Valuing home modifications: The street-level policy work of occupational therapists in Australian home modification
This paper reports on the findings of Phase 1 of a larger project, which involved interviews with 20 Occupational Therapists with experience in undertaking Home Modifications across Australia.
Phase 2 in currently underway, and involves interviews with individuals with disability & families who have experienced the home modification process.
Summary of Key Findings (Phase 1)
Concepts of Value for Money and Value in Occupational Therapy:
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
Aligning values and managing expectations
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.
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