Occupational Therapy and Our Role in Housing

Many people have never heard of occupational therapy (OT), let alone considered how an OT would be beneficial in the home building industry. Most people come into contact with an OT for the first time through a hospital setting or in a school, and may not realize the plethora of settings in which OTs are valuable within the community.

This article isn’t being written to explain the profession’s diversity, but rather to discuss their unique role in collaborating with designers and builders. In this regard, an OT’s role is to provide input about how people function in a home environment when illness, injury, or disability are present.

If you are an architect, builder, or another related professional, this article will help you understand the unique perspectives OT has within the home building industry. Similar to the different interests and skill sets developed through training for building and design professionals, OTs fall into different practice areas and niches. This article will also help you decide what kind of OT would be the best collaborator depending on the needs of your project.

Occupational Therapy (OT) Defined

What is an “occupation”?

According to the Merriam-Webster dictionary, an occupation is simply “an activity in which one engages”. In other words, it’s any activity that occupies someone’s time.

What does an OT do?

Occupational therapists (OTs) are uniquely trained to help people across the life span engage in meaningful occupations, especially after they’ve encountered an illness, disability, or injury that affects their performance in daily tasks. In order to maximize a patient’s independence with a certain occupation, an OT might help them relearn the activity in a new way or adapt the environment. Some activities that are addressed in OT include toileting, bathing, dressing, and grooming, which are called activities of daily living or (ADLs). Additionally, OT’s can help people achieve higher-level tasks such as grocery shopping, cooking meals, paying bills, and driving a car.

Furthermore, OTs are trained to consider how the physical environment can influence how someone performs their occupations. According to the Occupational Therapy Practice Framework (OTPF): Domain & Process, “physical environments can either support or present barriers to participation in meaningful occupations”. Additionally, the OTPF states that “occupational therapy practitioners recognize that for clients to truly achieve an existence of full participation, meaning, and purpose, clients must not only function but also engage comfortably with their world.”

What does this all mean?

The environment has a direct impact on how well someone can do something.

An unsupportive environment can lead to greater dependence on others, missing out on valued activities, and even safety concerns. OTs are experts at not only analyzing the fit between a person and their environment, but also generating solutions for current or potential problems. They have extensive training in a wide variety of health conditions and understand how the design of an environment can impact someone’s independence in daily tasks at any age or ability level.

OT’s Roles + Practice Areas

There are several different avenues an occupational therapist can take to help clients modify their homes. None of these areas of practice are better than another. They are just different by the typical interventions provided and the focus area chosen while helping a client.

Graphic describing three practice areas an OT can work. In a clinical setting, focusing on Home Modification, and in Universal Design.

Clinical OT

1After a health event occurs, a person would typically go to a clinical setting, such as a hospital or rehabilitation center. In these settings, collaboration occurs between other healthcare team members, like doctors, case managers, nurses, and other therapy disciplines. It is rare that an OT gets to collaborate with a building professional at this stage.

In clinical settings, the OT must start planning for the patient’s discharge on day one of their stay. Along with improving their overall function, an OT in this setting will interview their client to learn more about their home environment.

An OT would focus on these questions:

  • Do you live in a single family home or apartment? How many floors? Is there stairs or an elevator?
  • Do you have steps to enter/exit the home? Is there a railing?
  • Do you have a bathtub or walk-in shower? Are there grab bars?
  • Do you live alone or with family members? Is there anyone that can assist you?

Frequently, homes do not accommodate someone after they acquire an illness, injury, or disability. For example, doorways might be too narrow for a wheelchair, the full bathroom might be upstairs, or there might be steps to enter the home. Many of these things can be a barrier for that person to return home. At this stage, OTs can only do so much to help with environmental changes. They can recommend equipment to adapt the environment or teach their patients new techniques for familiar tasks. They might even be able to give them a handout on how to get a ramp built, suggest they install swing away hinges, or widen a doorway.

OTs who work in clinical settings don’t typically connect or collaborate with service providers to do the construction work. It’s not because it wouldn’t be helpful, it’s just because most healthcare systems haven’t established a way for this to happen. Having direct contact with someone in the construction field at this point in the process would be extremely helpful for someone who has just undergone a health event and is determining if their home is safe for their return, as most needs are immediate in nature.

We discuss this topic in more depth in a podcast episode if you’d like to learn more.

Home Mods OT + Consulting

2There is a newer niche of OT beginning to form, where OTs are branching out of clinical settings and developing their own consulting businesses. These OTs specialize in home modifications and can be hired as a consultant during renovations to help the aging population or people with complex disabilities. Home modifications are typically geared toward individuals living in a specific home and with specific needs.

“Home modifications are changes made to adapt living spaces to increase usage, safety, security, and independence.”

Home Modifications and Occupational Therapy AOTA

The OT would typically evaluate their client’s abilities and analyze how well they perform their occupations in their home. If the environment doesn’t work for them, the OT will make recommendations for how to improve it and then collaborate with a building professional to make it happen. Some occupational therapists have created partnerships within the builder or architect’s company and are employed by the company to modify existing homes for a specific family.

Types of modifications could include installing grab bars around the toilet to help someone stand up and sit down safely, purchasing a stairlift so someone is able to access their second-story bedroom, or building a ramp so people who use mobility devices can enter/exit the home. Unfortunately, these modifications can end up looking like an add-on, since accessibility was not considered in the original design of the home. Additionally in this area of practice, compromises are often made because of time and money. This results in a person with impairments only being able to use a portion of their home.

OTs in this practice area can also work on new additions built onto the home, as well as the remodel of a bathroom or kitchen for maximum independence. These modifications can even increase the resale value of the home.

If you are a builder looking for an OT involved in home modifications, the Home Modification Occupational Therapy Alliance may be helpful.

OT in Universal Design

3An even more unique area of practice is one in which OTs participate in the design and build of new homes for a wide variety of users. This means that the finished product is flexible enough to work for different types of needs and not specific to just one person.

Side note: universal design applies to more than homes, but we’re just focusing on homes for this article.

Universal design is design that’s usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.

– Ron Mace


It is much easier and less costly to implement functional features in the entire home from the start by collaborating directly with the architect. OT’s can contribute to the successful implementation of universal design by considering the abilities and needs of all people. Our organization utilizes this infographic during our collaborative design process. It helps us visualize the wide variety of impairments that need to be addressed in our design work. Our goal is to create designs that are a good fit for many different people as our focus reaches beyond wheelchair access.

The creativity of this area of practice lies within making the space flexible. The environment needs to meet a wide variety of needs and design must allow for easy adjustment if needed.

Importance of Collaboration

Interprofessional collaboration with those in building and design fields, although difficult, is essential for implementing changes to an existing home or designing a new one. Designers and builders understand the science behind the build and OT understands the science behind human function. All professionals at the table must see the value of each profession’s skill set. Then they can work together to create something that has an impact on the way people use and live in their homes.


12 responses to “Occupational Therapy and Our Role in Housing”

  1. Amy Homan DePoy, OT/L, CAPS Avatar

    Great article! Thanks for breaking this down and making it understandable to the consumer. There are so many individuals OT’s are uniquely equipped to serve. But most consumers don’t know how we can help!

    1. Kaitlyn Richardson Avatar
      Kaitlyn Richardson

      Thank you for reading, Amy! I appreciate your feedback.

  2. Anava Baruch Avatar

    Hi Kaitlyn,
    I am a housing OT from the UK. In 2012 I set up Design For Independence Ltd. Have a look at our website
    We specialise in translating medical conditions into architectural drawings. Taking into consideration the care and rehabilitation needs.
    Get in touch if you would like to hear more
    I am also on LinkedIn and have published some articles about our work there.

    Best Anava Baruch

    1. Kaitlyn Richardson Avatar
      Kaitlyn Richardson

      Thanks for reading Anava! Your work in the UK is admirable and I will definitely check out your website!

  3. Margot McWhirter, OT Reg.(Ont.), MA(Gerontology) Avatar

    Thanks for writing this, Kaitlyn! I often find myself having to explain* how what I do — and how I do it — is different from home safety assessments. (*not only to clients, funders, designers, and builders, but also to other OTs.) Your article will be an excellent resource, for me and others.

    1. Kaitlyn Richardson Avatar
      Kaitlyn Richardson

      Thank you, Margot!
      My mentor, Sarah Pruett, and I took a lot of time to write this article, as it can be quite difficult to clearly explain these three areas of practice to our stakeholders, clients, and other OTs. I am thrilled that you would consider using this article as a resource in the future!
      With thanks,

  4. Kathy Subasic Avatar

    Thank you for your thoughtfully written article. As an OT Entrepreneur in the Home Modification space, I appreciate your clear descriptions of how occupational therapists fit in this space.

  5. Shelby Osborne Avatar

    Hi Kaitlyn! My name is Shelby Osborne and I am also an OTD student but at the University of St. Augustine in Austin, Texas. My capstone mentor directed me to The Universal Design website because of y’all’s theory of PEO. I begin my experiential component of my project in January but am currently working on the didactic and literature review portion of it. My project is focusing on how occupational therapy can aide those who are homeless, using MOHO, such as obtaining gainful employment and how to engage in occupations that lead to employment. The site I am partnering with is Mobile Loaves and Fishes in Austin, Texas which I have attached the URL for. They are an outreach program that is built on 500 acres that offer jobs and micro homes to those who are homeless. Once my experiential component begins, I would LOVE to connect The Universal Design with Mobile Loaves and Fishes together so that y’all can expand into Texas, allow adaptable housing at their center for those who are homeless and also have a disability, and potentially help hire an OT there. This might not be until January but I wanted to at least offer now!

  6. Anna Chalmers Avatar

    Thank you, this article is so helpful at separating these roles out, and will be a great guide for explaining this to service users. Thank you

  7. Melissa Bressler Avatar
    Melissa Bressler

    Thank you Kaitlyn for your clearly and creatively written article. You article will continuously be a reference as someone that has spent most of my professional career in a clinical (outpatient) setting and just recently found myself working for a construction company specializing in home mods for seniors and all persons with accessibility concerns.

  8. […] Occupational Therapists (OTs) are health professionals who help people inhibited by injury, illness, or disability participate in the activities that they want and need to do each day. These activities might include bathing, socializing with friends, or folding the laundry. OTs are skilled in activity analysis, or breaking down an activity (aka occupation) into smaller tasks. This allows them to evaluate the skills and abilities a person needs in order to participate in valued activities. The knowledge OTs have about activity demands influences the design of more functional spaces and products that can be used by all. […]

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