For many of us, home represents much more than four walls. It is where we establish routines, spend time with family, prepare meals, celebrate milestones, and participate in the everyday activities that give our lives meaning. Not surprisingly, many older adults want to remain in their homes and communities as they age. But is the home ready to age with them?
When families think about home safety, they may immediately picture installing grab bars in the bathroom, removing throw rugs, or adding a shower chair. While these are important considerations, successfully aging in place requires looking beyond a traditional safety checklist. Occupational therapy (OT) offers a different perspective by addressing occupational performance and participation in areas including activities of daily living, instrumental activities of daily living, health management, rest and sleep, leisure, and social participation. OT practitioners consider not only whether a home is safe, but if the environment supports the person’s ability to safely and independently participate in the activities that matter most to them.
Let’s State the Facts
The United States population is getting older. According to the 2023 National Population Projections for the United States, the number of Americans age 65 and older is expected to increase from approximately 58 million in 2022 to 82 million by 2050 (U.S. Census Bureau, 2025). During that same period, older adults are projected to grow from 17% to 23% of the total U.S. population (U.S. Census Bureau, 2025). As this population grows, so does the importance of creating communities and homes that support people throughout the aging process. However, many existing homes were not designed with aging in mind.
A U.S. Census Bureau (2025) report examining the readiness of American housing found that only about 10% of homes could be considered “aging ready.” To meet this designation, a home needed features such as a step-free entrance, a bedroom and full bathroom on the entry level, and at least one bathroom accessibility feature (Vespa et al., 2020). That leaves a significant gap between the number of people who may wish to remain in their homes and the number of homes designed to support them.
The home environment also has implications beyond convenience. Miller et al. (2026) describes the home as an important social determinant of health because it can influence a person’s independence, lifestyle, and health. Inaccessible features can make everyday activities more difficult, create safety concerns, and restrict participation in the community. For rehabilitation professionals, this highlights an important opportunity: identifying environmental barriers before they contribute to falls, loss of independence, or unnecessary changes in living arrangements.
What Is Aging in Place?
Aging in place is more than remaining at the same address. It means being able to live safely and independently while maintaining autonomy, stability, well-being, and participation in meaningful daily activities (Sixsmith & Sixsmith, 2008). For rehabilitation professionals, this requires considering the interaction between the person, their occupations, and the environment. This is where OT adds an important layer to the conversation. Rather than evaluating the home in isolation, an OT evaluates how the person performs meaningful activities within that environment.
OT practitioners are trained to examine how people participate in meaningful daily activities, or occupations. These include bathing, dressing, toileting, meal preparation, managing medications, sleeping, home management, engaging in hobbies, and participating in the community. OT considers the fit between the person, the activity, and the environment. A feature that presents no difficulty for one person may create a significant barrier for another.
Home modification is therefore becoming increasingly important as more adults remain in their communities. Sheth and Cogle (2023) identified home modification as an important public health consideration for the growing population of community-dwelling older adults. More recent OT research has also demonstrated that individualized home assessment and modification can improve both safety and accessibility (Miller et al., 2026). OT’s role extends beyond recommending equipment or identifying environmental hazards. OT practitioners observe a person completing everyday tasks, identify the specific point at which performance becomes difficult or unsafe, and determines whether the challenge is related to strength, balance, cognition, vision, endurance, task demands, environmental setup, or the combination of several components. OT is particularly valuable when a patient experiences difficulty functioning safely and independently at home. For healthcare professionals, an OT referral may be appropriate when a patient’s independence with daily activities such as bathing, dressing, toileting, meal preparation, or home management are limited by environmental barriers in the home.
When Should I Consider an OT Referral?
“Is this person having difficulty safely completing the activities they need or want to do at home? If the answer is yes, consider an OT referral. One suggestion is for providers to consider asking clients the following questions:
- Does the person have difficulty bathing, dressing, toileting, or managing medications independently?
- Are they having difficulty preparing meals or completing household tasks?
- Have they changed how they perform daily activities because of pain, weakness, balance, fatigue, cognition, or vision?
- Are environmental barriers limiting their ability to use the skills gained during rehabilitation?
- Is there concern about falls or difficulty safely navigating the home?
- Would equipment, environmental modification, or changes to how an activity is performed improve independence?
A “yes” to one or more of these questions indicates an OT evaluation is needed.
If looking for a standardized tool providers may use the Katz Index of Independence in Activities of Daily Living(Hartford Institute for Geriatric Nursing, 2019) or Lawton-Brody Instrumental Activities of Daily Living Scale (Hartford Institute for Geriatric Nursing, 2008). These provide a more objective way to identify functional limitations or safety concerns that warrant further assessment by an OT in the home environment.
How Can I Make Aging in Place Work?
Instead of waiting for a fall, hospitalization, or major change in function, families may begin looking at the home proactively. Consider walking through the home while thinking about the following areas.
✓ Entering and Exiting the Home
Look beyond the front door. Are there steps, uneven surfaces, or high thresholds? Are railings available and secure? Could someone safely enter the home while carrying groceries or using a cane, walker, or wheelchair? Consider whether there is, or could eventually be, a step-free way to enter the home.
✓ Moving Through the Home
Consider how easily someone can navigate from room to room. Narrow pathways, furniture placement, flooring changes, cords, and clutter may become more challenging when balance, strength, vision, or mobility changes. Also consider whether there is enough room to safely turn or maneuver if a mobility device becomes necessary.
✓ Bathroom Routines
A grab bar is helpful, but bathroom safety involves much more.
Can the person safely get on and off the toilet? Step into the shower? Reach bathing supplies? Stand long enough to complete grooming? Manage clothing while toileting?
The key is to look at the entire activity, not simply whether a piece of equipment is present.
✓ Kitchen and Meal Preparation
Can frequently used items be reached without utilizing a step stool or excessive bending? Is there an opportunity to sit while preparing food? Can the person safely carry items between the refrigerator, counter, stove, and table? Consider the physical and cognitive demands of meal preparation, medication routines, and appliance use.
✓ Lighting
Lighting needs may change with age. Look for dim hallways, glare, poorly lit stairs, difficult-to-find switches, and inadequate nighttime lighting. Contrast can also help make important environmental features easier to identify.
✓ Cognition and Daily Routines
Aging-in-place planning is more than physical mobility. Consider medication management, remembering to turn off appliances, locating commonly used items, maintaining routines, and navigating the home safely. Environmental modifications, organization strategies, reminders, and technology may help support independence.
✓ Fatigue and Endurance
A home may technically be accessible while still requiring too much energy to navigate. How far is the bedroom from the bathroom? Is laundry located on another floor? Are there places to sit during lengthy activities? Could items commonly used be relocated to reduce unnecessary effort?
✓ Falls and Balance
Rather than looking only for obvious “fall hazards,” consider the interaction between the person’s abilities and the demands of the environment. Stairs, flooring transitions, reaching overhead, getting out of a low chair, stepping into a bathtub, or walking to the bathroom at night may all become more challenging as balance and mobility change.
✓ Technology
Technology is another tool for supporting independence. Emergency-response systems, smart lighting, medication reminders, automated devices, and other technologies may help individuals safely manage routines within the home. Technology should be selected based on the person’s individual needs, abilities, and comfort with using it.
✓ Future-Proofing
Perhaps the most important question is one family often overlooks: “Will this home still work for my loved one in the future?” Aging-in-place planning does not mean predicting every possible future need. It means thinking ahead. Could a first-floor room become a bedroom? Is there access to a full bathroom on every floor? Could a shower be modified? Could an entrance accommodate a ramp? Could daily activities be moved to one level of the home? Proactive planning can preserve options and reduce the need to make rushed decisions after a crisis.
Look Beyond the Checklist
Aging in place isn’t simply about adding equipment to a home. It is about creating an environment that continues to support safety, independence, participation, and meaningful participation in daily life. One shouldn’t only ask, “Can I stay in my home?” A better question is: “Will my home allow me to continue living the life I want to live?”
For families unsure where to begin, an OT can evaluate a person performing everyday activities within the home and identify barriers. OT recommendations are individualized to the person’s current abilities, routines, priorities, and anticipated needs. For all healthcare professionals, recognizing when mobility or medical interventions are not enough is an important part of supporting successful aging in place. When a patient is unable to safely and independently perform daily activities, an OT referral provides a more comprehensive look at the person, the task, and the environment to help translate rehabilitation gains into meaningful participation at home. The best time to address aging in place is not necessarily after something goes wrong, but while there is still an opportunity to identify barriers, make changes, and preserve independence.
References
Hartford Institute for Geriatric Nursing. (2019). Katz index of independence in activities of daily living (ADL). New York University Rory Meyers College of Nursing. Try_This_General_Assessment_2.pdf
Hartford Institute for Geriatric Nursing, College of Nursing. (2008). The Lawton instrumental activities of daily living (IADL) scale. New York University Rory Meyers College of Nursing. Try_This_General_Assessment_2.pdf
Miller, A., Subasic, K., & Sithong, C. (2026). Occupational therapy and the U.S. Department of Housing and Urban Development’s Older Adult Home Modification Program: A mixed-methods study. American Journal of Occupational Therapy, 80, 8002205130. https://doi.org/10.5014/AJOT.2026.051315
Sheth, S., & Cogle, C. R. (2023). Home modifications for older adults: A systematic review. Journal of Applied Gerontology, 42(5), 1151–1164. DOI: 10.1177/07334648231151669
Sixsmith, J., & Sixsmith, A. (2008). Aging in place in the United Kingdom. Aging International, 32, 219–235. DOI 10.1007/s12126-008-9019-y
U.S. Census Bureau. (2025, February 12). 2023 national population projections tables: Main series. https://www.census.gov/data/tables/2023/demo/popproj/2023-summary-tables.html
Vespa, J., Engelberg, J., & He, W. (2020, May 15). Old housing, new needs: Are U.S. homes ready for an aging population? U.S. Census Bureau, Current Population Reports. https://www.census.gov/library/publications/2020/demo/p23-217.html
