Ahead of his Occupational Therapy Show session, Paul Smith, Managing Director of Foundations, explains why occupational therapists should question some of the assumptions surrounding Disabled Facilities Grants – and how a more proportionate, person-centred approach could reduce delays and improve outcomes. 

Disabled Facilities Grants (DFGs) can make the difference between someone living safely and independently at home and facing avoidable risk, restriction or displacement. Yet, according to Paul, many of the processes surrounding DFGs are based not on what the legislation requires, but on established practice that has developed over decades. 

Paul will explore this distinction in his Occupational Therapy Show session, Disabled Facilities Grants: what everyone gets wrong, on 25-26 November. 

One source of confusion, he argues, is that DFGs sit within housing legislation – principally the Housing Grants, Construction and Regeneration Act 1996 – rather than social care or Care Act legislation. Professionals involved in assessing and recommending adaptations may therefore have received limited opportunities to examine the legal framework in detail. 

This can lead to decisions being framed as a contest between what a person “wants” and what they “need”. Paul believes this is neither an accurate reflection of the legislation nor a helpful starting point for a person-centred service. 

He illustrates the problem with a simple example: whether a toilet roll holder should be included when a DFG is funding access to a toilet. Treated in isolation, it might be dismissed as an additional “want”. Considered as part of the person’s ability to use the facility independently, however, it becomes a perfectly reasonable part of the conversation. 

These judgements matter. When someone feels that a legitimate request has been characterised as frivolous, it can create an unnecessary barrier between the person seeking support and the professionals trying to help them. 
 

Does everybody need a full assessment? 

Another assumption Paul wants occupational therapists to reconsider is that every DFG-funded adaptation must begin with a full occupational therapy assessment. 

The legislation says comparatively little about how an assessment should be conducted – or that an occupational therapy assessment is required in every case. Nevertheless, practices carried over from earlier systems of funding adaptations have often become treated as fixed requirements. 

The consequences can be significant. The ADASS Spring Survey 2026 estimated that 52,547 people were waiting for an occupational therapy assessment in England at the end of March 2026, including 7,977 who had waited for six months or more. 

Paul points to stairlifts as one area in which a more proportionate approach may be possible. Many more stairlifts are purchased privately without an occupational therapy assessment, while people seeking the same relatively straightforward adaptation through a DFG may be required to join an assessment waiting list. 

This is not an argument for removing occupational therapists from the process. Instead, Paul advocates stronger triage and greater use of occupational therapy assistants and trusted assessors. Straightforward cases could move forward more quickly, while occupational therapists would have more time to support the people whose circumstances genuinely require their expertise. 

“If everybody is stuck on a waiting list, the people who really need that assessment also have to wait longer,” he explains. 
 

Shifting the focus from administering a grant to delivering an outcome 

For Paul, there is also a more fundamental question about the purpose of the service. Too often, the process is designed primarily around checking eligibility, approving a grant and completing the associated administration. 

A better starting point would be to ask what service the person needs in order to make their home safer and support their independence. That could mean helping them obtain a stairlift, level-access shower or ramp, rather than simply awarding funding and leaving them to navigate the remaining process themselves. 

This shifts attention from organisational bureaucracy to the outcome the person is trying to achieve. 
 

Complex adaptations need a different approach 

The need for joint working becomes particularly acute in complex, high-cost cases. The maximum DFG in England is currently £30,000, although councils can provide additional funding through local policies. Major extensions or extensive adaptations can cost considerably more. 

Paul described cases in which an initial occupational therapy assessment identified a proposed solution before the available budget, technical feasibility or constraints of the property had been fully explored. As designs developed, projected costs rose dramatically and the original plan ultimately became undeliverable. Families were then left waiting for alternative accommodation or a new home, sometimes for several years. 

He believes housing, social care and other partners need agreed high-cost adaptation protocols before these cases arise. Funding, construction feasibility and the responsibilities of different organisations should be considered at the outset, alongside the occupational therapy assessment. 

Crucially, the person and their family must be involved throughout. Honest discussions about budgets, practical constraints and possible compromises may be difficult, particularly when a family is adjusting to a sudden change in circumstances. However, co-producing the design is far more likely to produce a realistic solution that supports how the person wants to live. 

Attempting to save time by making decisions without meaningful family involvement can have the opposite effect, leading to unsuitable adaptations, further building work, complaints and even legal challenges. 
 

A challenge to take back to practice 

Paul hopes delegates will leave his session prepared to distinguish between what the law requires, what guidance recommends and what has simply become routine locally. 

With more than 52,000 people waiting for an occupational therapy assessment, he believes “something has to give”. A more nuanced approach would not diminish the occupational therapist’s role: it would focus their expertise where it can add the greatest value. 

For delegates, the challenge will be to return to their services and ask whether every stage of the current process is necessary, proportionate and centred on the outcome the person needs. 

Hear more from Paul Smith in Disabled Facilities Grants: what everyone gets wrong at the Occupational Therapy Show on 25-26 November 2026.