The extent to which housing design can minimise levels of community caregiving has remained largely unmeasured. This paper reports the potential for home modifications to reduce caregiving in the peoples’ homes, particularly older people and people with a disability. It contributes to new knowledge in understanding how housing can play a role in community caregiving and acknowledges the role of the built environment in managing care levels in ageing societies. This paper analyses self-reported care data from 157 Australian community care recipients (average age: 72 years) who had received home modifications within the past 6 months. A before/after comparison of care provided revealed that home modifications reduced hours of care provided by 42% per week. More detailed analysis revealed that the positive association of home modifications with care reduction is stronger with informal care (46% reduction) followed by formal care (16% reduction). These results suggest the role that home modifications, and housing design in general, play in reducing care needs in a community setting.

Smart technologies and the Internet of Things (IoT), have the potential to play a significant role in enabling older people to age in place. Although there has been substantial development of new applications of sensor technology in the home, this has tended to be tele-health focused, and there has been less work done on the role of IoT and ageing in place that more broadly considers caregiving and the built environment. Research in the field of IoT development and evaluation has recognised a number of challenges and limitations associated with past smart technology developments to support Ageing in Place, calling for user centeredness and better integration with broader systems. Compounding this, research into Ageing in Place and home environments has focused on built environments and largely ignored the impact of technology in the lives of older people staying at home. Recognising a gap in acknowledging the potential impact of technology on Ageing in Place theories, the purpose of this paper is to conceptualise a way of framing smart technology within an Ageing in Place model that acknowledges the interaction of smart technology with the built environment and caregiving and to present a framework for visualising the interactions that take place. A review of Environmental Gerontology model development is undertaken and a new model is presented that recognises the role of technology in Ageing in Place. Based on this model, a template is developed and three case studies of older people’s experiences of smart home technology, home modifications and caregiving are mapped out. These are used to demonstrate “proof of concept” of the relationships put forward in the HAST model and the pre-curser for a template to help people map smart technology and its role in supporting caregiving and ageing in place. This paper’s position is that technologies such as IoT further support the role of the built environment and caregiving to produce outcomes that enable older people to remain autonomous, independent, safe and well at home. However, a number of risks were also identified through the case studies, the issues of maintenance, cost and ease of use, and willingness to use are considerations and potential barriers to the benefits of smart technology.

As home-based health services emerge as a focal point of international discussions of primary healthcare, the home environment is now recognised as a place for safe and independent living, and also delivery of care. Consequently, research into how housing improvements can directly impact health and care outcomes is an increasingly important area of trans-disciplinary research. The links between health and housing are well established and indicate that housing interventions may be an important mechanism in health maintenance and improvement. Studies of home modifications have been published across a number of fields and the extent of their effects are diverse. We undertook a scoping review according to systematic PRISMA-P (Preferred reporting items for systematic review and meta-analysis protocols) guidelines to map the breadth and scale of the evidence base, identify themes and gaps in the evidence as well as grading home modifications research quality. Seventy-seven studies from 16 countries were included and revealed that home modifications evidence is measured in terms of a diverse range of effects. Seven key themes emerged including (in decreasing order); injury and falls prevention; improved function, self-care or independence; physical health and well-being; caregiving; economic effectiveness; ageing process; and social participation. The strongest experimental evidence has been conducted in relation to falls prevention.

The multi-dimensional relationship between housing and population health is now well recognised internationally, across both developing and developed nations. This paper examines a dimension within the housing and health relationship – accessibility – that to date has been considered difficult to measure. This paper reports on the mixed method results of larger mixed-method, exploratory study designed to measure the impact of home modifications on Health-Related Quality of Life, supported by qualitative data of recipients’ experiences of home modifications. Data was gathered from 157 Australian HACC clients, who had received home modifications. Measurements were taken for both before and after home modifications and reveal that home modifications were associated with an average 40% increase in Health-Related Quality of Life levels. The qualitative results revealed that participants positively associated home modifications across six effect themes: increased safety and confidence, improved mobility at home, increased independence, supported care-giving role, increased social participation, and ability to return home from hospital. This exploratory research gives an insight into the potential for accessible architecture to impact improvements in community health and wellbeing.