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

IOWA DEPARTMENT ON 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:

1. Iowa Return to Community Pilot
Program Description: This state funded pilot in five counties involves voluntary participation by older adults who are being transferred from a hospital to a nursing home in their first 30 days of Medicare eligibility to facilitate discharge to their home. This discharge process may include home modifications as a part of a successful transition.
Population Served: Iowa residents age 60 or older, who are not Medicaid-eligible, and who indicate a preference to return to their community, and are deemed appropriate for discharge following a nursing facility or hospital stay.

2. Veteran-Directed Home and Community Based Services (VD-HCBS)
Program Description: The Veteran-Directed Home and Community Based Services program, a partnership between the Iowa Department on Aging and the Veterans Health Administration, 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.
Population Served: The VD-HCBS program helps veterans of any age who are enrolled in the Iowa City VA Medical Center and are potential candidates for nursing facility placement to receive care at home, in a caregiver’s home or in an independent living community.

IOWA MEDICAID ENTERPRISE: WAIVERS
Description: These Home and Community-Based Service waivers provide physical modifications to the home to assist with health, safety, and welfare needs of the member to increase independence. Modifications include bathtub and shower modifications, changes to the kitchen, turnaround space adaptations, ramps, lifts and door modifications.

1. Brain Injury (BI) Waiver
Population Served: Iowa residents with a brain injury diagnosis who are eligible for Medicaid and need a level of care that includes intermediate care facility for individuals with intellectual disabilities, a nursing facility, or a skilled nursing facility.

2. Elderly Waiver
Population Served: Iowa residents age 65 or older who are Medicaid-eligible and qualify for skilled nursing services. Maximum lifetime benefit of $1,061 (as of 2019) for home and vehicle modifications.

3. Health and Disability (HD) Waiver 
Population Served: Iowa residents age 18-64 who are blind or have a physical disability and must meet other Medicaid related eligibility requirements.

4. Intellectual Disabilities Waiver
Population Served: Iowa residents eligible for Medicaid that have a diagnosis of an intellectual disability as determined by a psychologist or psychiatrist.

5. Physical Disability (PD) Waiver
Population Served: Iowa residents under the age of 65 with a physical impairment as their disability and who meet other eligibility Medicaid related requirements.

IOWA STATE ASSISTIVE TECHNOLOGY PROGRAM

The Easter Seals Iowa Assistive Technology Program (ESI ATP)
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.

IOWA STATE FALL PREVENTION COALITION

Iowa Falls Prevention Coalition
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

Rebuilding Together Des Moines
Des Moines, Iowa
Rebuilding Together Des Moines is a non-profit affiliate of Rebuilding Together National. It relies on grants and fundraising for funding to support services that revitalize housing. The Safe and Healthy Housing Program of Rebuilding Together Des Moines serves low-income families that live in the Des Moines Metro Area. Services provided include minor and major modifications (e.g., wheelchair ramps, stair railings, and grab bars), repairs (e.g., electrical, plumbing, air conditioning, and broken windows). Rebuilding Together Des Moines also has a Veterans Housing Program that provides modifications and repair services to retired and active service men and women. They partner with corporate sponsors to provide these services to veterans.