Home Safety Self-Assessment Tool

Last Updated

September 05, 2024

Purpose

The Home Safety Self-Assessment Tool (HSSAT) is a resource aimed to reduce falls among older adults by identifying and addressing safety hazards in their homes.

Link to Instrument

Acronym HSSAT v.5

Area of Assessment

Life Participation
Occupational Performance
Quality of Life
Self-efficacy

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

Not a CDE – last searched 3/12/24

Older Adults and Geriatric Care

The HSSAT (v.5) consists of 7 major sections:
- The home safety self-assessment checklist and solutions
- Assistive Devices and Helpful Products to Prevent Falls: recommendations for products that can enhance home safety, such as grab bars, non-slip mats, and improved lighting solutions
- Home modification services, stores carrying durable medical equipment, and organizations to provide free services in Erie, NY
- "How to" Home Improvement Instructions: Step-by-step guides to assist users in making necessary modifications
- Tips for Fall Prevention: General advice to help prevent falls beyond the specific hazards listed
- ADA (Americans with Disabilities Act) instructions for the home environment
- Action Log: documentation method to record the hazards identified, actions taken, and dates of completion
The checklist examines and provides solutions for 10 specific areas of the home: Entrance to Front Door and Front Yard (1), Entrance to Back/Side Door (2), Hallway or Foyer (3), Living Room (4), Kitchen (5), Bedroom (6), Bathroom (7), Staircases (8), Laundry Room/Basement (9), Garage (10). Garage is the area most recently added to the HSSAT (v.5).
For each area, users review a list of potential hazards in each area. If a hazard is present, the user checks the corresponding box. After assessing all items in an area, the user counts the number of checked boxes to determine the total hazards for that section. This process is repeated for all areas, culminating in a grand total of hazards identified throughout the home.
The presence of hazards in each area can range from 0 to 10 determined by the number of home hazards identified
Maximum number of hazards found is 74

Number of Items

74 fall risk items

Pen or pencil
HSSAT Checklist

Approximately 30 minutes

Required Training

No Training

Elderly Adult

65 +

years

Instrument Reviewers

Joe Talbot, Jeremy Manlapaz, Natalie McCormack, & Monica Moy, UIC OTD Students under the direction of Sabrin Rizk PhD, OTR

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
General Health

Professional Association Recommendation

Occupational Therapy Geriatric Group at the University of Buffalo

Community Health Foundation of Western and Central New York

Considerations

Recommended home modifications are not inherently accessible. The HSSAT recommends several home modifications that may be expensive or difficult to install.
The HSSAT relies on individuals or caregivers to accurately identify hazards in their environment. Personal biases, limited knowledge of home safety risks, or failure to recognize hazards may lead to underreporting (Tomita et al. 2014).
Older adults or individuals with disabilities may face challenges in understanding or completing the tool without assistance. Providing caregiver or family support during the assessment can enhance its utility. Alternatively, training healthcare providers to guide individuals through the process may improve outcomes. (Horowitz et al. 2016)
The tool may not account for variations in cultural practices or differences in home layouts across regions or countries. An international version (v.5 int'l) was later revised by Angelo Grazioli for CGA Toolkit Plus in November 2021. https://www.cgakit.com/e-1-hssat?utm_source=chatgpt.com

Standard Error of Measurement (SEM)

Community-dwelling older adults: (Tomita et al., 2014; n = 26; mean age = 75.6 (8.7); 73.1% female; 53.8% living with someone; 46.2% with history of falls; administered 2 weeks apart with the previous version of the HSSAT)

SEM for the entire sample = 0.39

Minimal Detectable Change (MDC)

Community-dwelling older adults (calculated from Tomita et al., 2014)

MDC95 for the entire sample (n = 26): 1.53

Normative Data

Community-dwelling older adults: (Tomita et al., 2014; n = 26 older adults; n = 2 occupational therapists as Raters 1 & 2; n = 34 older adults with a history of falls within one year)

Mean total fall risk factors for the first trial of older adults (n = 26) = 4.5 (3.3)
Mean total fall risk factors for the second trial of older adults (n = 26) = 4.8 (3.3)
Mean number of risk factors identified by Rater 1 (occupational therapist) = 4.4 (1.9)
Mean number of risk factors identified by Rater 2 (occupational therapist) = 4.8 (4.6)
Mean number of risk factors identified by older adults with a fall history (n = 34) = 11.2 (10.6)

Test/Retest Reliability

Community-dwelling older adults: (Tomita et al., 2014)

Excellent test-retest reliability: (ICC = 0.97)

Interrater/Intrarater Reliability

Community-dwelling older adults: (Tomita et al., 2014; n = 2 occupational therapists trained for home safety assessment using older adults’ homes; 5 older adults’ homes tested; home visits within 1 week apart)

Excellent interrater reliability (ICC = 0.893)

Construct Validity

Convergent validity:

Older adults with a history of falls: (Tomita et al., 2014; n = 34; mean age = 77.4 (9.8) years; 91.2% female; 47.1% living with someone; participants first assessed their home with the CDC Home Safety Checklist and later with the HSSAT booklet within 2 weeks)

Excellent correlation between the HSSAT and the CDC Home Fall Prevention Checklist for Older Adults (r = 0.650, p < 0.001)

Discriminant validity:

Older adults with a history of falls: (Tomita et al., 2014; n = 34)

Excellent correlation between HSSAT and the Fall Efficacy Scale (r = 0.103, p = 0.506)

Content Validity

Older adults (Tomita et al., 2014; n = 4 occupational therapists who are experts in geriatric and home safety; each rated fall risk items on a 4-point scale from 1 = not essential to 4 = highly essential)

Excellent: item content validity index (I-CVI) = 0.98

Face Validity

Though not statistically assessed, the HSSAT has a good face validity as it can identify fall risks and can implement reductions of fall hazards in the home environment (Tomita et al. 2014).

Responsiveness

Community-dwelling older adults: (Tomita et al., 2014; n = 104; mean age = 73.3 (9.5) years; 77.9% female; 56.7% living with someone; 51% with a history of falls; 4-week interval between pre- and post-test)

Moderate responsiveness at detecting change 4 weeks after initial testing (standardized response mean = 0.57)

Bibliography

Cedar Midwest. (2017). Home Safety Self Assessment Tool (HSSAT) v.5. https://cedarmidwest.org/wp-content/uploads/2021/12/HSSAT-STL-2021-2.pdf

Home Modification Information Clearinghouse (2020). Evidence Based Practice Review: Self-assessment tools of the person-environment fit. Sydney: Home Modification Information Clearinghouse, UNSW Sydney. (December) [online]. https://doi.org/10.26288/5fec08907af77

Home Safety Self Assessment Tool (HSSAT). homemods.org / NRCSHHM. (2021, November 15). https://homemods.org/materials/home-safety-self-assessement-tool-hssat/

Horowitz, B. P., Almonte, T., & Vasil, A. (2016). Use of the Home Safety Self-Assessment Tool (HSSAT) Within Community Health Education to Improve Home Safety. Occupational Therapy in Health Care, 30(4), 356–372. https://doi.org/10.1080/07380577.2016.1191695

Tomita, M. R., Saharan, S., Rajendran, S., Nochajski, S. M., & Schweitzer, J. A. (2014). Psychometrics of the Home Safety Self-Assessment Tool (HSSAT) to prevent falls in community-dwelling older adults. The American Journal of Occupational Therapy, 68(6), 711–718. https://doi.org/10.5014/ajot.2014.010801