Introduction: Cognitive impairments are found among the vast majority of stroke survivors and negatively impact occupational performance. Aim: This study aimed to review the effectiveness of occupational therapy interventions in home-based care towards improving occupational performance of adult stroke survivors with cognitive impairments and detail the nature of these interventions. Method: Systematic review of empirical studies was undertaken across five databases to collate evidence of effectiveness. Results: Two studies meeting inclusion criteria provided occupation-based and occupation-focused interventions. One multiple-baseline intrasubject study demonstrated significant improvements in cognitive skills and basic activities of daily life performance. The second quantitative pilot study showed significant improvement in instrumental activities of daily life. Conclusions: The results may indicate that varied home programs which incorporate multiple intervention strategies positively effect cognitively impaired stroke survivors’ performance in activities of daily life. No conclusions can be drawn on the effectiveness of the interventions due to limited research. Significance: The benefits of home-based occupational therapy rehabilitation connect well with the growing need for more effective stroke rehabilitation. More research is needed to get a better understanding of the rehabilitation needs for this under-identified population group, and to investigate how occupational therapists can effectively meet the needs in home-based care.