Building Health into Homes: Why Housing Matters

A blog by Kate Sheehan, Occupational Therapist

I recently attended the launch of the Royal College of Occupational Therapists, ‘Building Health into Homes’ strategy report^[i] which prompted me to reflect on the importance of our homes and the impact poor housing has on our client’s occupational engagement. It states that poor housing costs health and social care £1.5 billion per year^[ii] This represents a significant cost that could be redirected to other services, if our housing stock provided for the needs of our population.

The launch made me reflect on my occupational therapy training, where I was first introduced to Maslow’s Hierarchy of Needs, developed by Abraham Maslow in the 1940s and 1950s, a theory that remains relevant today. This psychological theory explains that human motivation is driven by five fundamental categories of need, typically represented as a pyramid. It suggests that the essential needs at the base must be met before individuals can focus on the more advanced growth needs at the top. Within this foundational tier, one of the most critical requirements is shelter.

It is important to acknowledge that Maslow’s theory has been subject to criticism. Critics argue that it lacks robust empirical evidence, oversimplifies human motivation, reflects predominantly Western values, and offers a generic framework rather than placing the individual and their personal priorities at the centre. Nevertheless, there is substantial evidence that supports the view that having a home, or shelter, is fundamental to human wellbeing. 

Without a shelter that we can call home, we cannot survive. So what constitutes shelter? According to the RCOT report, a ‘home should be a safe, supportive space where health and wellbeing can thrive.’ As occupational therapists, are we discussing with our clients the impact their home environment has on their recovery and their ability to choose to do the occupations that bring them meaning and joy?

When working with our clients at Adaptation Design, the initial meeting is with our in-house occupational therapy team, as the meaning of home for each individual needs to be explored through an in-depth conversation about what they need to do and more importantly what they want to do in their own home. What does ‘self actualisation’ mean to them? We may not use those words but our goal is always to enable them to reach what they see as their potential.

It is important to remember that often our goals as therapists may not align with our client’s ‘wants’ and we must stop and listen to them to understand their priorities. A classic example is, we may be looking at how a client will be showering themselves as a task, yet the client may articulate they would rather be assisted to give them energy to play with their child. The environment should then be designed around a space suitable for paid care support; a working environment, with the future proofing element that as the client’s children grow and leave, they may wish to shower themselves.

In conclusion, accessible and well-designed housing is not simply a matter of comfort, it is a foundation for wellbeing, independence and participation. By understanding what home means to each individual and designing environments around their priorities, occupational therapists can help people achieve meaningful outcomes and improve their overall quality of life.

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^[i] https://www.rcot.co.uk/latest-news/poor-housing-damaging-health-driving-pressure-health-services

^[ii] https://www.health.org.uk/sites/default/files/pdf/2023-12/2023%20-%20Housing%20and%20health_0.pdf