Published Research
Impact of CAPABLE on Older Adult Home Accessibility Using Home for Life Design ®
Publication Date: July 1, 2026
ABSTRACT
Method: A secondary analysis of home accessibility was completed with data collected using Home for Life Design® for a single group pre/post cohort CAPABLE parent study conducted in Pennsylvania, U.S.A. CAPABLE is an evidence-based interprofessional intervention delivered by an occupational therapist, a registered nurse, and handy worker. The intervention includes up to 10 visits to the participants’ homes to assess accessibility, recommend modifications, and provide strategies to enhance independence and safety. Participants were recruited through an Area Agency on Aging and included in this study if they met the parent study’s inclusion criteria and completed both pre- and post-intervention home accessibility assessments. During the first and final occupational therapy intervention visits, the occupational therapist administered the Home for Life Design® assessment to gather an Accessibility Ratings™ (AR) score.
Results: Forty-four participants were included in this secondary analysis. The CAPABLE intervention was associated with significant, large improvements in home accessibility ratings (Z = −5.45, p < 0.001). Median accessibility scores increased by 19.80% from pre- to post-intervention following home modifications (pre = 58.55% and post = 78.35%).
Conclusion: The CAPABLE intervention may improve home accessibility, which may help older adults maintain independence and age in place. Results should be interpreted with caution due to lack of a comparison group, convenience sampling and potential assessor bias.
Link to full article: https://agmr.hapres.com/htmls/AGMR_1958_Detail.html
Occupational Therapy and the U.S. Department of Housing and Urban Development's (HUD) Older Adult Home Modification Program: A Mixed-Methods Study
Publication Date: March 1, 2026
ABSTRACT
Importance: Occupational therapy has a distinct role in home assessment and home modification (HM) interventions for nationwide aging-in-place (AIP) programming.
Objective: To examine the outcomes of a technology-based home assessment and explore client perspectives within the U.S. Department of Housing and Urban Development's Older Adult Home Modification Program (OAHMP).
Link to Abstract: https://journals.sagepub.com/doi/10.5014/ajot.2026.051315
Examining Content Validity of Home for Life Design Home Assessment for Home Safety and Accessibility
Publication Date: March 1, 2025
ABSTRACT
Background: Older adults aging in place face daily challenges in functional mobility and increased fall risk. Home environments lack accessibility and safety features that promote safety, independence, and longevity. Quality home assessments that are reliable, valid, and efficient are necessary to help determine the safety and accessibility of the built environment for persons aging in place.
Method: A mixed-method study was conducted to determine if the Home for Life Design (HfLD) Home Assessment is a valid assessment for measuring safety and accessibility in the home. Eight experienced occupational therapists completed a Content Validity Index (CVI) and qualitative interview with a thematic analysis to determine content validity.
Results: CVI results were between.875–1.0 for all five items (*value > .83 needed to be a valid assessment, (Yusoff, 2019), confirming the validity of the assessment. These scores were supported by four qualitative interview themes that emerged during the participants’ descriptions of professional use of the tool, including measures accessibility, measures safety, a preferred home assessment, and client-centric.
Conclusion: The HfLD Home Assessment appears to be a relevant and valid method to assess and measure the safety and accessibility of a person’s home environment.
Link to full publication: https://scholarworks.wmich.edu/ojot/vol13/iss2/9/
May 2021, Volume 6, Issue 2
by Carolyn Sithong, MS, OTR/L, SCEM, CAPS, FAOTA
-For AOTA Members Only-
Abstract
Covid-19 is an example of a challenging time for therapy practice and practitioner performance. Despite being experts in environmental adaptation and the theoretical underpinnings of how environments influence function, occupational therapy practitioners still experienced the effects of Covid-19 in the areas of work, self-care, and leisure. Fortunately, what holds true for clients also holds true for practitioners -- that in, most disabling situations, we rise to seize the opportunity and overcome the challenge.
Development and Validation of the Protocol for Administering Telehealth Home (PATH) Assessments
Publication Date: May 11, 2023
ABSTRACT
Home safety assessments and subsequent modifications can prevent hospitalization, institutionalization, and death among older adults. Telehealth has been shown to be an effective means to administer home safety assessments. However, a structured approach to synchronous telehealth home assessments has not been examined. This study involved development and validation of a structured telehealth home assessment protocol.
The Protocol for Administering Telehealth Home (PATH) assessment was developed based on literature review, clinical experience with in-person and telehealth home assessments, and interviews with content experts. Six older adults participated in the validation phase of the protocol using a quasi-experimental, mixed-methods, one-group research design. The validation process resulted in modifications to the protocol to enhance its utility in practice.
The PATH protocol provides a valid, structured approach to conducting synchronous telehealth home assessments and can be used by occupational therapists to administer home assessments for older adults desiring to age in place.
Link to full article: https://pmc.ncbi.nlm.nih.gov/articles/PMC10687956/
Impact of Online Instructions about Home for Life Design on Occupational Therapy Students: Suggesting a Standardized Home Assessment Tool
Publication Date: April 24, 2023
ABSTRACT
Background: The number of older adults that choose to age in place is rapidly growing creating a need for efficient and standardized home assessment measures. The Home for Life Design (HfLD), Home Assessment was created on a technology platform to enhance occupational therapy (OT) home assessment practice. This inter-rater agreement study includes the enhanced training including a Scoring Decision Guide that were developed during the inter-rater agreement analysis to improve the inter-rater agreement. This is a preliminary study for the tool’s standardization for reliable use by occupational therapists.
Method: The study composed of 52 occupational therapy student raters’ home accessibility scores against the author’s scores using a Rater Test. Prior to taking the Rater Test, the students viewed the on-line training that included instructions on how to use the newly developed Scoring Decision Guide. Each of the student raters’ scores were compared to the test author’s using descriptive stats and an intraclass correlation with absolute agreement, two way mixed effects model and 95% confidence interval.
Results: The average intraclass correlation for the 52 raters was .93, with a standard error of 0.011 and a 95% confidence level of 0.022. This indicates good/excellent inter-rater agreement between the 52 raters and the author of the tool.
Conclusion: Practitioners who choose to measure accessibility of a client’s home and follow the on-line training of the HfLD Home Assessment, can use this tool as a reliable OT home assessment.
Link to full article: https://ecronicon.net/ecnh/impact-of-online-instructions-about-home-life-design-on-occupational-therapy-students-suggesting-a-standardized-home-assessment-tool
Home for Life Design (HFLD)
Home Assessment Psychometric Study:
Inter-Rater Reliability of a Home-Safety Assessment Tool
August 2019 - Volume 73, Issue 4, Supplement 1
Primary Author and Speaker: Debra Lindstrom
Additional Authors and Speakers: Carolyn Sithong, Katherine Sullivan
-For AOTA Members Only-
Abstract
The focus of the Home for Life Design (HFLD) app-based home assessment is to determine a person’s ability to safely complete an occupation in context, and if and how the environment limits safety. An inter-rater reliability study with OT students (n=32) used online training v.5; ICC between individual raters and the author was high (.92; 95% CI). These findings contribute to the evidence that the HFLD home assessment is a reliable tool for OTs making home-safety recommendations.