America is growing old in homes no one has measured.
Home for Life Design Accessibility Ratings®
Most people don't lose their independence. Their home takes it.
The Home for Life Design Accessibility Rating® is an evidence-based, numeric index that measures home accessibility and independent living skills. It places a number on how well a home supports the person living in it.
Every home either supports independent living or stands in its way. The Home for Life Design Accessibility Ratings® put a number on it, so you know where to start and can prove what your work changed.
Millions of Americans are aging in homes that no one has measured.
Why does a home need a score?
Hospital-at-home programs, value-based care, and Medicaid home and community-based services now deliver care in bathrooms and kitchens that were never built for it. Fewer than 4 percent of American homes have a no-step entry, single-floor living, and doorways wide enough for a walker.
Measure a person's function inside a home that is working against them and you will overstate their dependence, overstate their need for a caregiver, and understate what they can actually do. You will also miss the thing that could be fixed by Friday.
By 2030 there will be roughly 73 million Americans over 65. One in four of them will fall this year. Non-fatal falls already cost about $80 billion a year, headed toward $101 billion by the end of the decade. Every one of those numbers has a house behind it.
"The home environment does one of two things: it enables function, or it disables function. "
Carolyn Sithong, Founder, CEO, Home for Life Design®
Harvard Joint Center for Housing Studies, CDC, NCOA.
It is not your fault you cannot reach the closet rod. The rod is in the wrong place.
Who created the Accessibility Ratings?
Carolyn Sithong spent twenty-five years as an occupational therapist inside people's homes, watching patients master the rehab gym and lose it at their own front door. Early in her hospital career she was handed the standard home assessment form. The most relevant box on it said: remove the throw rug.
She built what the field was missing, out of occupational therapy science and data from thousands of homes. The Home for Life Design Accessibility Ratings® are now the home accessibility measure in use across public agencies, national nonprofits, independent living networks, and occupational therapy education programs nationwide.
Carolyn Sithong, MS, OTR/L, SCEM, CAPS, FAOTA. Founder and CEO, Home for Life Design®
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Certified Aging-in-Place Specialist (CAPS) Designee of the Year.
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Former statewide lead of AARP's HomeFit program in Florida.
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Published in the American Journal of Occupational Therapy, The Open Journal of Occupational Therapy, and the Building Performance Association Journal.
"You are only as professional as the tool you are using, and your impact is only as good as the measure you take."
Carolyn Sithong
Two assessors. Same home. Same rating.
How are Accessibility Ratings captured?
Assess
A trained professional walks the home, in person or virtually, and observes the activities that matter to the person living there.
Score
The software turns those observations into accessibility and safety scores, by room and overall. The score is produced by the assessment, not assigned by opinion.
Track
Score again after the modification. The distance between the two numbers is the proof.
A score does not replace clinical judgment. It gives that judgment a structure that can be documented, compared, and defended.
A ramp is never just a ramp.
What does a better score actually change?
Thousands of assessments in, the same two barriers keep surfacing: the stairs and the tub. Here is what one of them costs.
A woman had not taken a real shower in three years, because she could not step over the edge of her tub. After it was replaced with a walk-in shower, she stood under the water until it ran cold. Then she went to church to see her friends, for the first time in years.
That is the ripple effect, and it keeps traveling: independence first, then the cost of care, then the weight a family has been quietly carrying, then how many more years home stays possible at all.
For the organizations paying for the work, the same score answers the harder question. Did it change anything?
An opinion cannot be benchmarked. A score can.
What does the research show?
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Inter-rater reliability of .92 among occupational therapist raters (American Journal of Occupational Therapy, 2019), replicated with 52 raters in 2023.
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Content validity indices of .875 to 1.0 across the rating items (The Open Journal of Occupational Therapy, 2025).
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Validated for virtual, telehealth-based assessment (International Journal of Telerehabilitation, 2023).
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In HUD's Older Adult Home Modification Program, homes scored before and after modification improved 52 percent in accessibility and 48 percent in safety (American Journal of Occupational Therapy, 2026).
HUD's evaluation puts the average modification at $5,400 a home. One time. Less than a single month of assisted living.
A recommendation is not a measurement.
How is this different from a checklist or an AI home report?
A checklist records what is present. A new wave of tools generates suggestions from a photo. Both can be useful, and neither can be tested for reliability, compared across assessors, or tracked from one visit to the next.
The Ratings are the only home assessment that produces a standardized, research-validated accessibility score: one that can be compared across homes, across a program, and across years.
When a funder, a health plan, or a state program has to defend where the money went, that difference is the entire conversation.
Who's using our Accessibility Ratings?
Providers & Health Enterprise
Bring a standardized home environmental assessment into discharge planning, home health, and hospital-at-home, so no one is readmitted because of a step nobody measured.
Colleges & Universities
Teach standardized home assessments with the instrument the field is being measured by.
State, Local, Gov't Agencies
Find the homes carrying the most risk, then show a funder what the money changed. Used in HCBS waiver home modification programs, Older Americans Act Title III-B services, HUD's Older Adult Home Modification Program (OAHMP), and state and local home modification grants.
Non-Profits, Research Groups
One common measure across every person you serve, and grant reporting that writes itself.
MCO's, Insurers, Payors
Standardized documentation of home conditions and outcomes across a supported population, for plans administering SSBCI home safety benefits, Medicare Advantage home modification benefits, D-SNP supplemental benefits, and MLTSS home modifications.
Aging in Place
Determine the greatest area in need of home repair for the aging and disabled. These ratings can be tracked before and after to measure the success of the home modification service process.
FAQs
See what your homes are actually scoring.
Bring one home or ten thousand. We will show you what a standardized measurement looks like in a house you already know.
How one entryway rating kept a program funded.
Where has this worked?
A homeowner in a HUD-funded program could not leave her house without a spouse's hand to steady her. Her front entry scored 0 percent accessible. That number told Finger Lakes Community Action exactly where to start. After the ramp went in, the entry scored 100.
The same before-and-after data helped the program document its outcomes and secure continued funding. The story is published in the Building Performance Association Journal.