PURPOSE: The purpose of this study was to develop and validate a protocol that a typical caregiver can use to assist an occupational therapist in conducting a remote home-safety assessment.

RATIONALE: Older adults overwhelmingly want to stay home as they age. However, age-related frailty and disability can limit the ability to function at home and can result in falls and accidents. In areas of poor access to occupational therapy, strategical assessment of home-safety and older adults’ aging in place is often not available. Therefore, we developed a standardized remote assessment protocol that guides caregivers to remotely provide occupational therapists with information about their home environments.

DESIGN: Iterative development and qualitative validation of a protocol by using cognitive interviewing techniques of caregivers and practical demonstrations

PARTICIPANTS: A team of experts including 2 occupational therapists, an architect researcher, and 6 research team members specializing in rehabilitation, aging, accessible design, and technology developed the protocol. Then, 6 caregivers of veterans from the Gainesville Veterans Affairs Medical Center participated in the validation of the protocol.

METHOD: A literature review was conducted to identify research-based home-safety instruments/checklists. The research team developed the first draft of the protocol based on the identified instruments. The protocol was further refined on the basis of the consent of an expert group panel and validated with a group of 6 caregivers. Cognitive interviews and demonstrations were iteratively conducted with all caregivers. Experts’ agreement was obtained for final validation of the protocol.

ANALYSIS: Descriptive analysis of experts’ group meetings and qualitative validations of caregivers’ feedback and demonstrations

RESULTS: Our literature review revealed 20 instruments that have research support. We selected the Westmead Home Safety Assessment for the guidance of the first protocol because it is research based and validated and showed good interrater reliability. Experts and the research team’s suggestions were adding a narrative component to the protocol, avoiding technical tasks (i.e., taking measurements), avoiding biased language, providing directive action guidance, offering step-by-step instruction, using illustrations, and embedding occupational therapists’ perspectives.

Cognitive interviews and hands-on demonstrations resulted in simplification of the language, designing a separate section of guidelines to stress three key factors to remember—checking the flashing red light of the camera, watching out for steps while recording, and vocally describing the home environment. The readability level of the protocol was at the sixth-grade level.

DISCUSSION: We developed and validated a protocol for conducting a remote home-safety assessment based on experts’ opinions and caregivers’ feedback and demonstrations. The finalized protocol includes an appealing design including illustrations, a convenient size, and well-balanced distribution of information and tasks. This protocol should enable caregivers to provide clinically significant information to assist occupational therapists in conducting a remote home-safety assessment. In a follow-up study, we will test the equivalence of using remote assessment compared with the gold standard of practical assessment.

IMPACT STATEMENT: By following a standardized remote assessment protocol, a caregiver’s assistance can help an occupational therapist obtain meaningful information to evaluate loved ones’ safety and function at home.