Valuing Home Modifications
About the Project
Home modifications can provide value and value for money in a number of ways – from more measurable outcomes like a reduction in paid caregiving hours (which can pay back the cost of the modification many times over) - through to harder to quantify, but equally important domains, such as improved health, activity, participation, wellbeing, control, autonomy, dignity, safety and quality of life.
This project explores the definitions and uses of value and value for money from the perspectives of a range of stakeholders in the home modification process. Phase one of the project engaged with 20 occupational therapists (OTs) across Australia. Phase two engaged with 16 'end-users' of home modifications (i.e. the people whose homes are being modified) to improve understandings of how these central concepts are being defined, measured and applied within home modification practice in Australia.
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Summary of Key Findings - Phase 1
When prescribing home modifications, OTs are often asked to provide estimations of value and value for money to funders. Yet there is often an absence of clear guidance and definitions these concepts for application in practice.
Value for money is a critical factor in many home modification schemes, however there is an identified lack of clear and consistent frameworks for determining value for money when prescribing home modifications. OTs reported using a range of individual approaches, the most commonly reported of these were:
- Formal care as a metric
- Informal care as a metric
- The ‘Cheapest option’
- Value for money over time
OTs occupy a unique position at the intersection between clients and families, organisations and systems. OTs spoke of challenges associated with reconciling or aligning the values of different stakeholders (i.e. Funders and end-users) in the Home Modification process. This ‘value alignment’ work is often unarticulated, but emerged as critical in creating solutions that all stakeholders consider to be valuable. Among the challenges they faced in ‘aligning values’, clarity from funders regarding how value and value for money would be determined was one of the greatest. Funding schemes with collaborative or team-based approaches (i.e., those where the funder collaborates directly with professionals and clientele to co-produce solutions) were reported more positively by occupational therapists. Specifically, this type of approach can facilitate more explicit communication of values and decision-making criteria, enabling more direct ‘value alignment’ between stakeholders.
This study has highlighted that value for money determinations are not purely economic in nature but require the ability to understand and balance the values and expectations of different stakeholders. It has captured the importance of articulating, and making transparent, the range of stakeholder values which underpin understandings of what does or doesn’t constitute value for money.
Summary of Key Findings - Phase 2
The 'Survive-Strive-Thrive' Framework of Home Modifications was developed out of the phase 2 data. Full publication of phase 2 findings is forthcoming.
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