48% Safer, 52% More Accessible: What a New Peer-Reviewed Study Found About OT-Led Home Modification

Most of the outcome data in this field is anecdotal. A contractor will tell you a ramp changed someone's life. A family will say the bathroom remodel gave their mother her independence back. All of that is real, and none of it is measured.

In March, a peer-reviewed study published in the American Journal of Occupational Therapy did something this field doesn't get very often: it measured. Researchers followed 25 rural older adults through HUD's Older Adult Home Modification Program, tracked their safety and accessibility ratings before and after occupational therapy-led modifications, and put actual numbers to what changed. Personal safety ratings rose an average of 48%.

Accessibility ratings rose an average of 52%. In the strongest individual cases, the gains topped 100%.

If you're an OT weighing whether home modification consulting deserves a real place in your practice, or a professional trying to explain to a client why this work is worth doing carefully, this is the kind of data point that doesn't come along often. Here's what the study actually found, and just as important, what it doesn't claim.

What the Study Actually Measured

Led by researcher Anna Miller, with co-authors Kathy Subasic and Carolyn Sithong, the study followed participants in HUD's Older Adult Home Modification Program (OAHMP) across two rural program sites. All 25 participants had an occupational therapy practitioner conduct a home assessment before any modifications were made, and a follow-up assessment within 30 days after the work was completed, using a tool called Home for Life Design (HFLD).

The HFLD assessment is client-led. The person being assessed walks the OT through their own home, room by room, based on what they actually do there, not a generic checklist. In each room, the OT rates accessibility on a 0/5/10 scale (not accessible, partially accessible, fully accessible), and the client rates their own personal safety on a 0-to-10 scale. Do that once before the modification and once after, and you have a before-and-after number that isn't a guess.

That's worth naming clearly: this study did not compare OT-led modification to no modification, or to modification done without OT involvement. It measured change within one group, before and after, using a standardized tool. It's an explanatory sequential mixed-methods study, not a randomized controlled trial, and the researchers say so themselves. What it offers is a documented, repeatable way to measure whether a modification changed the room, and by roughly how much.

The Numbers, and Where They Came From

Across all 25 participants, personal safety ratings increased by an average of 48%, with the highest single gain at 112%. Accessibility ratings increased by an average of 52%, with a high of 118%. Gains above 100% reflect participants who started from a very low baseline rating in that room.

Bathroom modifications came up most often. Fourteen of the 25 participants named bathroom changes as the most impactful part of the process, with grab bars, comfort-height toilets, adjustable shower heads, tub benches, and antislip flooring cited most frequently. Entryways mattered too. One participant described replacing a well-meaning but genuinely unstable neighbor-built plywood ramp with a properly constructed ramp and handrails, and rated the result "a million percent safer." Another had been stepping off a back porch onto a cinderblock before two code-built steps and handrails went in. Bedroom modifications, transfer poles and bed rails, came up less often but mattered just as much to the people who needed them.

None of this will surprise anyone who's spent time doing this work. What's different here is that it's now published, peer-reviewed, and attached to a number.

One Thing Worth Naming Plainly

One of the study's co-authors, Carolyn Sithong, is also the CEO of Home for Life Design, the company that built the assessment tool used to generate these numbers. That's disclosed in the study itself, and it belongs here too. It doesn't invalidate the findings. The tool's reliability and content validity were established in separate, previously published research that the study cites. But if you're going to reference these numbers with colleagues, referral partners, or clients, know the full picture rather than presenting the tool as an independent third-party instrument.

It's also, plainly, a small study. Twenty-five participants at two rural program sites is not a sample you generalize from broadly, and the researchers say as much themselves. What this study offers isn't proof that every home modification produces these exact gains. It's a documented, real-world example of what a client-centered, occupation-based approach to home modification can look like when someone actually stops to measure it.

Why This Matters If You're Building a Home Modification Practice

For years, OTs doing home modification work have leaned on clinical judgment and client-reported satisfaction to make the case for what they do. That's not nothing. But when you're talking with a referral source, a program administrator, or a family weighing the cost of the work, "trust me, it helps" carries less weight than "here's a peer-reviewed study measuring a 48% average safety gain."

That's the real value of this study for an OT building a home modification consulting practice. It's not proof of anything universal. It's a citable, peer-reviewed example of outcome measurement that shows what thorough, occupation-based assessment can produce, and a model for how to track it yourself.

The qualitative side of the study backs that up. Participants didn't just report better numbers, they described feeling heard. Three themes ran through nearly every interview: how much it mattered that the OT understood their daily routines and not just their diagnosis, how the modifications changed what they could actually do in their own home, and how thorough the whole process felt from first assessment to final check-in. Twenty-three of the 25 participants described feeling validated by the process itself, separate from the physical changes.

The Piece This Study Doesn't Cover

What the study measures is the clinical assessment, before and after. What it doesn't measure is what happens in between: getting the modification actually built, to code, on budget, without the installation problems and miscommunication the researchers themselves flagged as the leading source of participant frustration.

That's the gap CAPS training is built to close. An OT's assessment tells you what has to change in a home and why. CAPS training is what lets a professional, OT or contractor, speak knowledgeably about how: blocking placement for a grab bar that will actually hold weight under real use, clearance measurements that meet code, a ramp slope that's safe and durable, not a neighbor's plywood fix. The assessment identifies the need. The construction knowledge is what keeps a 48% safety gain from becoming a callback six months later.

If this study makes a case for anything beyond its own data, it's that measuring outcomes matters, and that the handoff between clinical assessment and accurately scoped, buildable work is where a lot of this field's value actually gets made or lost. CAPS certification training is where OTs and the professionals they work alongside learn to make that handoff well. And if you're following the workforce side of this story too, we covered what's driving OTs toward this work right now.

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Fritzi Gros-Daillon, MS, CAPS, SHSS, is an NAHB Master Instructor and 2019 NAHB Educator of the Year. She teaches CAPS courses nationwide and consults with families and professionals on aging-in-place home assessment and modification.