Occupation-based Home Assessment

Client Name:__Keith R_______________

Date of Assessment:____9/08/14_______

Type of Housing: house_____ apartment______ mobile/motor home______ Other______

Residents in home:____1__________________________________________
Area outside and immediately surrounding the home:
What occupations, if any, take place in the area immediately surrounding the home and/or inside the
garage?
The outside area has a dumpster which the client takes the trash down the stairs and across the parking
lot, this falls under the IADL of home management. The outside area also has a grassy area where the
client will sometimes take part in meal prep and grill.

Terrain:

Incline

Grass

Pavement

Other

Porch/Patio/Balcony/N.A.
Surface material: Concrete
Number of stairs: 14 stairs
Height of stairs: 11 inches
Railing present (location, height, ease of use): railing present on right side when going up stairs.
Use is relatively easy, and presents minimal challenges.
Type and width of door to area: Sliding glass door and is 60 inches wide
Type of furniture/ease of use: One plastic patio chair that is very low. Can be seen as a hazard.
Plugs/switches (location, height, ease of use): One plug, eye level.
YardN/A
Maintenance required:
How maintenance is completed currently:
Equipment/activities present (play, hobby, work, machinery):
Ease/efficiency of use of equipment:
Garage/workshop---NA

How many cars:

Proximity of cars to entrance:
Number and height of steps from garage to entrance:
Railing present (location, height, ease of use):
Storage systems:
Ease/efficiency of use of tools/equipment:
Ways to improve occupational performance, improve mobility, and/or improve safety in area
immediately surrounding the home?

Front Entrance
Number and height of steps: 14 steps to front entrance, with each step being 11 inches high
Railing present (location, height, ease of use): One railing is present, and is located elbow height
Surfaces: surface is concrete
Types of knobs/locks: Front door includes a lever handle and has a deadbolt lock that is opened
with a key
Width of door: 36 inches
Back EntranceNA, only 1 entrance and exit in this unit
Number and height of steps:
Railing present (location, height, ease of use)::
Surfaces:
Types of knobs/locks:
Width of door:
Any concerns with safety/ease/convenience of entering the home?

Kitchen
List all occupations that take place in the kitchen and the primary users of this space:
Occupations that take place in the kitchen include meal prep and cleanup, feeding and eating, leisure
also is included since cooking is a preferred activity for the client.

Width of doorway into kitchen: 50 inches

Height of kitchen dining table: 30 inches
Height of countertops: 36 inches
Continuous surfaces for sliding objects? Yes, there are no breaks in surfaces in the kitchen
Type of stove: Gas stove
Types and location of controls on stove/burners: knob controls, located on front of stove
Types of controls on oven: Knob control, located on front of stove
Height of oven: 36 inches
Effort needed to open/close oven: Moderate effort required. Handle on oven is loose and not
very stable.
Are pots/pans too heavy or do they get too hot? Pots and pans get hot, the handles are also
loose.
Type of refrigerator: Standard refrigerator, freezer on top and refrigerator on bottom half.
Height of handles and refrigerator shelves: 33.5 inches for handle height
Depth of shelves: 32 inches
Dishwasher controls: N/A dishwasher is not used by client
Ease of loading/unloading:
Ease of transporting items:
Plugs/switches: height, ease of use: There are 4 separate outlets in the kitchen, and 8 plugs. 3
outlets are eye level and 1 outlet is out of reach near the ceiling.
Storage (ability to reach, handles, organization, amount): Storage presents minimal challenge.
Kitchen is equipped with many cabinets.

DME typically used in this area: Client does not utilize DME. However, a safety step ladder
could be useful.
Ways to improve occupational performance, improve mobility, and/or improve safety in kitchen area?
In order to improve safety and occupational performance, client could purchase cookware guards to
protect himself from possible burns from pots and pans. The oven knob has the numbers worn off and
it is difficult to see the off button. Purchasing a new knob or putting a tactile dot on the knob would be
a possible option as well. The oven door handle and the handles on the pots and pans also need to be
tightened.
Bathroom
Occupations that take place in the master bath:
Occupations that take place include: grooming, toileting, bathing, hygiene and home management
including cleaning
Width of doorway: 50 inches
Flooring: linoleum flooring with a throw rug
Types of faucets at sink: lever faucets
Types of faucets in tub/shower: lever faucet
Non-skid surface in tub/shower: none
Height of step into tub/shower: 25 inches
Height of toilet: 17 inches
Type of lever to flush: standard lever
Location of toilet paper: in reach on left side
Plugs/switches: 2 within arms reach
Height of mirror: 48 inches
Cupboards (height, type of handle, organization): cupboards are located 4 inches from the floor
and are along the sink area
DME typically used in this area: Client does not utilize any DME, however a non-skid mat would
be helpful in this situation
Ways to improve occupational performance, improve mobility, and/or improve safety in bath area?

In order to improve safety the client can put a non-skid mat in the bathtub and discard the throw rug
which can be a tripping hazard.
Bedroom
Occupations that take place in the bedroom area: leisure, rest and sleep, education
Doorway width: 32 inches
Type of door/knob to access closet: lever knob
Height of closet rod: 60 inches
Type of handles, ease of use of Dresser drawers: types of handles on dresser include knob
handles which open with minimal challenge
Organization of storage/ease of finding items? Items are organized in dresser and on shelves in
closet, however, there are many items of clothing on the ground of the closet.
Height and type of Lighting: One desk lamp is on the nightstand next to the bed
Ease of access to lighting by the bed: A desk lamp is on the nightstand next to the bed,
however, the switch for it is by the door.
DME typically used in this area: not used by client, however a step ladder could be useful for
gather items from top shelf in closet.
Ways to improve occupational performance, improve mobility and/or improve safety in bedroom area?
More shelves could be put in closet to diminish the clutter left on the floor by the clothes. More lamps
could also be put into the room.
Living room
Occupations that take place in the living room:
Leisure, rest and sleep
Doorway width: 36 inches
Most used furniture (type and height): sectional sofa, measuring 110 wide x 80 deep x 41
deep x 38 high
Locations and Ease of access to electronics: All electronics are located by the television stand,
they are a little tangled by the walkway showing a moderate hazard
Types and controls of window coverings: vinyl shades
Types of controls to open/close windows: drawstring

Storage (type, access, organization): No storage other than the bottom of the television stand
DME typically used in this area: No DME is used in this area by the client
Ways to improve occupational performance, improve mobility, and/or improve ease of use in living
room area?
In order to improve occupational performance, the client could purchase storage boxes so there is not
clutter under the television stand. In addition, to address the tangled cords, the client can organize
them and put them in a shoe box so they are not in a walkway.

Cleaning:
Laundry (front/side load, controls, storage of detergent):
The washer are dryer are stackable. The washer is a top load and has the controls on the top.
The detergent is stored on top of the dryer.

Supplies (able to reach, organization, location):

All of the supplies are stored on top of the dryer and the client used a chair to reach them.
Garbage removal (bags, process, transport):
The client keeps the garbage under the sink as well as extra garbage bags. In order to dispose of the
garbage the client must walk down 14 steps, walk across the parking lot and throw the garbage into a
dumpster.
Equipment (vacuum, mop, broom, dustpan):
All cleaning supplies are kept under the sink, the broom is too large and it is propped between the
counter and the refrigerator in the kitchen.
Ways to improve occupational performance, improve mobility, and/or improve ease of use related to
cleaning?
It would be beneficial for the client to have alternate storage spaces other than the dryer.
Other considerations
Ease of access to communication within and throughout the home:
Minimal challenge
Access and ease of use of Thermostat: Minimal challenge, thermostat is eye level and easy to use

Access to Community Transportation: Not much community transportation in the area, however, the
client does have his own vehicle

Access to grocery Store, drug store, etc.: There is a Walgreens that is approximately a 5 minute walk
from the complex

Pets in the home and any related safety concerns: No pets in the home

Presence of environmental hazards (rugs, cords, obstacles in major pathways, etc.): No major hazards,
however, there is clutter in the unit. There is clothing on the floor as well as cords which could be a
tripping hazard. In addition to a throw rug in the bathroom, the unit has poor lighting as well.

Summary: List the top 5 modifications to the space that you feel would have the biggest impact on
improving occupational performance, mobility, and/or safety in the home.
1. Diminishing clutter

2. Tightening loose screws

3. Adding additional lighting

4. Organizing cords and clearing walkways

5. Adding more storage

Additional recommendations:
The suggestions are inexpensive, but can make the quality of life much safer

Occupational Therapist Name Printed: ___Sylvia Niemyjski_____________________________________

Signature: _______________________________________________________________

Date and time:_________9/08/14, 10:00___________________________________________________