In this post, home modifications occupational therapist, Paige Hays, is sharing her experience of transitioning from traditional occupational therapy into starting her own online and in-person home modifications business.

Paige is from the Twin Cities in Minnesota, she is the mother of two girls, loves DIY projects, and been working in home modifications for several years now. She specializes in home modifications for both adults and children with a wide range of impairments, ranging from cognitive and sensory issues to neuromuscular disabilities and complex medical needs.

Paige is the owner and founder of the online business called Beyond Accessibility. Beyond Accessibility connects people with quality resources to improve how people live. Through her business, Paige passionately works to find practical solutions to everyday problems at home that go beyond making environments accessible.Beyond-Accessibility-logoMany of you have expressed interest in working in home modifications, and I can’t think of a better person than Paige to teach us all about it. Thanks so much, Paige, for sharing your experience and insight!


[Paige Hays]: I didn’t realize that even after many years of being a “grown-up,” I would still be dreaming about what I wanted to be when I grew up. Luckily, one of the best things about a career in occupational therapy (OT) is the diversity of our work; this makes changing career paths to find your passion achievable.

Why I Chose OT 

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One of the main reasons I chose to study occupational therapy was its focus on quality of life. I liked the process: how it took the big picture (the occupations, meaning what you need or want to do in life) and broke it down systematically into components that could be addressed through interventions. While studying in OT school, I found that the environmental side of the Person- Environment- Occupational Performance model (PEOP model by Baum & Christensen) held special interest for me.

I was raised in a family that taught me how to make things. I learned to create and build things using a paintbrush, level, measuring tape, drill, and saw. I was one of the only people in my OT class that knew about load-bearing vs. partition walls, coefficient of friction of tile coating, or how to install new faucets or wiring.

It was a perfect niche for me within OT. I even created a business plan while in school as part of our OT management course; I was becoming passionate about environmental modifications. Then, just as I graduated, the housing market crashed, and a home modification business was out of the question.

The Start of My OT Career

I spent the first decade of my OT career in traditional OT settings. I worked in schools, outpatient clinics, acute care, and home health. I worked with infants through centenarians. I learned intervention specialties focused on the “person” component of the PEOP model for sensory processing disorders, medically complex patients, feeding needs, dementia care, orthopedic care, and neuro-rehab.

The experience was incredibly valuable. I would have loved to jump into home modifications straight from graduation, but in hindsight, I wasn’t ready. I needed the experience and time with patients, listening to patient stories from their hospital beds, counseling families about safety for older adults with dementia at home, and seeing families’ needs change as their children with disabilities grew-up.

Feeling Burned Out

So, many years of experience later, I was an experienced OT. However, I also had become burned out; my passion had faded. I had lost sight of the meaning of “occupation” in my clients’ lives. The pressures and constraints in these traditional settings was too much. My ideal OT model was impractical and impossible most of the time, and I felt I was constantly fighting the system to be able to meet my clients’ needs.

Each system has its owns issues. School services are limited by IDEA (Individuals with Disabilities Education Act) and the requirement to only work on education-related goals. Clinic services are limited by the restrictions of the health insurance payer, with limitations on types of treatment and number of visits. Acute care is limited by short hospital stays and the push to discharge quickly while also preventing re-admissions.

Every setting is limited by time and money, and I felt I was spending more time worrying about “productivity” than occupations. These limitations are a reality in most settings, but they often push OTs further away from the vision of ideal OT we are taught in school. I point this out not to debate these realities, but as part of the reason I, and many other OTs, lose our passion and find themselves dreaming about what we want to be as an OT.

Life circumstances finally pushed me to rediscover my passion for occupational therapy. After my second child joined our family through adoption, I found myself constantly torn between meeting the demands at home and meeting the demands at work. I was working so hard, but realized I wasn’t working towards my passion for OT, so I stopped.

Deciding to Make a Career Change

I stayed at home with my children. While at home, I had a lot of time to think about my OT career. After a while, I stopped thinking about insurance regulations, treatment codes, and productivity; instead, I found myself dreaming again about helping people by focusing on occupations using the PEOP model.


I began to daydream while making trips to the playground and picnicking with my children about what I kind of OT I wanted to be when I “grew-up.” My passion slowly returned: it was time to jump into home modifications as a business.

Becoming an OT Entrepreneur

I have always loved learning, and there was a lot to learn. Being an entrepreneur isn’t simple. I made many trips to the library to get books about starting a business, marketing, website design, and accounting. I learned how to establish an LLC business, do billing and accounting, create marketing strategies, and design a website. Throughout this process, I felt push back from the constraints of the traditional OT roles. I had to make key decisions.

First: Whether the type of OT services I wanted to provide would be paid for by health insurance. After much thought, I decided to design my business model so that my services aren’t covered by health insurance, because I didn’t want to feel restricted by the massive regulations that come with taking health insurance payment.

Second: I decided not to work on public spaces that are required to follow ADA regulations. I didn’t want to be the person forcing legal regulations on people to “be accessible.” These were very freeing decisions. I could design my care model based on the OT framework without constrictions. So, while waiting at sports practices and during naptime for my children, I got out my OT Framework and revisited occupation and participation and their relation to quality of life.

I reviewed The Model of Human Occupation (MOHO) by Gary Kielhofner and Lawton’s Theory of Environmental Press. I did an intensive literature review of evidence for environmental modifications and an international program review about home modification programs.

I was ready to start.

Deciding On My Target Home Modifications Market

The major problem was going to be who was going to pay for my OT services. All the OT jobs I had done over the years ended up being very restrictive because of the payer source. Who would my payer source be that would allow me to do OT the way I was passionate about? I am not going to claim I have an easy answer to this question, but I am jumping into my business with a degree of faith in my skills, knowledge, and the value of the service I have to offer.


This has led me to consider a wider perspective of who my clients might be. The first thought was that my clients will be home-owners with a disability needing home modifications, but this can be expanded to their families and caregivers. There are also the people who provide the home modifications services: dozens of types of building professionals, such as architects, interior designers, contractors, or handymen.

There are also large companies that want to tap into the market of older adults wanting to age-in-place that need insight into how to best help the older adult population.

Additionally, there are community agencies providing information and resources for people with disabilities, such as local area agencies on aging or national foundations for conditions such as arthritis or low vision.

The more thought I put into the potential business opportunities, the more I realized I could think big picture.

Occupational therapists have so much to offer with our unique perspective and model of care. As I looked for other OTs within the home modification field, I saw that the international community has been utilizing OTs as leaders in this area of practice (such as in the UK, Australia, and Canada).

However, the US is behind. The reasons are complex, but the simple answer is that the US systems are fundamentally different from these other countries. I have to learn to work within the US systems and develop my business to fit the needs of my community.

My Business: Beyond Accessibility

My creation has been an OT run company, Beyond Accessibility, that provides in-person and online home modification information and consulting services to a wide audience of people. My goal is to take the occupational therapist perspective, along with the evidence to support home modification to improve safety and quality of life, and provide useful resources to the many people who might seek it out.


The truth is I have to challenge myself to enter into new worlds of business where I am uncertain and uncomfortable, all while proving the worth of my services and the OT model of care. It is a bit daunting, but also invigorating.

It is hard work that I am passionate about. I get excited at each new opportunity to share what OT can do and what our role in environmental modification can be. In the end, I feel passionate again about being an OT.

Want to learn more about home mods? Check out these other helpful articles from Paige:

This post was originally published on July 26, 2017 and updated on February 23, 2023.

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  • Stephanie Skroch August 19, 2017   Reply →

    I love this and would love to be in contact with Paige about opportunities and mentoring. If interested or willing Paige I’ll give my info!

  • J August 5, 2019   Reply →

    Would you mind if I (an OT looking to get into Home Modification as an independent contractor) connected with you for a bit of guidance?

  • Cindy Beard September 1, 2020   Reply →

    Hi Paige,
    I am an OTA with over 26 years of experience. My wheelhouse is home safety and modifications. I am going to look at your site! I live in Texas and am ready to make a change. Thank you for all of your insite.

  • Nicole Salamone July 7, 2022   Reply →

    Hello Paige,
    When I read your reasons for wanting to leave the traditional OT roles, I was relieved to hear another OT had the same experiences! I’ve always wanted to somehow combine my OTA skills with making home modifications and builders. I have so many questions. I’ll start with, can I do this independently or must I have an OT for supervision? I am in Illinois

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