Home Modifications and Going Mobile: A New Way to Advance OT Expertise and Practice 
Carolyn Sithong, MS, OTR/L, SCEM, CAPS

The AOTA Centennial Vision continues to bring the occupational therapy (OT) profession to new and exciting levels of practice. Educational programs encourage students to seize opportunity in home and community-based services or bring a ‘newness’ to the standards of practice in traditional places of work. In the workforce, technology is pushing both the profession and practitioners to new achievements to help centralize data, measure outcomes, enhance interventions and facilitate best practice. Specialized areas such as home modifications thrive in these circumstances as OT services progress from “the therapy that helps me put my socks on” to address recently emerging service needs in efficient provision of care.

Home modifications and aging in place are hot topics for occupational therapists and occupational therapist assistants. Leaders in the field have helped demonstrate OT value with many big players such as AARP, Home Depot and the National Association of Home Builders (Goldhammer, et. al, 2015). As the conversations develop and these service providers look for the best way to capture this market, it behooves occupational therapy practitioners to take time and reflect on where they can contribute and offer their home assessment expertise. 

The assessment of the environment is a critical component to maximizing Person- Environment-Occupation fit (Law et al., 1996), but one where practitioners commonly forget to “let their light shine.” Our profession has the capacity to analyze the environment and person, assess the occupational behavior of the person in the environment and recommend environmental features that are necessary in supporting independence (Siebert, et. al, 2014). Practitioners have the ingrained understanding that environments, and all of their contexts, especially the physical, will either inhibit or inspire function. They are always striving and working towards the latter.

Recently the White House Conference on Aging (WHCOA) in an answer to the 73 million baby boomers about to enter the long-term care continuum issued the “Long-Term Care Services and Support Policy Brief.” This document addresses the lack of long-term care support services that prolong activities in daily living (ADL) participation in the home, stating, “technologies hold promise for assisting older adults” in the areas of fall prevention and detection, and mobility impairments (p.8). In addition, the WHCOA’s Healthy Aging Policy Brief, stated 1 in 3 people over 65 will fall; therefore, the Center for Disease control is striving “to increase the level of engagement of, and partnership with, the medical community to integrate falls screening, assessments, and interventions into the clinical setting” (p. 3).

Whether in home health, a rehab setting, an acute care hospital, a skilled nursing facility, or an assisted living facility (ALF) there is opportunity to bring OT knowledge to the patient’s home. Seibert et al (2014) found, “Evidence supports that the basic home modification process-evaluation; intervention, including task analysis conducted with the client in the home environment; implementation of the modifications; and training for their effective use- is entry-level, generalist practice” (p. 57). Too often, however, we rely on checklists or basic home audits that simply list all of the home hazards instead of providing solutions that move clients toward implementation and make the home healthy and functional. Makeshift home assessments developed and modified over many years of use in clinics or hospitals may not facilitate the best standards of practice nor lead to effective outcomes for the patient. Standardized home assessments like the Westmead and the SAFER-HOME tool are important tools proven to measure home safety, but lack in helping the clinician to find the best solutions for the barriers found in the home (Asher, 2014). Many practitioners resort to Google for images, uploading pictures to phones, and going back to places of work and then writing narratives to suggest simple everyday products. This time lapse can be unfavorable for patients looking to transition home quickly from a hospital or rehab clinic and for those who may benefit from a grab bar installation and bath modification during in their 30-day home health benefit. This time consuming process may have resulted in doing away with the critical home visit prior to discharge.

Home assessments combined with technology can empower practitioners by offering real-time home modification solutions and reducing the amount of time and paperwork. Using technology can also help achieve a larger impact where OTs work, especially if intervention outcomes occur through re-evaluations of the home upon completion of the modification. 

Recently Home for Life Design, launched a mobile application named, “Home for Life Home Assessment,” that connects practitioners with the products and solutions they need to help their patients live safely in the home (Sherman, 2015). The author developed the app after working in this area of practice for many years without an easy standard for gathering and storing assessment findings. Based on the best practices of occupational therapy and years of research in the home modification industry this solution now helps to centralize data, measure outcomes, and provide important information for products in the home, positioning the occupational therapist as the expert in home assessments. The goal in development was to help take the burden out of the home assessment process by reducing the data input and saving quality clinic time. Web-based platforms and mobile tools like these also help users to stay connected as a team and update solutions and service delivery models at a proficient rate.

Knowing advancements in OT practice can help seize the opportunity to make a difference in an area where practitioners have experience and knowledge. Researching the latest publications and resources on home modifications is the best way to grow that knowledge. AOTA has recently published, “Occupational therapy practice guidelines for home modifications,” and offer a Self-Paced Clinical Course on the topic. A free CE is available to AOTA members entitled, “Home Modifications 101: Kitchen Modifications for Older Adults” featuring a step-by-step process on how to enable occupation in this important area of the home. Visit www.aota.org to learn more about these products.

In November 2015, FOTA will offer a four hour institute on Home Modifications and Assessments. Visit www.flota.org to register.


  • Asher, I. (Ed). (2014). Asher’s occupational therapy assessment tools: An annotated index (4th ed.).Bethesda, MD: AOTA Press 
  • Goldhammer, T., Richmond, T., Smith, K. & Sithong, C. (April, 2015). (AOTA) Emerging Opportunities for OTs in Home Assessments/Modifications. Presented at the 95th Annual Conference and Expo of the American Occupational Therapy Association, Nashville, TN.
  • Law, M.L., Cooper, B. A., Stron, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment- Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 631(1), 9-23. 
  • Siebert, C., Smallfield, S. & Stark, S. (2014). Occupational therapy practice guidelines for home modifications. Bethesda, MD: AOTA Press. 
  • Sherman, Christopher, (2015). AARP Selects Cutting-Edge Health Tech Finalists for LivePitch Competition, Retrieved March 31, 2015, from http://www.aarp.org/about-aarp/
  • press-center/info-03-2015/livepitch-competition-miami.html White House Conference on Aging. (2015). Healthy Aging Policy Brief. Retrieved from: http://www.whitehouseconferenceonaging.gov/blog/policy/post/healthy-aging-policy-brief
  • White House Conference on Aging. (2015). Long Term Servicesand Supports. Retrieved from: http://whitehouseconferenceonaging.gov/issues/index.html#lt 

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