Occupational therapist home evaluations: inequalities, but doing the best we can?
OBJECTIVE
The purpose of this study was (a) to describe the occupational therapy recommendations provided to patients discharged to inner city homes, and (b) to examine the relationship between patient health insurance and the number and type of occupational therapist recommendations for equipment and home modifications.


METHODS
An archival review was conducted of all referrals to the home evaluation program (n = 755) at a large urban rehabilitation hospital between January 1, 1994, and December 31, 1998. Additional patient demographic data and Functional Independence Measure (FIM) data were obtained in electronic form from the hospital information database.


RESULTS
Analysis of results showed that while the pattern of equipment and modification recommendations varied little, publicly insured patients received fewer home modification recommendations compared to privately insured patients (t = 3.7; p < .0005), and were discharged from rehabilitation with significantly lower functional independence (MANOVA F = 3.9; p = .05).


CONCLUSIONS
Results alert occupational therapists to the relationship between health insurance and treatment recommendations and point to patient advocacy and health policy as potential pathways to desired a achieve social change.
Lysack
Catherine L
CL
Institute of Gerontology, 231 Knapp Building, 87 E. Ferry Street, Wayne State University, Detroit, Michigan 48202, USA. c.lysack@wayne.edu
Neufeld
Stewart
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000458:organization & administration / Q000706:statistics & numerical data; D012047:Rehabilitation Centers; D014505:Urban Population