What a Home Technology Assessment Actually Involves

People book an assessment expecting a shopping list. What they usually get is a shorter shopping list than they came in with, plus an answer to a question they had not thought to ask.

This is a plain description of the process, what the research says it accomplishes, and what you can get for free before you pay anyone. I would rather you arrive knowing all three.

First, what the evidence supports

The strongest research on this is a 2023 Cochrane review of environmental interventions for preventing falls in older people living in the community. Its findings are unusually clean, and they cut both ways.

For people already at elevated fall risk, home hazard assessment and modification reduced the rate of falls by about 38 percent, with a rate ratio of 0.62 (95% CI 0.56 to 0.70). Cochrane rated that high-certainty evidence, which is rare. In plain terms, that works out to roughly 702 fewer falls per 1,000 people per year. The number of people who fell at all dropped by about 26 percent.

For lower-risk older adults who were not selected for any particular risk, the rate ratio was 1.05 (95% CI 0.96 to 1.16). No meaningful effect. Also high-certainty.

So the honest answer to “does a home assessment work” is: it depends on who you are.

If your mother has already fallen, or has weakness, balance trouble, cognitive change, or a stack of medications, the evidence behind a proper home assessment is about as good as evidence gets in this field. If she is 72, healthy, walking two miles a day, and you are being cautious, an assessment is unlikely to change her fall risk. It may still be worth doing for other reasons, but do not let anyone sell it to you on falls.

A related program is worth knowing about. CAPABLE, developed at Johns Hopkins, sends an occupational therapist, a nurse, and a handyworker into the home for up to 10 visits over about five months. In a randomized trial of 300 low-income older adults with functional disability, difficulty with daily activities dropped 30 percent relative to control. A separate analysis found Medicaid spending averaged $867 per month lower per participant. The program costs roughly $3,000 to $5,000 per person.

How my assessment actually works

My process has a name, the Mansfield Traverse, and it starts somewhere that surprises most families: before we talk about a single device. I work virtually with families nationwide by video call, with in-person assessments available in the Houston area, and the method is the same either way.

1. The conversation before the technology

The Traverse is a structured conversation with five stops, and the first one is not about technology at all. It is about what brought you here now. There is almost always a moment, a near-miss, a phone call, a worry that would not go away, and the real catalyst is often not the stated one. We start there.

I also want to know what a normal day looks like, in your parent’s own words. What she has stopped doing and when. Who is part of her everyday life, including the pets. What she would absolutely not want a device to do in her home, even if it promised to help. If a family member is on the call, I will usually ask to talk with your parent alone for part of it. Not to keep secrets. Because the answers change.

Underneath every question runs what I call the Dignity Line: is your parent present in her own decision, is what she wants at the center, and does her preference win over everyone else’s default, including mine.

2. Low-tech first, always

The second stop has a gating rule I do not bend: exhaust the low-tech and no-tech options before reaching for a new device. A device is the last resort, not the first move. Better lighting, a different chair, moving what she uses to waist height, and a medication review with her doctor solve more problems than most products on the market.

This is also where we inventory every device already in the house, including the ones in drawers. What each was supposed to do. Whether it is charged. Whether she uses it, and if she stopped, when and why. That “why” is the single most valuable data point in the whole assessment, and families are usually too embarrassed about the drawer to volunteer it.

You should not be. Abandonment is the normal outcome, not the exception. The classic study on assistive technology abandonment found that close to a third of devices were completely abandoned by their users. A 2022 French study following 102 older adults over six months found 20.6 percent stopped using their mobility devices, and those who did had a much higher rate of serious falls, 57.1 percent versus 21.0 percent. Treat the size of that gap with caution, it was a small study, and treat its direction seriously. An abandoned device is not neutral. It is worse than no device, because everyone believes the problem is solved.

3. The home, seen honestly

For the home itself, I use structured tools rather than impressions, because a checklist keeps me from anchoring on whatever I noticed first. The professional instruments are public and you can look at them: HOME FAST (25 items, University of Sydney), the Westmead Home Safety Assessment (72 items by room), and the CDC’s free “Check for Safety” consumer checklist. In the Houston area I can walk the home in person; on video, your parent or a family member carries the phone and we walk it together, room by room, in the order she actually uses them.

The unglamorous part is decisive: where the wifi actually reaches, cell signal in the bathroom, whether there is an outlet where a device would need to live, who knows the passwords, what happens in a power outage. Half the failures I see are not device failures. They are a sensor mounted in a dead spot, or an app on a phone nobody set up. And whatever we consider has to pass the fit questions: her hands (arthritis, tremor, grip), her eyes and ears (glare, font size, alert pitch), her memory and routine (devices that need new habits fail more than devices that attach to old ones), and her dignity (if she would be embarrassed for a neighbor to see it, it ends up in the drawer, and no feature list changes that).

One more rule from my practice: recommendations must be portable. Unless the living situation is locked in for five years, which it almost never is, I prefer light-touch and reversible over heavyweight and built-in. A plan that cannot survive a move is a plan with an expiration date nobody agreed to.

4. The Care Decision Plan

What you receive in writing is a Care Decision Plan, typically 15 to 20 pages, and it is built to be a mirror: your family’s own words carry the document, with my framework as scaffolding underneath. It covers what we heard, in direct quotes; the household profile; a holistic needs assessment; technology priorities; and three to five recommendations, each with why, what, how to start, and what success looks like at 90 days.

It also contains the section I consider the most important thing I write, and the one you will not get from anyone selling products: What We Are Not Recommending Yet, and Why. Every device we considered and set aside, with the reasoning. Absence is itself a recommendation.

The plan closes with a 90-day sequencing plan, so nobody tries to change everything at once, and a five-year horizon, because the plan is a living document, not a one-time deliverable. We walk through it together on a follow-up call, and you have 30 days of email support while the first steps happen.

If the plan you get from anyone, me included, is a list of products with no reasoning attached, you did not get an assessment. You got a sales call.

A note on the numbers behind “who supports it”

Every device needs a human: batteries, updates, the day it stops working. Name that person before you buy, not after. As of 2025, 78 percent of adults 65 and over own a smartphone and 70 percent have home broadband, so adoption is no longer the barrier. But Pew also found that about three-quarters of Americans 65 and older say they usually need someone else to set up a new device, and in an older survey only about a quarter felt very confident using their devices. Those confidence figures are dated; their direction has held up in every home I have worked with.

Before you pay anyone: what is free

I would rather you exhaust these first. Some families never need to hire me, and I would rather say that here than after you have paid.

Try before you buy. Every state, plus DC, Puerto Rico and the territories, has an Assistive Technology Act program funded through the Administration for Community Living. Fifty-six of them. Every one is required to run device demonstration, device loan so you can borrow equipment and try it, device reuse, and financing help. Find your state’s program at at3center.net/state-at-programs.

That single sentence is the most useful thing in this article. Your mother can borrow the device and live with it for a few weeks before anyone spends money.

Eldercare Locator, 1-800-677-1116. A free public service of the Administration for Community Living, and the right first call when you do not know where to start.

Your Area Agency on Aging. In a 2019 national survey with a 78.5 percent response rate, 61 percent of Area Agencies on Aging said they directly provide or contract for home modification and repair, and another 46 percent make referrals. Among those providing it, 94 percent do minor modifications such as grab bars, raised toilets and handheld showers. Most of that is funded through the Older Americans Act, and much of it is aimed at low-income older adults.

Medicaid HCBS waivers. Forty-seven states and DC operate at least one 1915(c) waiver, and equipment, technology and home modifications are among the most commonly covered services. Coverage varies enormously by state and waiver, so this is a phone call, not a guarantee.

The CDC checklist. Free. Do it yourself this weekend.

What Medicare does and does not cover

Families ask me this constantly, and the answer is more specific than most articles admit.

There is no Medicare benefit called “home safety assessment.” An occupational therapist can absolutely evaluate the home and recommend environmental modifications, and Medicare covers that, but only as a component of a skilled therapy plan of care ordered and signed by a physician.

Two pathways, with an important catch:

Home health. You pay nothing for covered home health services. But you have to be homebound, need part-time or intermittent skilled services, be certified by a provider after a face-to-face assessment, and use a Medicare-certified agency. The catch: occupational therapy alone cannot establish eligibility. Medicare requires that eligibility was established by a prior need for skilled nursing, physical therapy, or speech-language pathology. OT can continue eligibility once it exists. It cannot start it. So your mother cannot get home health simply because an OT thinks the house is unsafe.

Outpatient OT under Part B. No homebound requirement. You pay 20 percent of the Medicare-approved amount after the deductible, and there is no annual cap on medically necessary therapy. This is the pathway families overlook.

Neither one covers the technology consulting I do, and I want that stated plainly rather than discovered later.

About credentials

You will see “CAPS” after some names, meaning Certified Aging-in-Place Specialist. It is issued by the National Association of Home Builders. It requires three courses, a signed code of ethics pledge, and a fee of $195 for NAHB members or $245 for non-members. Contractors additionally show insurance and a business license where the state requires one.

CAPS is a designation, not a license. That does not make it worthless. It means somebody took the training, and the training is real. It means less than most families assume when they see letters after a name, and I would rather you know that from me.

The same applies to my own field. Gerontology is not a licensed profession in any state. Ask anyone, including me, what degree they hold, from where, and what license, if any.

What it costs, and what to compare it against

My Assessment & Care Decision Plan is $1,800, flat, one time. It includes the full intake conversation, the assessment, the written plan, the follow-up call, and 30 days of email support. If you start with a $249 Technology Triage Call instead, the full $249 credits toward the assessment if you book within 30 days, and the first 15-minute call is always free. Current details are on our Families page.

The useful comparison is what the alternatives cost. As of the 2025 CareScout Cost of Care Survey, the national median for an in-home non-medical caregiver is $35 an hour, which comes to $80,080 a year at 44 hours a week. Assisted living runs a median of $6,200 a month, or $74,400 a year. A semi-private nursing home room runs $114,975 a year.

A one-time assessment sits against those numbers. It will not always avoid them. Sometimes the honest finding is that the house is not the answer and the family needs to plan for something else. But if the assessment buys another good year at home, the arithmetic is not close.

Where I fit

I am a gerontologist, not a clinician. I cannot diagnose your mother, prescribe anything, or bill Medicare. When what she needs is a physician or an occupational therapist, I will tell you, and I will tell you which one.

What I do is the part nobody else is looking at: whether the technology in front of you fits this specific person’s hands, eyes, memory, routine and sense of herself, in this specific house. I sell no products and take no commissions, which is why I can tell you the answer is no device at all.

Frequently it is.

Where to start

If you have one pressing question, start with a Technology Triage Call: 60 minutes with me by video or phone, a one-page written action summary within two business days, for $249, and the full $249 credits toward an Assessment if you book within 30 days. If you are not sure what you need yet, start smaller: the first 15-minute call is always free, and its only job is to work out together whether I am the right kind of help. https://book.thegerontechnologygroup.com