Of particular relevance and importance is the applicability, or lack thereof, of randomized controlled trials and longitudinal studies (Wahl et al., 2009). Clearly, a myriad of issues confound environmental studies. A synthesis of the evidence. (1997). Nonetheless, housing is not being designed, and often is not being remodeled, with these needs in mind. Like home modifications and assistive technologies, medical devices and technologies for self-management can have a large impact on the home environment and on the individuals living there. As a result, interventions based on such information are determined irrespective of the actual abilities of the individuals for whom the interventions are intended. However, linking specific environmental barriers and facilitators in the home directly to activities is a formidable task (Connell et al., 1993; Connell and Sanford, 1997). Amityville, NY: Baywood. 171-191). Traditional medical models (World Health Organization, 1980) attribute activity performance and health outcomes primarily to an individual’s functional abilities. American Journal of Public Health, 93(9), 1,451-1,456. On the demand side, the fragmented delivery system also ensures that consumers are uninformed about the benefits and costs of UD and other environmental modifications. Generally the assumption is that the faster one can perform a task, the better. (2002). ), The psychology of adult development and aging (pp. Subjective dimensions of environmental adaptation among the elderly: A challenge to models of housing policy. Yet the earliest example of a building law—the New York City Tenement House Act of 1867—was precisely a means to social policy (Davis, 1997). Whereas Lawton’s environmental press model suggests the role of the environment in activity and health, the enabling-disabling process model of the Institute of Medicine specifically identifies the environment as a pathway for intervention (Institute of Medicine, 1997). Reviews of Environmental Health, 19(3-4), 223-252. 277-303). To do so, measures of efficacy must be defined that are relevant to individuals, programs, and government agencies on both the supply and demand sides of the equation. However, because the reimbursement system is client-centric, it is concerned with meeting the needs of individual clients. Scheschareg, R. (2006). However, simply getting this technology into homes is only part of the problem. Technology has long been an integral part of health care delivery, primarily in clinical settings to permit diagnosis, intervening treatment, and care of acute or chronic health conditions. However, these visitability ordinances are by no means “universal design lite.” Visitability enables wheelchair users to visit. While assessments of expected demand link environmental attributes to expected levels of ability and activity performance, few assessments examine all three: (1) ability, (2) activity, and (3) attributes. The question, therefore, is not about the costs of housing if UD is made a health care intervention, but about the costs of care if nothing is done. Although the article is based on reimbursement for an assistive device, the same policies hold true for environmental modifications. The physical environment of the hospital may appear to be a very superficial factor, but it can in fact strongly affect the health of patients one way or another. Disposal of medical supplies, particularly used needles, and a backup generator in case of a power outage are also major considerations. 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