The following examples demonstrate opportunities for agencies to emulate and highlight efforts of Aging Network providers to: 1) oversee home modification or repair services and funding; and 2) directly administer home modification or repair services.

As part of a national network of state and local agencies that provide supportive services to help older adults and people with disabilities live independently, many Aging Network agencies oversee home modification and repair services. Approaches include working with other providers, accessing outside funding sources, and utilizing volunteers.

Examples that demonstrate opportunities include:

• The Area 4 Agency on Aging in Sacramento, California supports three home modification services that serve diverse communities from urban Sacramento to very rural Sierra County: 1) FREED Center for Independent Living “Fix It” program directly addresses resident needs by assisting with removing hazards in the home such as securing loose rugs, repairing loose floorboards, stairs, or decking as well as providing assistive devices such as handrails, grab bars for the shower or tub, raised toilet seats, and shower chairs and handheld shower heads; 2) Placer Independent Resource Services (PIRS) provides minor home modifications to make the home safer and provide access for people with disabilities. PIRS does an in-home safety check to insure the homes are safe and as barrier-free as possible; and 3) Rebuilding Together Sacramento specifically targets older adults who live in mobile homes to fill a service gap in the community, particularly since fiberglass showers and very steep entryways are challenging in these settings.
• The Delaware Division of Services for Aging and Adults with Physical Disabilities (SUA) statewide Delaware Home Modification Program funds home modifications made in the permanent residences of a person aged 18 years or older with a permanent or long-term physical disability. Program assistance is provided when an individual has no other funding source available to them or when funds from another source are not adequate to pay for the needed modifications. Regional Aging and Disability Resource Centers help to carry out the program.
• The Florida Department of Elder Affairs oversees the Community Care for The Elderly (CCE) Program, a state-funded program of community-based services for individuals aged 60 and older and functionally impaired. Services can include minor emergency home repairs. The Department administers the program through contracts with AAA, which subcontract with Community Care for the Elderly lead agencies.
• The Iowa Department on Aging (IDA) engages in several home modification service delivery efforts in support of its goal to be the state level resource hub for home modifications, providing networking support and helping consumers and professionals to find home modification funding and services. IDA received an Empowering Communities Fall Prevention Grant from the Administration for Community Living to pilot the evidence-based Community Aging in Place – Advancing Better Living for Elders (CAPABLE) Program in four counties. CAPABLE includes home modifications from a handyworker as part of a three-pronged service strategy with an occupational therapist and a registered nurse with the goal of decreasing fall risk, improving safe mobility, and improving the ability to safely accomplish daily functional tasks. IDA CAPABLE partners include Connections Area Agency on Aging, Greater Des Moines Habitat for Humanity, and Dallas County Hospital. IDA also obtained $100,000 in Coronavirus Aid, Relief, and Economic Security (CARES) Act funds that they awarded to Easterseals the state assistive technology program to provide older adults and people with disabilities with assistive devices and training on how to use them. IDA also provides informal technical assistance to its AAAs regarding home modifications to help them identify untapped funding sources and services.
• The Kentucky Department for Aging and Community Living (SUA) administers several programs with a home modification component that build upon the services included in the Older Americans Act, including: 1) the Kentucky Homecare Program which provides minor home adaptations, additions, or modifications to support older adults at risk of institutionalization with living independently and/or safely or to facilitate mobility including, where appropriate, emergency summons systems; and 2) the Hart-Supported Living Program which provides grants for supportive supports so that Kentuckians with disabilities can live in their homes and communities of choice and avoid institutionalization. Home modification is an eligible service. In addition, the Kentucky Older Americans Act Title IIIB: Home Repair Services, administered by AAAs, provides minor home adaptations, additions, or modifications to enable older adults to live independently.
• The Maryland Department of Aging (SUA) Community for Life Program provides a package of services for homeowners and renters over the age of 65, as a fee-based, local nonprofit model that involves three pillars of support including initial home assessment and handyworker support, transportation, service navigation. It offers home maintenance/light home repair provided by a community “handyman” based on a list of vetted contractors, transportation, and community access navigation in a cost-effective and supportive manner. As of 2022, there are 11 local partners in the state carrying out the Community for Life Program, including AAAs and community health agencies.
• Michigan Aging and Adult Services Agency (SUA) has established home repair and home modification/home injury control as approved services under Older Americans Act (OAA) Title III-B. In FY 2018, six of the sixteen Michigan AAAs expended $191,782 in OAA and local funds on home modification/home injury control to 1,245 individuals and $79,500 on home repair services to 195 individuals. The state of Michigan also has a weatherization program that is administered by local agencies, including AAAs, that also offers some home modifications.
• The Minnesota Department of Human Services, Aging and Adult Services Division (SUA) has a program called the Live Well at Home Grant (LWAH), wherein grant money is provided to grantees to build the Long-Term Services and Support System throughout the state. Through LWAH, money is awarded to grantees that deliver home modifications in homes that lack the necessary structural features and support systems to make aging in place viable. Between the years of 2017-19, LWAH funded several local grantees with a focus on home modifications, including the evidence-based Community Aging in Place—Advancing Better Living for Elders (CAPABLE) intervention to help older people age in the community. As the designated Area Agency on Aging providing services to older adults 60 years of age and older, caregivers, and grandparents/relatives raising relative children within the Minnesota Chippewa Tribe communities, the Minnesota Indian Area Agency on Aging administers the Live Well at Home Program which includes environmental accessibility modifications. It also has a Fall Prevention Program with A Matter of Balance Program which also addresses home safety.
• The Nevada Department of Health and Human Services Aging and Disability Service Division (SUA) administers the Assistive Technology for Independent Living (AT/IL) Program, a statewide program that supports an individual’s choice to live in their community. Non-profit community partners C*A*R*E* Chest of Sierra Nevada and Easterseals provide assistance with home modifications so that Nevada residents with permanent disabilities can care for themselves or be cared for in their homes and community rather than in a care facility.
• The South Carolina Department on Aging (SUA) has administered the ElderCare Trust Fund since 1992 which helps South Carolinians in need by awarding grants to innovative programs that help older adults age in place and avoid institutionalization. The South Carolina Department of Aging has awarded over $400,000 to more than 30 non-profit organizations statewide via the Trust Fund, including the Anderson Interfaith Ministry Housing Program which assists low-income homeowners to remain in their homes by providing ramps and repairs to support health and safety in the home.
• The Tennessee Commission on Aging and Disabilities (SUA) oversees the $36 million Senior Trust/Elder Trust related to the settlement of two court cases. Funding is granted to six different in-state organizations for the purposes of implementing statewide initiatives designed to improve older Tennesseans’ lives. Two grantees focus on home modification and repair: 1) Habitat for Humanity of Greater Memphis’ Aging in Place (AIP) Program is providing home modifications for more than 1,000 older Tennesseans to support aging in place in their own homes; and 2) Westminster Home Connection is providing critical home modification and repairs as well as sort-pack-move services for older Tennesseans in three counties who are transitioning housing.
• The Washington State Aging and Long-Term Support Administration (SUA) administers the Veterans Administration-funded Veteran Directed Home Services which provides eligible Veterans with home and community-based services that support living independently in their homes and communities. Services include ramps, grab bars, modifications of doors, and minor home repairs. The services are coordinated and delivered by four AAAs in Western Washington. Participants may choose to spend funds on a modification to their residence to accommodate their disabilities and promote functional independence, health, safety, and welfare.

Along with overseeing home modification and repair services, the Aging Network contributes to service access by directly administering home modification and repair services, especially at the local level. Of the AAAs directly administering home modification or repair services,  94% provide minor home modifications (e.g., installation of grab bars and raised toilet seats) and 52% provide major home modifications (e.g., remodeling bathrooms and installing ramps). Over half of the AAAs provide home repairs, an important supportive housing service since a home may need to be repaired before any safety modifications are made. Assessing the home environment is a key home modification service to identifying problems and solutions specific to the resident and almost 1/3 of AAAs (30%) indicate conducting home assessments. Tribal organizations also offer a range of home modification and repair services to tribal elders. Title VI grantees are more likely to provide minor home modification (52%) than major modifications (12%) or repairs (11%). One quarter of Title VI grantees provide home assessments to determine need for modifications.

Examples of state and local level efforts to directly administer home modification and repair services demonstrate opportunities for other agencies to emulate and include:

• The State of Alaska, Senior and Disability Services (SUA) administers the Environmental Modification (E-Mod) Home Accessibility Program to individuals who are eligible for one of Alaska’s Medicaid waiver programs. When Medicaid waiver program recipients need home modifications, they contact their waiver program care coordinator. The care coordinator assists recipients and caregivers with determining what modifications are needed and requests cost estimates from Medicaid certified contractors. Modifications have a cost cap of $18,500 that is renewable every 3 years.
• The Southern Alabama Regional Council on Aging (SARCOA), an Area Agency in Dothan, Alabama, covering seven mostly rural counties, has the Neighbors for Seniors Program which is fully funded by donations with modifications provided by volunteers. This program matches older adults who need ramps, handrails, or other minor safety and health-critical home repairs to volunteers looking for worthwhile community projects. The total cost per client averages $800-900, fully funded by donations. About 25 modifications are completed annually, meeting urgent needs with no cost to the recipient or to the agency.
• The Washington, DC Department of Aging and Community Living’s Safe at Home Program provides safety adaptations in and around the homes of qualifying residents aged 60 years and older as well as individuals with disabilities age 18-59 years old. Adaptations include handrails, grab bars, bathtub cuts, shower seats, furniture risers, chair lifts, and security cameras. The Safe at Home Program completes approximately 1,000 home modifications annually. Safe at Home is a minor home modification program administered and funded by the DC Office of Aging and Community Living and carried out by the private, non-profit agency, Home Care Partners. In operation since 2016, Safe at Home’s mission is to promote aging in place for residents aged 60 years and older and residents living with a disability (age 18 to 59 years) by offering home accessibility adaptation grants that reduce the risk of falls and reduce barriers that limit mobility.
• The Area Agency on Aging District 7, Inc. has a Home Repair Program serving older homeowners who meet income eligibility requirements and live in the agency’s ten-county region. The program is funded by the Ohio Department of Development Housing Trust Fund Housing Assistance Grant Program and the State of Ohio Senior Community Services Program. Services include installing ramps to improve accessibility, kitchen and bathroom modifications, and housing repairs.
• The Area 10 Agency on Aging in Elletsville, Indiana has the REPAIRS (Reliable Experts Providing Accessibility, Independence, Rehabilitation, and Safety) Program in which a volunteer team determines the extent of a job and then provides information on material costs to the program participant. The participant then pays for the materials with their own funds, grants, or loans and volunteers provide all labor at no cost. Repairs include designing and building ramps or shallow steps; installing safety features such as grab bars and rails; repairing minor plumbing, electrical issues, unsafe wooden steps, and floors; and checking smoke alarms and light bulbs.
• The CICOA Aging and In-Home Solutions, an Aging and Disability Resource Center (ADRC) in Central Indiana, administers the Safe at Home Program which provides home modifications and repairs to homeowners 60 years or age or older or who have a disability. Participants must be at or below 250% federal poverty guidelines. Modifications include ramps, widening doorways, grab bars and handrails, and replacing doorknobs or faucet knobs with lever handles. Safe at Home services about 90 households and approximately 150 individuals per year, with an average total cost per client of $2,000.
• The Contra Costa County Area Agency on Aging’s Fall Prevention Program conducts in-home Occupational Therapist assessments and evaluations for seniors at risk of falls and/or of being institutionalized due to a lack of a supportive home environment. It also provides assistive devices and home modifications that support aging safely at home. Additionally, the Fall Prevention Program provides “Tai Chi for Better Balance” county-wide classes in various sites as well as in homes to improve balance and decrease instances of falls.
• The Health and Human Services Department of the Salt River Pima-Maricopa Indian Community, in Scottsdale, Arizona has the Environmental Health and Injury Prevention Program which offers fall prevention services to Tribal elders who are 55 years and older and clients who have fall risk factors identified. Home assessments, fall risk testing, and Tai Chi for Fall Prevention and Yoga for Fall Prevention classes are among the services that support older adults at home.
• The Grand Traverse Band of Ottawa and Chippewa Indians Elders Program in Peshawbestown, Michigan works with the Grand Traverse Band Housing Department on the Emergency Home Repair and Handicap Accessibility Program to provide ramps, bathroom renovations (grab bars, supportive toilet, walk in showers, walk in tubs, and sinks), kitchen renovations (counter and cupboard lowering, and roll up sinks), and door widening. Funding is provided at a maximum of $20,000 for older homeowners or homeowners with a disability who meet income requirements. Repairs are made by licensed and insured contractors.
• The Ute Mountain Ute Tribe Elder Care and Wellness Center, a Title VI grantee in Towaoc, Colorado administers the Elder Assistant Program which serves tribal members aging 55 and up. It provides assistance to tribal elders who need home furnishings and minor home repairs. This program works with other departments to coordinate services to meet elder’s needs.
• The Pueblo of Isleta Elder Center in Isleta, New Mexico administers the Home Chores and Minor Repair Program which provides a part-time handyworker who conducts minor home repair services for individuals 60 years of age or older. Services include replacements to windows, doors, screens, glass, and doorknobs/handles.
• The Saint Regis Mohawk Tribe Office of the Aging in Akwesasne, New York receives funding and support from the New York State Office for the Aging, Older Americans Act Title VI Native American Programs, Saint Regis Mohawk Seniors Club, and the Tribal General Fund to provide Home Chores and Minor Repair services to the elders of Akwesasne. The maintenance staff assists tribal elders with minor home repairs, lawn care, snow removal, and helping tribal elders to find appropriate service providers if the repair request is beyond the program’s capacity.
• The Kiowa Tribe Administration on Aging in Carnegie, Oklahoma loans assistive devices such as portable ramps, grab bars, shower chairs to elders and individuals with disabilities. Tribal elders may also receive referrals for related service providers referral (e.g., home modification programs, occupational/physical therapists, funding sources) as needed.