONAL READINGS

Somerville, E., Stark, S. (2015). Home modifications to improve the performance and participation of older adults with chronic conditions. AJOT: The American Journal of Occupational Therapy, 69, 6911515046p1. doi:10.5014/ajot.2015.69S1-RP102C

*In these skills, a "classic" reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.

Elsevier Skills Levels of Evidence

  • Level I - Systematic review of all relevant randomized controlled trials
  • Level II - At least one well-designed randomized controlled trial
  • Level III - Well-designed controlled trials without randomization
  • Level IV - Well-designed case-controlled or cohort studies
  • Level V - Descriptive or qualitative studies
  • Level VI - Single descriptive or qualitative study
  • Level VII - Authority opinion or expert committee reports