A newly published study in Disability and Rehabilitation: Assistive Technology reinforces what occupational therapists have long advocated: strategic home modifications can significantly improve quality of life while reducing environmental hazards for older adults. The single-group intervention study by Akyurek and Özata Değerli (2025) provides timely evidence for OT practitioners seeking to strengthen their home modification services in 2026.
Why This Research Matters
Home modifications address the critical mismatch between an older adult’s functional abilities and their living environment. When environmental demands exceed a person’s capabilities, quality of life declines and fall risk increases. Research demonstrates that therapist-led home modification programs can reduce in-home falls by nearly 40% and achieve a 7% overall reduction in fall incidents, with cost-effective implementation averaging $432 per fall prevented (Cha, 2025, Doyle, 2025a, Stark et al., 2009).
Implementation Strategy #1: Use a Client-Centered Assessment Process
Effective home modification begins with a structured assessment that prioritizes the client’s identified performance problems. Expert clinical assessment goes beyond using a checklist or standardized tool. Rather than imposing a checklist approach, engage clients in ranking activities that matter most to them. This collaborative process increases adherence and satisfaction with modifications. Observation and analysis of the occupational performance, within the home environmental constraints, form the basis for collaborative problem-solving.
Practical Application:
- Conduct comprehensive environmental assessments using validated tools to identify person-environment fit issues (Doyle, 2025a, Stark et al., 2009).
- Observe clients performing actual daily activities in their homes to identify specific barriers (Stark et al., 2009).
- Present 2-3 modification options for each barrier, allowing clients to choose solutions that align with their values and aesthetic preferences (Lee et al., 2025).
Implementation Strategy #2: Address Both Physical Safety and Emotional Considerations
Older adults often resist home modifications when they feel excluded from decision-making or perceive changes as threats to independence. The evidence shows that aesthetic and personal meaning considerations may override known safety benefits, suggesting that purely risk-focused approaches are insufficient (Lee et al., 2025).
Practical Application:
- Frame modifications as tools for maintaining independence rather than accommodations for disability (Lee et al., 2025).
- Discuss how modifications can support clients’ desired activities and social engagement (Pynos, Steinman, & Nguyen, 2010).
- Address emotional responses to aging-related changes with empathy while highlighting functional benefits (Lee et al., 2025).
Implementation Strategy #3: Implement a Two-Visit Model
Research supports a structured two-visit approach where occupational therapists assess needs, recommend modifications, provide education, and conduct follow-up. This model ensures proper installation, trains clients in using new features, and allows for adjustments based on real-world use (Doyle, 2025). Further visits for collaborative decision making, training, and caregiver education may be needed, depending on the situation and the complexity of the recommendations.
Practical Application:
- Visit 1: Comprehensive assessment, barrier identification, collaborative goal-setting, and modification planning (Stark et al., 2009).
- Between visits: Coordinate with construction partners and family members as requested (Stark et al., 2009).
- Visit 2: Verify proper installation, provide hands-on training with new equipment or features, and ensure client comfort and competence (Doyle, 2025).
Implementation Strategy #4: Focus on High-Impact Modifications
The evidence identifies specific modifications with the greatest impact on safety and independence. Prioritize interventions that address the most common environmental hazards while supporting clients’ functional goals (Cha, 2025).
Practical Application:
- Bathroom modifications: Install grab bars, shower seating, and slip-resistant surfaces (Doyle, 2025).
- Lighting improvements: Enhance visibility in hallways, stairways, and entrances (Doyle, 2025).
- Accessibility features: Add ramps, widen doorways, and lower countertops as needed (Cha, 2025).
- Assistive equipment: Provide tub benches, raised toilet seats, and reaching aids (Stark et al., 2009).
Documentation and Advocacy
Monitor and document outcomes related to fall reduction, enhanced independence, and quality of life improvements. This data strengthens referral relationships with physicians and supports reimbursement advocacy with payers who increasingly recognize the cost-effectiveness of preventing falls and delaying institutional care transitions.
Moving Forward
The Akyurek study adds to the growing body of evidence demonstrating that occupational therapist-led home modifications are essential interventions for supporting aging in place. By implementing these client-centered, evidence-based strategies, practitioners can deliver measurable improvements in safety, function, and quality of life while building sustainable home modification programs within their practices.
The Critical Role of Advanced Training and Professional Competency
Achieving optimal outcomes in home modification requires advanced-level clinical skills that extend beyond entry-level occupational therapy education. The complexity of balancing environmental assessment, client-centered decision-making, construction knowledge, and evidence-based intervention necessitates specialized training. Occupational therapists who pursue focused professional development in home modifications demonstrate superior ability to identify nuanced person-environment barriers, recommend cost-effective solutions, and navigate the emotional and practical challenges clients face. The CHAT (Certified Home Assessment Training) program represents the only therapist-focused training specifically designed to advance these specialized competencies. By investing in advanced training like CHAT, practitioners develop the sophisticated clinical reasoning required to deliver evidence-based home modification services that maximize safety, independence, and quality of life outcomes for older adults. For more about the CHAT certification:
References:
Akyurek, G., & Özata Değerli, M. N. (2025). The effect of home modification on quality of life and environmental risk in older adults: a single-group intervention study. Disability and rehabilitation. Assistive technology, 1–12. Advance online publication. https://doi.org/10.1080/17483107.2025.2610356
Cha S. M. (2025). A Systematic Review of Home Modifications for Aging in Place in Older Adults. Healthcare (Basel, Switzerland), 13(7), 752. https://doi.org/10.3390/healthcare13070752
Doyle, S. (2025a). Occupational therapist-led home modifications: Evidence, impact, and insights. The Home Accessibility Therapist blog: Retrieved from: https://thehomeaccessibilitytherapist.blog/2025/09/17/occupational-therapist-led-home-modifications-evidence-impact-and-insights/
Stark, S., Landsbaum, A., Palmer, J. L., Somerville, E. K., & Morris, J. C. (2009). Client-centred home modifications improve daily activity performance of older adults. Canadian journal of occupational therapy. Revue canadienne d’ergotherapie, 76 Spec No(Spec No), 235–245. https://doi.org/10.1177/000841740907600s09
Lee, J. J., Patel, D., Gadgil, M., Langness, S., von Hippel, C. D., & Sammann, A. (2025). Understanding Barriers to Home Safety Assessment Adoption in Older Adults: Qualitative Human-Centered Design Study. JMIR human factors, 12, e66854. https://doi.org/10.2196/66854
Pynoos, J., Steinman, B. A., & Nguyen, A. Q. (2010). Environmental assessment and modification as fall-prevention strategies for older adults. Clinics in geriatric medicine, 26(4), 633–644. https://doi.org/10.1016/j.cger.2010.07.001
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