Getting the House Ready for Home Health: OT Checklist

Your parent is coming home from the hospital, and a nurse or therapist from the home health agency will usually be there within a couple of days, or on the date the doctor ordered. You want the house to be ready. You may not know what "ready" means.

I'm an occupational therapist, and I've walked into a lot of homes on that first visit. Most of what makes a house safer costs little and takes an afternoon. This is my checklist, room by room.

One thing to know first. These are an occupational therapist's suggestions, not Medicare requirements, and the nurse or therapist will tailor them to your parent. Where an item comes from the CDC's fall-prevention checklist, I say so.

Before the First Visit

What to have on the table

The first visit is long. A lot of it is the clinician asking questions and checking lists. You can save time, and catch mistakes, by having these out:

The hospital discharge papers. All of them, including the medication list from the hospital.
Every medication bottle in the house. Prescriptions, over-the-counter pills, vitamins, supplements, creams, inhalers, eye drops. Bring the old bottles too, even ones you think were stopped. In my experience, the bottles are how mix-ups get caught.
Insurance cards. Medicare, any Medicare Advantage or supplement plan, and Medicaid if your parent has it.
A list of doctors. Names and phone numbers, including specialists.
The pharmacy. Name, location and phone number.
An emergency contact. Name and phone number of the person the agency should call.

Set up the room

Pick where the visit will happen. Usually that's the kitchen table or the living room. Then:

Clear a path from the front door to that spot.
Put out a sturdy chair with arms for your parent. Arms make it much easier to stand up.
Turn on the lights, or move a lamp close. The clinician will be reading labels and looking at skin.
Put pets in another room for the visit.

The rights paperwork

Expect paperwork about your parent's rights. Medicare's rules say the agency must give your parent, and their legal representative if they have one, written notice of their rights and responsibilities "during the initial evaluation visit, in advance of furnishing care to the patient" (42 CFR §484.50(a)(1)), and get a signature confirming they received it (§484.50(a)(2)).

Room by Room

Some items below come from the CDC's Check for Safety checklist, part of its STEADI fall-prevention program. I've marked those and quoted CDC's own words. The rest is my practice as an OT.

Entry and stairs

Get the walk-in right first. The first trip home is usually the hardest. Check the steps up to the door and the threshold before the ride home.
Clear the stairs. CDC: "Always keep objects off the stairs."
Fix broken steps. CDC: "Fix loose or uneven steps."
Handrails on both sides. CDC: "Make sure handrails are on both sides of the stairs, and are as long as the stairs."
Light the stairs. CDC's checklist asks, "Is there a light and light switch at the top and bottom of the stairs?"
Think about where your parent will sleep. If the bedroom is upstairs and stairs are hard right now, a bed on the main floor for the first weeks is worth talking over with the therapist.

The path through the house

Walk the route your parent will use most. Bed to bathroom, bed to kitchen, chair to front door. Walk it yourself and look down.
Move furniture out of the way. If you have to step around it, so will they. If your parent will use a walker, the path needs to be wider than the walker.
Pick things up. Shoes, mail, laundry baskets, pet bowls.
Leave sturdy furniture where they reach for it. Many people steady themselves on the same chair back or counter every day. Don't move that one without asking.

Lighting, cords and rugs

Throw rugs. CDC: "Remove the rugs, or use double-sided tape or a non-slip backing so the rugs won’t slip." In my experience, taking them up is the better choice for someone using a walker.
Cords. CDC: "Coil or tape cords and wires next to the wall so you can’t trip over them."
Light. Brighter bulbs in hallways. Switches your parent can reach at the entrance of each room, so they never cross a dark room to turn on a lamp.

The bedroom

Light by the bed. CDC: "Place a lamp close to the bed where it’s easy to reach."
Night light. CDC: "Put in a nightlight so you can see where you’re walking." Put one between the bed and the bathroom.
Bed height. What I look for: when your parent sits on the edge, their feet are flat on the floor and their knees are about level with their hips. Too low is hard to stand up from. Too high and their feet dangle.
Phone in reach. Keep a charged phone, or a medical alert button, where they can reach it lying down.
Night-time toileting. If the bathroom is far, ask the therapist whether a bedside commode makes sense for now.

The bathroom

This is where I spend the most time on a first visit.

Non-slip floor in the tub or shower. CDC suggests "a non-slip rubber mat or self-stick strips" on the floor of the tub or shower.
Grab bars, not towel bars. CDC: "Have grab bars put in next to and inside the tub, and next to the toilet." A towel bar is not built to hold a person's weight, and in my experience it is the first thing people grab when they slip. Grab bars should be screwed into the wall studs or put in with proper anchors.
Raised toilet seat. A low toilet is one of the hardest places to stand up from. A raised seat, or a frame with arms around the toilet, often helps.
Shower chair or tub bench. Sitting to wash takes away a lot of the risk. A tub transfer bench lets someone sit down outside the tub and slide across.
Hand-held shower. It makes washing seated much easier.
Bath mat outside the tub. Use one with a rubber back, or none at all.

The kitchen

Move everyday things down. CDC: "Keep things you use often on the lower shelves (about waist high)." I aim for the zone between waist and shoulder, so your parent doesn't have to bend low or reach up high for a mug or a plate.
Step stools. CDC: "If you must use a step stool, get one with a bar to hold on to. Never use a chair as a step stool." Honestly, right after a hospital stay, I'd rather nobody climbed at all.
Plan for carrying. If your parent uses a walker, carrying a plate across the room gets hard. A walker tray or a rolling cart can help. Ask the therapist which fits.

Equipment and What It Costs

Medicare.gov says you pay nothing for covered home health services. Equipment is separate. Our guide to what home health costs with Medicare covers the details.

Item	Original Medicare
Walkers, wheelchairs and scooters, canes, hospital beds	Covered under Part B as durable medical equipment when medically necessary and a doctor or other provider orders it for home use
Commodes	Covered if the patient is confined to bed or room
Grab bars	Not covered: "self-help device; not primarily medical in nature"
Bathtub seats and raised toilet seats	Not covered: "hygienic equipment; not primarily medical in nature"

For covered equipment, Medicare.gov says: after you meet the Part B deductible, you pay 20% of the Medicare-approved amount, if your supplier accepts assignment. Medicare only pays when you get the item from a supplier enrolled in Medicare.

My advice: wait for the OT or PT to recommend specific equipment before you buy. I've seen many families buy a shower chair that doesn't fit the tub, or a walker set to the wrong height. The therapist will measure the bathroom, watch your parent move, and tell you exactly what to get.

What the Therapist Will Look At

When the physical or occupational therapist comes, they will mostly watch your parent move. In general, they look at:

Getting in and out of bed. Lying down, sitting up, standing up from the edge.
Getting on and off the toilet. How low it is, and what they push up from.
Getting in and out of the shower or tub. Often the riskiest move in the house.
Walking. From room to room, over thresholds, on stairs if they have to use them.

They'll suggest changes based on what they see. Some suggestions will match this list. Some will be specific to your parent. When their advice differs from this list, follow theirs.

Frequently Asked Questions

Do we have to change the house before home health starts?

No. The checklist here is an occupational therapist's suggestions, not a Medicare requirement. A clear path, good light and no loose rugs help on day one. The nurse or therapist will look at the home and tell you what matters most for your parent, so wait for them before you buy bigger equipment.

What should we have ready for the first home health visit?

The hospital discharge papers, every medication bottle in the house including over-the-counter pills, vitamins and supplements, the insurance cards, a list of doctors with phone numbers, the pharmacy's name and number, and an emergency contact. Put them on the table where the visit will happen.

Does Medicare pay for grab bars or a tub seat?

Not under Original Medicare's equipment benefit. CMS's coverage list denies grab bars, bathtub seats and raised toilet seats because they are not primarily medical. Walkers and wheelchairs are different: Part B covers them when medically necessary, and you pay 20% of the Medicare-approved amount after the Part B deductible if the supplier accepts assignment.

What will the therapist look at in the home?

Mostly how your parent moves. How they get in and out of bed, on and off the toilet, and in and out of the shower or tub. How they walk from room to room, and what they hold on to. Their advice is built around those moments.

Sources

Not sure your parent qualifies for home health?

Answer a few questions about your parent and get a plain answer: likely, probably not, or ask the doctor.

Check if they qualify

Getting the House Ready for Home Health: A Room-by-Room Checklist From an OT