The Home and Community Environment Instrument (HACE) is a self-report questionnaire that assesses the physical and social environment of people with disabilities. It was developed by Keysor, DeJong, and Dijkers (1998) to measure the impact of the environment on people’s ability to participate in activities of daily living, instrumental activities of daily living, and social roles.
The HACE consists of 60 items, which are divided into six domains:
- Home mobility: This domain assesses the physical accessibility of the home environment, such as the presence of stairs, doorways, and bathrooms that are wide enough for a wheelchair.
- Community mobility: This domain assesses the physical accessibility of the community environment, such as the presence of curb cuts, ramps, and accessible public transportation.
- Basic mobility devices: This domain assesses the availability of assistive devices, such as wheelchairs, walkers, and canes.
- Communication devices: This domain assesses the availability of communication devices, such as hearing aids, speech-generating devices, and TTYs.
- Transportation factors: This domain assesses the availability of transportation, such as personal vehicles, public transportation, and paratransit services.
- Attitudes: This domain assesses people’s perceptions of the attitudes of others towards people with disabilities.
The HACE has been shown to be a reliable and valid measure of the home and community environment. It has been used in a variety of research studies, including studies of the impact of environmental barriers on people’s quality of life, studies of the effectiveness of environmental interventions, and studies of the relationship between the environment and participation in activities of daily living.
The HACE is a valuable tool for assessing the physical and social environment of people with disabilities. It can be used to identify environmental barriers that may be impeding people’s ability to participate in activities of daily living, instrumental activities of daily living, and social roles. The HACE can also be used to evaluate the effectiveness of environmental interventions.
Here are some of the strengths of the HACE:
- It is a comprehensive measure of the home and community environment.
- It has been shown to be reliable and valid in a variety of research studies.
- It is easy to administer and score.
Here are some of the limitations of the HACE:
- It is a self-report measure, so it is susceptible to social desirability bias.
- It is a relatively new measure, so there is limited research on its long-term validity.
- It is not available in all languages.
Overall, the HACE is a valuable tool for assessing the physical and social environment of people with disabilities. It is a reliable and valid measure that can be used to identify environmental barriers that may be impeding people’s ability to participate in activities of daily living, instrumental activities of daily living, and social roles.
Domain: Home mobility
What type of home of home do you live in?
□ single family □ multi-family □ apartment building or condominium complex □ congregate housing/assisted living □ nursing/rest home □ other
How many steps are at the main entrance of your home?
□ none □ 1-2 □ several □ 10 or more
Is there a railing at the main entrance steps?
□ yes □ no
Is there a ramp at the main entrance steps?
□ yes □ no
Does the door at the main entrance open electronically or is someone available to open the door?
□ yes □ no
How many steps are there from the main entrance of your building to your main living area?
□ none □ 1-2 □ several □ 10 or more
How many steps are there inside your main living area?
□ none □ 1-2 □ several □ 10 or more
Is there a chairlift or elevator inside your main living area?
□ yes □ no
Is there a chairlift or elevator inside your building?
□ yes □ no
Domain: Community Mobility
To what extent does your local community have:
Uneven footpaths or other walking areas
□ a lot □ some □ not at all □ don‟t know
Parks and walking areas that are easy to get to and easy to use
□ a lot □ some □ not at all □ don‟t know
Safe parks or walking areas
□ a lot □ some □ not at all □ don‟t know
Places to sit and rest at bus stops‚ in parks or in other places where people walk?
□ a lot □ some □ not at all □ don‟t know
Curbs with curb cuts
□ a lot □ some □ not at all □ don‟t know
Domain: Basic mobility devices
Do you have:
Manual wheelchair □ yes □ no
Electric wheelchair or electric scooter □ yes □ no
Walker □ yes □ no
Stick or crutch □ yes □ no
Bedside commode‚ raised toilet seat or grab bars near toilet □ yes □ no
Grab bars or bench in tub or shower □ yes □ no
Reachers □ yes □ no
Dressing aids such as button adapters or zipper pullers □ yes □ no
Eating aids such as built-up cutlery or kitchen aids such as cutting boards that hold food or utensils that are designed to be used with one hand □ yes □ no
Domain: Communication devices
Do you have: Aids to help you communicate with people such as boards or papers with pictures or telephones with big dials and hearing devices Voice-output communication aids‚ such as voice generating computers A computer Access to internet
□ yes □ no □ yes □ no □ yes □ no □ yes □ no
Yes = 1 No = 0
Domain: Transportation factors
Do you have a car available to you at your home? □ yes □ no
Do you drive? □ yes □ no
To what extent does your local community have:
Public transportation that is close to your home
□ a lot □ some □ not at all □ don‟t know
Public transportation with adaptions for people who are limited in their daily activities
□ a lot □ some □ not at all □ don‟t know
Adequate disabled people‟s parking
□ a lot □ some □ not at all □ don‟t know
Domain: Attitudes
People in your building have negative attitudes towards persons with limitations in daily activities
□ strongly agree □ agree □ neither agree or disagree □ disagree □ strongly disagree
People in your building are willing to help persons with limitations in daily activities
□ strongly agree □ agree □ neither agree or disagree □ disagree □ strongly disagree
People in your community have negative attitudes towards persons limitations in daily activities
□ strongly agree □ agree □ neither agree or disagree □ disagree □ strongly disagree
People in your community are willing to help persons with limitations in daily living
□ strongly agree □ agree □ neither agree or disagree □ disagree □ strongly disagree
* higher score denotes more obstacles ie worse situation all other domain scores – higher score indicates more positive situation
This instrument can be found pages 17-20 of Compendium of Clinical Measures for Community Rehabilitation‚ available online at: http://www.health.qld.gov.au/qhcrwp/docs/clinical_measure.pdf
Keysor‚ J‚ Jette ‚A & Haley S 2005‚ „Development of the home and community environment (HACE) instrument‟‚ Journal of Rehabilitation Medicine‚ vol. 37‚ no. 1‚ pp. 37-44.
