63. CCA Study Notes: Rehabilitation Services, Settings, and Home Assessment

The Big Picture

People receive rehabilitation services in different places, including hospitals, specialized facilities, long-term care facilities, and community programs.

Rehabilitation also looks at how well a person’s home fits their needs. A home assessment checks access, daily living areas, mobility, and safety. Support workers also have an ongoing role in watching for home safety problems and reporting concerns.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Health Problems That Often Require Rehabilitation

Many health problems require rehabilitation services. These include:

• acquired brain injury
• alcoholism
• amputation
• brain tumour
• burns
• cerebral palsy
• chronic obstructive pulmonary disease
• mental illness
• myocardial infarction, or heart attack
• Parkinson’s disease
• spinal cord injury
• spinal cord tumour
• stroke
• substance abuse

Rehabilitation services are available in health care facilities and community settings.

Hospitals

Most hospitals have rehabilitation units for both inpatients and outpatients ⓘ.

Many hospital rehabilitation programs focus on:

• brain injury and brain tumours
• spinal cord injury
• stroke

Some hospitals also provide cardiac and respiratory rehabilitation. Some programs serve people with complex medical or surgical conditions, including wounds and unstable diabetes.

Rehabilitation Robotics

Rehabilitation robotics refers to robotics and technology used in rehabilitation medicine.

Research in rehabilitation robotics has focused on improving quality of life through robotics and technology.

Research in this area includes:

• wheelchair biomechanics
• technologies that assess spinal structure and function
• assistive robotics
• virtual reality

Virtual reality uses computer technology to create a simulated image or environment.

Robotics in rehabilitation are currently used mainly by physicians and rehabilitation teams. In the future, robotic devices adapted for rehabilitation use in homes and clinics will likely become the norm.

Specialized Facilities

Some health care facilities focus on particular health problems.

Examples include facilities that focus on:

• mental health disorders
• substance abuse or addiction

Long-Term Care Facilities

Most long-term care facilities provide rehabilitation services similar to those found in hospitals.

Some facilities use the term restorative care rather than rehabilitation because the client and family, nurses, and support workers provide the care.

Restorative care focuses on preventing health deterioration, maintaining or improving quality of life, and restoring the client toward their previous level of functioning as much as possible.

Community Care

Community rehabilitation services include:

• home care services
• adult day programs ⓘ

A community program for people with brain injuries, for example, might teach life skills, social behaviour, and work techniques.

Home Assessment

The rehabilitation team assesses the client’s home to identify safety risks and health hazards.

After the assessment, the case manager or occupational therapist discusses identified concerns with the client and family. Changes are made when needed to make the home environment more appropriate for the client.

During the assessment: A support worker may be asked to assist a rehabilitation team member with the home assessment.

After the assessment: The support worker should continue watching for safety risks during future contacts with the client and gently suggest changes to the client or family to ensure a safe environment.

Report: If the support worker identifies a problem, they must report it to the supervisor.

What a Home Review Looks At

A home review examines different parts of the client’s environment. The review looks at whether the client has suitable access, whether the home supports needed movement and activities, and whether safety concerns exist.

Outdoors

• the location of the parking area and its distance from the door
• the location of the mailbox
• where the client’s vehicle is parked, when the client has one
• car-door width
• whether the client can turn the key and open and close doors
• whether ramps or handrails are needed
• whether entrances have enough lighting
• whether the client has access to private or public transportation
• whether the client can operate a motor vehicle
• the widths and heights of ramps and sidewalks, when present

Indoors

• obstructions on floors
• steps in the home and where they are located
• furniture arrangement and whether the client can use the furniture
• telephone locations
• whether the client can raise and lower windows
• floor coverings, including carpeting, tile, hardwood, and throw rugs
• whether a client using a wheelchair can move throughout the home
• the location of the fuse or circuit-breaker box ⓘ
• whether the client can control the heating
• whether walkways, doors, and halls are wide enough for a wheelchair when needed
• whether an elevator is available when the client lives in an apartment or condominium building

Kitchen

• access to the stove, sink, cupboards, storage areas, workspace, refrigerator, and other appliances
• the height of the sink and countertops
• whether enough open space exists under the sink for a wheelchair when needed
• whether the client can turn faucets on and off
• whether the client can use the microwave oven
• whether the client can reach stove knobs
• whether appliances are arranged for the client’s convenience

Bathroom

• the heights of the sink, toilet, shower, and tub
• whether the client can reach the faucets
• whether the client can turn the faucets on and off
• whether enough space exists for a wheelchair or another needed mobility device
• whether the client can get into and out of the tub or shower
• whether grab bars are present near the toilet, shower, and tub

Bedroom

• the height of the client’s bed
• whether the client can access the closet and reach its rods and shelves
• whether the client can transfer into and out of bed safely
• furniture arrangement
• whether the furniture arrangement allows use of a wheelchair or another needed mobility device
• the location of the nearest bathroom

Overall Safety

The safety review checks whether:

• the house number is easy to see and read in an emergency
• deadbolts ⓘ and locks provide complete security and the client can use them
• the client can see and speak with a visitor at the door without being seen
• steps, the porch, and the front door have enough lighting
• steps, the porch, and the front door have protection from rain, sleet, and snow
• a nonslip doormat is present
• the client can use the telephone
• emergency telephone numbers are kept close at hand
• the client can control the water temperature
• electrical outlets have childproof covers
• smoke detectors are present and working
• rooms and hallways have enough lighting
• the client can control indoor and outdoor lighting
• the client can leave the home quickly during an emergency
• oxygen is used in the home and safety measures are in place when needed
• the client has access from bed to a telephone or cell phone, television, radio, laptop or electronic tablet, and lights
• space heaters are used and safety measures are in place when needed
• the client shows good judgement about cooking and stove use
• fire extinguishers are available in the kitchen and near fireplaces
• children have a safe play area
• the client can safely dispose of blood, body fluids, secretions, and excretions
• trash is stored in a way that remains free from pests