OBJECTIVE. This systematic review investigated the role of home modification interventions to improve participation outcomes for community-living adults and older adults. METHOD. Thirty-six articles met the inclusion criteria. The majority of the studies investigated older adult populations and used occupational therapists as interventionists. RESULTS. Strong evidence was found for home modification interventions to improve function for people with a variety of health conditions and for both single and multicomponent interventions that included home modifications to reduce the rate and risk of falls among older adults. Moderate evidence was found for improved caregiving for people with dementia. CONCLUSION. Comprehensive, higher intensity interventions demonstrated greater efficacy to improve occupational performance. Emerging evidence was also found for the role of occupational therapy in providing effective home modification interventions. Implications for occupational therapy practice, education, and research are discussed.