The Missing Clinician: Occupational Therapy in Aging-in-Place Renovations
Why occupational therapists should be involved earlier in aging-in-place renovations, what the research shows, and what renovators, OTs, families and government can do.
Key Insight
This is a short summary of our commentary, The Missing Clinician. It asks when that second perspective adds value, and how renovators, OTs, families and government can bring it in earlier. The full version, with 30 references, is on our publications site.
What the research shows
The strongest evidence comes from a 2023 Cochrane review of environmental interventions for preventing falls. In the pooled analysis of home fall-hazard reduction, these interventions probably reduced the rate of falls by about a quarter. Among people at higher risk, such as those who have fallen in the past year, were recently in hospital or need help with daily activities, the reduction was larger and the evidence was high certainty. Among people not selected for fall risk, the review found no reduction.
Evidence on who should deliver the work is mixed. Some trials suggest OT-led home assessments work better, while a large UK trial found no reduction in falls from a single OT visit. A New Zealand trial showed that simple changes installed by qualified builders, such as stair handrails, grab rails, outdoor lighting and slip-resistant surfaces, were linked to fewer medically treated fall injuries at home.
Read together, the evidence supports targeting. Hazard reduction helps most where risk is highest. It does not show that every renovation needs an OT. The case for earlier OT involvement is strongest for people who have fallen, been in hospital, need help with daily activities, or face questions about transfers and equipment.
Why OTs and renovators rarely work together
The commentary describes four possible barriers, offered as plausible explanations rather than proven causes:
- ✓Access to publicly funded OT is organized around assessed care needs. Someone planning ahead, before any need arises, may have to pay privately for clinical advice.
- ✓Clinical advice and construction are arranged separately. In Ontario's Home and Vehicle Modification Program (HVMP), an OT writes the recommendation and the applicant gets building quotes on their own. Nothing requires the two to work through the design together.
- ✓Each discipline holds part of the knowledge. Renovators are not trained in clinical assessment, and OTs are not usually trained in construction in their entry-level education.
- ✓Planning is often delayed. Many people put off planning for changing needs until a fall, a hospital stay or a loss forces the decision.
What each group can do
Renovators can ask simple functional questions (Who will use this space? Has anyone had a fall here? Does anyone use a cane or walker?), know where their competence ends, and suggest an OT in writing when clinical questions come up. They can also plan for future needs during planned work, such as wall reinforcement for grab bars and wider doorways, and build OT recommendations as written.
Occupational therapists can write recommendations a builder can build, with measurable heights, locations and clearances. They can rank what is essential and what is ideal for households on a budget, and review drawings before construction where possible.
Homeowners and families can start with their daily routine, noting what is becoming harder, and share that list with their renovator. Ask about an OT assessment if there has been a fall, a hospital stay or a mobility aid, and check funding before any work begins: HVMP does not reimburse work done before authorization. The Home Accessibility Tax Credit and HVMP are explained in our grant guides.
Government can publish clear rules on whether the OT documentation needed to apply for HVMP is paid for, by whom and when, offer a route for people who cannot pay upfront, and invest in awareness through family physicians, pharmacists and hospital discharge teams.
At Still at Home, our free Home Safety Assessment starts with the same functional questions the commentary recommends, and we suggest an occupational therapist when a question needs clinical judgment.
The question we are asking
The research supports targeted home fall-hazard reduction, most clearly for people at higher risk. It is less certain about who should deliver it. Earlier collaboration is a practical way to make sure clinical advice carries through to the finished home.
To the occupational therapists reading this: what single change would make you more likely to collaborate with a renovator on a client's home?
This article is based on a peer-quality publication with full references and methodology.
Published October 5, 2026 · SAH-2026-004 · Arton Sallahi · Still at Home Inc.
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