How to Become a Home Modifications Occupational Therapist

There are so many amazing non-clinical career and business routes that occupational therapists and occupational therapy assistants can transition into, including home modifications and aging in place. As I’ve become very interested in taking this path myself, I am so excited to share this super helpful guest post written by Emma Shapiro, PT, DPT, all about how you can dive into home modifications as an occupational therapist or OTA. 

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What you’ll learn in this article:

• What are home modifications?
• Why OTs and COTAs are uniquely qualified
• Conducting evaluations and follow-ups
• Business and career opportunities for OTs and COTAs

What are home modifications? How are OTs and COTAs uniquely qualified?

Home modifications, according to Eldercare.acl.gov are defined as “Home improvements, modifications, and repairs [that] can help older adults maintain their independence and prevent accidents. Work can range from simple changes, like replacing door knobs with pull handles, to major structural projects such as installing a wheelchair ramp.”

There are so many areas that home modifications encompass.

Many of us may think of home modifications as only changing doorways or adding a ramp to the entryway, but home modifications encompasses so much more.

Some services you may provide if you perform home modifications include:

1. Recommendations of different products to aid in transfers, safety, mobility in the home
2. Recommendations on adjustments to the universal design (aka the floor plan) of the home
3. Caregiver, family, and patient training on how to use the new equipment
4. Recommend appropriate assistive devices and training on these devices
5. Follows to ensure the modifications were appropriate and overcome any questions or challenges
6. Project management with interior designers and contractors to ensure the needs of the client are properly conveyed

What is the process of a Home Modification Evaluation?

When you perform home modifications, you’ll first interview the patient/client, family, and caregivers to learn about their health history, current activity level, prior level of function, and goals for aging in place. This could take roughly 30 minutes to complete and document. There are several different types of assessments you can use to help guide your home modification evaluation.

A few free home modifications assessments include:

• Safe at Home Checklist (from AOTA and AARP) 
• Complex Home Modification Assessment
• HSCSN Order for Home Assessment for Modification(s) or Adaptations
• Home Modification Assessment & Planning Tool

You’ll then walk through the entire home, from the backyard and patio, the front entrance, the living room, dining room, kitchen, garage, basement, bedrooms, stairs, bathrooms and any other areas around the home, even the driveway.  You’ll measure areas, take pictures, and most importantly – you’ll watch the client perform tasks to see the problems they may be having.

You may suggest some changes or equipment on the spot, but usually a home modification evaluation is very thorough and as a result, it may take time to process and write up. You’ll return home to create a write up of your ideas, recommendations with product links if possible, funding ideas, and other tips you may have.

To finalize the evaluation, you may simply provide this paperwork to the client but many times you’ll also perform an in-person, phone, or online chat to discuss your findings and answer any last questions.

At this point, your home modifications evaluation is complete. After your evaluation, you may want to recommend more services that you or others in your network provide. These services could include:

• Contractor or handyman services
• Purchasing certain equipment and returning for training on these items
• Therapy services
• Home health aide services
• Other as-needed services

Why are occupational therapists and assistants uniquely qualified to perform home modifications?

Both OTs and COTAs know the human body extremely well. You are anatomy and physiology experts. You know neurologic and orthopedic conditions and more importantly, you know the progression of these, the prognosis, and the medical care needed to properly care for these diagnoses.

One of the biggest differences often between a contractor and a therapist who performs a home modification evaluation is the medical knowledge and the disease knowledge you have that contractors don’t. You cannot only perform modifications for the needs of the client today. With modifications that may be thousands of dollars, one cannot afford to continue to redo modifications whenever a change happens. As OTs and COTAs, you know the outcomes and can predict and make sure these changes to the home are as lasting as possible.

Another major difference is that you understand FUNCTIONAL mobility. Your goal is maximizing one’s independence with activities of daily living and your creativity is second to none. There may be one way to do something, but your keen eye may be more creative, coupled with your medical experience and the hundreds or thousands of patients you have seen over your career.

What do you need in order to perform home modifications as an occupational therapist?

Occupational therapy practitioners have an amazing medical background and therefore can actually perform basic modifications without any certifications. In fact, many of us are already performing home modifications in some way in our current roles.

However, there are some certifications that are very helpful to ensure you know all the rules and regulations, the business keys, and the key measurements to ensure your modifications are the best possible for the client.

The top two home modifications certifications are:

1. CAPS – Certified Aging in Place Specialist

The Certified Aging in Place Specialist course (discounted link) is a series of three six-hour online live training sessions. Most CAPS trainers are not approved for AOTA and PT CEUs, but the above-linked Alternative Healthcare Careers’ is. In addition, most CAPS trainers do not provide additional business training, marketing materials and career materials but Alternative Healthcare Careers’ course does.

Within the Alternative Healthcare Careers’ CAPS program, you receive:

• 3 live training sessions (online via Zoom) taught by two OT instructors that have full time businesses within home modifications
• A 4 hour home modification specific business course that walks you through performing evaluations, connecting with contractors and other referral sources, working with clients/patients, billing, pricing, and other business tips specific for home modifications
• A 4 hour general business course that walks you through EIN, entity set up, liability insurance, organic and paid marketing, social media and more
• 18 hours of AOTA-approved CEUs when you complete the full CAPS program
• Canva marketing materials you can brand as your own
• Canva grant template you can brand as your own
• Website template you can copy, as well as technology tutorials
• A free home modification directory you can place your business on
• Facebook group
• Price: $735 with our special discount link

If you have any questions about this course, please email the Alternative Healthcare Careers team at info@alternativehealthcarecareers.com.

2. USC’s Executive Certificate in Home Modifications (ECHM)

• This is a 5 course home modifications series from the University of Southern California that is performed online, through structured exercises, handouts, homework, and 2 online videos to watch per class. 
• Each course is about 12 hours of class time and can be applied towards AOTA-approved CEUS.
• Price: $1100 ($950 for AOTA members)

Can occupational therapy assistants perform home modifications?

The answer is yes and no. Many non-licensed clinicians such as realtors and contractors can perform home modifications. However, these are non-medical evaluations. If there is a non-medical evaluation, for example an evaluation for an Airbnb or a rental in order to prevent falls from a renter, then assistants could perform that evaluation. Let’s say there is a follow up session required, project management, or caregiver training required, then these are roles that OT assistants could perform as well.

However, if it is a Medicare evaluation, such as a patient that recently was discharged from the hospital and is under home health care, then these evaluations can only be performed by an OT or a PT.

Home Modifications Business Opportunities for OTs and COTAs 

Occupational therapists and assistants can enter into the home modification business sector in 3 ways:

1. Contracting with other companies (1099). Some companies hire OTs for evaluations and they’ll do all the work. All you need to do is show up.
2. As a side hustle
3. As your own long-term business 

The amazing thing is that home modifications blend very well with occupational therapy services. It is often advised that if you have a therapy business then adding this to your service list is a perfect fit, and vice versa. You should think about adding therapy services to your offering as many times those with home modification needs may also need your therapy services.

Assistants could run their own business and simply hire an OT to perform the evaluations. This allows you to scale your business and you could take a small cut of the evaluations performed.  There are many assistants that run their own therapy business and it’s the same process.

What can you bill for your OT home modification services?

If you are performing a Medicare evaluation, then you’ll be reimbursed the Medicare rate. However, there are many instances where you could bill cash based and for that, you can change based on hour, based on a package of services, or based on other needs. Usually around $150-250 per evaluation is a fair starting point. In addition to this cost, you can upsell with different services such as equipment training, project management, follow ups, and therapy services.

How to find your first home modification clients?

Four quick ways to find your first client include:

1. Contact home modifications companies; this way they find the clients and you simply do the evaluations.
2. Use social media: find groups that are focused on rehabilitation or on certain diagnoses and promote your services there.
3. Use local SEO through Google My Business and set up your own website as well.
4. Talk to various local hospitals, rehabilitation facilities, assisted living facilities, and adult day centers to share your services.

How to find contactors to help you with the home modification repairs and remodeling?

There are so many contractors out there! The easiest way is to see if any local family and friends and neighbors have solid recommendations and give them a call. If you have local Facebook groups, that is another great way to get feedback on reputable contractors to use and continue to refer to. 

Career opportunities for OTs and COTAs within Home Modifications

There may be some therapists and assistants who are not interested in a side hustle or business, and the exciting thing about home modifications is that this is still very useful in your current career!

With additional training, you could discuss adding home modifications as a service that your employer could offer. You could be the go-to person or even the manager of this division. This could be a great way to transition away from the heavy lifting and stress we often have as hands-on therapists and assistants.

You can also find new employment in this field. Hospitals are starting to hire for these roles, the Veterans Affairs (VA) has several different types of roles they hire that look highly upon therapists who are CAPS trained, and even DME companies are looking for specialists in this area.

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We hope this article has helped you discover new ways to use your OT/COTA skills! Home modifications can be a wonderful route to help prevent or reduce your burnout. From starting a side hustle or a business or even moving up in your current position, home modifications is such a unique and fulfilling opportunity to explore.

If you have any follow-up questions about home modifications or her CAPS course, please email Emma at info@alternativehealthcarecareers.com.

This post was last updated on May 31, 2026.