Occupational Therapy Home Modification Evaluations: Creating Safer, More Accessible Homes

Your home should support your independence, not create barriers to it.

For someone recovering from a neurological injury, living with a progressive neurological condition, using a wheelchair or mobility device, or experiencing frequent falls, the physical setup of the home can have a major impact on safety and independence. A doorway that is a few inches too narrow, an inaccessible shower, poorly positioned grab bars, a difficult entrance, or appliances that cannot be reached safely can turn everyday activities into significant challenges.

At Neuroplastic Rehab, our occupational therapy home modification evaluations take a clinical, individualized approach to identifying these barriers and determining how the home can better support the person living in it.

Research supports this individualized approach. A systematic review published in the American Journal of Occupational Therapy found strong evidence that home modification interventions can improve function in people with a variety of health conditions and that comprehensive interventions tend to produce better occupational performance outcomes (Stark et al., 2017).

Our goal is not simply to determine whether a home meets accessibility guidelines. We evaluate the interaction between the person, their functional abilities, the activities they need and want to perform, and the environment in which those activities occur.

When Is a Home Safety or Home Modification Evaluation Recommended?

We receive referrals for occupational therapy home safety and modification evaluations for many different reasons. Common concerns include:

• Frequent falls or near-falls

• Fear of falling in the home

• Difficulty entering or exiting the home

• Difficulty navigating stairs

• Wheelchair or walker accessibility concerns

• Inaccessible bathrooms, showers, or tubs

• Difficulty transferring onto the toilet, into the shower, or in and out of bed

• Difficulty reaching kitchen appliances, cabinets, sinks, or other frequently used items

• Reduced strength, balance, endurance, vision, cognition, or coordination

• Changes in functional independence following an injury or neurological diagnosis

• Progressive conditions that may require planning for future accessibility

• Caregiver difficulty assisting with transfers or daily activities

• A desire to safely age in place

• Plans to remodel, renovate, build, or move into a new home

  
  

Our evaluations reflect the variety of reasons someone may be referred. For example, our clinical process may address high fall risk and general home accessibility, while another evaluation may focus specifically on accessibility for bathing and toileting.

We commonly work with individuals with neurological and complex medical conditions, including traumatic brain injury (TBI), spinal cord injury (SCI), stroke, Parkinson's disease, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), dementia, post-concussion syndrome, and other conditions affecting mobility, cognition, balance, vision, or independence.

Why Is an Occupational Therapist Involved in Home Modifications?

A contractor understands construction. An occupational therapist understands function.

That distinction is important.

A contractor may be able to determine whether a wall can be moved or a shower can be rebuilt. An occupational therapist evaluates whether the person will actually be able to safely use the finished space.

For example, two people who both use wheelchairs may need completely different bathroom designs based on their transfer abilities, trunk control, upper-extremity strength, cognition, caregiver assistance, endurance, equipment, and anticipated progression.

Research supports the role of occupational therapy in this process. A systematic review of randomized controlled trials found that occupational therapist-driven home modification programs, particularly when combined with clinical, physical activity, or behavioral components, demonstrated some of the strongest outcomes among the home modification models reviewed (Powell et al., 2023).

That is why our process begins with the person, not the house.

What Happens During a Home Modification Evaluation?

Step 1: Understanding Your Medical and Functional Needs

We begin with a shortened version of our traditional occupational therapy evaluation.

Before recommending equipment or construction, we need to understand how the individual currently functions.

Depending on the reason for referral, we may review: Medical and functional history; diagnosis, medical history, precautions, pain, fall history, current therapies, assistive devices, previous level of function, current ADL and IADL independence, transfer abilities, functional mobility, caregiver assistance, current concerns, and goals for the home and community.

This is an important part of the evaluation because an accessible home is not one-size-fits-all.

Step 2: Objective Occupational Therapy Testing

Next, the occupational therapist may complete objective testing based on the person's diagnosis, presentation, and reason for referral. This can include assessment of: Strength, balance, functional mobility, transfers, endurance, fine motor skills, gross motor skills, grip strength, coordination, cognition, executive functioning, vision, fall risk, and ADL/IADL performance. We believe standardized assessments are always appropriate, and results are compared with established age- and sex-based normative data.

For example, our evaluations may include quantitative grip-strength testing, manual muscle testing, MoCA cognitive screening, clinical visual screening, FMC assessment (9HPT), etc. More specifically, a vision screening may assess areas such as ocular range of motion, convergence, saccades, smooth pursuits, and functional visual concerns. More importantly, these allow us to answer the question: What does this particular person need from their environment to function as safely and independently as possible?

Step 3: Evaluating the Home Environment

After assessing the individual, we evaluate the environment itself. Some referrals require a whole-home accessibility evaluation, while others focus on one particular area, such as a bathroom, entrance, bedroom, or kitchen.

The scope is determined by the needs and requests of the client, family, case manager, physician, attorney, rehabilitation team, or other referral source. Depending on the referral, we may assess:

• Entrances and exits: stairs, ramps, railings, thresholds, door width, pavement, transfer surfaces and accessibility with mobility equipment.

• Kitchen: appliance access, counter and sink accessibility, storage height, turning space, thresholds, pathways, and opportunities for seated task completion and energy conservation.

• Bathroom: doorway width, shower or tub access, toilet height and positioning, grab-bar placement, shower seating, transfer space, sink accessibility, storage, handheld shower systems, and adaptive equipment.

• Bedroom: bed height, transfer space, doorway width, pathways, flooring, lighting, bedside equipment, furniture placement, and access to nearby bathroom facilities.

• Living spaces and hallways: clear pathways, flooring transitions, furniture placement, lighting, doorway widths, wheelchair or walker maneuverability, and trip hazards.

• Stairs and level changes: stair dimensions, handrails, landing space, accessibility alternatives, and whether ramps or lifts may be appropriate.

Our reports document environmental measurements and compare relevant features with established accessibility guidance. For example, evaluations may document doorway clearance, ramp configuration, railings and maneuvering requirements.

*However, we do not recommend a modification simply because a measurement differs from an accessibility standard. The recommendation must make sense for the individual using the space.

Step 4: Measurements, Photographs and Clinical Recommendations

The occupational therapist takes detailed measurements and, with appropriate permission, photographs relevant areas of the home. These are incorporated into the report so the rehabilitation team, insurance company, family, and contractors can clearly understand both the environmental barrier and the proposed solution. Recommendations can range from relatively simple changes, such as:

removing trip hazards, repositioning furniture, changing storage locations, adding lighting, installing grab bars, adding adaptive equipment, changing door hardware, or installing threshold ramps, to larger modifications such as: doorway widening, zero-threshold showers, accessible bathroom remodels, wheelchair-accessible sinks, exterior ramps, stair modifications, vertical platform lifts, accessible kitchen modifications, or significant changes to the home's layout. The recommendations are based on clinical need rather than simply selecting a standard accessibility product.

One of our evaluation formats, for example, documents how the feasibility of a ramp can depend on the actual rise and available space. When the required ramp would not reasonably fit the environment, another accessibility solution such as a vertical platform lift may be more appropriate. Similarly, a bathroom recommendation may incorporate a zero-threshold shower, accessible toilet and grab bars, shower seating, accessible storage and sink access when those features correspond with the individual's mobility, transfer and endurance limitations.

Our Goals: Safety, Independence and Barrier-Free Living

The goal of a home modification occupational therapy evaluation is bigger than checking boxes for ADA accessibility. We want the environment to support the person's ability to participate in everyday life.

Our recommendations typically focus on several interconnected goals, but reducing falls and injuries is a big one. Environmental barriers can contribute to fall risk, particularly when combined with changes in strength, balance, vision, cognition, endurance, or mobility. Research has found that appropriately targeted home hazard interventions can reduce falls. In a randomized clinical trial, an occupational therapist-led home hazard removal program reduced the rate of falls by 38% among community-dwelling older adults at high risk (Stark et al., 2021). A 2023 systematic review and meta-analysis similarly concluded that thorough, targeted home modification programs with an environmental-fit perspective and appropriate follow-up can reduce falls (Lektip et al., 2023).

Improving accessibility is the second-most common goal. A home should allow someone to reach the rooms, equipment, appliances, and everyday items they need as independently as their abilities allow. Supporting independence with ADLs and IADLs. Modifications may make bathing, toileting, dressing, cooking, grooming, household mobility, and other daily activities safer and more manageable.

Conserving energy is very important. For clients with limited endurance, weakness, pain, neurological fatigue, or progressive conditions, the best solution is not always simply making an activity physically possible. We also consider how the environment can reduce unnecessary exertion and make essential activities more efficient.

Increasing confidence is a must. Fear of falling or difficulty navigating the home can change how someone participates in daily life. Our goal is to create an environment in which clients and caregivers feel more confident completing everyday activities.

Lastly, planning for the future is imperative, also known as aging in place. Particularly with progressive diagnoses or aging-in-place goals, we consider not only what works today, but what is likely to remain functional as needs change.

Home Modification Evaluations Aren't Limited to Your Current Home

Although most occupational therapy home safety evaluations take place in the client's current residence, that is not the only environment we can assess.

Evaluations can be completed for:

• A current home that needs safety or accessibility modifications.

• A potential future home when a client or family is considering moving and wants to determine whether the space will meet current and anticipated accessibility needs.

• A planned renovation before construction begins.

• Architectural plans for a new home, allowing accessibility needs to be considered during the design process rather than after construction is complete.

Planning early can prevent expensive situations where a newly completed space technically looks accessible but does not function well for the person who actually needs to use it.

What Happens After the Evaluation?

Our involvement does not end when the evaluation is finished.

1. You Receive a Detailed Written Report

Neuroplastic Rehab provides the completed occupational therapy home modification evaluation report within 48 hours, or two business days, of the initial assessment. The report includes relevant clinical findings, environmental observations, measurements, photographs when appropriate, identified barriers, recommendations, and clinical justification for recommended modifications or adaptive equipment. Our reports connect recommended equipment and modifications directly to functional needs such as transfer safety, fall prevention, caregiver burden, accessibility and independence rather than providing a generic equipment list.

2. Contractor Quotes Are Obtained

When construction or installation is needed, we can help coordinate with local ADA-accessibility and home modification contractors with whom we have worked and with whom our clients have had positive experiences. We typically recommend obtaining a minimum of three contractor quotes, and Michigan auto insurance cases may require multiple bids before authorizing modifications. This allows the client and funding source to compare proposed solutions, scope of work, cost, and contractor fit.

3. The OT Can Meet With the Contractor

This is one of the most valuable parts of the process.

When needed, the occupational therapist can return to the home while the contractor is evaluating the project. The contractor brings expertise in construction and installation. The occupational therapist brings expertise in the client's functional abilities and medical needs.

We can explain considerations such as:

• How the client currently transfers

• What mobility equipment is used

• Wheelchair dimensions and maneuvering needs

• Upper- and lower-extremity strength

• Balance and fall risk

• Cognitive or visual impairments

• Caregiver assistance

• Medical precautions

• Current and anticipated functional abilities

That collaboration helps ensure that the products being quoted are not simply capable of fitting into the space, but are appropriate for the person who will use them.

4. The Client Selects a Contractor and Modifications Begin

Once the requested contractor quotes have been obtained and any necessary funding or insurance authorization is completed, the client can determine which contractor is the best fit. The selected contractor then completes the approved modifications.

Throughout this process, the occupational therapist remains available as an active clinical consultant to answer questions, clarify recommendations, review proposed changes, and advocate for the client's functional needs.

This follow-through matters. Research examining implementation of OT home-assessment recommendations found that individualized recommendations, client choice, family involvement, written recommendations, and strategies supporting implementation can facilitate whether recommended modifications are ultimately carried out (Ting et al., 2022).

Why Individualized Home Modifications Matter

There is no such thing as one universally "accessible" home.

A grab bar in the wrong location may be useless. A beautiful roll-in shower may still be difficult to use if the shower seat does not match the person's transfer strategy. A ramp may meet a general guideline yet be impractical for the available space. Lowering a countertop may help one wheelchair user while making no functional difference for another.

That is why our process combines: clinical assessment + objective testing + environmental assessment + client goals + accessibility principles + real-world function.

The evidence around home modification also reinforces an important point: simply identifying hazards is not enough. Research findings are not uniformly positive when recommendations are not implemented or interventions are too limited. For example, a large randomized trial of a single OT home environmental assessment did not demonstrate a reduction in falls, and implementation of recommendations varied substantially (Cockayne et al., 2021). In contrast, broader systematic reviews have found stronger outcomes when home modifications are comprehensive, appropriately targeted, individualized, and incorporated into multicomponent interventions.

That is a major reason our process extends beyond identifying what is wrong with the environment. We want to help determine what should change, why it should change, and how that recommendation translates into a functional solution.

Occupational Therapy Home Modification Evaluations in Michigan

Neuroplastic Rehab provides in-home occupational therapy and home modification evaluations in Michigan for individuals with neurological injuries, progressive neurological conditions, mobility limitations, fall risk, and accessibility needs.

Whether the concern is a single bathroom, frequent falls throughout the home, wheelchair accessibility, aging in place, or designing an accessible future residence, our goal is the same: Create a home environment that reduces barriers, improves safety, supports independence, conserves energy, and allows the individual to participate more fully in everyday life.

If you are a client, family member, case manager, physician, rehabilitation professional, or other member of the medical team looking for a home safety or home modification evaluation, contact Neuroplastic Rehab to discuss your referral and determine the appropriate scope of evaluation.

References

1. Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. American Journal of Occupational Therapy, 71(2), 7102290010p1–7102290010p11. https://doi.org/10.5014/ajot.2017.018887 

2. Sheth, S., & Cogle, C. R. (2023). Home modifications for older adults: A systematic review. Journal of Applied Gerontology, 42(5). https://doi.org/10.1177/07334648231151669 

3. Stark, S., Keglovits, M., Somerville, E., Hu, Y. L., Barker, A., Sykora, D., & Yan, Y. (2021). Home hazard removal to reduce falls among community-dwelling older adults: A randomized clinical trial. JAMA Network Open, 4(8), e2122044. https://doi.org/10.1001/jamanetworkopen.2021.22044 

4. Lektip, C., Chaovalit, S., Wattanapisit, A., Lapmanee, S., Nawarat, J., & Yaemrattanakul, W. (2023). Home hazard modification programs for reducing falls in older adults: A systematic review and meta-analysis. PeerJ, 11, e15699. https://doi.org/10.7717/peerj.15699 

5. Harper, K. J., et al. (2022). Barriers and facilitating factors influencing implementation of occupational therapy home assessment recommendations: A mixed methods systematic review. Australian Occupational Therapy Journal. https://doi.org/10.1111/1440-1630.12823 

6. Cockayne, S., Pighills, A., Adamson, J., Fairhurst, C., Crossland, S., Drummond, A., Hewitt, C. E., Rodgers, S., Ronaldson, S. J., McCaffery, J., Whiteside, K., Scantlebury, A., Robinson-Smith, L., Cochrane, A., Lamb, S. E., Boyes, S., Gilbody, S., Relton, C., & Torgerson, D. J. (2021). Home environmental assessments and modification delivered by occupational therapists to reduce falls in people aged 65 years and over: The OTIS RCT. Health Technology Assessment, 25(46), 1–118. https://doi.org/10.3310/hta25460