Home Modification and Repairs for Older Adults: Challenges and Opportunities for State Units on Aging: This report by the USC Fall Prevention Center of Excellence and ADvancing States reports on a national survey

FAMILY AND SOCIAL SERVICES ADMINISTRATION – DIVISION OF AGING (State Unit on Aging)

State Units on Aging (SUAs) are designated state-level agencies that develop and administer state plans that advocate for and provide assistance, including home modifications or repairs, to older residents, their families, and adults with physical disabilities. SUAs administer funds, including Older Americans Act funds, which may be used to support home modification or repair services through local Area Agencies on Aging and other state and local entities. Program(s) with home modification or repairs include:

Community and Home Options to Institutional Care for the Elderly and Disabled (CHOICE) Program
Program Description: The CHOICE program is administered by the Indiana Division of Aging through the state’s 16 Area Agencies on Aging. It provides home and community-based services, including environmental modification, to assist individuals in maintaining their independence in their own homes or communities for as long as is safely possible.
Population Served: Indianans age 60 or older or who have a disability and are at risk of losing their independence (e.g., difficulties with activities of daily living).

INDIANA MEDICAID
Program Description: Home and community based care services provided via Medicaid Waivers for individuals who would otherwise require a nursing facility level of care. Services include environmental modifications and sometimes environmental modification assessments.

1. IN Aged and Disabled Waiver
Population Served: Older adults, individuals who are blind or have a disability and reside in or are transitioning to a home and community-based care setting and with an income no higher than 300% of the Social Security Income level. Must also meet the nursing home level of care.

2. IN Community Integration and Habilitation (CIH) and Community Based Services Waiver
Population Served: Individuals who had an intellectual disability diagnosed before age 22 and reside in or are transitioning to a home and community-based care setting and with an income no higher than 300% of the Social Security Income level. Must also meet the nursing home level of care.

3. IN Traumatic Brain Injury Waiver 
Population Served: Older adults or individuals living with a disability who have a traumatic brain injury. Income must be no higher than 300% of the Social Security Income level and meet the nursing home level of care.

INDIANA STATE ASSISTIVE TECHNOLOGY ACT PROGRAM
The State Assistive Technology Grant Program, funded under the Assistive Technology Act of 2004, supports comprehensive, statewide programs in each state that improve the provision of assistive technology (often home modification-related) to individuals with disabilities of all ages.

INDIANA STATE FALL PREVENTION COALITION
The Coalition has hosted Fall Prevention Awareness Day and involved Area Agencies on Aging statewide for a half-day of service wherein volunteers were recruited to help modify the homes of older adults.
For an up to date list of all state fall prevention coalitions, visit: https://www.ncoa.org/resources/list-of-state-falls-prevention-coalitions/

1. To locate the Area Agency on Aging in your state, please contact Eldercare Locator at https://eldercare.acl.gov/Public/Index.aspx

2. Data Brief: Building Community Capacity to Serve Older Adults: The Role of Area Agencies on Aging in Home Modifications and Repairs
This Data Brief highlights key findings from the 2019 National Survey of Area Agencies on Aging on how Area Agencies on Aging are providing and funding home modification and repair activities. It was developed by the USC Fall Prevention Center of Excellence in partnership with the National Association of Area Agencies on Aging as part of the Administration for Community Living project, “Promoting Aging in Place by Enhancing Access to Home Modifications.”

3. Featured Efforts:

Environmental Modifications and Handy Chore Services
Southwestern Indiana Regional Council on Aging (SWIRCA)
Evansville, Indiana
The Southwestern Indiana Regional Council on Aging has two home modification related services: 1) environmental modifications that are necessary to ensure the health, welfare and safety of the individual and enable functioning with greater independence in the home, and without which the individual would require institutionalization; and 2) “Handy Chore” services are minor home maintenance activities that help to ensure an individual’s health and safety in their home. These activities include installation of health and safety equipment such as handrails, ramps, deadbolts, smoke detectors, and locks.

REPAIRS (Reliable Experts Providing Accessibility, Independence, Rehabilitation, and Safety) Program
Area 10 Agency on Aging
Ellettsville, Indiana
A volunteer team provides no cost labor and information on the cost of materials. The resident pays with their own private funds, grants, or loans. REPAIRS also provides an annual Safe at Home Fair as part of Fall Prevention Awareness Week.

Safe at Home
CICOA Aging & In-Home Solutions
Indianapolis, Indiana
This extensive home modification program of the CICOA Aging and In-Home Solutions Area Agency on Aging focuses on safety and fall prevention for low-income older adults and people with disabilities in Central Indiana. It includes a home assessment process and creative funding sources to address residents’ needs. CICOA case managers refer clients who need home modifications to the Safe at Home Program. Evaluations are conducted before and after the finished modifications. CICOA’s Safe at Home service targets the following housing features: non-slip floor surfaces, egress for access to the home with personal mobility products, wider doorways, lever-handle door knobs and faucets, higher or lower electrical outlets, and improved interior and exterior lighting. Additional home improvements provided by Safe at Home that promote accessibility and prevent falls include: adding grab bars, adding or repairing handrails in stairwells, leveling uneven floors, repairing faulty steps, installing wheelchair ramps, replacing bathtubs with roll-in showers or tub cut outs for easier access, and raising toilets. CICOA also hosts a Safe at Home event, which is an annual, high-impact, half-day of service to homeowners over the age of 60 or to persons of any age with a disability. The event coincides with Fall Prevention Awareness Week in September each year. The Safe at Home program relies on philanthropic funding for 100 percent of its revenue. CICOA continues to seek additional support from foundations which share a common interest in supporting this target population.