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Home and Community Occupations
Home Modifications Process
The built environment includes structures such as
- Public buildings
- Schools
- Hospitals
- Private dwellings
- Parks and playgrounds
- Streets and footpaths that have been designed and constructed by
and for people
In Australia environmental modifications undertaken by occupational
therapists are mainly in domestic dwellings
Client groups generally fall within on of the following
- Privately funded clients
- Compensable clients
- State based publicly funded organizations
- Community Housing
- Public Housing
Barriers to home modifications
Psychological
- Concern about stigma
- Lack of social support
- Perception of them not being needed
- Denial of disability
Practical
- Cost
- Aesthetics/desirability
- Lack of secure tenure
- Lack of home-modification knowledge
Person who are depressed and or cognitively impaired are less likely
to value environmental changes
The Client
 A transactional approach considers that the interaction between the
client and their environment is a dynamic entity and that the
person and the context at that point in time can only be understood
and assessed together, as a unified system and not in isolation of
each other (Tanner, 2011). This is the concept that underpins the
preferred method of a home assessment – with the client present.
 An occupational therapist may be requested to undertake an
assessment without the client present and this is often a necessity to
ensure that the home environment can support the visit itself
(particularly in the case of severely injured or debilitated clients)
however it is difficult to determine function / environmental press
inherent in the person-environment-occupation relationship
without the client being at the assessment.
 Assessment is an active process that requires selective attention and
assists human reasoners to make sense of complex and sometimes
contradictory data.
 The development of the ability to notice and attend cues
appropriately in the home-modification scenario is crucial in
learning discrimination.
 In Intervention, the focus shifts to overt action in extending and
testing understanding.
 Observing and/or measuring humans in their physical environment
in terms of features and their component attributes provide the data
needed for occupationally successful outcomes
 Occupational reasoning means that the shower-hob’s water-
containment structure need to be evaluated in terms of their
location, height, surrounding and shape
 Evaluation of a building problem from a home-modification
perspective judges the qualities of all relevant components by their
features relative to the intervention goal
 Modification may be motivated by desire to improve safety by
reducing or eliminating the building components that require good
dynamic balance.
 Consideration of alternative requires a wider analysis
- Consideration of the impact on available circulation space
- Existing wall support structures
- Existing floor treatments
 Modification reasoning requires movement from a specific building
component out to its wider contextual situation
 Consideration of the wider implications allows a better
understanding of the problem and makes possible a more explicit
statement of modification goals
 The feasibility of modification as an activity depends on being able
to evaluate and appropriately communicate the extent and scope of
the changes required.
 Occupational Therapist Knowledge and Skills acquired to
effectively determine the fit between individual and their home
environments include:
- A health care perspective
- Assessment of performance
- Knowledge of modification interventions and assistive technology
- Knowledge of specific diseases and disability
- Knowledge of life span development
 Difficulty in moving from sitting to standing could be due to one or
all of the following
- Stiff joints
- Poor endurance
- Unsuitable footwear
- Slippery or unstable surfaces
Home Assessment Components
Interview
- Provide overall profile of the client’s abilities
- Understand client’s priorities in relation to task performance
- Target tasks requiring further in-depth evaluation
Observation of task performance
- Assess the performance of components of tasks identified as being
difficult for the client to perform
- Identify possible intervention strategies
- Ascertain whether a change in the environment would enable ease
of task performance
Examination of the home environment
 Assess for environmental hazards
 Suitability of environment for client
 Understanding of culture and values of client
 Assess structural and maintenance issues
Home Modification competencies relevant to Occupational Therapists
- Respects the individuality and worth of each client within their
environment
- Establishes and maintains collaborative working arrangements
with other disciplines
- Assesses the occupational environment(s) of the individual or
group
- Prescribes specialized adaptive equipment and techniques
- Provides consultation regarding modification to the workplace,
home and leisure environments
- Understands the role of the client’s caregiver
- Utilizes available community resources and facilities
Home Assessment Tools
 Occupational therapists need effective assessments to help evaluate
the physical, social, and psychological aspects of the home
environment when planning home modification interventions.
 Assessment tools need to have a client-centered focus, emphasis on
occupation or occupational performance, comprehensive
evaluation of the environment, strong psychometric properties, and
clinical utility.
 When selecting an assessment tool, occupational therapists also
need to take into an account the type of home modification
interventions that they will be able to complete in a given treatment
context.
 Because of the unique needs of each home modification
intervention, there is no one-fits-all assessment; the best tool will
depend on the context of care.
SAFER
 Home assessment by occupational therapist
 Covers 97 items within 14 sections (living situation, mobility,
kitchen, fire hazards, eating, household, dressing, grooming,
bathroom, medication, communication, wandering, memory aids
and general
 Based on IADL categorization (i.e. mobility, medication, etc.) with
inclusion of aspects of living situation (trip hazards) and fire
hazards. Little or no theoretical base and associated issues with
content and construct validity
 Assesses an individual's abilities to safely manage functional
activities within their home
 This assessment considers both the environmental feature along
with client's capabilities
SAFER
 Evolved out of occupational therapy home visit proforma’s
currently in use in Canada. Concept of person and environment
unclear
 Designed for older adults (who may or may not have cognitive
impairments) but can be used for other age groups
 Unclear, behaviors implicit with exception of cognitive impairment
markers such as wandering
 Manual contains suggestions for home modification-interventions
 45 - 90 minutes to complete
 The SAFER tool provides 95th and 99th percentile scores for each
category, allowing comparison of the client's score
SAFER
Strength
- Familiar and commonsensical
- No prior training required if used by an occupational therapist
- Problem identification linked directly to helpful hits about potential
solutions
- Evidence of psychometric review particularly in terms of reliability
Weaknesses
- Limited information on sample size, selection methods and
population demographics
- No cautions or limitations listed
- Summary score based on ordinal level data
- Insufficient space to record recommendations
Westmead Home Safety Inventory
 Home hazard identification by occupational therapist
 72 item checklist of fall hazards in the following categories:
internal/ external trafficways, general/ indoors, living area, seating,
bedroom, bathroom, kitchen, laundry, footwear, medication
management (60 minutes to complete (1 home visit)
 Limited to housing environmental data associated with fails and
successful fall-related interventions
 Evolved out of international environmental review of fall factors.
Concept of environment related to environmental settings. Concept
of person unclear
 Unclear, scoring is based on environmental hazards. The
relationship to diagnosis, mobility, fall history and anthropometric
dimensions implicit
Westmead Home Safety Inventory
 Items are rated as relevant/ not relevant for the client, then the
items rated as relevant are deemed as a hazard/ not a hazard
Strength
- Excellent training tool
- Comprehensive
- Evidence of psychometric review (i.e. attention paid to issues or
reliability and validity)
- Designed to be used in conjunction with the inventory prompt thus
not bulky or difficult to apply
Weaknesses
- Takes considerable time to process manual and integrate concepts
- Some aspect not always valid for the environment of concern
- No detail provided about potential solution
- Insufficient space to record recommendations
HOMEFAST
 Home hazard utility screening, identify seniors at increased risk of
falls help facilitate referral for more detailed assessment and
recommend interventions.
 25 items in total
 Includes data about function and environment. Little or no
theoretical base and associated issues with content and construct
validity
 Evolved out of NSW Home falls safety checklist. Concept of person
and environment unclear
 Unclear, scoring is based on observation of a combination of
environmental factors and human performance in environment
factors
HOMEFAST
 The assessment focuses on functional tasks and mobility within the
home
 This screening tool looks at environmental hazards which may
contribute to falls
 Allows problem identification but no explicit ink to modifications
 Higher scores are predictive of falls risk
 Construct validity : HOME FAST can be used to identify relative
risk for falls
HOMEFAST
Strengths
- No prior training required
- Evidence of psychometric review of inter-rater reliability and
content validity
- Good reliability for showering and bathing
- Evolved out of NSW Home falls safety checklist
- Intended for rural application
- Designed for speed of administration
Weaknesses
- Reliability assessed with occupational therapist, occupational
assistants and social worker
- Significant reliability difference with expertise
- Poor reliability for outdoor paths
Home Enabler
- Home accessibility assessment by occupational therapist, and as a
social participation and planning tool
- 198 items in full version (also shorter version possible). Four parts,
outdoor environment, entrances, indoor environment and
communication
- Includes data about functional limitations and environment. Based
on the enabler model developed from a 1979 review of the literature
on accessibly
- Evolved out of the enabler accessibility matrix and Swedish
handicap codes. Concept of person similar to WHO impairment
levels. Concept of environment related to environmental settings
Home Enabler
Interaction between person and environment
- Relationships are predetermined and weighted according to
observed severity of impairment generally
Relation to home modification
- Problems are summarized across the four sections but no explicit
link to modifications
Home Enabler
Strength
- Having two separate profiles increases flexibility allowing one
functional profile to be compared across several environmental
profiles and vice versa
- Evidence of psychometric review including content and external
validity based on Swedish handicap codes. Inter-rater reliability
good.
- Predictive environmental score is based on presence and severity of
functional impairments
Weaknesses
- Does not address hazards per se (i.e. omits smoke detectors and fire
egress)
- Requires education and training to apply appropriately
- Consensus about functional limitations and degree of dependency
on equipment unstable
Occupational Performance Model (Australia)
 In the center of the OPM(A) is occupational performance. Five
main components constitute occupational performance:
- Biomechanical performance
- Sensory-motor performance
- Cognitive performance
- Intrapersonal performance
- Interpersonal performance.
 The external environment is divided into the physical, sensory,
cultural and social environments.
Occupational Performance Model (Australia)
 Core elements of occupational performance are the body element,
the mind element and the spirit element.
 Occupational performance is embedded in space and time.
 Space refers to physical matter (physical space) and the person's
experience of space (felt space).
 Time refers to the temporal ordering of physical events (physical
time) as well the meaning that is attributed to time by the person
(felt time)
Model of Human Occupation
 The center of the MoHO is the human system.
A system refers to any complex of elements that interact and
together constitute a logical whole with a purpose of function.
 Occupational behavior is a result of the human system, the task
and the environment.
 The human system has three subsystems:
- The volition subsystem (for making occupational choices; consists
of values, interests and personal causation)
- The habituation subsystem (consists of habits of occupational
behavior)
- Mind-brain-body performance subsystem (describes the
performance capacity).
Model of Human Occupation
 In addition, the environment influences human occupational
behavior: physical, social and cultural environments constitute
occupational behavior settings such as in the home, school or
workplace and recreation sites
Canadian Model of Occupational Performance
 In the center of the CMOP is occupational performance.
 Occupational performance is defined as the overlap of three key
terms: occupation, environment and a person.
 The result of the dynamic relationship between occupation,
environment and a person is occupational performance.
 The key elements of the environment are cultural, institutional,
physical and social.
 Purposes of occupations can either be leisure, productivity or self-
care.
 The CMOP presents the person as an integrated whole who
incorporates spiritual and affective, cognitive and physical needs
 Individuals carrying out occupations have a human body with
particular performance potentials and human measurements (i.e.
anthropometric) in conjunction with socially acquired activity-
relevant skill and knowledge
 An individual’s ability to perform is shaped, on the one hand by
their health status and their performance of preferred
habit/routines; while on the other hand, an environmental setting
shapes the occupations afforded by defining the activity spaces and
the equipment available.
 It is the interaction between the individuals and their
environmental settings that enables the development, practice and
fulfilment of personally valued activities.
Factors on decision-making outcomes
- Knowledge of environmental risks
- Having an injury history
- Personal perspective (i.e. preventative versus immediate functional
outcome)
- Acceptance of risk
- Attachment to objects (i.e. symbolic meaning and vessel of
memories)
- Exploration of alternatives
- Valuing the recommended change
- Feasibility (i.e. ability and opportunity) for change
- Beliefs (i.e. that risk could be effectively averted via behavioral
change alone)
- Degree of perceived personal freedom in decision-making affecting
the home
The built environment includes structures such as
- Public buildings
- Schools
- Hospitals
- Private dwellings
- Parks and playgrounds
- Streets and footpaths that have been designed and constructed by
and for people
In Australia environmental modifications undertaken by occupational
therapists are mainly in domestic dwellings
Client groups generally fall within on of the following
- Privately funded clients
- Compensable clients
- State based publicly funded organizations
- Community Housing
- Public Housing
Other areas where modifications can take place are
- Independent Living Units
- Retirement villages
- Boarding houses whose residents may be included in any of the
above groups
Occupational therapist who work in the area of home modifications,
must have:
- Knowledge of basic accessibility guidelines
- Local and national building codes
- Other relevant legislation ( i.e. negligence, product liability,
trespass, etc.)
- When planning to modify a home, it must be compliant with all
necessary building codes, standards and regulations.
- Environmental legislation and regulations need to be check
(especially as zoning laws and/or development legislation may
directly impact on home modification options)
- Building codes stipulate the minimum necessary standards (e.g.
health, safety, amenity, and sustainability of the buildings)
- Accessibility standards provide guidance on aspects of physical
accessibility relevant to design outcomes.
- The degree to which accessibility standards are implemented
depends on whether they are called up in legislation or regulation.
Home Modification that Enable Occupational Performance
Changes to the Physical Environment:
- Modify the layout (remove a door to make the opening wider)
- Provide adaptive equipment (provide a tub bench)
- Architectural modifications (provide a ramp, bathroom
modifications)
Modification of the occupation
- Educate the user in how to use the environment in a different way
- Use of everyday items for a different purpose or to achieve goals
Supports from people
- Caregiver education (such as transfer techniques)
- Engaging in person based services (such as meal delivery).
Key concepts of client-centered practice:
- Individual autonomy and choice
- Partnership
- Therapist and client responsibility
- Enablement
- Contextual congruence
- Accessibility
- Respect for diversity
Home modification team:
- Insurance agents
- Occupational therapists
- Project Managers
- Designers, Builders etc.
- People with disability and their families
Assessment of the Home Environment
- Access (front, back, side)
- Bathroom
- Toilet
- Lounge or sitting room
- Laundry
- Bedroom
- Kitchen
Home Modifications can:
- Reduce institutionalization and promote participation and
community inclusion
- Significantly reduce the number of falls in older people
- Delay performance loss and dependency
- Reduce the overall cost of care by decreasing the risk of injury and
hospitalization or institutionalization
- Improve occupational performance, safety or accessibility
- Greater independence
- Heightened confidence
- Greater security
- Increased sense of wellbeing
Home modifications must:
- Be reasonable and necessary.
- Be appropriate for funding by the insurer.
- Maximize client control, choice and participation in decision-
making.
- Address individual goals and needs which are articulated in
participant plans, including participation in occupational activities,
social and economic life.
- Represent value for money (by project and in comparison with
alternatives.)
- Be effective and beneficial with regard to the existing structure and
site of the home.
- Be of good quality and compliant with building codes and
regulations.
Complexity of decisions process in home modification
(example associated with toilet rail placements)
 Length
- Minimum length is 300 mm and increments are usually in 150 mm
units
- Person’s height and height of any co-habitants ability to flex and
extend hips and knees and competency of this ability
 Profile
- Circular, square, oval
- Person’s hand size, degree of muscle tone and dynamic grip
strength
 Diameter
- Minimum is 20 mm but can go up to 50mm
- Person’s hand size, degree of muscle tone and dynamic grip
strength
 Shape
- Straight, angled, curved
- Number of persons utilizing a grab rail and their ability to shift
center of balance in a normal sit-to-stand maneuver
 Location of fixings
- Wall, ceiling, floor
- Person’s upper-limb segment length and preferred transfer
procedure
 Distance from pan to proximal projection point
- Can vary widely
- Person’s arm segment length
 Distance from floor to distal projection point
- Can vary widely
- Person’s height and limb segment lengths
 Material
- Wood, plastic, galvanized iron, chrome, aluminum, brass
- Person’s ability to exert dynamic grasp, torso and upper-limb
muscle strength and the possibility of contact with water
 Fixing
- Screws, loxins, dynabolt
- Persons weight, wall fabric
 Surface texture
- Degree of slip resistance
- Possibility of contact with water, excessive sweating in hands or
contaminants such as soap
 Angle of insertion
- Vertical, horizontal, variety of angles in between
- Number and height of all users utilizing the same rail, person’s
stated transfer method
 Projection from wall surface
- Can vary, minimum is considered to be 25 mm
- Size of hand and chance of arm becoming entrapped should slip
occur
 Obstructions and protrusions that might prevent usage
- Pipes, wires, toilet roll holders
- Ability of an individual to gain grip purchase
Specialist knowledge and skills include:
- Responsive to the needs of people with different experience of
disability
- Solutions-focus to deliver home modifications that result in
improvement in safety and independence for the participant, their
family and carers
- Fluent in the application of universal design principles
- National Construction Code and standards related to access in the
residential setting
- Project management skills
- Design and construction knowledge and practice
- Applied understanding of insurance principles
Insurance principles
- Reasonable and necessary
- Appropriate for funding by the insurer
- Maximize client control, choice and participation in decision-
making
- Address individual goals and needs which are articulated in
participant plans, including participation in occupational activities,
social and economic life
- Represent value for money(by project and in comparison with
alternatives.)
- Effective and beneficial with regard to the existing structure and
site of the home
- Good quality and compliant with building codes and regulations
Privately funded clients:
- Generally the occupational therapist (whether public or private)
will advise the client of the modifications they recommend and the
client will choose to arrange a private builder or tradesperson at
their own expense to undertake these recommendations.
- It is considered prudent for the occupational therapist to let the
client source their own builder, or if the OT does have a list of
builders they have used provide the list and let the client make their
own decision about which provider to use.
Compensable clients
- Various kinds of compensation exist in the Australian context,
depending on the management of the client’s injury and how it
occurred.
- The main focus is personal injury claims through WorkCover,
Motor Vehicle Accident insurance, public liability claims and civil
and medico legal claims.
- Different states and territories have different compensation
schemes (e.g. Life Time Care and Support in NSW, and TAC in
Victoria), as well as case law and liability legislation.
- While the Occupational Health & Safety Act (2000) is a federal
piece of legislation the application for the WorkCover
compensation process is generally run at a local level by the
various insurers that cover the region.
Department of Veterans’Affairs (DVA)
- This Commonwealth department provides and funds a number of
services to veterans and their dependents (under programs such as
HomeFront) including home modifications.
- The level of service from an occupational therapist is dependent on
the Veterans’ level of claim (White or Gold).
If the client has a Repatriation Health Card
- For All Conditions (Gold Card), DVA will pay for occupational
therapy services available through DVA arrangements that meet the
client’s clinical needs.
If the client has a Repatriation Health Card
- For Specific Conditions (White Card), DVA will pay for
occupational therapy services if provided under DVA arrangements,
that are required because of an accepted war or service caused
injury or disease.
Where a White Card has been issued for:
• Malignant cancer;
• Pulmonary tuberculosis
• Post traumatic stress disorder (PTSD)
• Anxiety and/or depression whether war caused or not,
DVA will fund treatment for clinical needs related to these conditions
(The Department of Veteran's Affairs, 2011)
Government funded organizations
 The Home and Community Care (HACC) Program is a joint
Australian, State and Territory Government Initiative.
 The HACC Program provides services such as domestic assistance,
personal care as well as professional allied health care and nursing
services, in order to support older Australians, younger people with a
disability and their carers to be more independent at home and in the
community and to reduce the potential or inappropriate need for
admission to residential care
Community Housing (such as The Community Housing Federation of
Victoria)
 There are 3 main types of community housing: housing associations,
co-operatives and church owned housing.
 Housing associations manage the vast majority of community
housing tenancies, the others play a crucial part in making
community housing the vital and diverse sector that it is (NSW
Federation of Community Housing Inc., 2011).

- Housing associations are specific professional not-for-profit housing
providers. While they mainly manage rental housing, they may
provide other services as well.
- Co-operative housing is subsidized by government, but is fully
managed by the tenants themselves, providing real control and
‘ownership’ of their housing.
- Church-based agencies have responded to need in their local
communities and bring church resources to the table.
 Generally community housing is delivered by funded community
organizations and tenancy will be managed by that community
housing organization.
 In that vein, when planning modifications it is essential to contact
the Community Housing Provider (CHP) with regard to their policy
and/or procedures in this regard.
 In some cases, particularly if the client is HACC eligible, the CHP
may only be required to supply the “Authority to Install” document.
 In others case, the CHP may choose to offer relocation to a more
suitable property within their range of available housing stock.
Aboriginal Community Housing
 There is a distinct, Indigenous-controlled, housing system. While
much of this housing is managed through the relevant state
department that manages public housing, there is also significant
number Aboriginal community based housing providers
Public Housing (such as The Department of Housing, Western
Australia).
 Each state and territory in Australia has its own public housing
program and each have programs within it to modify/retrofit existing
housing to suit their tenants abilities, to purpose build specific
properties for people with different abilities and disabilities, and to
support tenants with specific environment needs access the private
rental marker if nothing is available in their geographical area.
Each States body has a different name and policy on this.
 Most occupational therapy departments will have information on the
practices of their local public housing body and the best way to
communicate with their modifications program.
 Unlike other funded services, eligibility is usually focused on the fact
that the client is already in public housing. The request for
modifications usually only needs to state the functional reason for
the person need the modification, not an in depth medical
background.
 Client privacy and confidentiality is relevant here and the clinical
senior in the area will probably have an example of a report that will
demonstrate the level of information that is required in order to have
modifications undertaken.
 In some cases the relevant body may decide that the cost of
modifications is untenable and will recommend that the client
relocate to a more suitable property.
 There is a caveat in housing tenancy documents that covers this
eventuality and it may be prudent to advise your client of this prior to
lodging a request for major modifications.
 The client can decline the recommendation to relocate and accept
the agency’s decision to decline the modifications for that particular
property.
 If there are particular reasons as to why the client relocating is
untenable (such as carer availability or proximity to relevant
locations) these should be documented and reported on if a response
to the modification decline is prepared.
 For example if a client’s primary carer does not drive and walks to
the client each day, relocation may cause significant impact on the
client’s well being and ability to manage in the community
Legislation and Regulations
 Access standards and building codes, while useful for general
guidance, cannot account for individual needs.
 All therapist-determined recommendations (relevant to client
anthropometrics and subsequent function) should be identified and
documented and then put to test against any relevant legislation /
regulations and codes by the installing tradesperson
 In some cases, where the Australian Standard 1428 is used as part of
a home modification service delivery guideline for example, a
client’s anthropometrical data can determine that the AS1428 is not
relevant for that person and it should then be used as a guide only.
 The therapist will need to document this and any negotiation with
the relevant tradesperson / home modifications coordinator
Legislation and Regulations
 Other Standards, for example the Electrical Standards Act, the
requirements are legislated and cannot be altered. Although
occupational therapists are not trained in these specific areas and
should not profess expertise with regard to building, plumbing etc.,
occupational therapists need to be aware of specific, relevant
legislative requirements and regulations/codes.
 Not all these are directly related to the built environment but may
have indirect relevance when their purpose is examined more
closely.
 Areas such as Privacy, and Discrimination are also relevant to the
practicing occupational therapist
Commonwealth legislation and regulations AS 1428
 Australia’s primary legislated guidelines for Accessibility, AS 1428
Part 1 (Standards Australia, 2001) and Part 2 (Standards Australia,
1992b) do not include accessible front entrance solutions, primarily
because the Standards were developed with commercial entrances in
mind; consequently the AS1428 suite focuses on urban, commercial
entrances requiring ramps or lifts, not domestic responses for
individuals.
 It is worth noting that scooters are not considered in the A90
footprint sizing and that many wheelchairs are also larger than this
specification. There has been a recent amendment to this standard
Access to Premises
 The Access to Premises Standards (commonly referred to as the
‘Premises Standards”) is intended to clarify how designers,
developers, managers and building certifiers can meet their
responsibilities under discrimination law to ensure that buildings are
accessible to people with a disability
 The Standards apply to ‘public buildings’, which includes hotels,
tourist accommodation, and retail premises, commercial and
industrial buildings, government buildings, theatres and cinemas as
well as the common areas of strata apartments
Building Code of Australia (2011)
 The Building Code of Australia (BCA) is produced and maintained
by the Australian Building Codes Board (ABCB) on behalf of the
Australian Government and all State and Territory Governments.
 The BCA has been given the status of building regulations by all
States and Territories. The BCA is updated on a regular basis
(usually each year).
 The goal of the BCA is to “enable the achievement of nationally
consistent, minimum necessary standards of relevant, health, safety
(including structural safety and safety from fire), and amenity and
sustainability objectives efficiently.”
Electrical Standards Australia/Standards New Zealand. (2007).
 Australian/New Zealand Standard, Electrical Installations: Wiring Rules
(3000:2007, Amendment Nos 1, 2 & 3 ed.): Standards Australia/Standards New
Zealand.
Disability Discrimination
 The Disability Discrimination Act (DDA) 1992 provides protection
for everyone in Australia against discrimination based on disability.
It encourages everyone to be involved in implementing the Act and
to share in the overall benefits to the community and the economy
that flow from participation by the widest range of people.
 Disability discrimination happens when people with a disability are
treated less fairly than people without a disability.
 Disability discrimination also occurs when people are treated less
fairly because they are relatives, friends, carers, co-workers or
associates of a person with a disability (HREOC, 2011).
Privacy
 The Privacy Act regulates 'information privacy'. It covers a number
of different activities and sectors.
 The type of privacy covered by the Privacy Act is the protection of
people's personal information, where personal information is
defined as information that identifies a person or could identify a
person.
 Personal information, such as a client name or address. Personal
information can also include medical records, bank account details,
photos, videos, and even information about what someone likes,
their opinions and where they work - basically, any information
where someone is reasonably identifiable. Information does not have
to include a name to be personal information.
Privacy
The Privacy Act definition of personal information is:
"... information or an opinion (including information or an opinion
forming part of a database), whether true or not, and whether recorded
in a material form or not, about an individual whose identity is
apparent, or can reasonably be ascertained, from the information or
opinion" (Office of the Australian Information Commissioner, 2010)
Home and Community Occupations - Home Modification Process

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Home and Community Occupations - Home Modification Process

  • 1. Home and Community Occupations Home Modifications Process
  • 2. The built environment includes structures such as - Public buildings - Schools - Hospitals - Private dwellings - Parks and playgrounds - Streets and footpaths that have been designed and constructed by and for people In Australia environmental modifications undertaken by occupational therapists are mainly in domestic dwellings Client groups generally fall within on of the following - Privately funded clients - Compensable clients - State based publicly funded organizations - Community Housing - Public Housing
  • 3. Barriers to home modifications Psychological - Concern about stigma - Lack of social support - Perception of them not being needed - Denial of disability Practical - Cost - Aesthetics/desirability - Lack of secure tenure - Lack of home-modification knowledge Person who are depressed and or cognitively impaired are less likely to value environmental changes
  • 4. The Client  A transactional approach considers that the interaction between the client and their environment is a dynamic entity and that the person and the context at that point in time can only be understood and assessed together, as a unified system and not in isolation of each other (Tanner, 2011). This is the concept that underpins the preferred method of a home assessment – with the client present.  An occupational therapist may be requested to undertake an assessment without the client present and this is often a necessity to ensure that the home environment can support the visit itself (particularly in the case of severely injured or debilitated clients) however it is difficult to determine function / environmental press inherent in the person-environment-occupation relationship without the client being at the assessment.
  • 5.  Assessment is an active process that requires selective attention and assists human reasoners to make sense of complex and sometimes contradictory data.  The development of the ability to notice and attend cues appropriately in the home-modification scenario is crucial in learning discrimination.  In Intervention, the focus shifts to overt action in extending and testing understanding.  Observing and/or measuring humans in their physical environment in terms of features and their component attributes provide the data needed for occupationally successful outcomes  Occupational reasoning means that the shower-hob’s water- containment structure need to be evaluated in terms of their location, height, surrounding and shape
  • 6.  Evaluation of a building problem from a home-modification perspective judges the qualities of all relevant components by their features relative to the intervention goal  Modification may be motivated by desire to improve safety by reducing or eliminating the building components that require good dynamic balance.  Consideration of alternative requires a wider analysis - Consideration of the impact on available circulation space - Existing wall support structures - Existing floor treatments  Modification reasoning requires movement from a specific building component out to its wider contextual situation
  • 7.  Consideration of the wider implications allows a better understanding of the problem and makes possible a more explicit statement of modification goals  The feasibility of modification as an activity depends on being able to evaluate and appropriately communicate the extent and scope of the changes required.
  • 8.  Occupational Therapist Knowledge and Skills acquired to effectively determine the fit between individual and their home environments include: - A health care perspective - Assessment of performance - Knowledge of modification interventions and assistive technology - Knowledge of specific diseases and disability - Knowledge of life span development  Difficulty in moving from sitting to standing could be due to one or all of the following - Stiff joints - Poor endurance - Unsuitable footwear - Slippery or unstable surfaces
  • 9. Home Assessment Components Interview - Provide overall profile of the client’s abilities - Understand client’s priorities in relation to task performance - Target tasks requiring further in-depth evaluation Observation of task performance - Assess the performance of components of tasks identified as being difficult for the client to perform - Identify possible intervention strategies - Ascertain whether a change in the environment would enable ease of task performance Examination of the home environment  Assess for environmental hazards  Suitability of environment for client  Understanding of culture and values of client  Assess structural and maintenance issues
  • 10. Home Modification competencies relevant to Occupational Therapists - Respects the individuality and worth of each client within their environment - Establishes and maintains collaborative working arrangements with other disciplines - Assesses the occupational environment(s) of the individual or group - Prescribes specialized adaptive equipment and techniques - Provides consultation regarding modification to the workplace, home and leisure environments - Understands the role of the client’s caregiver - Utilizes available community resources and facilities
  • 11. Home Assessment Tools  Occupational therapists need effective assessments to help evaluate the physical, social, and psychological aspects of the home environment when planning home modification interventions.  Assessment tools need to have a client-centered focus, emphasis on occupation or occupational performance, comprehensive evaluation of the environment, strong psychometric properties, and clinical utility.  When selecting an assessment tool, occupational therapists also need to take into an account the type of home modification interventions that they will be able to complete in a given treatment context.  Because of the unique needs of each home modification intervention, there is no one-fits-all assessment; the best tool will depend on the context of care.
  • 12. SAFER  Home assessment by occupational therapist  Covers 97 items within 14 sections (living situation, mobility, kitchen, fire hazards, eating, household, dressing, grooming, bathroom, medication, communication, wandering, memory aids and general  Based on IADL categorization (i.e. mobility, medication, etc.) with inclusion of aspects of living situation (trip hazards) and fire hazards. Little or no theoretical base and associated issues with content and construct validity  Assesses an individual's abilities to safely manage functional activities within their home  This assessment considers both the environmental feature along with client's capabilities
  • 13. SAFER  Evolved out of occupational therapy home visit proforma’s currently in use in Canada. Concept of person and environment unclear  Designed for older adults (who may or may not have cognitive impairments) but can be used for other age groups  Unclear, behaviors implicit with exception of cognitive impairment markers such as wandering  Manual contains suggestions for home modification-interventions  45 - 90 minutes to complete  The SAFER tool provides 95th and 99th percentile scores for each category, allowing comparison of the client's score
  • 14. SAFER Strength - Familiar and commonsensical - No prior training required if used by an occupational therapist - Problem identification linked directly to helpful hits about potential solutions - Evidence of psychometric review particularly in terms of reliability Weaknesses - Limited information on sample size, selection methods and population demographics - No cautions or limitations listed - Summary score based on ordinal level data - Insufficient space to record recommendations
  • 15. Westmead Home Safety Inventory  Home hazard identification by occupational therapist  72 item checklist of fall hazards in the following categories: internal/ external trafficways, general/ indoors, living area, seating, bedroom, bathroom, kitchen, laundry, footwear, medication management (60 minutes to complete (1 home visit)  Limited to housing environmental data associated with fails and successful fall-related interventions  Evolved out of international environmental review of fall factors. Concept of environment related to environmental settings. Concept of person unclear  Unclear, scoring is based on environmental hazards. The relationship to diagnosis, mobility, fall history and anthropometric dimensions implicit
  • 16. Westmead Home Safety Inventory  Items are rated as relevant/ not relevant for the client, then the items rated as relevant are deemed as a hazard/ not a hazard Strength - Excellent training tool - Comprehensive - Evidence of psychometric review (i.e. attention paid to issues or reliability and validity) - Designed to be used in conjunction with the inventory prompt thus not bulky or difficult to apply Weaknesses - Takes considerable time to process manual and integrate concepts - Some aspect not always valid for the environment of concern - No detail provided about potential solution - Insufficient space to record recommendations
  • 17. HOMEFAST  Home hazard utility screening, identify seniors at increased risk of falls help facilitate referral for more detailed assessment and recommend interventions.  25 items in total  Includes data about function and environment. Little or no theoretical base and associated issues with content and construct validity  Evolved out of NSW Home falls safety checklist. Concept of person and environment unclear  Unclear, scoring is based on observation of a combination of environmental factors and human performance in environment factors
  • 18. HOMEFAST  The assessment focuses on functional tasks and mobility within the home  This screening tool looks at environmental hazards which may contribute to falls  Allows problem identification but no explicit ink to modifications  Higher scores are predictive of falls risk  Construct validity : HOME FAST can be used to identify relative risk for falls
  • 19. HOMEFAST Strengths - No prior training required - Evidence of psychometric review of inter-rater reliability and content validity - Good reliability for showering and bathing - Evolved out of NSW Home falls safety checklist - Intended for rural application - Designed for speed of administration Weaknesses - Reliability assessed with occupational therapist, occupational assistants and social worker - Significant reliability difference with expertise - Poor reliability for outdoor paths
  • 20. Home Enabler - Home accessibility assessment by occupational therapist, and as a social participation and planning tool - 198 items in full version (also shorter version possible). Four parts, outdoor environment, entrances, indoor environment and communication - Includes data about functional limitations and environment. Based on the enabler model developed from a 1979 review of the literature on accessibly - Evolved out of the enabler accessibility matrix and Swedish handicap codes. Concept of person similar to WHO impairment levels. Concept of environment related to environmental settings
  • 21. Home Enabler Interaction between person and environment - Relationships are predetermined and weighted according to observed severity of impairment generally Relation to home modification - Problems are summarized across the four sections but no explicit link to modifications
  • 22. Home Enabler Strength - Having two separate profiles increases flexibility allowing one functional profile to be compared across several environmental profiles and vice versa - Evidence of psychometric review including content and external validity based on Swedish handicap codes. Inter-rater reliability good. - Predictive environmental score is based on presence and severity of functional impairments Weaknesses - Does not address hazards per se (i.e. omits smoke detectors and fire egress) - Requires education and training to apply appropriately - Consensus about functional limitations and degree of dependency on equipment unstable
  • 23. Occupational Performance Model (Australia)  In the center of the OPM(A) is occupational performance. Five main components constitute occupational performance: - Biomechanical performance - Sensory-motor performance - Cognitive performance - Intrapersonal performance - Interpersonal performance.  The external environment is divided into the physical, sensory, cultural and social environments.
  • 24. Occupational Performance Model (Australia)  Core elements of occupational performance are the body element, the mind element and the spirit element.  Occupational performance is embedded in space and time.  Space refers to physical matter (physical space) and the person's experience of space (felt space).  Time refers to the temporal ordering of physical events (physical time) as well the meaning that is attributed to time by the person (felt time)
  • 25. Model of Human Occupation  The center of the MoHO is the human system. A system refers to any complex of elements that interact and together constitute a logical whole with a purpose of function.  Occupational behavior is a result of the human system, the task and the environment.  The human system has three subsystems: - The volition subsystem (for making occupational choices; consists of values, interests and personal causation) - The habituation subsystem (consists of habits of occupational behavior) - Mind-brain-body performance subsystem (describes the performance capacity).
  • 26. Model of Human Occupation  In addition, the environment influences human occupational behavior: physical, social and cultural environments constitute occupational behavior settings such as in the home, school or workplace and recreation sites
  • 27. Canadian Model of Occupational Performance  In the center of the CMOP is occupational performance.  Occupational performance is defined as the overlap of three key terms: occupation, environment and a person.  The result of the dynamic relationship between occupation, environment and a person is occupational performance.  The key elements of the environment are cultural, institutional, physical and social.  Purposes of occupations can either be leisure, productivity or self- care.  The CMOP presents the person as an integrated whole who incorporates spiritual and affective, cognitive and physical needs
  • 28.  Individuals carrying out occupations have a human body with particular performance potentials and human measurements (i.e. anthropometric) in conjunction with socially acquired activity- relevant skill and knowledge  An individual’s ability to perform is shaped, on the one hand by their health status and their performance of preferred habit/routines; while on the other hand, an environmental setting shapes the occupations afforded by defining the activity spaces and the equipment available.  It is the interaction between the individuals and their environmental settings that enables the development, practice and fulfilment of personally valued activities.
  • 29. Factors on decision-making outcomes - Knowledge of environmental risks - Having an injury history - Personal perspective (i.e. preventative versus immediate functional outcome) - Acceptance of risk - Attachment to objects (i.e. symbolic meaning and vessel of memories) - Exploration of alternatives - Valuing the recommended change - Feasibility (i.e. ability and opportunity) for change - Beliefs (i.e. that risk could be effectively averted via behavioral change alone) - Degree of perceived personal freedom in decision-making affecting the home
  • 30. The built environment includes structures such as - Public buildings - Schools - Hospitals - Private dwellings - Parks and playgrounds - Streets and footpaths that have been designed and constructed by and for people
  • 31. In Australia environmental modifications undertaken by occupational therapists are mainly in domestic dwellings Client groups generally fall within on of the following - Privately funded clients - Compensable clients - State based publicly funded organizations - Community Housing - Public Housing Other areas where modifications can take place are - Independent Living Units - Retirement villages - Boarding houses whose residents may be included in any of the above groups
  • 32. Occupational therapist who work in the area of home modifications, must have: - Knowledge of basic accessibility guidelines - Local and national building codes - Other relevant legislation ( i.e. negligence, product liability, trespass, etc.) - When planning to modify a home, it must be compliant with all necessary building codes, standards and regulations. - Environmental legislation and regulations need to be check (especially as zoning laws and/or development legislation may directly impact on home modification options)
  • 33. - Building codes stipulate the minimum necessary standards (e.g. health, safety, amenity, and sustainability of the buildings) - Accessibility standards provide guidance on aspects of physical accessibility relevant to design outcomes. - The degree to which accessibility standards are implemented depends on whether they are called up in legislation or regulation.
  • 34. Home Modification that Enable Occupational Performance Changes to the Physical Environment: - Modify the layout (remove a door to make the opening wider) - Provide adaptive equipment (provide a tub bench) - Architectural modifications (provide a ramp, bathroom modifications) Modification of the occupation - Educate the user in how to use the environment in a different way - Use of everyday items for a different purpose or to achieve goals Supports from people - Caregiver education (such as transfer techniques) - Engaging in person based services (such as meal delivery).
  • 35. Key concepts of client-centered practice: - Individual autonomy and choice - Partnership - Therapist and client responsibility - Enablement - Contextual congruence - Accessibility - Respect for diversity Home modification team: - Insurance agents - Occupational therapists - Project Managers - Designers, Builders etc. - People with disability and their families
  • 36. Assessment of the Home Environment - Access (front, back, side) - Bathroom - Toilet - Lounge or sitting room - Laundry - Bedroom - Kitchen
  • 37. Home Modifications can: - Reduce institutionalization and promote participation and community inclusion - Significantly reduce the number of falls in older people - Delay performance loss and dependency - Reduce the overall cost of care by decreasing the risk of injury and hospitalization or institutionalization - Improve occupational performance, safety or accessibility - Greater independence - Heightened confidence - Greater security - Increased sense of wellbeing
  • 38. Home modifications must: - Be reasonable and necessary. - Be appropriate for funding by the insurer. - Maximize client control, choice and participation in decision- making. - Address individual goals and needs which are articulated in participant plans, including participation in occupational activities, social and economic life. - Represent value for money (by project and in comparison with alternatives.) - Be effective and beneficial with regard to the existing structure and site of the home. - Be of good quality and compliant with building codes and regulations.
  • 39. Complexity of decisions process in home modification (example associated with toilet rail placements)  Length - Minimum length is 300 mm and increments are usually in 150 mm units - Person’s height and height of any co-habitants ability to flex and extend hips and knees and competency of this ability  Profile - Circular, square, oval - Person’s hand size, degree of muscle tone and dynamic grip strength  Diameter - Minimum is 20 mm but can go up to 50mm - Person’s hand size, degree of muscle tone and dynamic grip strength
  • 40.  Shape - Straight, angled, curved - Number of persons utilizing a grab rail and their ability to shift center of balance in a normal sit-to-stand maneuver  Location of fixings - Wall, ceiling, floor - Person’s upper-limb segment length and preferred transfer procedure  Distance from pan to proximal projection point - Can vary widely - Person’s arm segment length  Distance from floor to distal projection point - Can vary widely - Person’s height and limb segment lengths
  • 41.  Material - Wood, plastic, galvanized iron, chrome, aluminum, brass - Person’s ability to exert dynamic grasp, torso and upper-limb muscle strength and the possibility of contact with water  Fixing - Screws, loxins, dynabolt - Persons weight, wall fabric  Surface texture - Degree of slip resistance - Possibility of contact with water, excessive sweating in hands or contaminants such as soap  Angle of insertion - Vertical, horizontal, variety of angles in between - Number and height of all users utilizing the same rail, person’s stated transfer method
  • 42.  Projection from wall surface - Can vary, minimum is considered to be 25 mm - Size of hand and chance of arm becoming entrapped should slip occur  Obstructions and protrusions that might prevent usage - Pipes, wires, toilet roll holders - Ability of an individual to gain grip purchase
  • 43. Specialist knowledge and skills include: - Responsive to the needs of people with different experience of disability - Solutions-focus to deliver home modifications that result in improvement in safety and independence for the participant, their family and carers - Fluent in the application of universal design principles - National Construction Code and standards related to access in the residential setting - Project management skills - Design and construction knowledge and practice - Applied understanding of insurance principles
  • 44. Insurance principles - Reasonable and necessary - Appropriate for funding by the insurer - Maximize client control, choice and participation in decision- making - Address individual goals and needs which are articulated in participant plans, including participation in occupational activities, social and economic life - Represent value for money(by project and in comparison with alternatives.) - Effective and beneficial with regard to the existing structure and site of the home - Good quality and compliant with building codes and regulations
  • 45. Privately funded clients: - Generally the occupational therapist (whether public or private) will advise the client of the modifications they recommend and the client will choose to arrange a private builder or tradesperson at their own expense to undertake these recommendations. - It is considered prudent for the occupational therapist to let the client source their own builder, or if the OT does have a list of builders they have used provide the list and let the client make their own decision about which provider to use.
  • 46. Compensable clients - Various kinds of compensation exist in the Australian context, depending on the management of the client’s injury and how it occurred. - The main focus is personal injury claims through WorkCover, Motor Vehicle Accident insurance, public liability claims and civil and medico legal claims. - Different states and territories have different compensation schemes (e.g. Life Time Care and Support in NSW, and TAC in Victoria), as well as case law and liability legislation. - While the Occupational Health & Safety Act (2000) is a federal piece of legislation the application for the WorkCover compensation process is generally run at a local level by the various insurers that cover the region.
  • 47. Department of Veterans’Affairs (DVA) - This Commonwealth department provides and funds a number of services to veterans and their dependents (under programs such as HomeFront) including home modifications. - The level of service from an occupational therapist is dependent on the Veterans’ level of claim (White or Gold).
  • 48. If the client has a Repatriation Health Card - For All Conditions (Gold Card), DVA will pay for occupational therapy services available through DVA arrangements that meet the client’s clinical needs. If the client has a Repatriation Health Card - For Specific Conditions (White Card), DVA will pay for occupational therapy services if provided under DVA arrangements, that are required because of an accepted war or service caused injury or disease. Where a White Card has been issued for: • Malignant cancer; • Pulmonary tuberculosis • Post traumatic stress disorder (PTSD) • Anxiety and/or depression whether war caused or not, DVA will fund treatment for clinical needs related to these conditions (The Department of Veteran's Affairs, 2011)
  • 49. Government funded organizations  The Home and Community Care (HACC) Program is a joint Australian, State and Territory Government Initiative.  The HACC Program provides services such as domestic assistance, personal care as well as professional allied health care and nursing services, in order to support older Australians, younger people with a disability and their carers to be more independent at home and in the community and to reduce the potential or inappropriate need for admission to residential care
  • 50. Community Housing (such as The Community Housing Federation of Victoria)  There are 3 main types of community housing: housing associations, co-operatives and church owned housing.  Housing associations manage the vast majority of community housing tenancies, the others play a crucial part in making community housing the vital and diverse sector that it is (NSW Federation of Community Housing Inc., 2011).  - Housing associations are specific professional not-for-profit housing providers. While they mainly manage rental housing, they may provide other services as well. - Co-operative housing is subsidized by government, but is fully managed by the tenants themselves, providing real control and ‘ownership’ of their housing.
  • 51. - Church-based agencies have responded to need in their local communities and bring church resources to the table.  Generally community housing is delivered by funded community organizations and tenancy will be managed by that community housing organization.  In that vein, when planning modifications it is essential to contact the Community Housing Provider (CHP) with regard to their policy and/or procedures in this regard.  In some cases, particularly if the client is HACC eligible, the CHP may only be required to supply the “Authority to Install” document.  In others case, the CHP may choose to offer relocation to a more suitable property within their range of available housing stock.
  • 52. Aboriginal Community Housing  There is a distinct, Indigenous-controlled, housing system. While much of this housing is managed through the relevant state department that manages public housing, there is also significant number Aboriginal community based housing providers Public Housing (such as The Department of Housing, Western Australia).  Each state and territory in Australia has its own public housing program and each have programs within it to modify/retrofit existing housing to suit their tenants abilities, to purpose build specific properties for people with different abilities and disabilities, and to support tenants with specific environment needs access the private rental marker if nothing is available in their geographical area. Each States body has a different name and policy on this.
  • 53.  Most occupational therapy departments will have information on the practices of their local public housing body and the best way to communicate with their modifications program.  Unlike other funded services, eligibility is usually focused on the fact that the client is already in public housing. The request for modifications usually only needs to state the functional reason for the person need the modification, not an in depth medical background.  Client privacy and confidentiality is relevant here and the clinical senior in the area will probably have an example of a report that will demonstrate the level of information that is required in order to have modifications undertaken.  In some cases the relevant body may decide that the cost of modifications is untenable and will recommend that the client relocate to a more suitable property.
  • 54.  There is a caveat in housing tenancy documents that covers this eventuality and it may be prudent to advise your client of this prior to lodging a request for major modifications.  The client can decline the recommendation to relocate and accept the agency’s decision to decline the modifications for that particular property.  If there are particular reasons as to why the client relocating is untenable (such as carer availability or proximity to relevant locations) these should be documented and reported on if a response to the modification decline is prepared.  For example if a client’s primary carer does not drive and walks to the client each day, relocation may cause significant impact on the client’s well being and ability to manage in the community
  • 55. Legislation and Regulations  Access standards and building codes, while useful for general guidance, cannot account for individual needs.  All therapist-determined recommendations (relevant to client anthropometrics and subsequent function) should be identified and documented and then put to test against any relevant legislation / regulations and codes by the installing tradesperson  In some cases, where the Australian Standard 1428 is used as part of a home modification service delivery guideline for example, a client’s anthropometrical data can determine that the AS1428 is not relevant for that person and it should then be used as a guide only.  The therapist will need to document this and any negotiation with the relevant tradesperson / home modifications coordinator
  • 56. Legislation and Regulations  Other Standards, for example the Electrical Standards Act, the requirements are legislated and cannot be altered. Although occupational therapists are not trained in these specific areas and should not profess expertise with regard to building, plumbing etc., occupational therapists need to be aware of specific, relevant legislative requirements and regulations/codes.  Not all these are directly related to the built environment but may have indirect relevance when their purpose is examined more closely.  Areas such as Privacy, and Discrimination are also relevant to the practicing occupational therapist
  • 57. Commonwealth legislation and regulations AS 1428  Australia’s primary legislated guidelines for Accessibility, AS 1428 Part 1 (Standards Australia, 2001) and Part 2 (Standards Australia, 1992b) do not include accessible front entrance solutions, primarily because the Standards were developed with commercial entrances in mind; consequently the AS1428 suite focuses on urban, commercial entrances requiring ramps or lifts, not domestic responses for individuals.  It is worth noting that scooters are not considered in the A90 footprint sizing and that many wheelchairs are also larger than this specification. There has been a recent amendment to this standard
  • 58. Access to Premises  The Access to Premises Standards (commonly referred to as the ‘Premises Standards”) is intended to clarify how designers, developers, managers and building certifiers can meet their responsibilities under discrimination law to ensure that buildings are accessible to people with a disability  The Standards apply to ‘public buildings’, which includes hotels, tourist accommodation, and retail premises, commercial and industrial buildings, government buildings, theatres and cinemas as well as the common areas of strata apartments
  • 59. Building Code of Australia (2011)  The Building Code of Australia (BCA) is produced and maintained by the Australian Building Codes Board (ABCB) on behalf of the Australian Government and all State and Territory Governments.  The BCA has been given the status of building regulations by all States and Territories. The BCA is updated on a regular basis (usually each year).  The goal of the BCA is to “enable the achievement of nationally consistent, minimum necessary standards of relevant, health, safety (including structural safety and safety from fire), and amenity and sustainability objectives efficiently.” Electrical Standards Australia/Standards New Zealand. (2007).  Australian/New Zealand Standard, Electrical Installations: Wiring Rules (3000:2007, Amendment Nos 1, 2 & 3 ed.): Standards Australia/Standards New Zealand.
  • 60. Disability Discrimination  The Disability Discrimination Act (DDA) 1992 provides protection for everyone in Australia against discrimination based on disability. It encourages everyone to be involved in implementing the Act and to share in the overall benefits to the community and the economy that flow from participation by the widest range of people.  Disability discrimination happens when people with a disability are treated less fairly than people without a disability.  Disability discrimination also occurs when people are treated less fairly because they are relatives, friends, carers, co-workers or associates of a person with a disability (HREOC, 2011).
  • 61. Privacy  The Privacy Act regulates 'information privacy'. It covers a number of different activities and sectors.  The type of privacy covered by the Privacy Act is the protection of people's personal information, where personal information is defined as information that identifies a person or could identify a person.  Personal information, such as a client name or address. Personal information can also include medical records, bank account details, photos, videos, and even information about what someone likes, their opinions and where they work - basically, any information where someone is reasonably identifiable. Information does not have to include a name to be personal information.
  • 62. Privacy The Privacy Act definition of personal information is: "... information or an opinion (including information or an opinion forming part of a database), whether true or not, and whether recorded in a material form or not, about an individual whose identity is apparent, or can reasonably be ascertained, from the information or opinion" (Office of the Australian Information Commissioner, 2010)