Respect for Client’s Competence…  There is huge meaning in one little word:  WITH


Considering the following statements:

  • “Here is the plan I made for you” vs. “Here is the plan I made with you.”
  • “I did this for you” vs. “I did this with you.”
  • “I can solve this problem for you” vs. “I can problem solve with you.”

The best professionals in any field work WITH clients, not FOR clients.

With” is respectful and teaches self-advocacy skills.

With” builds a strong relationship with clients, working together to solve problems as a team.

With” communicates a strong message that the client is competent and knows their own wants and needs.

What is Competence?

Competence is a client’s capacity (or ability) to make and implement wise decisions (reference: Model of Human Occupational by Keilhofner, 2008).

In practice, this would mean that the client is competent, having valuable input and knowledge in every part of the home modification process:

  • The client is competent to identify problem areas in their daily routines (or occupations).
  • The client is competent to set goals for improving performance or participation in the home environment.
  • And, the client is competent to select and implement interventions (such as home modifications or improvements).

This does not mean that the client knows all the information or has all the skills necessary to do this alone, just that their input is inherently critical to the process. This leads to professionals and clients working as a team, with different team members having expertise in different areas, but the client has the capacity to direct team’s work. (More on the home modification team here.)

Who is helping who?  The key is working together with clients.

Example: OT and handyman working “for” a client

Joan’s OT recommends a grab bar be installed in her home bathroom because the OT assumes that Joan is struggling to sit and stand from her toilet after a painful knee replacement.

The OT has the client call and hire the handyman with the instructions to put a grab bar by the toilet. The handyman comes out with a standard grab bar (silver color, 42” long) and installs it based on ADA guidelines (placed horizontally, 36” up from the floor). (See examples of ADA guideline here:

However, when Joan sees the grab bar, she hates the look of it. When she tries the grab bar out, it feels too high and hurts her shoulder when she pushes up on it.

The result:

Joan can use the grab bar, but it causes her pain. She also hates how it makes her bathroom feel like a “public toilet” and how it makes her feel disabled. She would remove it, but then there would be holes left in her walls. Joan is left feeling dissatisfied with both the OT and handyman, and she does not know how to proceed in solving her problem. She feels helpless.

Traditional grab bar that was unacceptable to client.

Example: OT and handyman working “with” a client

Joan’s OT visits her at home and asks about using the toilet after her knee replacement. She learns that Joan’s husband has been coming in to help her stand up from the toilet because she is fearful of falling.

The OT emails the MD to recommend a physical therapy referral to work on balance and strength. The OT also recommends a grab bar near the toilet to help her stand up safely without her husband’s help. Joan expresses concern about the appearance, so they look together for ideas that would fit better into her bathroom décor.

The OT communicates with the handyman in advance and asks him to bring 2-3 specific options to look at. The OT, handyman, and Joan meet together; Joan is able to be part of the team, giving her input and asking questions at each stage of the process.

The OT simulates the toilet transfer with a variety of handholds for support to mimic the grab bar styles and positions. They found that she needs placement at about 30” due to her short height and near her torso to allow her to push up in a positions that didn’t hurt due to her shoulder and wrist arthritis. She only needs a single hand hold to get up, so they select a toilet paper holder that had a grab bar built in on top. The handyman marks the exact spot, verifies feasiblity of the location, and recommends appropriate wall anchors to hold the necessary force/weight with transfers. Installation is done while OT is present, and Joan is able to try out her new grab bar before the team leaves to ensure it works well for her.

The result:

Joan can use her toilet safely and independently with the new grab bar, and she feels that it blends well into her bathroom and can be left in place long-term. Joan was part of the entire process, working with the OT and handyman. She felt competent to make decisions with the help of professionals.

Joan begins to advocate more for herself in other areas of daily living, such asking her OT questions like, “What can we add to help me get up from the couch?” and “Do you have any ideas about my spring garden?”

Joan’s bathroom.


Grab bar alternative solution that was functional and appealing to client.

Common Concerns:

My client says they don’t know what they want?

  • What they probably mean is they don’t know how to solve their problem, and that is ok. The professionals (such as an OT and handyman team) are there to help in this process. Most clients do know what the problem is and what his or her goal is, if you take the time to talk through it together. Many times the client needs reassurance that there are solutions available and professionals committed to helping them find the right solution.  (Learn more about who benefits and what the benefits are of home modifications.)

This will take too much time!

  • Yes, it will likely take longer. However, doing the job right the first time will save time. Satisfied customers are really good for business in the long-term. Clearly defining team members roles and working together with clear communication will help make this more efficient. (Learn more about the home modification team here.)

My client refuses all my ideas?

  • Clients who are refusing all ideas likely need to spend some time deciding if they have a problem they want help solving. Often, professionals jump in before the client is ready to make changes, which only leads to frustration for everyone. Some clients may be ready to problem-solve, but need to given control in the process because of the impact of the home modifications on their home (read more about the meaning of home here.)

My client wants to be in control, but his/her ideas won’t work (or aren’t safe).

  • If the client’s ideas are not safe or effective, we must provide clear counsel based on our professional judgement. First, we must always listen and understand.  Then we take the time to teach and explain and work with a client’s concerns. However, your client still gets to make their own decision, which may not always align with the professional recommendations. Ultimately, the more the team works together and respects the values and priorities of the clients, the better the solutions will be.