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This two-year project investigated whether use of technological assistance is associated with lower levels of human assistance. Using cross-sectional and longitudinal analyses of the NHIS Disability Survey (Phases 1 and 2), it found that mobility equipment (such as walkers and canes) substitutes for human help and that injurious falls are more common in homes without any basic modifications.
The substitution of mobility equipment for human help: While the use of mobility aids does not mean that a person requiring care can go without the help of another person, it does suggest that the level of help required may be less than if no aids are used, and that aids may allow an individual to remain independent in performing specific daily living activities. However, only 40% of people with mobility and ADL-impairments used any aids at all, indicating that many could benefit from expanded access to such aids as well as more information about their potential usefulness. Use of aids also lowers the cost of home care, since provision of such aids is substantially cheaper than human help. Furthermore, use of assistive technology may be more acceptable to users than dependence on human assistance, potentially increasing the autonomy of adults with disabilities.
The impact of home modifications:The study also found that injurious falls are more common in homes without any basic modifications. In addition, the fact that less than half the wheelchair users reported bathroom modifications and only 10.5% had kitchen modifications suggests that many wheelchair users live with restricted access within their homes. These finding suggest that falls could be reduced if access to home modifications were increased by making home modifications a reimbursable expense under Medicare, Medicaid and other health insurers and encouraging the creation of barrier-free universal design environments.
Finally, the findings of this study suggest the value of investment in research in the area of technological equipment and home adaptations as home care resources. This project represents a promising beginning that validates the need for future investigations.
Publications
Berg K, Hines M, Allen S. 2002.
"Wheelchair users at home: Few home modifications and many injurious falls."
American Journal of Public Health, 92(1): 48.
Allen, S.M. 2001.
Policy Brief: Canes, Crutches and Home Care Services: The Interplay of Human and Technological Assistance.
NY: Home Care Research Initiative, Center for Home Care Policy and Research, Visiting Nurse Service of NY.
Allen, S.M., Foster, A., and Berg, K. 2001.
"Receiving Help at Home: The Interplay of Human and Technical Assistance."
Journal of Gerontology: Social Sciences, 56B(6): S374-S382.
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