Home Accessibility Standards Gain Momentum with Aging Population Growth
Healthcare is increasingly shifting to the home, but only a small percentage of U.S. homes are equipped with basic accessibility features that support safe, independent living. According to the Harvard Joint Center for Housing Studies, fewer than 4% of U.S. homes meet the standards for a no-step entry, single-floor living, and wide halls and doorways. This has prompted the creation of a standardized method to measure home accessibility, with the goal of establishing a national standard.
Home for Life Design®, the creator of the Home for Life Design Accessibility Ratings®, has published a detailed case for a consistent, research-backed approach to evaluating whether homes support safe, independent living. The shift towards home-based care is accelerating, with the U.S. Census Bureau projecting that the population aged 65 and older will reach approximately 73 million by 2030. Additionally, one in four adults over 65 falls each year, according to the U.S. Centers for Disease Control and Prevention (CDC).
The Home for Life Design Accessibility Ratings® are standardized scores that measure how safely and confidently a person can function in their home. These ratings are based on occupational therapy science and data from thousands of client homes. They can be captured in any home, tracked before and after modifications, and compared across programs or populations.
The reliability and validity of the ratings have been documented in peer-reviewed research. A 2019 study in the American Journal of Occupational Therapy reported an inter-rater reliability of 0.92 among occupational therapist raters. A 2023 replication study with 52 raters confirmed this reliability. A 2025 study reported content validity indices ranging from 0.875 to 1.0 across the rating items. Another 2023 study evaluated the instrument's use in virtual, telehealth-based assessments. In a 2026 study of the U.S. Department of Housing and Urban Development's (HUD) Older Adult Home Modification Program, homes assessed before and after modifications showed a 52% improvement in accessibility scores and a 48% improvement in safety scores.
HUD's evaluation of the same program reported that basic accessibility modifications average $5,400 per client as a one-time cost, while assisted living averages about $5,900 per month. Carolyn Sithong, MS, OTR/L, SCEM, CAPS, FAOTA, founder and CEO of Home for Life Design and a 25-year occupational therapist, stated, "Healthcare has moved into the home faster than anyone imagined. Surgical recovery, chronic care, whole lives now depend on living rooms and bathrooms that were never measured."
The Home for Life Design Accessibility Ratings® are already proving their value in various programs. For instance, Finger Lakes Community Action used the ratings to score homes before and after modifications under HUD's funding, helping the program secure continued funding by demonstrating outcomes. The ratings are currently in use by organizations such as the NYC Department of the Aging, the Virginia Department of Aging and Rehabilitative Services, Inglis in Philadelphia, and Area Agencies on Aging, Centers for Independent Living, and housing organizations across more than 30 states.
These standardized ratings are transforming how healthcare, agencies, and independent-living programs approach home modifications. Carolyn Sithong emphasized, "For the first time, we can measure which home enables function or disables it. There is no neutral. This changes what every family, every agency, and every health plan can do next."
By providing a clear and reliable metric, the Home for Life Design Accessibility Ratings® are helping to ensure that homes are equipped to support the growing number of older adults who need safe, independent living environments.