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Icon: Home Modifications InterventionsHome Modifications Interventions: Home Visits by an Occupational Therapist

Cumming, et al.

This intervention used an occupational therapist (OT) who visited participants in their homes, identified environmental hazards and unsafe behaviors, and recommended home modifications and behavior changes. Fall rates were reduced by one-third but only among men and women who had experienced 1 or more falls in the year before the study.


All participants were 65 or older and lived in the community. More than half of the participants were female.

Geographic Locale

Sydney, Australia


Assess and reduce home hazards.

Program Setting

The program was conducted in participants’ homes.


The OT visited each participant’s home and conducted an assessment using the standardized Westmead Home Safety Assessment form (see Available Materials below). The OT identified environmental hazards such as slippery floors, poor lighting, and rugs with curled edges, and discussed with the participant how to correct these hazards.

Based on standard occupational therapy principles, the therapist also assessed each participant’s abilities and behaviors, and how each functioned in his or her home environment. Specific unsafe behaviors were identified such as wearing loose shoes, leaving clutter in high-traffic areas, and using furniture to reach high places. The OT discussed with the participants ways to avoid these unsafe behaviors.

Two weeks after the initial home visit the OT telephoned each participant to ask whether they had made the modifications and to encourage them to adopt the recommended behavioral changes.


One-hour home visit with a follow-up telephone call 2 weeks later. Total contact time was approximately 2 hours.

Delivered by

An occupational therapist with 2 years experience.

Minimum Level of Training Needed

A degree in occupational therapy is the minimum qualification needed to conduct the home assessments, develop the recommendations, and supervise the home modifications.

Key Elements

  • Using an experienced occupational therapist is critical.
  • These researchers emphasized that this study should not be used to justify widespread, untargeted home modification programs implemented by people who do not have skills in caring for older people.

Available Materials

Information on the falls prevention kit, which includes the Westmead Home Safety Assessment form and a booklet that gives background information on falls and hazards can be purchased from the following company:

Co-ordinates Therapy Services PO Box 59, West Brunswick Victoria 3055, Australia Tel: +61 (3) 9380 1127 Fax: +61 (3) 8080 5996 E-mail:

Study Citation

Cumming RG, Thomas M, Szonyi M, Salkeld G, O’Neill E, Westburg C, Frampton G. Home visits by an occupational therapist for assessment and modification of environmental hazards: A randomized trial of falls prevention. Journal of the American Geriatrics Society. 1999 Dec;47(12):1397-1402.


Practitioners interested in using this intervention may contact the principal investigator for more information:

Robert G. Cumming, PhD
School of Public Health, Building A27
University of Sydney
Sydney NSW 2006, Australia
Tel: +61 (2) 9036 6407
Fax: +61 (2) 9351 5049

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