Home for Life Design

Home Assessment Report

Galileo Basilio of Touro University, performed the following occupational therapy home assessment to determine the
safety and current functional status of Apfel in the home. This report details Barbara Apfels feeling of safety and
measures the accessibility of important occupations that occur throughout areas of the home. Information was gathered
via professional interview with the client and/or family, activity analysis, objective measurements and photography. This
assessment was performed on: 10/1/2015

Patient Information:
Patient Name:

Apfel, Barbara

Date of Birth: 2/5/1943

Address:

1881 W. Alexander Rd. Apt#2145

Gender:

Female

North Las Vegas, NV 89032

Tennant Type:

Owner

Is Veteran:

No

Housing Type:

Apartment/Condo

Has HOA:

No

No. Floors:

Lives With:

Self

Special Considerations:
Inaccessible
Areas:

Assistive quad cane, single-point cane, 4WW

Devices:

If the client has fallen, did the most recent fall:

Where did the fall occur: Outside the Home

Result in Injury: Yes

What Room:

Result in Hospitalization: No

Fall Cause Type: Environmental

Result in Rehabilitation: Yes

Fall Cause Comments:

Other Considerations:
Consideration Type
Has a History of Falls

Therapist Note
Falls were correlated to functional deficits related to
diagnosis of multiple sclerosis.

Home and Personal Findings:

The following rooms assessed each indicate the Personal Safety Rating given by the patient and the Therapist
Accessibility Rating determined by activity analysis during skill performance:

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Pre-Assessment
Personal Safety
Rating %

Therapist
Accessibility
Rating %

Bathroom, Bathroom

70.00 %

66.67 %

Bedroom, Main bedroom

100.00 %

100.00 %

Dining Space, Dining space (open area with

minimal clutter)

80.00 %

87.50 %

Entryway, Main entryway

40.00 %

75.00 %

Kitchen, Kitchen

100.00 %

85.71 %

Living/Family Room, Living room

50.00 %

75.00 %

Hallway, Hallway

50.00 %

75.00 %

Outdoor Space, Outdoor area (including walk

way to condo)

60.00 %

50.00 %

Stairs, Stairs

40.00 %

25.00 %

Room Assessed

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Post-Assessment
Therapist
Personal Safety
Accessibility
Rating %
Rating %

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Home Recommendations Based on Findings:

Bathroom, Bathroom

Personal Safety Rating

Accessibility Rating

70.00 %

66.67 %

Recommended Modifications:
- Shower Seat with Armrests
- Dependa Bar
- Toilet Safety Frame with Rails
- Low Threshold Shower
- Organize/Declutter Space

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Bedroom, Main bedroom

Personal Safety Rating

Accessibility Rating

100.00 %

100.00 %

Recommended Modifications:
- Add Lighting
- Organize/Declutter Space

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Dining Space, Dining space (open area with minimal clutter)

Personal Safety Rating

Accessibility Rating

80.00 %

87.50 %

Recommended Modifications:
- Organize/Declutter Space

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Entryway, Main entryway

Personal Safety Rating

Accessibility Rating

40.00 %

75.00 %

Recommended Modifications:
- Add Levered Handles
- Add Easy-to-Use Locks
- Add >1/4 in. Threshold

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Kitchen, Kitchen

Personal Safety Rating

Accessibility Rating

100.00 %

85.71 %

Recommended Modifications:

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Living/Family Room, Living room

Personal Safety Rating

Accessibility Rating

50.00 %

75.00 %

Recommended Modifications:
- Organize/Declutter Space

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Hallway, Hallway

Personal Safety Rating

Accessibility Rating

50.00 %

75.00 %

Recommended Modifications:
- Add Lighting
- Organize/Declutter Space
- Add Hand Rails

Outdoor Space, Outdoor area (including walk way to condo)

Personal Safety Rating

Accessibility Rating

60.00 %

50.00 %

Recommended Modifications:
- Add Accessible Mailbox
- Add Hand Rails
- Create Smooth Pavement

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Stairs, Stairs

Personal Safety Rating

Accessibility Rating

40.00 %

25.00 %

Recommended Modifications:
- Add Stair Glide
- Add Hand Rails

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Additional Service Recommendations (e.g. home health, medication management):

- Stair lift is warranted if client wants to remain independent due MS diagnosis and other medical conditions.
Additional Notes:
- Loss of sensation in right hand.
- Continuous muscle spams throughout her body that limit functional ambulation.

Submitted By:

Galileo Basilio, , License #

10/7/2015

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