With aging populations and cost constraints, state and local Aging Network agencies are increasingly integrating home modifications into their home and community-based and long-term care programs, with State Units on Aging identifying this building block as their most prevalent role in home modification.
These approaches help to expand access and availability of home modifications for at-risk older adults and people with disabilities who may already be participating in programs that support home and community living. For example, SUAs (34%) report collaborating on home modification efforts with state Medicaid offices related to home-and community-based waivers. The Vermont SUA conducted an analysis of Medicaid Waiver participants and found that very few were accessing Waiver funds available for home modifications, yet the Waiver program’s fall rate was very high.
In response, the SUA and the Medicaid team worked together to improve the case management process so that Medicaid Waiver funds for home modifications are used when a need is identified. This approach is maximized when the SUA is housed within the State Health Department of vice-versa and is occurring more often. For example, in 2021, the state of Michigan created the new Health and Aging Services Administration within the Michigan Department of Health and Human Services which combines the Aging and Adult Services Agency and Medical Services Administration to focus on integration, coordination, and innovation for the growing elderly population in Michigan.
The Aging Network integrates home modification and repair services within several types of home and community-based and long-term care programs including Medicaid Long Term Services and Supports and Home and Community-Based Care Waiver Programs; nursing home transition programs; and caregiver programs. The examples below of Aging Network efforts within these home and community-based and long-term care programs provide opportunities for other state and local agencies to emulate.
One source of funding for home modification is Medicaid waiver programs which can include “environmental adaptations” as an allowable service. A Medicaid waiver allows a state to waive certain Medicaid eligibility requirements, covering supportive and health care services estates can specifically target services to individuals needing Long Term Services and Supports. These waivers are called home- and community-based services (HCBS) 1915 waivers. Agencies engaged with Medicaid waiver programs are likely to be knowledgeable about and have the capacity to connect waiver participants with accessing home modifications as an allowable service under the waiver programs. SUAs indicated that their number one source of home modification funding is Medicaid Waiver prorgrams. Aging Network agencies may oversee or help to administer Medicaid Long Term Services and Supports and Home- And Community-Based waivers, supporting the creation of an integrated delivery system involving provider agencies and case managers. Likewise, the AAA may be an approved provider for home modification services under their state Medicaid waiver or the AAA may administer a waiver program directly and provide the home modification services as a part of this role.
To ensure successful transitions of patients from nursing homes to supportive community settings, nursing home transition programs (both federal and state funded) are increasingly including home modifications as part of the transitional care plan. In our surveys and interactions with Aging Network agencies, many indicated providing home modifications for clients transitioning from skilled nursing facilities to home. This provision is critical since, often, a person might get discharged from a nursing home and have recommendations for modifications to the home to ensure their independence. Aging Network agencies can help ensure that a person’s recovery process follows them home.
The federal National Family Caregiver Support Program as well as state and other funded caregiver support programs help to support home and community-based care delivery and can often include home modifications. The supportiveness of the home can affect caregiver capacity to provide assistance. Physical demands of caregiving can endanger caregivers’ health and strength. A supportive home can reduce caregiver burden and help to preserve their strength. The Aging Network has important roles to play to ensure the home environments in which caregiving takes place are supportive.
This document is one in a series of documents that make up the publication below. Please use the following citation:
Overton, Julie, Nabors, Emily, and Pynoos, Jon. Building Blocks for the Aging Network: Enhancing Home Modification and Repairs for Older Adults and People with Disabilities. (2022). USC Leonard Davis School of Gerontology: Los Angeles, California.
Examples of data sources utilized for this document include, but are not limited to: 1) surveys conducted by the USC Leonard Davis School of Gerontology in partnership with Advancing States and USAging of State Units on Aging, Area Agencies on Aging, and Title VI grantees to ascertain efforts in home modification and repair; 2) reports: State Units on Aging Efforts in Home Modification, Area Agencies on Aging Efforts in Home Modification and Repair, and Home Modification and Repair Services and Needs in Indian Country: A Data Brief of the Title VI Native American Aging Programs Survey ; and 3) a comprehensive review and environmental scan of local and state home modification efforts of the Aging Network.
Programs often change. Please visit the web sites of the agencies identified for the most up to date information.
Please contact us if you have any updates to this document.
Fall Prevention Center of Excellence
Leonard Davis School of Gerontology
University of Southern California
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Los Angeles, CA 90089
This project was supported, in part, by grant number 90PPHM0001 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.