Physical therapy at home: what the research says about recovering safely

After a hospital stay, a surgery or a fall, the first weeks at home matter a great deal. The stairs, the bathroom and the walk to the mailbox are where strength and balance get tested, and where falls tend to happen. Physical therapy at home brings the therapist to that exact place. This note covers what the strongest research says about exercise and home safety, what a therapist does on a visit, and how Medicare covers therapy at home.

Why falls matter so much after 65

Falls are the leading cause of injury for adults 65 and older, according to the CDC. Over 14 million older adults, about 1 in 4, report falling every year.¹ The age-adjusted death rate from falls among older adults rose 21% from 2018 to 2024, from 64.7 to 78.4 per 100,000.¹

A fall rarely has one cause. The CDC’s clinical guidance puts it this way: “Most falls are caused by the interaction of multiple risk factors.”² Some of those factors live in the body, such as muscle weakness, problems with walking and balance, low blood pressure on standing, poor vision and fear of falling. Others live in the house: no handrail on the stairs, no grab bars in the bathroom, dim light, clutter and slippery or uneven floors.² Many of them can be changed.²

That’s why the research on prevention looks at two things, the person and the home, and why therapy at home can work on both at once.

Exercise is the best-studied way to prevent falls

The strongest evidence comes from a Cochrane review led by Catherine Sherrington that pooled 59 trials with 12,981 older people living in the community. Exercise reduced the rate of falls by 23%.³ The reviewers put it in everyday numbers: if 1,000 people would have 850 falls over a year, exercise would mean about 195 fewer.³ They rated that evidence high certainty, the strongest grade a review gives.

The kind of exercise matters.³

• Balance and functional exercises, the movements of daily life such as standing up from a chair, turning and stepping, reduced the rate of falls by 24%, with high-certainty evidence from 39 trials.
• Programs that combined several kinds, most often balance and functional work with strength training, probably reduced it by 34%.
• Tai chi may reduce it by 19%.
• For programs built mainly on strength training alone, dance or walking, the reviewers couldn’t say.

In practice, the exercises that prevent falls look like the hard parts of an ordinary day: getting up, turning, stepping and carrying something at the same time.

The home itself, with a professional’s eye

A second Cochrane review, led by Lindy Clemson, looked at the home itself: an assessment of what makes a fall more likely in that house, then changes like clearing trip hazards and clutter. Across 22 studies with 8,463 older people, reducing home hazards lowered the rate of falls by about a quarter, 26%.⁴ For people at higher risk of falling, the reduction was larger, 38%.⁴ In the review’s own example, 1,000 people who had already fallen would go from 1,847 falls to 1,145 over about a year.⁴

Cochrane’s summary of the review adds that “professional support from an occupational therapist is an important intervention for many people living at home.”⁴

After a hip fracture, home exercise helps

A hip fracture is one of the hardest recoveries an older adult faces. A 2024 review of 21 randomized trials with 2,470 older adults looked at exercise done at home after hip fracture surgery.⁵ Compared with usual care, home exercise improved balance, mobility on a standard get-up-and-walk test, leg strength and the physical side of quality of life.⁵ It didn’t clearly change walking speed, endurance, everyday tasks or fear of falling, and it didn’t raise the risk of emergency visits, readmissions or falls.⁵ The authors concluded that home-based rehabilitation “might be recommended” for patients after they leave the hospital.⁵

That’s an honest picture: real gains in the abilities that keep a person steady, and more work to do on others. It’s also why therapy plans change as a person improves.

What a therapist does at home

At HealthView, physical therapy at home follows the same steps every time, built around the person’s own house and routine.

• An evaluation. Strength, balance, walking, pain, and how the person gets in and out of bed, a chair, the shower and the car.
• A look at the home. The stairs, the bathroom, rugs, cords, lighting and the path to the front door, with clear changes to make.
• A plan with goals the person cares about. Getting to the mailbox, back to church, or through a grandchild’s birthday party.
• Exercises that match daily life. Balance, functional movement and strength, practiced where they’ll be used.
• Progress checks. The plan changes as the person changes.
• Teaching the family. How to help safely, what to watch for, and how to keep the gains after visits end.

HealthView’s home health team also includes occupational therapists, who work on the skills of everyday life like bathing, dressing and getting in and out of bed safely, and speech therapists, who help with speaking, swallowing and memory after a stroke or a long illness.

How Medicare covers therapy at home

Under Medicare’s home health benefit, physical therapy, occupational therapy and speech-language pathology are covered when a person qualifies: a doctor’s order and plan of care, a need for skilled care, being homebound, an in-person visit with a provider who confirms the need, and a Medicare-certified agency.⁶ Covered home health services cost nothing.⁶ Occupational therapy can continue on its own once the other therapies or nursing have ended.⁶

Getting better isn’t the only reason Medicare pays. Since the Jimmo v. Sebelius settlement in 2013, CMS has said plainly that “a beneficiary’s lack of restoration potential cannot, in itself, serve as the basis for denying coverage.”⁷ Skilled therapy that keeps someone from getting worse can qualify.⁷ For someone living with Parkinson’s disease or recovering from a stroke, that rule can decide whether therapy continues.

Our note on who qualifies for home health walks through each condition in detail.