What an Occupational Therapist's Home Assessment Looks Like

What an occupational therapist does

An OT is a health professional trained to help people take part in daily life despite illness, injury, disability or ageing. For older adults, they:

• assess how a person manages daily activities, such as bathing, dressing, eating, cooking, moving about the home, managing medicines and using the phone;
• identify hazards and barriers in the home;
• recommend equipment, such as grab bars, raised seats, reachers and cooking aids;
• suggest changes to the home, such as ramps, rails and rearranged furniture;
• teach techniques and routines, such as safer ways to get in and out of the bath;
• advise on cognitive and memory support, including orientation aids and routines;
• help with recovery after stroke, surgery or hospital stay; and
• advise carers on safe handling and on balancing their own needs.

They work with physiotherapists, doctors, nurses and social workers, each with a different focus. See physiotherapist's walking assessment for the physiotherapy side.

When to ask for an assessment

Consider an OT assessment when your parent:

• has had a fall or a near fall at home;
• is coming home after hospital, a stroke, a fracture or surgery;
• finds bathing, dressing, cooking or climbing stairs hard;
• has memory loss or dementia, and the home may no longer be safe;
• has arthritis, tremor or weakness affecting everyday tasks;
• uses a wheelchair, walker or hoist, and the home needs adapting;
• lives alone and you worry about safety;
• has a progressive condition such as Parkinson's disease; or
• is stopping activities they used to enjoy.

Assessments can be arranged privately, through hospitals and community services where available, and via some care services. Ask for a home visit, since seeing the real home reveals problems that no clinic can.

Before the visit: how to prepare

• Write down your concerns: which tasks are hard, when problems began, any falls or near misses.
• List medical conditions and medicines, and bring recent reports.
• Have your parent ready to show how they do things, such as getting out of bed, using the toilet, making tea.
• Make the home as normal as possible, not tidied up so much that problems are hidden.
• Ask a family member who knows your parent well to be present, with your parent's agreement.
• Think about your parent's goals: what matters to them. Is it staying in their own bedroom upstairs, cooking their own meals or going to the temple?
• Allow time: an assessment usually takes an hour or more.

The conversation

The OT will talk to your parent, and to family, about:

• the person's day, routines, hobbies and what they value;
• what they find difficult, and what they avoid;
• falls, pain, breathlessness, tiredness, mood and memory;
• the people who help them;
• the home, including stairs, bathroom, bedroom and kitchen;
• worries about safety, such as night-time toilet trips; and
• what they hope to achieve.

The OT listens for the person's own priorities, which drive the plan. Be honest and let your parent speak for themselves, adding detail kindly where needed.

Watching tasks

The OT will usually ask your parent to show how they do everyday tasks, in the real places.

• Getting in and out of bed and chairs.
• Walking through the home, including stairs and thresholds.
• Using the toilet and, where appropriate, the bath or shower.
• Dressing, including socks and shoes.
• Preparing a drink or a simple meal in the kitchen.
• Opening jars and doors, using taps and switches.
• Managing medicines and using the phone.
• Reaching items in cupboards and on shelves.

They look at posture, balance, strength, grip, pain, speed, memory and judgement, and note how safe and how tiring each task is. Many OTs also use short standard tests of daily function and cognition.

Checking the home

The OT will look around each room.

• Entrances and steps: rails, ramps, lighting, door width and thresholds.
• Stairs: rails, step height, lighting and carpets.
• Floors: loose rugs, slippery tiles, clutter, cables.
• Lighting: dark areas, switches, night lights; see lighting for older eyes.
• Bedroom: bed height, space for aids, route to the toilet at night; see bedroom setup for night-time safety.
• Bathroom and toilet: grab bars, seat height, non-slip surfaces, shower access; see bathroom safety checklist for seniors.
• Kitchen: layout, heights, appliances, gas and fire risks; see kitchen safety for older adults.
• Living area: chair height and firmness; see choosing a chair for an older person.
• Safety systems: smoke alarms, locks, an emergency alert.
• Heating, cooling and ventilation.

What the OT recommends

After the assessment, an OT may suggest:

• Equipment: grab bars, raised toilet seats, shower chairs, reachers, long-handled aids, cutlery aids, dressing aids, pill organisers, orientation aids; see daily living aids that keep older adults independent.
• Mobility aids: referral to a physiotherapist or advice on sticks, walkers or wheelchairs.
• Home changes: ramps, rails, widened doorways, rearranged rooms, a ground-floor bedroom or bathroom.
• Techniques: how to get in and out of the bath, use stairs, transfer from bed to chair or manage tasks one-handed.
• Routines: pacing activities, energy conservation, breaking tasks down.
• Memory and safety strategies: labels, clocks, routines and safety devices.
• Carer training: safe handling and communication.
• Referrals: to doctors, social workers, dieticians or other services.
• A written report summarising findings and recommendations.

Ask what is essential, what is helpful and what can wait, and what each item costs.

After the assessment

• Read the report and ask for explanations.
• Prioritise: do safety-critical items first, such as a grab bar by the toilet, a night light and removal of loose rugs.
• Arrange equipment, via suppliers; our care advisors can help source and install.
• Practise the new techniques with the OT's help, until they are comfortable.
• Follow up: ask for a review after a few weeks to see how it is working, and adjust.
• Share the plan with all family members and carers.
• Review again if health changes, after a fall or a hospital stay.

Making it a good experience

Home visits can feel intrusive. Help your parent by explaining that the OT is there to help them stay independent, not to judge. Keep the tone friendly, let your parent lead, and respect their wishes. If your parent is reluctant to change, the OT can discuss options and compromises. Remember that a recommendation is only useful if it will be used.

Cost and finding an OT

Fees vary by city and service. Ask what is included: the visit, the report, equipment advice and follow-up. Choose a qualified OT with experience in older adults and ask about registration with a recognised professional body. Be careful with anyone who sells equipment aggressively. Ask for several options. See mobility aid budget for Indian families for money advice.

When to ask a professional

An OT is the professional to ask. Ask a physiotherapist for walking and balance concerns and a doctor for new symptoms or illness. See geriatric assessment explained for a broader view. Our care advisors can arrange an OT home assessment and help with equipment and modifications.