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Press Releases

Read important articles and official releases from Home for Life Design®

Healthcare Is Moving Into the Home.

Home Accessibility Now Has a Validated Score.

In this release:
 

Why home-based healthcare requires a consistent accessibility standard

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  • How the Home for Life Design Accessibility Ratings® measure home readiness

  • What peer-reviewed research shows about reliability, validity, and virtual use

  • How agencies, providers, and payers can use accessibility data to document outcomes

 

American healthcare is increasingly relocating into the home. Hospital-at-home programs, value-based payment models, and Medicaid home- and community-based services are moving care into living rooms, bedrooms, entrances, kitchens, and bathrooms as the U.S. population over age 65 approaches roughly 73 million by 2030.

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Home for Life Design®, creator of the Home for Life Design Accessibility Ratings®, makes the case for a consistent national method of measuring whether a home supports safe, independent living.

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The company was founded by Carolyn Sithong, MS, OTR/L, SCEM, CAPS, FAOTA a 25-year occupational therapist, CAPS Designee of the Year, former statewide lead of AARP's HomeFit program in Florida, and creator of the Ratings.

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Home for Life Design's position is that the measurement infrastructure the healthcare and housing systems need already exists: a standardized, research-validated score that can assess an individual home, track change following modification, and compare results across a program or population.

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Key facts:

 

Why home-based healthcare requires a consistent accessibility standard

Hospital-at-home programs, home- and community-based services, and value-based care models increasingly depend on the home as a setting for healthcare delivery. That shift makes the physical environment more than a lifestyle consideration. Entrances, pathways, bathrooms, bedrooms, kitchens, stairs, and other spaces can directly affect whether a person can complete daily activities safely and independently.

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“Healthcare has moved into the home faster than anyone imagined. Surgical recovery, chronic care, whole lives now depend on living rooms and bathrooms that no one ever measured,” said Carolyn Sithong, MS, OTR/L, SCEM, CAPS, FAOTA, founder and CEO of Home for Life Design and a 25-year occupational therapist. “The home does one of two things: it enables function, or it disables it. There is no neutral. For the first time, we can measure which one, and that changes what every family, every agency, and every health plan can do next.”

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Despite the growing role of the home in healthcare delivery, home readiness is still frequently assessed through walkthroughs, checklists, or professional judgment. Two qualified professionals may evaluate the same residence and produce different recommendations, with no common score that allows the results to be compared with another home or with the same home after a modification.

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“An opinion, however experienced, cannot be benchmarked, tracked, or proven,” Sithong said. “A score can.”

A standardized measurement gives practitioners, agencies, providers, and funders a common language. It can help establish baseline conditions, identify barriers, prioritize interventions, evaluate changes, and compare results across multiple residences.

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How the Home for Life Design Accessibility Ratings® measure home readiness

The Home for Life Design Accessibility Ratings® are designed to measure the relationship between a person's functional needs and the physical environment of the home. The assessment converts observations about the residence and the individual's ability to perform daily activities into standardized accessibility and safety scores.

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Unlike a general checklist, the Ratings are intended to produce repeatable data that can be captured before and after a home modification. Results can also be aggregated from a single residence to a geographic service area, funded program, payer population, or portfolio of supported homes.

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The distinction is important as a new generation of home-safety tools enters the market. AI-generated reports and remote recommendation tools may identify potential changes, but a recommendation is not the same as a standardized measurement. The Home for Life Design Accessibility Ratings® are supported by published research examining reliability, validity, and virtual administration.  See the Published Research & Resources section below.

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A standardized score does not replace occupational-therapy judgment. It gives that judgment a consistent structure that can be documented, compared, and evaluated over time.

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“You can't improve what you can't measure, and now, finally, you can measure the home,” Sithong said. “We didn't invent aging in place. We invented the measurement agencies, providers, and payers deciding where the next dollar goes deserve a number they can trust, and the people living in those homes deserve decisions made on evidence.”

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What peer-reviewed research shows about reliability, validity, and virtual use

A study by Lindstrom, Sithong, and Sullivan published in the American Journal of Occupational Therapy in 2019 reported inter-rater reliability of .92 among occupational-therapist raters using the Home for Life Design Accessibility Ratings® (Lindstrom, Sithong, & Sullivan, doi:10.5014/ajot.2019.73S1-PO8023).

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The reliability findings were subsequently replicated with 52 raters in research published in EC Nursing and Healthcare in 2023 (Lindstrom, D., et al., “Impact of Online Instructions about Home for Life Design on Occupational Therapy Students: Suggesting a Standardized Home Assessment Tool,” 5.6: 38-47).

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A 2025 content-validity study by Lindstrom and Nguyen, published in The Open Journal of Occupational Therapy, reported content-validity indices ranging from .875 to 1.0 across the rating items (“Examining Content Validity of Home for Life Design Home Assessment for Home Safety and Accessibility,” 13(2), 1-13, doi:10.15453/2168-6408.2385).

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The PATH protocol, published in the International Journal of Telerehabilitation in 2023, also evaluated the instrument for virtual, telehealth-based home assessment (McBride, C., Story, S., & Cason, J., “Development and Validation of the Protocol for Administering Telehealth Home (PATH) Assessments,” 15(1), e6545, doi:10.5195/ijt.2023.6545).

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Together, the studies provide a published evidence base for evaluating the Ratings as a standardized instrument rather than an informal home-safety checklist.

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How agencies, providers, and payers can use accessibility data to document outcomes

Standardized scores allow an organization to record conditions before an intervention and compare them with conditions after a modification. This can help agencies demonstrate whether funded work produced a measurable change rather than relying only on project counts, photographs, testimonials, or narrative reports.

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The measurement is proving itself where programs meet funders.

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In a 2026 peer-reviewed mixed-methods study of HUD’s Older Adult Home Modification Program, homes assessed with the Ratings before and after modification showed a 52 percent improvement in accessibility scores and a 48 percent improvement in safety scores.

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The study, “Occupational Therapy and the U.S. Department of Housing and Urban Development’s Older Adult Home Modification Program: A Mixed-Methods Study,” was published in the American Journal of Occupational Therapy, 80(2) (Miller, Subasic, & Sithong, 2026; doi:10.5014/ajot.2026.051315).

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When Finger Lakes Community Action used the Ratings to score homes before and after modifications under OAHMP funding, the resulting data helped the program demonstrate outcomes and secure continued funding. The program’s experience is documented in the Building Performance Association Journal.

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The Ratings are in use by public agencies, nonprofits, independent-living networks, and occupational-therapy education programs across the country. Organizations using the Ratings include the NYC Department of the Aging; the Virginia Department of Aging and Rehabilitative Services; Area Agencies on Aging including Land of Sky (Asheville, NC), Region IV Area Agency on Aging (St. Joseph, MI), Tri-Valley Inc. (Dudley, MA), the Southwest Georgia Regional Commission, Partners in Care Foundation (San Fernando, CA), and the Association on Aging in New York; Centers for Independent Living including CIL Orlando and empower: abilities (Springfield, MO); housing organizations and authorities including Inglis (Philadelphia), Rebuilding Together DC Alexandria, WARM NC (Wilmington), Housing Alliance HTX (Houston), Lewiston Housing (Maine), the City of Longview (Texas), and the City of Dubuque (Iowa); and community organizations including Finger Lakes Community Action (New York), Mid Michigan Community Action, Ypsilanti Meals on Wheels (Michigan), and Hospice of Savannah (Georgia).

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For agencies and providers, comparable data can support program evaluation, quality improvement, intervention prioritization, funding documentation, and population-level analysis.

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For payers and managed-care organizations, the Ratings may provide a measurement layer for home-based benefits and services by documenting conditions and outcomes across supported populations. 

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Frequently asked questions

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How do you measure whether a home is safe for aging in place? 

Home accessibility and independent-living readiness can be measured by evaluating how well the physical environment supports the functional needs of the person living there. The Home for Life Design Accessibility Ratings® convert that relationship into standardized accessibility and safety scores that can be documented and compared over time.

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What is a home-accessibility rating? 

A home-accessibility rating is a standardized score describing how safely and independently a person can perform daily activities within a specific home. It measures the interaction between the person and the environment rather than evaluating the person or the environment alone.

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What does a home safety assessment for older adults include? 

A home safety assessment evaluates the environmental features that affect fall risk and daily function: entrances and steps, bathrooms, bedrooms, kitchens, lighting, flooring, and pathways, considered against the abilities of the person living there. Assessments range from informal checklists to standardized instruments; the Home for Life Design Accessibility Ratings® conduct this evaluation as a standardized measurement, producing accessibility and safety scores that support fall prevention and aging in place.

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Why use a score instead of a home-safety checklist? 

A checklist usually records whether certain features are present or absent. A standardized score can be tested for reliability and validity, compared across assessors, tracked before and after an intervention, and aggregated across a program or population.

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How are the Ratings different from an AI home-safety report? 

An AI home-safety report may generate observations or recommendations. A recommendation is not a measurement. The Home for Life Design Accessibility Ratings® produce a standardized score supported by published research on inter-rater reliability, content validity, and virtual administration.  See the Published Research & Resources section below.

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Can the Ratings be completed remotely? 

The instrument has been evaluated for virtual, telehealth-based home assessment in research published in the International Journal of Telerehabilitation in 2023. Whether remote assessment is appropriate may depend on the individual, the residence, the program, and the professional conducting the evaluation. (McBride, Story, & Cason, 2023, doi:10.5195/ijt.2023.6545)

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Can a program measure results across hundreds of homes? 

Because each residence is assessed using the same standardized scoring framework, results can be aggregated from a single home to a program or population. This can help organizations identify where barriers concentrate, prioritize resources, and evaluate whether funded modifications changed accessibility or safety scores.

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Do home modifications prevent falls, and what do they cost? 

Falls are the leading cause of injury among adults 65 and older, and one in four falls each year, according to the CDC. Published research associates home modifications with reduced fall risk, and in the 2026 AJOT study of HUD's Older Adult Home Modification Program, homes assessed with the Ratings showed an average 52 percent improvement in accessibility scores and 48 percent in safety scores after modification. In that federal program, HUD's evaluation reports an average one-time cost of $5,400 per client for basic accessibility modifications, less than a typical single month of assisted living.

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Can the score show whether a home modification worked? 

The Ratings can be collected before and after a modification, allowing the two measurements to be compared. The resulting data may help show whether accessibility or safety scores changed following the intervention, although results depend on the person, the home, and the modifications performed.

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Why would a Medicaid, aging-services, or home-modification program need a score? 

A standardized score allows a program to document baseline conditions and measure changes after an intervention. Aggregated results may also help administrators and funders evaluate outcomes across multiple homes, service areas, or participant populations. This applies across funding mechanisms, including Medicaid HCBS waivers, Older Americans Act Title III-B services, and HUD's Older Adult Home Modification Program.

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Are the Ratings only for older adults? 

The Ratings measure the relationship between a person's functional needs and the home environment. Therefore, they can be used across the lifespan in any type of home and when there is any change of personal, health or home status. That includes people with disabilities, people recovering from injury or surgery, caregivers, and participants in hospital-at-home programs: any person, any condition, any time, any home.

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Published research & resources

 

About Home for Life Design®

Home for Life Design® is a software platform that generates the Home for Life Design Accessibility Ratings®: standardized, research-validated scores of how safely and confidently a person can function in their home. Built from occupational-therapy science and data from thousands of client homes, the Ratings can be captured in any home, tracked before and after modification, and compared across a program or population. The company was founded in 2015 by Carolyn Sithong, MS, OTR/L, SCEM, CAPS, FAOTA, a 25-year occupational therapist, CAPS Designee of the Year, and former statewide lead of AARP's HomeFit program in Florida.

 

Learn more at homeforlifedesign.com

 

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Media Inquiries:

Brooke Smith

bsmith@thevariable.com

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