Introduction

Individuals go through a demanding functional rehabilitation process following a spinal cord injury (SCI). Having an SCI involves taking into account important issues (e.g., financial support, insurance, technological devices or equipment) when planning for discharge home. Appropriate housing and attendant care are cornerstones of successful community reintegration. In cases where individuals are more vulnerable, the quality of these resources, especially in terms of functionality and availability, can make the difference between whether an individual can live independently or not.

For the past three decades, these issues have been of interest to both the academic and disability communities and have been addressed to some extent. The work done by the disability community has been oriented towards increasing access to specific resources, such as support and equipment, as well as to mainstream resources such as transportation, housing, health, and educational services. These advocacy actions have been undertaken to increase choice and control over issues related to the living arrangements of people with disabilities, in particular those with SCI. In this chapter, we present the findings specific to people with SCI.

Housing is a fundamental need for all people. Finding appropriate living arrangements within the community can be difficult for many people with SCI after they are discharged from rehabilitation. Because of the cost associated with altering the physical environment to accommodate someone with SCI, housing presents a financial challenge and therefore can be a significant obstacle limiting one’s opportunities to resume an active role and fully integrate within the community. Housing and quality of built environment play a key role in the social participation of people living with an SCI. The quality of the housing, the opportunity to choose one’s living environment and the availability of community resources and support all play a key role in the community reintegration and social participation of people living with an SCI.

Attendant care services are a resource designed to provide a person with SCI with support so they can engage in activities of daily living that are considered important. This support is usually put into place after discharge from rehabilitation when the individual returns to his/her community. Several important decisions are required when considering attendant care services, such as who will provide the support, how it will work, and who will pay for it. At the same time, the relationship between rehabilitation services and community resources must also be considered in the context of the built environment to ensure the best opportunities for independent living among people with SCI. For example, the quality of housing adaptations can influence how the attendant care services will be provided in terms of the intensity and frequency of care.

In this chapter we provide a review of literature related to housing and attendant care services, and the influence of these factors on the quality of life and social participation of people with SCI living in the community. In order to develop a more comprehensive analysis of this material, the literature selection and review methods used have been expanded beyond those traditionally used for the other SCIRE reviews (see SCIRE Review Process and Methodology). Specifically, two new databases with a focus on the social sciences were searched (Social Sciences Abstracts and Social Work Abstracts), and the inclusion criteria were broadened to include any study (including qualitative studies) that was at least partially community-based examining factors influencing satisfaction with housing and attendant care needs after SCI, issues with access, and/or interventions improving outcomes.