Practice Answers: What is the OT's role in the Support at Home AT-HM Scheme?

Clear answers to common questions about occupational therapy practice in community aged care and Support at Home.

Occupational Therapists play an important role in the Assistive Technology and Home Modifications (AT-HM) Scheme, particularly where a person's needs require clinical assessment, prescription or advice.

The OT's role is not simply to prescribe a piece of equipment or home modification. It is to determine whether an intervention is appropriate for the person, their goals, functional needs and environment.

What might the OT be responsible for?

Depending on the intervention and level of clinical support required, an Occupational Therapist may be involved in:

• assessing the person's functional needs and goals

• identifying environmental barriers or risks

• considering whether AT or home modifications are appropriate

• considering alternative strategies or interventions

• identifying appropriate AT or home modification options

• arranging or completing trials where required

• prescribing and documenting recommendations

• liaising with suppliers, builders, providers and other professionals

• supporting implementation, fitting or installation

• reviewing whether the intervention is safe, appropriate and achieving its intended outcome.

The level of OT involvement should be proportionate to the complexity and risk of the intervention.

Not every AT item requires the same level of prescription

The AT-HM Scheme recognises different levels of risk and clinical support.

This means the role of the OT will vary. Some relatively straightforward items may be recommended as part of the initial assessment, while more complex or higher-risk interventions require further assessment, trials, clinical reasoning, prescription and follow-up.

Funding approval and clinical prescription are not the same thing

This distinction is particularly important, because an Occupational Therapist's recommendation is often used as 'evidence' for a higher tier allocation. This means that sometimes the scenario arises, where the need for additional AT-HM funding must be established before an OT can reasonably complete trials, obtain all required information or make a final prescription.

An OT may therefore be able to identify and provide clinical evidence of a person's likely AT or home modification need without yet being in a position to prescribe a specific solution.

This is different from making a definitive recommendation without sufficient assessment.

Putting this into practice

One of the more difficult documentation scenarios is when you can identify that a person is likely to require a higher AT-HM funding tier, but you don't yet have the funding required to complete trials or make a specific prescription.

We've developed an AT-HM Needs and Evidence Summary specifically for this stage of the process. It helps OTs document the identified need and clinical rationale for additional funding without prematurely prescribing a specific solution.

It's included in our AT-HM Documentation Bundle, alongside the AT-HM Prescription Template and practical guidance for using both documents.

A shift in clinical governance

The existence of AT-HM funding does not mean an item is automatically appropriate for a particular client. The 'prescribing rules' have softened somewhat since the July release of the updated ATHM list. The updated list steps down the required input of an allied health professional for prescribing. It affirms the need for a prescription for higher risk items as 'recommended' rather than 'required'. An Occupational Therapy prescription for home modifications remains mandatory

This is an important area of clinical governance that Registered Providers should tread carefully with. Risk sits beyond an item and can shift significantly depending on the person for which it is being prescribed.

Occupational Therapists comprehensively assess a person's abilities, goals, preferences, environment, risks, available alternatives and expected outcomes.

Practice takeaway: Think of the OT's role in AT-HM as a clinical reasoning pathway rather than an equipment-ordering process: identify the need → assess → explore options → trial where required → prescribe → implement → review.