Say the phrase “aging in place” and a familiar picture forms. A determined older adult. A worried daughter. A few grab bars, a stern conversation about the stairs, and a shared hope that willpower and luck will hold out. We talk about aging in place as a personal aspiration, something an individual achieves through grit and good fortune. After twenty-five years as an occupational therapist working inside thousands of homes, I can tell you the picture is wrong in one important

There is a moment I have seen more times than I can count in twenty-five years as an occupational therapist. A patient spends weeks recovering from a fall, a stroke, a hip replacement. In the hospital, she is a success story. She walks the corridor with her therapist beside her. She manages the practice stairs in the rehab gym. Her discharge paperwork says she is ready to go home, and by every clinical measure, she is. Then she goes home, and the home undoes it. The front ent