Cohabitants’ perspective on housing adaptations: a piece of the puzzle

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The growing number of older adults and people living at home with disability 1 increases the role of family and friends in providing care and support. Over recent decades informal caregiving for older adults has increased in Sweden 2 and in the United States, more than 50 million individuals now provide care annually 3. Besides being an arena for informal caregiving, the home is a central place in most people's lives: for younger adults 4 as well as for older people 5. To be able to remain living at home despite disabilities and being in need of care, changes to the built home environment might be necessary. When people consider altering their homes, studies have indicated that the aesthetics of the adaptation, costs associated with the installation, available space in the home and considerations about the future (such as health changes and the resale value) all affect the decision to have the house adapted 6. When altering the home, the meaning of the home can change and it might be necessary to change habits and learn new routines for daily activities 7. Most likely, this would be the case for both the individuals in need of a housing adaptation as well as the cohabiting partner or informal caregiver, but the research focusing on the cohabitants’ experiences is scant. To gain a greater understanding of how housing adaptations influence daily life for those who share their life and home with someone in need, the following research question was focused upon: What does it mean for the cohabitant to have his/her home altered by a housing adaptation intended for his/her spouse? This knowledge is important to be able to better understand and support cohabitants in their roles as caregivers and partners.
A housing adaptation (HA) is an individually tailored intervention eliminating physical barriers in the home environment. It includes alterations on fixed features of the home such as replacing a bathtub with a shower or building a ramp at an entrance staircase. It does not include interventions relating to assistive devices or loose objects, or reorganising furniture to get more space. All Scandinavian countries provide individual grants for HAs. In Sweden, the intervention aims at promoting safe and independent living for people with disabilities in ordinary housing and is regulated by the Swedish Housing Adaptation Act. The publicly funded HAs are administered by the Swedish municipalities and can be granted after a needs‐based assessment 8. In 2014, the most commonly granted HAs were removal of thresholds, installation of grab bars, ramps at entrances and timers on kitchen stoves. Grants for approximately 116 million € were granted and 58% of the grants regarded adaptations for less than 520 €. More than 72% of the applicants were 70 years or older 9.
With an increasing number of older people 10 who are expected to age‐in‐place in the face of disability and dependence on others, the need of interventions such as adaptations and modifications of the home is likely to increase. Home modifications, a related but broader concept, include housing adaptations as well as adaptations such as rearrangement of furniture and provision of assistive technology and assistive devices 11. Several positive outcomes of home modifications and HAs for the client have been demonstrated, for example in relation to falls 12, usability 15 and activity 16.
While some studies have explored the applicants’ experiences of HAs 19 and home modifications 6, studies with an explicit focus on the cohabitants’ or caregivers’ expectations and experiences of sharing home where HAs have been made are lacking.
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