Building Health into Homes: Practitioner Toolkit

As an occupational therapist, you already have the skills you need to start a housing conversation. 

You know that the environment shapes what a person can do. You’re adept at exploring what matters to someone, to understanding what they do at home and considering how their circumstances might change.

The earlier a person starts thinking about their housing, the more options they have available to them. Once a health condition progresses or a crisis occurs, the choices become fewer and the costs – personal and financial – significantly higher. A brief, well-timed conversation can open a door that might otherwise stay shut.

This framework enables every OT to address housing as part of an assessment, wherever you work and whoever you work with. It also empowers the people you support, giving them information and identifying options to enable them to take control and make decisions for themselves. 

Four principles for early housing conversations

1. Ask early, not just at crisis point. The most useful housing conversations happen before things go wrong. Every contact is a potential opportunity.
2. Start with what matters to the person. A housing conversation isn’t a checklist. It begins with understanding what the person values about where they live, what they do there and what they want to be able to continue doing.
3. Open the door, don't force it. People might not be ready to think about their future housing needs, particularly in relation to ageing or disability. Your role is to make the conversation available, not to push it. Plant the seed and revisit when the person is ready.
4. Don’t expect to have all the answers. Unless you’re in a specialist housing role, you’re unlikely to know every solution. Your role is to start the conversation, share what you do know, and connect people to the services and colleagues that can take it further. This might include helping someone think about whether their current home is right for them, or whether making some changes or moving to somewhere more suitable could make things easier in the long run.

Download the full practitioner toolkit to access conversation starters and useful resources for different practice settings.

There is no single, recognised pathway to becoming a specialist housing OT, and the exact responsibilities of the role vary from service to service. 

These pen portraits come from OTs working across a range of housing roles, from housing needs assessment and new build design to asset management, tenancy sustainment and complex needs. Each person has taken a different route.

In these portraits they share what their role involves, what skills and knowledge it demands, what they wish they’d known sooner and what they value most about their work.

The portraits are written for OTs at any stage of their career, whether you’re considering a move into housing and wondering how your current skills might transfer, or simply want to understand what colleagues in this area of practice are doing and why it matters. Read them as a starting point. If one resonates, use it as a prompt to explore further.

• Anava Baruch – CEO and Clinical Lead, Design for Independence Ltd
• Catherine O’Donnell – Housing OT, Somerset Council
• Claire Wise – Director of Supported Housing (interim), Metropolitan Thames Valley Housing
• Diane Chandler – Lead OT, East Sussex Community Learning Disability Team
• Jennifer Jarrett – Housing OT, Abri Housing Association
• Jenny Haslock – Principal Health Manager, Leeds City Council
• Jill Pritchard – Self-employed Housing OT
• Kate Sheehan – Independent OT
• Lorraine Abernethy – Advanced Practitioner OT, Northern Health and Social Care Trust
• Sadie Cooper – Principal Housing OT, Caerphilly County Borough Council
• Shane Elliott – Head of Housing and Health, Department of Health/Northern Ireland Housing Executive
• Tess Whitehead – Clinical Lead for Housing Occupational Therapy and Property Search Services, Adaptation Design Ltd

Your home is meant to allow you to live your life to the best that you can and to open up the world to you, not close it down. I didn't appreciate that until I went through the whole journey… I feel lucky to be in a home that meets my needs, as I know many people are inadequately housed. But I shouldn’t have to feel lucky; accessible housing should be a given."

Martha Hall, Expert by Experience

Occupational therapy is a person-centred profession, but OTs often encounter people at a single point in time – a hospital admission, an assessment, a referral.

That snapshot rarely shows the full picture of what it means to live in a home that doesn’t work for you, or the cumulative impact of a system that addresses needs in isolation rather than as a whole. To really understand why housing matters, and why every OT should be concerned about people’s homes, it’s vital to listen to people who depend on the system getting it right.

Martha Hall is an Expert by Experience and member of the Building Health into Homes project steering group. She has generously shared her housing journey, which spans inpatient mental health care, discharge planning, supported living, homelessness, temporary accommodation and – eventually – finding a home that genuinely works for her.

We asked Martha what she wants OTs to know about housing:

• See the whole person, not the diagnosis. At multiple points in Martha's journey, professionals made assumptions based on her disability rather than engaging with her as an individual. Understanding the relationship between person, environment and occupation helps us view people in their entirety.
• Accessible on paper isn’t the same as accessible in practice. Martha's first home didn’t meet her needs, despite being described as accessible. An assessment that asks what a person does, how they move through a space, what they value and what they want to do in five years, is very different from one that checks compliance alone.
• What matters to the person matters clinically. Martha’s assistance dog is central to her daily occupations, her independence, her wellbeing and her identity. The OT who understood this, and could articulate it in a way that changed a funding decision, made a significant difference for Martha. Understanding what matters, and being able to express it in language that influences decision-makers, is a valuable OT skill.
• Housing is everyone's business. Martha's story touches mental health services, inpatient settings, community teams, discharge planning, supported living, housing allocation and temporary accommodation. At every stage, an OT who understood housing could have contributed something. You don’t need to be a housing specialist to ask whether a person's home enables them to live their life. 
• Housing reports are powerful tools. Effective housing reports don’t just capture physical access requirements. They include occupational need, what matters to the person and their future requirements. An OT housing report can shape allocation decisions and make sure people find homes that enable them to thrive. Martha reflects that without her report, she may still be living in an unsafe, unsuitable property.
• Compassionate communication matters. Martha describes the people who supported her most effectively as those who explained the difficult realities – and the limits of what systems could offer – with genuine empathy. The information was the same, but their compassion and honesty made it easier to hear and respond to.

Download the full practitioner toolkit to read Martha’s whole story.

Download the full practitioner toolkit to access resources that will help you navigate the terminology and practice guidance of housing.

This includes a glossary of terms and links to a range of accessible design guides.    

• Ainsworth E, de Jonge D (2018) An occupational therapist’s guide to home modification practice. 2nd ed. New York: Routledge.
• Centre for Accessible Environments (2018) Wheelchair housing design guide. 3rd ed. London: RIBA Publishing.
• Habinteg Housing Association, Runnalls J (2024) The inclusive housing design guide. London: RIBA Publishing.
• Parker R, Badger J, Owen D (2024) Key skills for housing adaptations: a workbook for occupational therapists and students. London: Jessica Kingsley Publishers.