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Housing

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Housing is a primary need for all individuals. The necessity of having a safe home compatible with one’s personal needs increases when an individual is vulnerable. One of the first questions asked when a person has sustained and survived an SCI is where he/she will be able to live. Successful community reintegration is intimately linked to housing within the background of the person’s needs, the attributes of relevant environmental factors, and the preferred choice of living environment of the person with the injury. Until recently, SCI authors generally only discussed the issue of the suitability of a home regarding its physical accessibility and adaptations (Heywood 2004; Forrest and Gombas 1995; McAweeney et al. 1996). Forrest and Gombas (1995) showed that a lack of accessible housing increases a person’s length of stay on the rehabilitation unit, thus increasing the overall cost of healthcare services after SCI.

The choice of living environment for people with SCI is critical because of their increased need for human and environmental support, requiring them to carefully consider who they will live their life with and where. In some cases, individuals with SCI do not have a choice because of the lack of accessible housing inventory. Having a range of choices of housing likely hastens and enhances the transition from rehabilitation to community while improving the personal match to the living environment. Sixteen non-intervention housing articles are presented below. Given stable housing is a basic human need, ethical research practice precludes the development of intervention studies in this research area.

Table 1: Housing

From the onset of SCI, the rehabilitation services and the resources required for independent living remain two of the key elements for successful community reintegration. This is particularly true for people with spinal cord injury who use more services (particularly related to housing) than other consumers with disabilities such as TBI or Stroke (Fuhrer et al. 1990). According to Tate and Forchheimer (1998) participation in an independent living program (e.g. peer counseling, group support, etc.) can provide better knowledge of the resources needed and may lead to better personal control and adjustment upon return to the community. However, a follow-up study of an independent living program revealed it had little or no impact on life satisfaction or personal control of participants with SCI (Forchheimer and Tate 2004). Marital status and transportation barriers are the most important predictors related to living arrangement post-SCI (DeJong et al. 1984). Boschen (1996) found the best predictor of residential satisfaction was having the perception of choice of residence, and satisfaction with residential placement was correlated with life satisfaction. Boschen (1988, 1990) found the level of satisfaction with the home is also related to difficulties encountered living in the home, primarily because of environmental barriers. Moreover, the level of satisfaction was higher among persons with SCI living in their own apartment. In previous work, Boschen (1988) revealed having one’s own apartment was preferred by the individuals with SCI and their choice is determined by the quality of the environment, particularly in terms of accessibility. The choice of residence is limited by many factors and the limitations are magnified as the severity of disability increases. Therefore individuals with tetraplegia are at a significant disadvantage. The findings indicate those with tetraplegia move several times after discharge from rehabilitation. The moves are influenced by factors such as information, money, accessibility, insurance, personal assistance, etc. Individuals with SCI who eventually end up living with their parents or in an institution consider such living arrangements as their last option (Bergmark et al. 2008). Anzai et al. (2006) found certain social and personal factors (e.g. age, having insurance or private funding) reduce the risk of moving to a nursing home after discharge from rehabilitation. A low FIM score appears to increase the risk to move to a nursing home amongst individuals with SCI after rehabilitation discharge (Gulati et al. 2010). Living in an environment considered to be minimally restrictive which enables active participation in daily decisions according to the principles of independent living is more likely to contribute to improved quality of life (DeJong and Hughes 1982). Finally, safety at home is important to persons with SCI, particularly related to fire. Many participants indicated they would need assistance with this dimension of home safety (Cesar et al. 2002).

The evidence reveals the importance of the continuity of services between rehabilitation and return to the community (Fuhrer et al. 1990). The lackof accessible housing is an important barrier which may have an impact on the community reintegration process as well as on rehabilitation service costs. According to the findings by Kennedy et al. (2010), the transition process is difficult because of the lack of resources, mainly in terms of adaptation, accommodation and equipment. Community services play an important role, especially in housing and peer support to return to independent living (Fuhrer et al. 1990; Tate and Forchheimer 1998). Finally, the quality of the built environment is one of the key determinants of the ability to find housing which meets the needs of persons with SCI, which also affects their level of satisfaction with respect to where they reside. Freedom of choice related to selecting where they will live constitutes as a lient feature of life satisfaction for many. However those individuals who encounter obstacles (related to accessibility, financial support and so on) will likely have little choice when it comes to selection of housing (Boschen 1988; 1990). Scovil et al. (2012) provide evidence of chronic housing problems for individuals with SCI in Nepal, finding approximately 80% of individuals are unable to enter their homes independently (Scovil et al. 2012). Some qualitative findings revealed individuals with SCI experienced some difficulties when they returnedhome. Those difficulties are related to loss of camaraderie, lack of post discharge care and negative experiences with other persons related to being a wheelchair user (Dickson et al. 2011). Drawn on a qualitative study, individuals with SCI who described their community in social and relationship terms presented a more positive perspective of the community than those who described it in terms of physical space and access (Kuipers et al. 2011). Despite opportunities to participate in transitional or independent living programs before discharge from rehabilitation, the common finding of this body of work is the move back into the community following SCI seems to be a real test of both the supportiveness of the environment and the resilience and resourcefulness of the individual in determining the success of the reintegration.

Conclusion

There is level 5 evidence (Forrest and Gombas 1995) that discharge from hospital was delayed for a significant portion of SCI patients due to lack of accessible housing, which leads to unnecessary increase of cost of care.

There is level 5 evidence (Fuhrer et al. 1990) that ILCs with MRP relationships serve more clients than those without, and that the most frequently serviced individuals are those with SCI who attend for peer counseling, skills training, and discharge planning.

There is level 5 evidence (DeJong and Hughes 1982) that living with a spouse and/or children, living alone, or living with unrelated persons were more desirable arrangements than living with parents and spouse/children together, living with distant family (i.e. grandparents), or living with parents and siblings.

There is level 4 evidence (DeJong et al. 1984) that marital status, transportation barriers, education level, medical supervision requirements, economic disincentives, services received, and severity of disability are predictors of independent living.

There is level 5 evidence (Boschen 1996) that issues of choice and control are important when planning living situations and setting goals with clients because they are directly related to residential and life satisfaction.

There is level 5 evidence (Boschen 1990) that individuals with SCI have lower perceived life satisfaction, locus of control and satisfaction with certain aspects housing than a normative sample.

There is level 5 evidence (Boschen 1988) that accommodation options for a person with a disability are limited. The preferred accommodation is a private house or apartment.

There is level 5 evidence (Anzai et al. 2006) that living with someone prior to SCI, having insurance or private funding for equipment, and being younger decreases the risk of being discharged to an extended care facility following SCI rehabilitation.

There is level 5 evidence (Cesar et al. 2002) that individuals with SCI have a need for assistance with fire safety to increase their perception of home safety.

There is qualitative evidence (Bergmark et al. 2008) that suggests individuals with SCI move multiple times after injury. In most cases they start living with their parents and/or in an institution before moving into their own homes.

There is qualitative evidence that suggest individuals with SCI have difficulties adjusting to life at home (Dickson et al. 2011). Reported difficulties are related to the loss of camaraderie, lack of post-discharge care and negative experiences with other people related to being in a wheelchair.

There is qualitative evidence (Kuipers et al. 2011) that suggest individuals with SCI who described their community in social and relationship terms reflected more positive views about this community compared to those who described their community in terms of physical space and access.

  • In many cases, discharge from hospital is delayed for SCI patients due to lack of accessible housing, which leads to unnecessary increase of cost of care.

    ILCs with MRP relationships serve more clients than those without, and the most frequently serviced individuals are those with SCI who attend for peer counseling, skills training and discharge planning.

    Living with a spouse and/or children, living alone, or living with unrelated persons are more desirable arrangements than living with parents and spouse/children together, living with distant family (i.e. grandparents), or living with parents and siblings.

    Marital status, transportation barriers, education level, medical supervision requirements, economic disincentives, services received, and severity of disability are predictors of independent living.

    Choice and control are important when planning living situations and setting goals with clients with SCI because they are directly related to residential and life satisfaction.

    Individuals with SCI have lower perceived life satisfaction, locus of control, and satisfaction with certain aspects of housing than a normative sample.

    Accommodation options for a person with a disability are limited. The preferred accommodation is a private house or apartment.

    Living with someone prior to SCI, having insurance or private funding for equipment, and being young decreases the risk of being discharged to an extended care facility following SCI rehabilitation.

    Individuals with SCI have a need for assistance with fire safety to increase their perception of home safety.

    Individuals with SCI move multiple times after injury. In most cases, they start living with their parents and/or in an institution before moving into their own homes.