Given cost constraints, competing priorities, the multi-disciplinary nature of home modifications, and the complexity of some major home modification and repairs, home modification and repair as a supportive service has been slow to emerge since the Aging Network was established in 1965. In the last decade, however, new developments have  elevated home modification on the public agenda.

The home environment is increasingly included in discussions about health in later life, underscoring its importance in aging in place. More accurate research has led to understanding types of housing features and their impact on residents and there have been calls for policy reform to make better use of home modification.

The extent to which Aging Network agencies provide leadership relative to home modification and repairs can impact availability and access for older adults and people with disabilities. To directly address barriers to home modification and repair activities, the Aging Network’s involvement in prioritizing and advocating for policy and funding changes to support home modification is imperative. Efforts that involve formal commitments to home modifications (such as including home modification goals in state and local plans) and advocacy for funding and policy change is imperative to increasing home modification and repair access and availability. Examples of Aging Network efforts below to prioritize home modification in state and local plans as well as advocate for home modification and repair funding and policies provide opportunities for other agencies to emulate.

The Aging Network is responsible for developing and administering multi-year state and local plans that provide supportive services to older residents, caregivers, and adults with physical disabilities. This process can include incorporating specific goals and objectives in their plans that address the need for home modifications and repairs in their states and localities. For example, about 1 in 4 State Units on Aging (SUAs) (24%) report that they had directly incorporated strategies to meet home modification and repair needs into their state plans as a way of formalizing and publicly articulating a commitment to home modification and repairs.

• The Area Agency on Aging (AAA) of Southwest Washington’s surveyed older adults when creating the 2020-2023 Area Plan and found that individuals need more home modification supports to stay in their homes as long as possible than they were currently receiving. As a result, the AAA Advisory Council submitted a proposal to the county government board that was accepted to pilot a one-year home modification program using $35,000 of the AAA’s discretionary funding. The HOME Program provides older adults with minor home modifications so they can continue to live independently and safely in their own homes. Modifications include grab bars, handrails, handheld showers, and access ramps. The pilot program currently serves adults over age 60 who reside in three counties and the AAA will expand the program to two more counties by 2023. To develop HOME on a limited budget, the AAA worked with a volunteer agency  who has a group of retired general contractors and handymen and  estimated they donated around $10,000 in labor and $800 in materials. The pilot served 28 clients during the first year of the program and then the county board voted to make the home program permanent with a running with a budget of around $40,000 each year. This all emerged from including home modifications as part of the local planning process and then using those results to request funds to create an ongoing program to fulfill a need.
• The Iowa Department on Aging (State Unit on Aging) State Plan on Aging – 2022-2025 recognizes home modification as a critical supportive service gap. Home modification has its own objective linked to care transitions under Strategies to Address Service Gaps: expand access to home modifications programs to ensure safe home environments for aging Iowans. Action items include: 1) participating with the Iowa Livable Homes Coalition to strategize and develop a better network of local and statewide providers to create a State Program Hub for home modifications; 2) creating a process for coordination and connectivity of available home modification resources. These resource navigation efforts will connect funding and providers back to expanded support for individuals in the Iowa Return to Community initiative to further ensure safe at home environments; and 3) piloting the Johns Hopkins Community Aging-in-Place: Advancing Better Living for Elders (CAPABLE) program and creating an infrastructure to sustain and grow CAPABLE across Iowa.
• The Minnesota Board on Aging (State Unit on Aging) includes very specific home modification and repair goals within the Minnesota 2019-2022 State Plan on Aging, including advocating for a state-level home modification multi-agency task force, specifically targeting at-risk low-income homeowners who may not qualify for other home modification programs, and working with other state departments such as the Housing Finance Agency and Rehabilitation to implement home modifications and repairs. The SUA is also launching a public-private partnership to complete home modifications and home maintenance repairs needed by the 16,400 very low-income older homeowners at risk of needing to move.
• Missouri Department of Health and Senior Services (State Unit on Aging) conducted a survey to determine the services older adults needed most in preparation for developing their State Plan on Aging.  The survey was of older adults, professionals serving older adults, caregivers, and SUA staff who provide Home and Community-Based Services Assessments. Each survey group listed home modifications as one of the highest needs for older adults, with funding for home modification as the primary barrier.  As a result, the SUA added home modification and repair to their “in-home services” definition so that it would qualify for the minimum spending requirement for in-home services under the Older Americans Act Title III-B.
• The Ohio Department of Aging (State Unit on Aging) Strategic Action Plan on Aging 2022-2022 includes strategies to: 1) research how funding is being used for home modification and repairs; 2) create pilot programs that utilize various professions to provide in-home assessments; and 3) evaluate specific home modification and repairs that are needed to assist individuals with remaining at home.

The availability of funding and supportive policies for home modification and repair is dependent on the priority that providers and policymakers place on it as a critical element in home- and community-based care. Home modification and repair is frequently reported by the Aging Network as an unmet need for older adults, with 90 percent of Title VI grantees reporting that there are some or significant unmet needs for home modifications in their areas. When asked what they need to ensure home modification services for older adults, SUAs overwhelmingly said more funding (92%). About one-quarter (24%) of SUAs report engaging in advocacy to increase home modification and repair, policies and/or services. This might be educating legislators or advocating for increases in spending limits for home modifications in public programs.

Examples of Aging Network efforts to advocate for home modification and repair funding and policies provide opportunities for agencies to emulate.

• Connections AAA, serving 20 counties in Southwestern and Western Iowa, successfully worked to increase the home modification funding amount included in a Medicaid waiver for older adults. The cap was a $1000 lifetime maximum for home modifications which was not adequate to even cover the cost of ramps of which they had great need. The AAA applied for an exception to this policy (the Medicaid cap) and got approval for $1500 to be spent. They then worked with an approved provider and were able to build modular ramps that when no longer needed, the provider would pick up the modular parts and the parts would then be used to help build a ramp for another individual needing a ramp. This combined strategy maximized access for individuals in need of a ramp.
• Nebraska AAA Advocacy: AAAs at the local level in Nebraska worked together to increase the allowable amount for home modifications and repairs under the Older Americans Act Title III-B. They jointly reached out to their SUA to communicate the need for a change in policy and the funding amount. As a result, the SUA 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 directly from the AAAs.
• The Nevada Aging and Disability Services Department (State Unit on Aging) educates legislators and community partners on available home modification services, gaps in services, and the needs of older adults and people with disabilities for home modification availability and access.