Knowing when to arrange an occupational therapy (OT) home assessment can help Support at Home providers identify changing needs and determine what practical support may help a participant remain safe and independent at home.
An OT assessment can be particularly useful when a participant is experiencing changes in mobility, difficulty completing everyday activities, concerns about falls, or problems accessing parts of their home. It can also be an important step when a home modification may be required.
When should a participant be referred for an OT home assessment?
There isn’t one single situation that means every participant needs an OT assessment. Instead, providers should consider whether there is a functional problem that needs to be understood in the context of the person’s home and daily activities.
Some common situations include:
1. The participant is having difficulty moving around their home
A participant may have started experiencing difficulty with:
- Walking between rooms
- Getting up from a chair
- Getting in and out of bed
- Using stairs
- Getting through doorways
- Moving around while using a walking aid or wheelchair
- Getting in and out of the home
These changes can indicate that the home environment may no longer be working well for the participant. An OT can assess both the person’s functional abilities and the physical environment to identify potential solutions.
2. The participant has experienced a fall
A fall can be an important reason to consider an OT home assessment, particularly if the participant is becoming less confident about moving around their home.
Rather than simply looking for an obvious trip hazard, an OT can consider:
- How the participant moves around the home
- Where they are having difficulty
- How they transfer between surfaces
- Lighting and visibility
- Stairs and entrances
- Bathroom access
- Mobility equipment
- Other environmental barriers
The aim is to understand why the activity has become difficult and whether changes to the environment could help.
3. The participant is becoming less independent
Sometimes the change is gradual. A participant may start asking someone else to:
- Help them shower
- Carry things around the house
- Get items from cupboards
- Help them use the stairs
- Assist them in and out of the bathroom
- Open or use a difficult door
- Complete activities they previously managed themselves
These changes can be easy to overlook because the participant may still technically be managing at home. An OT assessment can help determine whether a change to the environment, equipment or way an activity is performed could support greater independence.
4. The participant is avoiding parts of their home
This can be an important warning sign.
Perhaps they have stopped using the upstairs bathroom.
Perhaps they no longer go into the garden.
Perhaps they avoid the shower because getting in and out feels unsafe.
Perhaps they spend most of their time in one room because moving around the house has become difficult.
The home may not have changed, but the person’s ability to use it has.
An OT can help identify what is creating the barrier and whether a practical solution is possible.
5. The participant is struggling with their bathroom
Bathrooms are a common area where changing mobility can create difficulties. An assessment may be appropriate when a participant is having difficulty with:
- Getting into or out of the shower
- Standing in the shower
- Using the toilet
- Getting up from the toilet
- Moving across wet or slippery surfaces
- Accessing bathroom fixtures
- Managing transfers
Depending on the assessment, recommendations could include equipment or home modifications such as grab rails, shower seating or changes to bathroom access.
6. The participant needs a home modification
If a participant may require a home modification, an OT assessment is an important part of the process. Under the current Assistive Technology and Home Modifications (AT-HM) scheme, all home modifications must be prescribed by an occupational therapist working within their professional scope of practice. The prescription should identify the need the modification is intended to address.
Home modifications funded through the scheme can include things such as:
- Internal or external handrails
- Ramps
- Stair lifts
- Bathroom redesign
- Widening doorways or passages
- Other changes that improve safety and accessibility
The purpose is not simply to make a home look different. The modification should address an assessed need and help optimise the participant’s functioning or manage disability or age-related functional decline.
7. The participant’s mobility or health needs have changed
A person who was previously managing well may experience a significant change following:
- Hospitalisation
- Injury
- Surgery
- Reduced mobility
- A decline in physical function
- A change in the use of mobility equipment
- A new disability or functional limitation
When a person’s needs change, it can be worth reassessing whether their home is still appropriate for them.
An OT can assess the participant in the environment where they actually live and identify practical barriers and potential solutions.
8. The participant is having difficulty using mobility equipment at home
A walking frame, wheelchair or other mobility equipment may work well in one environment but create difficulties in another. For example, the participant may have difficulty:
- Getting through a doorway
- Turning in a bathroom
- Moving between rooms
- Accessing the shower
- Getting up a ramp
- Negotiating thresholds
- Entering or leaving the property
An OT can consider the interaction between the participant, their equipment and their home environment.
Not every problem requires a modification
An OT assessment isn’t simply a pathway to installing equipment or changing the home. The assessment may identify that the best solution is:
- A change to how an activity is performed
- Education or training
- Assistive technology
- A different piece of equipment
- Improved positioning
- A change to the participant’s routine
- A relatively simple environmental adjustment
- A home modification
- A combination of solutions
This is important because the right solution should be based on the person’s needs rather than starting with a particular product.
What should providers look for?
When speaking with a participant, care worker or family member, some useful questions include:
“What has become harder recently?”
This can reveal changes that aren’t immediately obvious.
“Are there things you have stopped doing?”
Avoiding an activity can be an early sign that the environment is creating a barrier.
“Are you getting help with things you used to do yourself?”
An increase in assistance may indicate a change in functional capacity.
“Have you had any falls or near misses?”
Falls and near misses can highlight areas requiring further assessment.
“Are there parts of the house you avoid?”
This can identify environmental barriers.
“What would you most like to be able to do independently?”
This brings the focus back to the participant’s goals.
When a referral makes sense
An OT home assessment may be particularly useful when there is:
A change in function → A difficulty completing everyday activities → A safety or falls concern → A barrier within the home → A possible need for equipment or modification
The assessment can help connect these issues together.
What happens after the referral?
For Support at Home providers, arranging an OT assessment doesn’t need to become another administrative task for the care team. Home Access Group can coordinate the process:
1. Refer the participant
Provide the participant details and reason for referral.
2. We coordinate the OT
We arrange an appropriate OT and coordinate the assessment with the participant.
3. The OT conducts the assessment
The OT considers the participant’s goals, functional needs and home environment.
4. The assessment and recommendations are provided
The provider receives the relevant assessment information and recommendations.
5. The provider determines the next step
This may include discussing options with the participant, considering AT-HM funding, arranging quotes or taking another appropriate course of action.
Support at Home providers are responsible for arranging and sourcing required AT-HM items and services and can engage third parties to assist with AT-HM services. Providers remain responsible for overseeing third-party services.
The earlier you identify a problem, the more options there may be
An OT home assessment doesn’t have to wait until a participant has experienced a serious fall or can no longer manage an activity.
Sometimes the most useful time to assess a home is when a participant says “It’s getting a bit harder.” That small change can be the beginning of a much bigger conversation about how the person can continue doing the things that matter to them.
The goal isn’t simply to make a home safer – it is to help make the home work for the person living in it.
Read more about the AT-HM scheme
A safer home starts with understanding the person
Every home is different. Every person is different. That is why the right approach starts with the individual rather than a list of products. At Home Access Group, we help coordinate OT home assessments that consider the person’s needs, goals, functional abilities and home environment.
The mission is simple: Help people stay safe, independent and at home for longer. If you or someone you care for is finding everyday activities around the home more difficult, an OT home assessment may be a useful place to start.
Your home should work for you – not the other way around. Reach out and we’ll get back to you as soon as possible.
Information about Support at Home and the Assistive Technology and Home Modifications scheme can change. Providers should refer to current Australian Government guidance when making funding and service decisions.
