Aging Safely in the Home - AOTA Everyday Evidence

Listen to the AOTA Everyday Evidence Podcast on Aging Safely in the Home to the right or listen to the podcast on Stitcher.  

For more information, check out Occupational Therapy Practice Guidelines for Home Modifications, the Home Modifications Critically Appraised Topic (pdf, member login), and additional resources in the home modifications section of our website.


Stephanie Yamkovenko: Did you know that one in three older adults fall every year in the United States? The injuries from a fall can make it difficult to live independently and to successfully age in place.

You may be thinking—well I will just stay at home and then I won’t fall. Unfortunately, more than half of all falls take place at home.

Today we’re talking to Susan Stark, assistant professor of occupational therapy at Washington University in St. Louis about why it is important for older adults to have a safe home.

Susan Stark: Often we’ll ask older adults, do you have any barriers in your home and they will tell us no. But when we, as OTs, come in and evaluate the home we are able to find things that older adults have noticed are more difficult or might put them at risk. One of the most common barriers that we see in the homes of older adults are in the bathroom. And those are toilet seats that are very low. Low toilet seats make it difficult for older adults that have poor strength in their lower extremities to stand up from a seated position. So the combination of a low toilet seat and the lack of something to hold on to like a grab rail makes getting on and off the toilet very difficult.

Yamkovenko: Susan has spent a lot of time reviewing the research that shows the effectiveness of home modifications provided by occupational therapy practitioners in decreasing the risk of falls. Why should older adults turn to an occupational therapist?

Stark: We know from the literature that occupational therapists, when they provide high quality home modification assessments and interventions, do a set of certain things. The first is they have the ability to carefully and objectively assess an individual’s capacity to do things—their strength, their vision. Then occupational therapists conduct the task analysis and they are able to actually observe older adults performing tasks in the environment and they can identify the potential barriers and current barriers that the older adult is facing or will face. They then have the ability to solve the barrier, usually in several different ways, in a way that’s acceptable for older adults. And then probably one of the most important steps is training and using the new environmental modifications in a safe way.

Yamkovenko: If you are interested in getting an assessment, you can contact your primary care physician for a referral or your local area agency on aging.

Stark: The assessment is covered by Medicare as are the training, the visits required to train people to safely use the types of intervention. So the cost of the occupational therapist is covered under Medicare.

Yamkovenko: Some private payers, the VA, and workers comp will reimburse for installing some home modifications, but typically the cost will be paid out of pocket.

Susan, what’s a simple tip for older adults to stay safe in their home?

Stark: So the biggest tip is to reassess your ability and to think carefully about things that used to be easy that might be getting more challenging, and ask for help. But the most important thing is to be aware of your surroundings, to look for things that might be a trip or a slip hazard and to recognize if your abilities are changing so that you can add some additional support if needed. These are all really simple things that might make living your daily life a lot easier.

Yamkovenko: For more information about occupational therapy, please visit