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Building Block 3: Funding - Home Modification Toolkit

Building Block 3: Funding

Building Block 3

Advance Home Modification and Repair Funding

Funding

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.

Building Block 1: Integration

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.

Opportunities

1) Accessing and Collaborating on Home Modification and Repair Funding with Other Agencies

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.

  • The Area Agency on Aging District 7, Inc. in Rio Grande, Ohio has a Home Repair Program that is funded by the Ohio Department of Development Housing Trust Fund Housing Assistance Grant Program and the State of Ohio Senior Community Services Employment Program. Services include installing ramps to improve accessibility, kitchen and bathroom modifications, and housing repairs. They are delivered to eligible older adults in the AAA’s ten-county region.
  • The Iowa Department on Aging SUA and the New Mexico Aging and Long-Term Services Department SUA partner with their Veteran’s Health Administration to administer the Veteran-Directed Home and Community-Based Services Program, which includes home modifications. The program uses a self-directed care model wherein participants choose and manage the long-term services they need to live independently. They are provided a monthly budget to contract with the individuals and agencies of their choice (including family members, friends, and neighbors) for goods and services, including home modifications.
  • The Vermont Department of Disabilities, Aging and Independent Living SUA partners with the Department of Health to promote program called “Vermont One Touch” that connects the delivery of energy, housing, and health programs with a common home assessment and electronic referral system. Government and non-profit agencies partner to conduct home visits that identify household conditions and family needs, resulting in referrals to relevant organizations. The state’s Weatherization program uses One Touch in all single-family weatherization projects and is able to do a falls risk pre-screening and make simple modifications during the visit.
  • The Vermont Department of Disabilities, Aging and Independent Living SUA conducted an analysis of Medicaid Waiver participants and found that very few were accessing funds available for home modification and repairs, yet the Waiver program’s fall rate was very high. In response, the SUA and the Medicaid team worked together to improve education and training of case managers about the use of Medicaid Waiver funds for home modification and repairs.
  • The West Virginia Bureau of Senior Services SUA administers the West Virginia Medicaid Aged and Disabled Waiver (ADW) Program which provides in-home and community services to individuals aged 18 and older who need support services to maintain their independence. Home modifications are an eligible supportive service based on a functional assessment by a medical professional.
Opportunities

2) Increasing Limits and Caps on Home Modification and Repair Funding Options

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.

  • The 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. There is a great need for modular ramps in Alaska given the housing stock. However, they were not categorized as a home modification but instead a durable medical equipment item so could not be supplied by the Medicaid contractors. Medicaid staff encouraged a change and the SUA recategorized modular ramps as a home modification that fits within the $18,500 cost cap and now can be covered to meet the need.
  • The Hawaii Executive Office on Aging submitted a request to waive the 1988 OAA Title III-B spending limit for home modifications from $!50 and change it to $500 per person for AAA-approved home modification expenses and a 1,000 maximum with approval from the SUA Director. It was approved and AAAs in Hawaii now utilize Title III OAA funding of up to $500 per older adult for simple home modifications and repairs.
  • The Minnesota Department of Human Services, Aging and Adult Services Division, recognizing the importance of home modifications and assistive technology, amended the Elderly Medicaid Waiver (EW) and requested an increase for environmental accessibility adaptations from $10,000 per year for an EW or Alternative Care (AC) enrollee to $20,000. This increase allows people on these programs to cover the market rate cost of the environmental accessibility adaptations they need including home modifications and adaptations to a vehicle.
  • The Nebraska State Unit on Aging worked with the Administration for Community Living (ACL) to obtain a waiver to increase the OAA Title III-B home modification allowable funding amount from the 1988 regulations limit of $150 per person to $500 for AAA-approved home modification expenditures and a $1,000 maximum on an as needed basis, with specific approval of the SUA Director. Advocacy for this change emerged from AAAs at the local level to increase the allowable amount for home modifications and repairs. As a result, the SUA decided to submit the request for an increase to their ACL regional office and was granted the increase. The Nebraska SUA provides ongoing formal guidance to AAAs for the use of OAA Title III-B services funds under materials distributions for necessary and permitted home modifications.
  • The Pennsylvania Department of Aging has been actively involved in increasing home modification funding limits of two programs. First, it implements the Help at Home: Options Program, a state-funded program for older adults via the Pennsylvania Lottery Aging Block Grant and administered through the AAAs. This program provides a variety of supplemental services to help individuals 60 years and older who have an unmet need for services to stay in their own homes, including home modifications to improve safety and accessibility. In 2018, the SUA increased the lifetime limit for home modifications in the Help at Home: Options Program. Second, the SUA administers The Caregiver Support Program focuses on decreasing the stresses of caregiving by reimbursing primary caregivers for costs associated with caregiving, such as respite, caregiving-related services, and modifications to the environment that support caregiving. The Pennsylvania Caregiver Support Act of 2021 increased the lifetime limit for the Caregiver Support Program for home modifications or assistive devices to $5,000 in 2021.
Opportunities

3) Creative Funding Approaches to Home Modification and Repairs

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.

  • The Arizona Department of Economic Security, Division of Aging & Adult Services SUA received a $1 million Family Caregiver grant from the Arizona state legislature to establish the Arizona Family Caregiver Support Program. It provides direct services to caregivers, including counseling, respite care, and supplemental services that complement care provided by caregivers. This includes home modifications, which may be reimbursed for up to 50% of the costs, and assistive care technology up to $1,000 for one or more care recipients.
  • The Minnesota Board on Aging SUA works with the Minnesota Housing Finance Agency’s (MHFA) Rehabilitation Loan Program to fund home modifications and maintenance for very low-income older homeowners. Additionally, the Minnesota Department of Human Services, Aging and Adult Services Division has a grant program called 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 execute home modifications for 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 grantees with a focus on home modifications, including the Community Aging in Place—Advancing Better Living for Elders (CAPABLE) intervention to help older people age in the community.
  • The Maryland Department of Aging SUA developed the Community for Life Program which provides a package of services for homeowners and renters. It is fee-based and implemented by local nonprofits which helps to defray the costs. The model involves three pillars of support including initial home assessment and repair person support, transportation, and community service navigation all focused on cost-effectiveness. It includes home maintenance/light home repair provided by a community “handyman” based on a list of vetted contractors. There are currently eleven partners in the state carrying out the Community for Life Program.
  • The New York State Office for the Aging SUA received $15 million in general state funds to address unmet service needs of older adults. Home modification and repairs were identified as a needed service and thus, a portion of the $15 million was dedicated to home modification and repairs.
  • The Rhode Island Office of Healthy Aging SUA helps to promote the Rhode Island Livable Home Modification Grant program through Aging and Disability Resource Centers across the state. The Grant Program is administered by The State of Rhode Island Governor’s Commission on Disabilities which partially reimburses accessible home modifications for individuals who have disabilities so that they may live more safely in their homes and remain in the community. The grant is 50% of the total retrofit costs and up to $5,000. Grant awards include the cost of the needs assessment and post renovation certification of compliance.
  • Saint Regis Mohawk Tribe Office for the Aging in Akwesasne, New York combines a variety of funding sources to provide housing maintenance and repairs. It receives funding and support from the New York State Office for the Aging, OAA Title VI Native American Programs, Saint Regis Mohawk Seniors Club, and the Tribal General Fund to provide services to the elders of Akwesasne. The maintenance staff can assist tribal elders with minor home repairs, lawn care, and snow removal. The maintenance staff also help tribal elders to find appropriate service providers if the repair request is beyond their capacity.
  • SARCOA Area Agency on Aging and Aging & Disability Resource Center in Southeast Alabama has the Neighbors for Seniors Program which matches older adults who need ramps or other minor safety and health-critical home repairs to volunteers looking for worthwhile community projects. Personalized write-ups about the individuals in need are posted on SARCOA’s website and volunteers can read the stories to select the person they would like to support. The program is primarily funded by donations from the community.
  • The South Carolina Department on Aging SUA administers the Eldercare Trust Fund 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 with remaining in their homes by providing ramps and repairs to support health and safety in the home.
  • The Tennessee Commission on Aging and Disability 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 of the organizations focus on home modification and repair: Habitat for Humanity of Greater Memphis and Westminster Home Connection. The population served is low-income older adults in Tennessee in need of home modification services.
  • The Texas Health and Human Services Commission SUA leads a process wherein local government codes in Texas allow multifamily residential developers the option of paying a fee to the housing finance corporations rather than reserve units for occupancy by low-income older persons. These fees are remitted to the Texas Health and Human Services Commission SUA and then awarded to AAAs to assist older adults with obtaining supportive housing, including home modification and repairs.
  • Valley Program for Aging Services AAA in Waynesboro, Virginia has a Home Renovation and Repair Program that it implements. In partnership with the local non-profit, Rebuilding Together, that uses volunteers to deliver the services. The Home Renovation and Repair program has case managers who handle phone requests for assistance from older adults, caregivers, professionals, and others. Requests may include information about home modifications in general, in-home assessments, and recommendations on how to meet an older adult’s home modification needs. Funding sources include Older Americans Act Title IIIB, Older Americans Act Title IIIE, and a state funded In-Home Service Program. Services provided include home assessments, minor home modifications (e.g., grab bars, raised toilet seats, handheld showers, handrails, lever door handles), major home modifications (e.g., remodel bathrooms, adjust counter/cabinet heights, ramps, elevator/platform, or chair lifts, widen doorways, roll-in showers), and repairs (e.g., roofing, electrical, carpeting/floors, stair repairs).
  • The Wyoming Department of Health, Aging Division SUA utilizes the federal Emergency Rental Assistance Program (ERAP) funding for home modification. Once a client is approved by Department of Family Services for ERAP funds, then they can apply for ERAP-HSS (Housing Stability Services), self-declaring to be either over the age of 55 or a person with a disability, and in need of home modifications. Then, a matched home modification provider completes intake forms with the client that include a checklist evaluation and a client service plan that includes permission from the landlord for work to be completed. The maximum amount for home modifications is $5,000 and trailer and mobile home repairs is $5,000. Home assessments may be carried out by anyone that the provider deems as appropriate, although higher level needs are recommended to coincide with doctor’s information. A closing evaluation is completed at the home to view the quality of the work, and then the Aging Division is billed for the home modification completed.

Suggested Citation:

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 ModificationArea 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
3715 McClintock Avenue
Los Angeles, CA 90089
www.homemods.org
homemods@usc.edu

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.