Collaboration for Successful Aging-in-Place Outcomes

By Debra Young, MEd, OTR/L, SCEM, ATP, CAPS   

Research shows that there are more than 124 million homes in the housing stock with a median age of 36 years. Although, America’s aging population is living longer, increasingly poor health and chronic conditions often limit their ability to participate in and complete activities.  

As such, it is no surprise that there is sustained interest in the CAPS designation and that aging-in-place home modification is the fastest growing segment of the residential remodeling industry.

Home modification is very much a team process, in which each player on the home modification team provides valuable information on the client’s behalf. Increasing our knowledge of each player’s role is integral to successful home modifications.  

Occupational therapists bring a unique perspective in addressing the needs of older adults who wish to continue to live at home. Collaboration between CAPS occupational therapists and CAPS remodelers provides a marriage of the medical and building industries for the benefit of home accessibility.  

What is the value of having an occupational therapist on my home modification team?

By using a science-driven, evidence-based background, occupational therapists are able to assess how a person may function in their home and participate in daily living activities. Our education affords us a holistic understanding of how an individual's  environment impacts their participation in meaningful activities and life roles.  

This is what occupational therapists call the person-environment fit.   

Occupational therapists also bring knowledge of products, both assistive and mainstream, including their usability and the ability to feature-match those products to meet a client’s current and potential long-term needs.  

This feature-matching comes from an evaluation of a client’s physical, sensory and cognitive abilities and the subsequent interaction with a particular piece of equipment, within a space. Having knowledge of the spectrum of equipment, devices and technology on the market is important; having knowledge of how your client will use that equipment within the modified space is key.

Providing recommendations from an occupational therapist not only integrates current and long-term client needs, it also limits liability for the remodeler as well as maximizes the client’s safety.  

Creating rapport with the homeowner is paramount in any home modification project.  

Part of the preliminary discussions with a homeowner may include delicate topics such as toileting and bathing.  Occupational therapists, as medical professionals, bring a level of comfort to homeowners when talking about intimate details regarding their daily living skill abilities.  

It is this sense of comfort and trust, along with the completion of the occupational therapy evaluation, that translates into home modification recommendations that help to meet a client’s current and long-term needs, while maintaining privacy and dignity throughout the project process.  

How do I locate an OT?  How do I know she/he is right for my project?

When attempting to determine if an occupational therapist is right for your project, it is important to consider the same criteria you would for any other professional consultant you might engage for collaborative work.   

We recognize that there are practitioners with different levels of expertise. All occupational therapists have a baseline knowledge of environmental modifications from their educational background, however, not all therapists specialize in environmental modifications or assistive technology for home modifications.  

It is recommended to contact the therapist to build rapport and learn more about their background knowledge and experiences with regard to home modifications. For instance you might ask:

  • How many years of experience do you have in the field of occupational therapy?
  • In what settings have you worked?  
  • Have you worked collaboratively with building professionals?  
  • What experiences have you had with home modification projects and what kind of recommendations have you made for previous projects?
  • Have your recommendations leaned toward the more basic environmental modifications such as basic adaptive devices, or have you had experience with more complex environmental modifications such as a complete remodel of a space in the home and/or providing recommendations for more specialized equipment that may be needed?   
  • Do you have any relevant certifications (i.e.: NAHB CAPS, AOTA Specialty Certification in Environmental Modifications, etc.) and/or professional development? (Some therapists may have completed courses and additional education to advance their knowledge in construction and design/build, accessible building guidelines, universal design, and architectural plan review to support their work within the environmental modifications specialty area of occupational therapy practice.)
  • Occupational therapists work in a variety of service delivery settings such as inpatient rehabilitation, home health and private practice. Each of these settings may have a different level of service that can be provided with regard to home/environmental modifications.  

For example, a hospital-inpatient occupational therapist may complete a report with recommendations for adaptive equipment and home modifications, however, may not be able to follow up with the remodeler once the client is discharged from the hospital.

This is a situation that may require another occupational therapist, perhaps one that works in private practice, to take the reins and continue the work within the home environment. The new therapist would then collaborate with the homeowner and the remodeler on the report recommendations, ensure that training is completed with the client within the home environment, make additional recommendations as appropriate and be available from start to finish for a project.   

The key is to make that initial connection with the occupational therapist early on in any project.  

The occupational therapist can provide guidance regarding the scope of services that she/he would be able to offer for your project.

OT and remodeler collaborations come in different packages. The spectrum runs the gamut of being a source of referrals to a complete partnership.  

In some cases it is the homeowner who is independently contacting the occupational therapist requesting home modification services. That homeowner may or may not have a remodeler on the team.  

This is a potential referral source for CAPS remodelers. On the flip side, the homeowner may have already contacted the remodeler, and not the occupational therapist. This is an opportunity for the remodeler to either reach out to the therapist and/or discuss with the homeowner the value of having an occupational therapist on the home modification team.  

In more developed collaborations, the remodeler and occupational therapist may already have a working relationship. Although they remain as separate entities, they continue to collaborate on home modification projects to maximize the outcome for the homeowner.  

A twist on this scenario is the occupational therapist working as a subcontractor for the remodeler versus as an independent, separate entity. One step further brings us to collaboration as a full partnership, whereby the occupational therapist may work for the remodeler’s company and/or they have created a mutual company specific to meeting the needs of aging-in-place home modifications.  

Whatever the collaboration, it all starts with getting to know one another. One place to start searching for an occupational therapist and create that dialogue is the NAHB CAPS directory.  

Currently there are 193 self-identified occupational therapy practitioners with CAPS designations. Locate and contact one, or a few, that may be in your local, state or regional area and begin to create a dialogue.

Another resource is the American Occupational Therapy Association (AOTA). You can contact the AOTA home modifications liaison, Karen Smith, at ksmith@aota.org for information regarding professionals within your area.  

Debra Young, M.Ed., OTR/L, SCEM, ATP, CAPS is the owner of EmpowerAbility® LLC in Newark, Delaware, specializing in space planning and design for inclusive housing and communities.  Her background in occupational therapy affords her the unique knowledge of the person-environment fit.  She can be contacted at dyoung@empowerability.com.

This story originally appeared in the Nov. 19, 2013 edition of CAPS Connection.


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