By Kate Sheehan
Earlier in the year the government appointed the University of West of England (UWE) to carry out an independent review of the Disabled Facilities Grants (DFG) in England. Shelia McIntosh from the UWE is working with, Dr Rachel Russell (OT), the Building Research Establishment, Ferret Information System and Foundations to look at both the delivery of the grant, financial limits and means testing and the wider delivery of home adaptations to promote independence and dignity of disabled and older people living in their own homes.
The grant sits in primary legislation which was placed on the statute book in 1996 under The Housing Grants, Construction and Regeneration Act, part of the act states that the local housing authority ‘shall consult the social services authority’ this has been the role of the occupational therapist and their duty after an assessment of need is to clearly define what is ‘necessary and appropriate’ to meet the needs of the disabled person.
At a recent Fix The DFG event, a number of questions were asked and the delegates opinion sought, unfortunately there was little time to debate due to time constraints and the set up of the day, however two areas really made me sit up, think, respond and latterly reflect on.
1. We were challenged about whether there is a need for an occupational therapist assessment; this seemed to stem mainly from the fact that there was, for some authorities, a long waiting time for an OT to visit and also that simpler adaptations don’t require a degree in OT to assess and create a specification for the necessary works.
I would agree that some adaptations could be undertaken by occupational therapy support staff under the guidance of a qualified member of the team and there could be some simple ways of creating effective specification templates to potentially speed up the process, however is that solving the underlying issue which is that there are not enough OTs? No it is not.
I would also suggest that the three years we train for and the experience we have enables us to make informed decisions on a client’s need based on our client’s individual experiences of their condition, their physical presentation, our understanding of their medical condition now and in the future, the psychological impact of their condition and their anthropometrics. I can describe numerous occasions where I have gone into a privately funded housing modification, to have to very gently explain that we need to re-do it due to a number of mistakes rendering the space unusable.
When challenging the premise that you don’t need an occupational therapist in the session I was told “you would say that you are a occupational therapist”, my statement wasn’t borne out of protectionism as was indicated but out of the client receiving the best outcome to meet their needs now and in the future.
2. The second issue was about funding, over the last few years the budget for the DFG has increased considerably, which in a time of austerity shows how this and previous governments have valued the cost effectiveness of keeping people in their own homes (let alone the psychological). There was a discussion about financing children’s adaptations, which tend to be more costly and time consuming. The presenters questioned the money spent on these cases and stated it was hard to justify to politicians.
My argument was, the reviewing team needs to go back to government and express we are not dealing with bricks and mortar, we are working with young peoples lives and we must allow these children to reach their full potential and not to be restricted by a built environment that impacts their independence and dignity.
I am passionate about my profession and the value it can add to our client’s journey following a catastrophic injury, acute or long-term medical condition or the impact of ageing. Our unique skills lie in being able to understand the physical, cognitive, sensory and mental health influences on our client’s abilities to carry out activities of daily living that they want, need and have to do. In addition we are able to understand the critical interaction between the person, their environment and occupations they wish to return to being able to do.
So my plea to all OTs working in this area is to complete the ‘Consultation survey for the independent review of Disabled Facilities Grants’ promote the value of occupational therapy in the home modification process and put the client firmly at the centre of this process.
And finally, lets fight for our profession, we are awesome and must never forget it.