Home for Life Design™

Home Assessment Report
Danielle Palmer of Touro University, performed the following occupational therapy home assessment to determine the
safety and current functional status of Palmer in the home. This report details Dodi Palmer’s feeling of safety and
measures the accessibility of important occupations that occur throughout areas of the home. Information was gathered
via professional interview with the client and/or family, activity analysis, objective measurements and photography. This
assessment was performed on: 9/10/2015

Patient Information:
Patient Name:

Palmer, Dodi

Date of Birth: 3/10/1931

Address:

2840 S Mann St

Gender:

Las Vegas, NV 89146

Height (in) 64, Weight (lbs) 130

Tennant Type:

Owner

Is Veteran:

No

Housing Type:

Single Family

Has HOA:

No

No. Floors:

1

Lives With:

Self

Female

Special Considerations:
Inaccessible None
Areas:

Assistive None
Devices:

If the client has fallen, did the most recent fall:

Where did the fall occur: N/A

Result in Injury: No

What Room:

Result in Hospitalization: No

Fall Cause Type: N/A

Result in Rehabilitation: No

Fall Cause Comments: The client has not experienced a fall.

Other Considerations:
Consideration Type
Other Concern

Therapist Note
Client wants to be safe living by herself.

Home and Personal Findings:
The following rooms assessed each indicate the Personal Safety Rating given by the patient and the Therapist
Accessibility Rating determined by activity analysis during skill performance:

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Pre-Assessment
Personal Safety
Rating %

Therapist
Accessibility
Rating %

Bathroom, Guest Bathroom

100.00 %

91.67 %

Bedroom, The Master Bedroom

100.00 %

87.50 %

Bathroom, Master Bathroom

100.00 %

90.00 %

Entryway, The Front Entrance Way

100.00 %

75.00 %

Living/Family Room, The Main Living Room

100.00 %

83.33 %

Living/Family Room, Living Room

100.00 %

83.33 %

Room Assessed

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Post-Assessment
Therapist
Personal Safety
Accessibility
Rating %
Rating %

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Home Recommendations Based on Findings:

Bathroom, Guest Bathroom

Personal Safety Rating

Accessibility Rating

100.00 %

91.67 %

Recommended Modifications:
- Towel Bar Grab Bar
- Angled Grab Bar
- Grab Bar Left Side of Bathing Entry
- Horizontal Grab Bar
- 18" - Textured
- Hand Held Shower

Bedroom, The Master Bedroom

Personal Safety Rating

Accessibility Rating

100.00 %

87.50 %

Recommended Modifications:
- Organize/Declutter Space

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Bathroom, Master Bathroom

Personal Safety Rating

Accessibility Rating

100.00 %

90.00 %

Recommended Modifications:
- Towel Bar Grab Bar
- Angled Grab Bar
- Grab Bar Left Side of Bathing Entry
- Horizontal Grab Bar
- 18" - Textured

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Entryway, The Front Entrance Way

Personal Safety Rating

Accessibility Rating

100.00 %

75.00 %

Recommended Modifications:
- Add Visible Steps
- Add Hand Rails

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Living/Family Room, The Main Living Room

Personal Safety Rating

Accessibility Rating

100.00 %

83.33 %

Recommended Modifications:
- Organize/Declutter Space

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Living/Family Room, Living Room

Personal Safety Rating

Accessibility Rating

100.00 %

83.33 %

Recommended Modifications:
- Add Visible Steps

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Additional Service Recommendations (e.g. home health, medication management):
Additional Notes:

Submitted By:

Danielle Palmer, , License #
9/17/2015

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