Building Block 7: Innovation

Building Block 7

Incorporate State-of-the Art Home Modification Funding and Service Delivery

An array of opportunities for home modification and repair services within well- tested programs have emerged over the past decade. A number of models for home modification and repair service delivery can now be replicated on a wider scale. These are based on evidence-based programs that have shown reliable, consistent positive outcomes in health-related and functional measures such as Johns Hopkins School of Nursing Community Aging in Place – Advancing Better Living for Elders (CAPABLE) and the Home Hazard Removal Program (HARP). Additionally, some evidence-based fall prevention programs incorporate home modification alongside exercise and other components, such as Stepping On, Matter of Balance, and Stanford University’s Farewell to Falls Programs. The Aging Network has several opportunities to incorporate state-of-the-art funding and service delivery strategies.


1) The evidence-based Community Aging in Place – Advancing Better Living for Elders (CAPABLE) Program

The evidence-based Community Aging in Place – Advancing Better Living for Elders (CAPABLE) Program, developed by Johns Hopkins University School of Nursing, is a five-month evidence-based program delivered at home to older adults with the goals of decreasing fall risk, improving safe mobility, and improving the ability to safely accomplish daily functional tasks. CAPABLE focuses on individual strengths and goals in self-care (both Activities of Daily Living and Instrumental Activities of Daily Living), targeting older adults who have at least one activity of daily living difficulty (​such as difficulty bathing, dressing, walking, eating) and who are cognitively able to identify goals in self-care. ​CAPABLE is delivered by an interprofessional team of: 1) an Occupational Therapist (6 visits); 2) a Registered Nurse (4 visits); and a Handyperson (contributes up to a full day’s work). Participants: 1) identify goals and barriers to achieving their goals; 2) ​create an action plan, ​and ​learn how to use new adaptive equipment, supplies, or minor modifications to their home. CAPABLE ​has been implemented by more than 45 organizations, usually partnerships between healthcare and housing services community nonprofits.  ​In addition to home health care and home repair agencies, CAPABLE has included partnerships with State Units and Departments on Aging, Area Agencies on Aging, community-based senior services programs, managed care organizations, home-based primary care clinics, and research centers.

Roles for the Aging Network include, but are not limited to:

  • overseeing CAPABLE implementation at local sites, such as the Iowa Department on Aging (e.g., the Iowa Department on Aging);
  • brokering CAPABLE services (e.g., the Minnesota River Area Agency on Aging);
  • securing grant funding to implement CAPABLE as part of a partnership;
  • serving as a partner to a CAPABLE site, including identifying and referring appropriate CAPABLE participants from the community (e.g., Allegheny County Area Agency on Aging, Pennsylvania);
  • educating case managers, transition coordinators, and caregiver counselors about the role of a community CAPABLE site; and
  • advocating for support and development of a CAPABLE site within their state or community.

2) The Home Hazard Removal Program (HARP), developed by Washington University at St. Louis

The Home Hazard Removal Program (HARP), developed by Washington University at St. Louis, provides a model for Aging Network agencies to emulate. It is s an evidence-based occupational therapy intervention designed to reduce falls by removing home hazards. The efficacy of HARP has been tested with an Area Agency on Aging. HARP, initially funded by the US Department of Urban Development, includes a comprehensive in-home assessment of the participant’s abilities, behaviors, and environment; a home hazard removal plan; and remediation of hazards. The intervention consists of 1-3 sessions, with a booster visit six months after the intervention. HARP was tested in a randomized clinical trial of older adults receiving services from the St. Louis Area Agency on Aging (SLAAA). In this study, 310 participants recruited from SLAAA were randomized, with 155 individuals assigned to HARP and 155 assigned to usual care. This study found a 38% reduction in the rate of falls for the HARP group compared to usual care. It also found that HARP was cost effective and had high adherence. HARP could be an important intervention to address the growing fall rate in the U.S. In 2022, a training program for HARP is being created by the intervention developers for delivery on a national scale, providing an opportunity for Aging Network providers to replicate HARP.


3) Evidence-Based Fall Prevention Programs

While there are about 15 evidence-based fall prevention programs approved by the U.S. Department of Health and Human Services, there are four evidence-based fall prevention programs that specifically include a home modification component: Stepping On, A Matter of Balance, Otago exercise program, and Tai Chi: Moving for Better Balance. Many AAAs are hosting Stepping on and Matter of Balance programs by having their staff trained as Master Trainers and holding the classes at their facilities.

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

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.