This case study project was conducted as part of the project, “Promoting Aging in Place by Enhancing Access to Home Modifications,” funded by the Administration for Community Living. The purpose was to highlight promising home modification service delivery efforts, provide a better understanding of how these services operate, and offer models for replication from five sites that represent a range of contexts (e.g., geographic, types of populations served, strategies utilized, resources available). Findings across case studies were compiled to share overarching challenges to home modification service delivery, advice to agencies that conduct or are planning to engage in home modification activities, and recommendations for increasing access to, and availability of, home modifications for aging in place. These findings are highlighted below.

Click Here to access the full report, Case Studies in Home Modification and Service Delivery: State and Local Aging Network Efforts Across the United States.

Challenges, Advice, and Recommendations

Case study agency and program representatives described the challenges they encounter related to home modification, advice to other agencies involved in home modification, and recommendations to increase access to and availability of home modifications for aging in place within the aging network.

Barriers and Challenges to Home Modification Service Delivery

  • Communicating the importance of being holistic to funders.
    Home modification is more complex than simply providing grab bars. Outcomes go beyond how many grab bars were installed. Taking a holistic approach reduces fall risk and can increase quality of life. Some important outcomes are difficult to measure. (SUA)
  • Working with renters.
    The program works in apartments in high rises, public housing, and rented houses. It must get permission from the landlord when serving renters and encounters difficulties. They have a partnership with a legal service, which allows pro bono lawyers to work with clients and inform landlords about the Fair Housing Amendments Act. (SUA)
  • Home repair.
    Homes can present serious issues that go beyond resolution by home modification. The intersection of health and housing needs to be looked at more closely, for example, mold, roofs, foundations, and lead. The program has installed grab bars in places with holes in the floor or roof. Some cases were referred to Adult Protective Services if there were deplorable conditions, but there are not many options for home repair. Home repair is a huge issue that is overlooked. (SUA)
  • Engaging contractors.
    We have had difficulty because we don’t always have a lot of funding available, projects can be limited in scope, and when construction is booming, contractors can make good money doing other things. (AAA)
  • Funding.
    I would like to go out and put in a barrier-free shower for 80% of the folks I meet. (AAA)
  • Securing volunteers.
    People didn’t know about the program, or thought they couldn’t do the work. It is harder to get volunteers than donations. (AAA)
  • Public awareness and acceptance.
    People are not planning ahead, and do not think about home modification until an emergency. People also tend to accept that activities are getting more difficult as they get older, rather than thinking about changing the home to make them easier. (SUA)

Advice to Agencies Working in Home Modification

Moving Home Modification Forward in Your State

  • Advocate with your state to provide home modifications through a Medicaid Waiver. It can make a significant impact.
  • Look at your state assessment, look at your data, and identify where your unmet needs are. Use your state’s strengths to improve a weakness while evaluating plans and during the assessment process.
  • Use a partner to move things forward, such as a Medicaid provider, Community Development Block Grants, Economic Development Board. It is unique to each state. Set small goals and bring it up and forward.
  • Take an agency-centered approach. Ask agencies what they need to deliver home modifications, where they see the gaps. It won’t help if you bring them funding and they don’t need it. Ask the locals what they need to fix the services.


Funding Local Home Modification Programs

  • Go for the funding that has no strings attached.
  • Get creative to help people whose needs go beyond the budget. Find someone to help meet the needs: Community members, organizations, Home Depot. Search high and low and seek groups with similar guiding principles.


Effective Service Delivery

  • Work with an Occupational Therapist (OT) who can objectively determine the necessary home modifications. An OT is not in a position to benefit financially, and they will take a holistic look at the person and the situation and determine what would serve the individual best regardless of whether the work uses the full budget available for the job.
  • Clearly communicate with clients to ensure they understand the work being done and how to use any new equipment.


Raising Community Awareness of Your Home Modification Program/Services

  • Conduct marketing or outreach to get the word out to eligible individuals that the program is available to them.
  • Get a good volunteer – a dedicated person who can go out and recruit other volunteers. It has been instrumental.
  • Personalize the need when seeking donations. Don’t just say, “We need $5,000 for ramps.” Say, “We have a lady who lives in this city, lost her husband, and is having trouble getting in and out of her home.”

Recommendations to Increase Access to and Availability of Home Modifications for Aging in Place within the Aging Network

  • Track the data.
    It is key to identify the level of need. If you can show that you have 50 people a month requesting home modifications and home repairs, that puts power behind your position. Get the word out and advocate on the state level. Identify one person at every Area Agency on Aging to participate in a digital network or community to share best practices.
  • There absolutely needs to be more funding.
    For example, $30,000-$40,000 for a whole year only covers 10 clients. If you cannot stay safely in your home, you will not benefit from other home and community-based services. We need to advocate for home modification. People are living longer, they want to stay in their homes, and often, their houses older.
  • Bridge the gap between health and housing.
    Challenges can arise when housing professionals encounter mental health issues such as hoarding or dementia, or when a social service agency tries to provide home modifications and end up hiring contractors who are not familiar with working with older adults. Find partners in the community who can address needs that go beyond the services that you provide.
  • Keep barriers low to accessing programs.
    Home modifications are not something that people are abusing. If people are applying for home modifications, they probably need it.
  • Giving accommodations to older renters
    makes more rental stock more aging friendly.
  • Provide funding for the underserved.
    Support people who cannot access a Medicaid Waiver or USDA loan grant program for home modifications. They are left to call the local church and if the church cannot do it, there’s nothing. Grants could help the ones who fall through the cracks. We have to catch everyone, and with limited resources and volunteers, everything only goes so far.
  • Building community.
    During the pandemic, people died alone in institutions. There should be a campaign about the importance of staying at home, in one’s community.

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.