Occupational Therapy and the U.S. Department of Housing and Urban Development’s Older Adult Home Modification Program: A Mixed-Methods Study

Importance: Occupational therapy has a distinct role in home assessment and home modification (HM) interventions for nationwide aging-in-place (AIP) programming. Objective: To examine the outcomes of a technology-based home assessment and explore client perspectives within the U.S. Department of Housing and Urban Development’s Older Adult Home Modification Program (OAHMP). Design: Explanatory sequential mixed methods. Setting: Homes of rural community-dwelling older adults. Participants: Older adults (N = 25) who qualified for the OAHMP. Outcomes and Measures: Quantitative data were collected using the Home for Life Design (HFLD) home assessment and analyzed with descriptive statistics. Thematic analysis allowed for qualitative data analysis of client interviews. Results: After the HM interventions, personal safety ratings averaged a 48% gain, with a high of 112%. Accessibility ratings increased by an average of 52%, with a high gain of 118%. Three themes emerged from the qualitative analysis: (1) perceptions of the occupational therapy practitioner, (2) impact of HMs on daily task performance in the home, and (3) perceptions of the OAHMP when using the HFLD home assessment. Conclusions and Relevance: The quantitative metrics from the HFLD home assessment demonstrated significant increases in home safety and accessibility after the HM interventions. A qualitative analysis indicated that a client-centric, occupation-based approach throughout the OAHMP increased occupational performance and supported AIP. Plain-Language Summary: Use of metric-driven, standardized home assessment technology helps occupational therapy practitioners track successful outcomes for clients. This study highlights occupational therapy’s role in delivering home modification services for aging in place and emphasizes the need to measure success to maintain a professional role with government agencies such as the U.S. Department of Housing and Urban Development.