Occupational Therapy Practice Guidelines for Home Modifications

Home modifications are generally provided to improve occupant functional performance, reduce hazards to prevent falls or other injuries, and reduce the demands on caregivers. The need for home modifications arises when the features of the environment pose challenges or demands that are incompatible with an occupant's ability to be safe. Such incompatibility may be the result of impairment, such as that associated with a health condition, or changes in abilities due to aging.

All occupational therapists are qualified to conduct home assessments and deliver home modification interventions, although some therapists may have advanced practice skills for complex interventions. Home modifications provided by occupational therapists involve a comprehensive evaluation of personal and environmental factors and daily activities; the development of an intervention plan to resolve the incompatibilities between the person and the environment; the facilitation of obtaining or installing the modifications; and training in the use of the modifications. The outcome of home modifications provided by occupational therapists is enhanced occupational performance.

This Practice Guideline, updated to reflect concepts from the Occupational Therapy Practice Framework, briefly discusses the domain and process of occupational therapy for home modification, including a summary of evidence from the literature regarding best practices. Intervention strategies include medical equipment, universally designed products, architectural modifications, major home renovations, or learning a strategy to use the environment differently. Appendixes contain evidence tables as well as diagnostic and billing codes.

It is the intention of this publication to help occupational therapists and occupational therapy assistants, as well as those who manage, reimburse, or set policy regarding occupational therapy services, understand the contribution of occupational therapy for home modification interventions. This guideline can also serve as a reference for health care professionals, health care facility managers, education and health care regulators, third-party payers, and managed care organizations.

Carol Siebert, MS, OTR/L, FAOTA, is principal, The Home Remedy, Chapel Hill, NC. Stacy Smallfield, DrOT, MSOT, OTR/L, is Associate Professor, Department of Occupational Therapy, University of South Dakota, Vermillion. Susy Stark, PhD, OTR/L, FAOTA, is Assistant Professor of Occupational Therapy, Neurology and Social Work, Washington University in St. Louis.