Adaptations without delay guide imageHelping to combat the issue of both minor and major housing adaptation delays, the Royal College of Occupational Therapists (RCOT) has outlined a new framework to organisations for how housing adaptations should be assessed and delivered throughout the UK.

In 2017, RCOT commissioned the Housing Learning and Improvement Network (Housing LIN) to conduct a review of the 2006 ‘Minor adaptations without delay’ guide to decide whether new guidance was necessary. The 2006 framework focused on enabling housing associations to provide minor adaptations without the need for an occupational therapy assessment.

An extensive review

Conducting an extensive UK-wide examination, Housing LIN conducted a nationwide survey completed by 800 frontline practitioners; telephone interviews with managers of occupational therapy services, housing providers, housing associations, home improvement agencies, and care and repair services; as well as focus groups involving key personnel and organisations.

Main causes of adaptations delay

Housing LIN’s review discovered that a more preventative approach to housing adaptations was needed to increase the health and well-being of elderly and disabled people.

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Additionally, one of the main causes for adaptations delays was people waiting for social care assessments, with the study highlighting that a misunderstanding of major adaptation funding legislation was being misinterpreted as being dependent on an occupational therapy assessment.

The review also revealed that to deliver adaptations effectively, current systems need to provide more person-centred outcomes through a more collaborative approach to the assessment, design and installation of adaptations.

Showers, stairlifts and ramps were cited as the most common in-demand products for adaptations. Housing LIN added that the need for adaptations has often been defined by the type or cost of the solution, as opposed to the complexity of the situation.

A fresh new approach

From Housing LIN’s review, RCOT outlined that a “radically different approach” was needed to address housing adaptations delays. Therefore, the new guide – ‘Adaptations without delay’ – seeks to tackle the causes of adaptation delays.

It sets out a better way of defining adaptations based on complexity, with an overall aim of reducing housing adaptations delays through providing relevant tools. It also ensures the valued and specialist skills of occupational therapists can be used to work with the growing number of individuals whose circumstances are complex.

The new framework

Now, the publication recommends a new decision-making framework for establishing the complexity of assessing an adaptation and determining the level of occupational therapy intervention required.

Defining the different levels of complexity as ‘universal’, ‘targeted’ and ‘specialist’, the guide says defining adaptations by complexity rather than the funding mechanisms for the type of solution that is being installed will help avoid the disproportionate use of specialist occupational therapy services on simple cases.

Adaptations without delay guide image

The Royal College maintains that this will enable OTs to employ their specialist skills with the growing number of individuals whose circumstances are complex, whilst working alongside unregulated staff for more straightforward adaptations, such as training and supporting trusted assessors to assess and make recommendations for major adaptations.

The levels of complexity can be described as following:


Defined as enabling people with low levels of needs to make informed decisions about how to stay well through the timely provision of home adaptations, universal types of intervention are often the simplest solutions were a person or their carer can be signposted to retail options and/or supported to install simple adaptations, such as an appropriately placed grab rail.


Defined as targeted types of intervention and services enabling older or disabled people with long-term health conditions to maintain their personal dignity and increase independence with housing adaptations.

According to the guide, these will be situations which are simple and straightforward but require support to identify the most appropriate solution, with the solution potentially being universal but likely being a non-structural adaptation or standard structural solution, such as a wet room.


Defined as the most complex of situations, “specialist types of interventions and services empower people with complex health and social care needs to maintain their personal dignity, and reduce unplanned health and social service care needs through the timely provision of home adaptations.”

These adaptations will likely be personalised non-structural or specialist structural solutions, requiring the direct specialist skills of occupational therapists, working alongside other organisations.

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