Home Usability

HOUSING CHARACTERISTICS, HOME EXPERIENCES AND COMMUNITY ENGAGEMENT OF PEOPLE WHO REPORT IMPAIRMENT AUTHORS AND ACKNOWLEDGEMENTS Authors: Craig Ravesloot PhD, Lillie Greiman MA, Bryce Ward, PhD, Andrew Myers Acknowledgements: This project is a collaboration between the RTC on Disability in Rural Communities at the University of Montana and the RTC on Community Living at the University of Kansas. Funding by: The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) LIFE STARTS AT HOME. Community participation is a central outcome in rehabilitation and independent living research. People who report experiencing an impairment, participate less. Qualitative research has highlighted how the home experience is linked to participation.

There is little quantitative research that examines home experience and community engagement. HOME AND PARTICIPATION BACKGROUND The home should includes spaces that facilitate rest and rejuvenation (Mallett 2004) disabled people [sic] often experience the home as a series of disembodied spaces, or places that are designed in way that are rarely attentive to their physiological and bodily needs and functions (Imrie, 2004) Longitudinal research on disability and aging highlights that difficulties in the home may first be experienced in completing ADLs like dressing and bathing (Dunlop, Hughes, & Manheim (1997) Intervention research in the bathroom focuses on fall and injury prevention, but not on participation outcomes (e.g., Gitlin, Miller & Boyce (1999). Barriers in the home impact the broader participation of people with disabilities (Dunn 1990, Stineman et al 2007, Hammel et al. 2015). OVERVIEW State of housing access (American Housing Survey) Time use at home and in the community (American Time Use Survey)

Home experience and community engagement (Home Usability Survey) Discussion and Conclusion STATE OF HOUSING ACCESS ACROSS THE UNITED STATES: 2011 AHS Lillie Greiman Research Associate RTC: Rural THE AMERICAN HOUSING SURVEY (AHS) Sponsored by HUD and performed by the US Census Provides a current and continuous series of data on housing across the US. Conducted every two years We used a sample collected for the 2011 AHS that included households with occupants between the ages of 18 and 75. Complete sample redesign with 2015 survey

DISABILITY AND ACCESSIBILITY VARIABLES IN THE AHS 2009 addition of the ACS (Census) disability indicators 2009 addition of the NOSTEP variable (presence of steps at entrance of unit) Outside, it is possible to enter this home/apartment WITHOUT climbing up or down any steps or stair? Please consider all entrances and ramps that could be used. 2011 Housing Modification Module Mobility equipment use Functional limitation Accessibility features RATES OF INACCESSIBLE HOUSING No household Household member Features uses mobility equipment

Stepped Entrance 57.2% Up stairs with no elevator* 71.6% Inaccessible kitchen 66.8% Inaccessible bathroom 56.1% No grab bars in bathroom 62.3% No entry level bathroom** 18.5% No entry level Cane, crutch, manual wheelchair, power wheelchair or scooter bedroom** 32.4% * Of apartments ** Of units with more than one floor

members use mobility equipment 60.9% 81.7% 69.5% 60.2% 86.7% 20.9% 42.2% Rate of Inaccessible Housing: Urban Rural Comparison (Of HH with individuals using a mobility 19.0% No entry level bathroom** 14.2% device) No entry level bedroom** Inaccessible bathroom Stepped Entrance No grab bars in bathroom

Inaccessible kitchen 33.6% 26.9% 57.3% 52.4% 56.4% 59.2% 63.8% 59.5% 68.5% 61.4% 68.8% Up stairs with no elevator* Outside MSA (Rural) * Of apartments ** Of units with more than 1 floor 91.0% Inside MSA (Urban)

Rate of Stepped Entrances (Of HH with individuals using a mobility device) Inside MSA (Urban) 69.7% 66.0% Outside MSA (Rural) 64.0% 63.0% 58.8% 48.5% Northeast Midwest South 51.3% 50.1%

West No Grab Bars in the Bathroom (Of HH with individuals using a mobility device) Inside MSA (Urban) 64.6% 58.3% Northeast 67.2% 62.9% 62.4% 57.5% 54.0% Midwest 64.3%

South West DATA LIMITATIONS Defining accessible No objective measurement (e.g.. 32 wide doorway, or outlets 15 off the floor) Cognitive testing (DeMaio, T., & Freidus, R. 2011). Many respondents reported that aspects of their home could possibly be utilized by those in a wheelchairthis resulted in over-report of wheelchair accessibility features. Rural/Urban data Inconsistent definitions: OMB definitions from 1980, 1990 and 2000 are used depending on the unit and when the unit was added to the survey. Limited data available for rural areas CONCLUSIONS AND IMPLICATIONS A large proportion of people with mobility impairments

live in homes that do not meet their needs. We see some rural-urban and regional variation in housing accessibility. Significant numbers of households with individuals with mobility impairments have steps or even a flight of stairs at their home entrance. Over half of households with individuals with mobility impairments do not have grab bars in their bathrooms. TIME USE AT HOME AND IN THE COMMUNITY Bryce Ward Associate Director Bureau of Business and Economic Research University of Montana DATA: AMERICAN TIME USE SURVEY (ATUS) 2008-2014 87,000 observations; 2,800 with mobility impairment 3

Main questions: What were you doing? Where were you? How long did you do this for? (For some years for 3 random activities) How did you feel? METHOD Compare time use for people with mobility impairments to time use for people without mobility impairments. People with mobility impairments differ from people without mobility impairments (e.g., 90% of mobility impaired are out of labor force, 74% do not live with a spouse or partner, 67% are female, mean age is 63). Thus we include controls for person characteristics (sex, age, education, employment, and school enrollment); family characteristics (number of kids, live with a partner, family income, own/rent home); location (region, MSA size); and interview (day of week, month, year, holiday).

WHAT DO MOBILITY IMPAIRED DO MORE/LESS OF RELATIVE TO SIMILAR NON-MOBILITY IMPAIRED? IRRs from GLM regression Caring for and helping nonhousehold members 0.5 Less More Educational activities 0.6 Caring for and helping household members 0.66 Household activities 0.69 Organizational, civic, and religious activities 0.75 Work 0.8 Purchasing goods and services

0.8 Eat and drinking 0.96 Personal care 1.09 Leisure and sports 1.11 NON-MOBILITY IMPAIRED SPEND ABOUT 50% MORE TIME (47 MIN/DAY) ON HH ACTIVITIES IRRs from GLM regression Exterior maintenance, repair, and decoration 0.3 Interior maintenance, repair, and decoration 0.41 Lawn and garden care 0.46 Travel related to household activities 0.67

Housework 0.73 Animals and pets 0.75 Food preparation and cleanup 0.76 Household management 0.8 FOR THE MOBILITY IMPAIRED, HH ACTIVITIES ARE ASSOCIATED WITH MORE PAIN, FATIGUE, AND STRESS (BUT ALSO MORE MEANING) HH Activities Mobility Impairment HH Activities * Mobility Impairment Pain (z) Tired (z) Stress (z)

Happy (z) Meaning (z) 0.06*** 0.07*** 0.01 -0.17*** -0.09*** (0.01) (0.01) (0.01) (0.01)

(0.01) 0.70*** 0.30*** 0.26*** -0.15*** -0.04 (0.04) (0.03) (0.03) (0.03) (0.03) 0.07

0.08* 0.06 0.04 0.14** (0.04) (0.04) (0.04) (0.05) (0.04) Regression with individual random-effects of well-being measure (standardized) on indicators for doing a HH activity, mobility impairment, and the interaction of the two, plus controls for sex, age, education, employment, number of kids, marital status, how well they slept the night before, their cumulative exertion (MET) to that point in the day,

interview day, interview month, interview year, holiday, metro/nonmetro, activity duration, activity start hour. Standard errors clustered on the individual in ( )s. MOBILITY IMPAIRED SPEND ABOUT 10% MORE TIME (55 MIN/DAY) ON PERSONAL CARE ACTIVITIES (AND 15%,121 MIN, MORE RESTING) Grooming 0.97 Sleep 1.07 Health-related self-care Resting (sleep, resting, low exertion relaxing/TV) 2.76 1.14 PEOPLE WITH MOBILITY IMPAIRMENTS

ARE LESS LIKELY TO REPORT ANY TIME SPENT GROOMING, BUT THOSE WHO GROOM SPEND MORE TIME GROOMING. % who report any time grooming Mean minutes grooming, for those who groom 80% 58 57 73% 65% All 64% Out of LF No Mobility Impairment

Mobility Impairment 51 All 51 Out of LF No Mobility Impairment Mobility Impairment PEOPLE WITH MOBILITY IMPAIRMENT ARE LESS LIKELY TO LEAVE HOME AND LESS LIKELY TO ENGAGE IN SOCIAL AND RECREATIONAL ACTIVITIES % who leave the house 88%

All 61% 56% 77% 55% % who spent some time in social or recreational activities 48% 52% Out of LF 48% No Mobility Impairment Mobility Impairment No Mobility

Impairment Mobility Impairment All Out of LF THE VAST MAJORITY OF PEOPLE WHO GO OUT/ENGAGE IN SOCIAL ACTIVITIES SPEND TIME GROOMING; HOWEVER, PEOPLE WITH MOBILITY IMPAIRMENTS ARE MORE LIKELY TO GO OUT WITHOUT GROOMING. % who left home and did not report any grooming time % who engaged in social/rec activity and did not report any grooming time 28% 26% 30% 29% 22% No Mobility

Impairment Mobility Impairment 17% All Out of LF 21% 17% All Out of LF No Mobility Impairment Mobility Impairment SO WHAT DOES THIS SUGGEST?

The facts are consistent with (but not definitive proof of) a simple economic story. People have a certain capacity for effort (i.e., effort is scarce). Every activity has an effort price. Effort price is determined by personal characteristics and environmental characteristics. People with mobility impairments may have less capacity for effort, may face higher effort prices for activities, or both. As such, they spend more time resting and less time engaged in activities particularly activities with higher effort prices. To increase activity/participation among people with impairments, need to increase capacity or lower prices of activities. This may be HOME EXPERIENCE AND COMMUNITY ENGAGEMENT Andrew Myers Research Associate RTC: Rural INTRODUCTION A large proportion of people with mobility impairments live in homes that do not meet their needs and abilities. People with mobility impairments spend less time washing, dressing, grooming and engaged in social

activities. How much do people with mobility impairments exert themselves in the home? How does exertion relate to community engagement? HEALTH AND HOME SURVEY Self-report survey to assess home usability, health, and participation developed with input from a team of CIL advisors Demographics Descriptive characteristics of the home Exertion within the home (BORG Exertion Scale; % of maximum) Number of social and recreation activities in the prior 7 PROCEDURES General Population Sample: Look at home usability across three urban communities using a random sample of approx. 2,500 address from zip codes surrounding local CILs in: Atlanta, Georgia (33 Zips) Fresno, California (25 Zips) Indianapolis, Indiana (30 Zips)

Total Design Survey Method (Dillman) Post cards to ID participants, surveys follow, reminder letters and priority surveys mailed SAMPLE DEMOGRAPHICS (N=170) Sex Female Male 62% 38% Mean Age (Range) 60 (23-95) Race and Ethnicity White 62% African American 25% Hispanic/Latino 13% Asian 5%

American Indian 3% Other 6% Education 19% Less than high school High school/GED 23% Some college/Assoc. degree 36% Bachelors and higher 22% Employment Not employed 81% Household Income < $20,000 57% $20,000-$60,000 26%

$60,001-$100,000 11% >$100,000 6% IMPAIRMENT AND HEALTH Impairment Walking 69% Errands 45% Dressing 38% Memory 36% Grasping 27% Hearing 22% Vision 17% No Impairment 15%

Time with limitations (mean) 11.2 yrs. Number of limitations (mean) 2.5 Equipment Cane Walker Manual Wheelchair Brace Health Excellent Very good Good Fair Poor 40% 27% 15% 14% 4%

13% 33% 39% 11% Percent of Maximum Exertion by Activity 3.9 3.4 2.0 1.1 2.8 1.5 2.7 1.0 Mobility Impairment (n=116) 2.4 0.8

2.4 0.7 2.0 0.9 No Mobility Impairment (n=54) 1.4 0.8 BATHROOM CHARACTERISTICS Characteristic Can enter bathroom Can open/close bathroom door Can use/reach bathroom sink Can get in/out of shower/tub Has toilet grab bars

Has shower/tub grab bars Needs toilet grab bars Mobility Impairment % 97% 90% No Mobility Impairment % 100% 98% 95% 100% 72% 28% 39% 41%

93% 15% 32% 17% Percent of Maximum Exertion: Needs Shower Grab Bars 3.9 1.7 1.9 0.74 Yes Mobility Impairment No No Mobility Impairment GLM REGRESSION OF BATHING EXERTION ON SOCIAL/RECREATION ACTIVITIES (N=159)

Variables p IRR SE z 95 CI Bathing exertion 0.74 0.07 -2.97 0.003 0.613; 0.905 Mobility impairment 0.62 0.11 -2.69 0.007 0.433; 0.877 Subjective Health (excellent excluded) Very Good 0.54 0.27 -1.21 0.226

0.203; 1.457 Good 0.55 0.27 -1.21 0.226 0.211; 1.445 Fair 0.61 0.30 -1 0.318 0.233; 1.606 Poor 0.39 0.23 -1.58 0.114 0.123; 1.253 White 0.76 0.13 -1.63 0.104 0.551; 1.507 Partnered

0.64 0.16 -1.79 0.074 0.388; 1.044 Lives with other people 1.40 0.26 1.81 0.07 0.973; 2.012 Constant 10.90 5.51 4.72 0 4.044; 29.354 Note: IRR= Incidence rate ratio; SE= standard error; Analysis completed using generalized linear model with a log link and a Poisson distribution SUMMARY & IMPLICATIONS People with mobility impairments exert themselves

in home activities more than people without mobility impairment. Exertion while bathing is related to perceived need for shower bars Level of exertion bathing is related to the number of social and recreation activities DISCUSSION AND CONCLUSIONS Many people with mobility impairment live in homes that are not accessible. People mobility impairment spend their time differently from people without mobility impairment. People with mobility impairment are less likely to bathe and less likely to leave home than people without mobility impairment. Level of exertion bathing is related to the number of social and recreation activities FOR YOUR CONSIDERATION How might reducing exertion in the home increase

opportunities and choices for participation? How might exertion in the home be reduced? CONTACT Craig Ravesloot, PhD 52 Corbin Hall University of Montana Missoula, MT 59812 406-243-2992 [email protected] http://rtc.ruralinstitute.umt.edu The Home Usability Network Intervention ( www.useablehome.com)

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