Home modification and repair is funded and administered at local, state, and national levels by disparate government agencies representing housing, health care, disability, and aging. These include but are not limited to: 1) the Department of Housing and Urban Development or HUD; 2) the Centers for Medicare and Medicaid Services or CMS; 3) the Administration on Aging (AoA) within the Administration for Community Living, 4) Veterans Affairs; 5) the U.S. Department of Agriculture (USDA); and 6) the Department of Energy (DOE) Weatherization Assistance Programs (descriptions of the funding sources under each of these agencies may be found in this publication Funding Sources for Home Modifications and Repairs).
Within the home modification service process, it is often unclear which of these agencies should be accessed for home modification funding and who qualifies for assistance from them. With different purposes, practices, agendas, and fiscal capacity, the result is often a confusing array of programs with diverse eligibility requirements, methods of assessment, coverage specifications, types of installers, and caps on costs.
An additional aspect to these complications is that there are two sides to the service provision: a “property” side (homeowner; a renter with concerns about how to get permission for changes; or a landlord wanting or needing to make changes) and a “person” side (age, disability, veteran, caregiver, income level, and residence location). All of these factors play a role in an individual’s access to home modification funding. More than one source often must be secured as the amount of necessary work becomes more extensive, especially among low-income households. These sources may have very low assistance maximums and be targeted at serving a narrow segment of households, properties or types of modifications. For example, funds from three to five sources might need to be located to complete a $15,000 or $20,000 ramp for a household with a low or modest income. Each source has its own eligibilities that must be met, paperwork that must be prepared, and disbursement procedures to follow.
While there are various funding sources to support home modification or repair services in tribes, the Aging Network overwhelmingly reports lack of funding as the greatest barrier to home modification service delivery with 73% of State Units on Aging (SUAs) identifying that limited funding is their greatest barrier related to home modification and repair services and over half of Title VI programs (57%) identifying funding deficiency as a barrier.
All of these factors provide challenges for the Aging Network relative to implementation and expansion of home modification and repair services and funding. The following examples of Aging Network efforts to advance home modification and repair funding sources provide opportunities for other agencies to emulate: 1) access and collaboration with other agencies; 2) increasing limits and caps on home modification funding sources; and 3) creative funding approaches to home modification and repairs.
Funding collaborations between SUAs, Area Agencies on Aging (AAAs), Title VI, and other government agencies and organizations can yield synergistic results that make it possible to reach more persons than by acting alone. Indeed, home modification and repair concerns often cut across programs and services in the aging, disability, housing, and health care sectors, and can impact individual outcomes related to wellbeing, quality of life, and the ability to age in place.
SUAs report home modification and repair funding collaborations with other governmental entities, the most common of which (34%) was with state Medicaid offices related to home-and community-based waivers (see Building Block 1: Integration for examples of these efforts). About a third of AAAs access Medicaid Home and Community Based Waivers wherein they may be an approved provider for home modification services under their state Medicaid waiver or they may administer a waiver program directly and provide the home modification services as a part of that Medicaid Waiver program.
While conducting referrals for all types of services is a key role for the Aging Network, nearly half of AAAs indicate conducting direct referrals to funding sources for home modifications or repairs as a way to access outside funding for consumers. This demonstrates the importance of Aging Network agencies being aware of home modification and repair funding provided by non-aging agencies in their community and state. Nearly 90% of the AAAs who refer to funding sources for home modification and repairs refer to the Department of Energy Weatherization Assistance programs, often for emergency repairs that accompany home modifications. Over half of AAAs refer to city/county housing community development departments and Medicaid waiver programs for funding.
Over half of Title VI Program Directors (66%) indicate that home modification or repair services are available to older adults in their tribes. The three most common sources of funding for home modification and repairs are tribal funding/non-HUD (58%), OAA Title VI funds (47%), and HUD programs or grants for Native Americans (43%) followed by non-HUD grant funds (27%) and the DOE Weatherization Assistance Program (23%).
Examples of Aging Network agency efforts to access and collaborate on home modification funding with other agencies provide opportunities for others to emulate.
Aging Network agencies are often faced with the difficult task of prioritizing the home and community-based services they support based on their community’s most prevalent or pressing needs. Funds for home modification and repairs coming from public sources such as the Older Americans Act and Medicaid Waivers are extremely limited relative to the scope of work covered. An SUA reported: “Most of our contracts are for limited resources on low-cost modification like grab bars. This is unfortunate in most cases because the older adult’s home is usually in shambles. It is very disheartening to see an individual’s home and to know the only thing we could offer is a grab bar. We have to make a choice between low-cost home modifications to serve more people or more meaningful and larger home modification but serve fewer people. Costly bills often leave little remaining funding for home modifications for families.”
One quarter (25%) of SUAs indicate that they are actively involved in financing home modifications under the Older Americans Act Title III-B funding. This could be assisting with rate setting for home modification and repair services or elevating home modification and repairs as a priority service under Title III-B. Of the AAAs who indicated that they directly deliver or contract out for home modification and repair services, the main source of funding for home modification and repair services is Older Americans Act Title IIIB Supportive Services with nearly 70% reporting this as a funding source for their home modification services. Home modification is among the more than 25 authorized services under Older Americans Act Title III-B. However, funding has remained limited, even as demand continues to grow. Home modification as a Supportive Service is capped at $150 per person based on an Older Americans Act 1988 federal regulation. This amount will only cover the most minor home modifications, and thus, is often inadequate to even pursue as a covered OAA service.
Given the realities of limited funding for home modification and repair services, some Aging Network agencies have worked to increase the limits or caps on home modification and repair funding options. The following examples provide opportunities for other agencies to emulate.
Given that home modification and repair services for older adults and persons with disabilities do not have a dedicated source of public funding and the available funding is limited, it is important that agencies consider creative funding approaches to expand funding availability and access. This might include accessing state general revenues, combining funding sources, requesting donations for services, cost-sharing, and using volunteer labor. Twenty-two percent of SUAs reported collaborations that promote access to state general revenues. About one-third of AAAs rely on donations to deliver home modification and repair services. This might be in the form of donated labor or materials. Almost one-fourth of the AAAs use cost-sharing wherein the AAA might provide the labor, but the home modification and repair recipient might pay for the materials and supplies to do the work. AAAs and Title VI grantees have created new ways to fund home modification and repair services by using volunteer labor such as accessing local community college students in construction classes, working with non-profits who use volunteers such as Rebuilding Together, and Habitat for Humanity, or recruiting retired handypersons or contractors. One AAA has shared that due to the use of volunteer handypersons, ramps cost approximately $1,700 whereas the same ramp built by one of their for-profit contractors would cost over $5,000. The following creative funding approaches by the Aging Network to delivering home modification and repair services provide opportunities for other agencies to emulate.
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
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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.