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

STATE UNIT ON AGING: TEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES – DEPARTMENT 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:

Elderly Housing Set-Aside
Program Description: The Texas Housing Corporation Act authorized local government codes that allow for multifamily residential developments to opt to pay a fee equal to one-tenth of the total principal amount of the loan to the housing finance corporations rather than reserve 5% of the units for occupancy by low-income older people. These fees are remitted to the Texas Health and Human Services Commission State Department of Aging, and then awarded to Area Agencies on Aging to help older adults obtain housing services, including home repair and modification. Since 2010, 1,083 households have been assisted and over 20 million in funds expended.
Population Served: Older Texans.

TEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES: INTELLECTUAL AND DEVELOPMENTAL DISABILITIES AND BEHAVIORAL HEALTH SERVICES

Home and Community-Based Services – Adult Mental Health (HCBS-AMH) Program
Program Description: This program provides services to persons with serious mental illness who meet certain clinical, financial and need-based criteria. One of the services provided is minor home modifications.
Population Served: Persons with severe mental illness.

TEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES: MEDICAID WAIVERS

1. Community Living Assistance and Support Services (CLASS)
Program Description: CLASS provides home and community-based services to individuals with intellectual disabilities or related conditions (a disability, other than an intellectual disability, that originated before age 22 and that affects a person’s ability to function in daily life) as an alternative to an intermediate care facility. Minor home modifications are included as a service with a lifetime maximum of $10,000 plus $300 per yearly Individualized Plan of Care for repair and maintenance after the lifetime limit has been utilized.
Population Served: Texas residents not living in an institutional setting who have been diagnosed with a related condition prior to age 22 as described in the Texas Approved Diagnostic Codes for Persons with Related Conditions. They must also meet the level-of-care criteria for placement in an intermediate care facility as well as specified income and resource limits.

2. Deaf Blind with Multiple Disabilities (DBMD) Program
Program Description: The DBMD Program provides home and community-based services to people who are deaf-blind with multiple disabilities to support living in the community. It includes minor home modifications with a lifetime maximum of $10,000 plus $300 per yearly Individualized Plan of Care for repair and maintenance after the lifetime limit has been utilized.
Population Served: Texas residents not living in an institutional setting who have a diagnosis of deafblindness (or a related condition that will result in deafblindness) as well as an additional diagnosis before age 22. There are also income and resource limits and the person must not be enrolled in any other Medicaid waiver program.

3. STAR PLUS Home and Community-Based Services Program
Program Description: STAR PLUS is a Medicaid managed care program for people who have disabilities or are age 65 or older. It offers minor home modifications to members who are enrolled in the STAR+PLUS Home and Community-based Services Program. There is a $7,500 lifetime limit for minor home modifications plus $300 per yearly Individualized Plan of Care for repair and maintenance after the lifetime limit has been utilized.
Population Served: STAR PLUS Home and Community-Based Services Program members who are age 21 or older with a disability or age 65 or older.

4. Texas Home Living (TxHmL) Waiver Program
Program Description: The TxHmL Medicaid Waiver Program provides supplemental essential services and supports not provided by other programs to individuals with an intellectual disability or a related condition so that they can continue to live in the community. Services include minor home modifications with a $7,500 lifetime limit plus $300 per yearly Individualized Plan of Care for repair and maintenance after the lifetime limit has been utilized.
Population Served: Medicaid-eligible Texans with an IQ of 69 or below or who have an approved related condition with an IQ of 75 or below with mild to severe deficits in adaptive behavior.

TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS

Amy Young Barrier Removal Program (AYBRP)
Program Description: Funded by the Housing Trust Fund of the Texas Department of Housing and Community Affairs, the Amy Young Barrier Removal Program provides one-time grants of up to $20,000 for persons with disabilities who need modifications to increase accessibility and eliminate hazardous conditions in their home. The program is implemented through partnerships with units of local government; councils of government; colonia self-help centers; nonprofit organizations; local mental health authorities; public housing authorities and other applicable organizations. It has served an average of 112 households per year since 2010.
Population Served: A homeowner or tenant with a disability whose household income does not exceed 80% of the Area Median Family Income.

TEXAS STATE AFFORDABLE HOUSING CORPORATION

Texas Foundations Fund/Home Repair Program
Program Description: Through the Texas Foundations Fund, the Texas State Affordable Housing Corporation provides grants to nonprofits to carry out home repairs and accessibility modifications in homes of very low-income homeowners.
Population Served: Low-income homeowners and families.

TEXAS STATE ASSISTIVE TECHNOLOGY PROGRAM

The Texas Technology Access 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.

TEXAS STATE FALL PREVENTION COALITION

Texas 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:

Care Coordination Program
Heart of Texas Area Agency on Aging
Waco, Texas
Email: info@hot.cog.tx.us
In this program, a case manager works with contracted providers to arrange home repairs and modifications that improve the home’s accessibility, structure, safety and weatherization for low-income homeowners ages 60 years and older living in unsafe and/or unhealthy environments.

Home Repairs Program
Bravos Valley Council of Governments, Area Agency on Aging
Bryan, Texas
The Brazos Valley Area Agency on Aging offers the Home Repairs Program as a collaborative effort between the Aging and Disability Resource Center and Housing Choice. To be eligible for services, one must be age 60 or older. Funding sources for the program include the Older Americans Act Title IIIB and Older Americans Act Title IIIE, state and local funds, and participant contributions. Services provided include: minor home modifications (e.g., grab bars, raised toilet seats, handheld showers, handrails, lever door handles); major home modifications (e.g., bathroom remodels, counter/cabinet height adjustments, ramps, elevator/platform or chair lifts, widening doorways, roll-in showers), and repairs (e.g., roofing, electrical, carpeting/floors, stairs). The program also conducts consumer and professional awareness activities and advocacy for home modification policies and funding; participates in task forces/coalitions or planning activities with other agencies; and partners with state or local non-profit home modification programs (e.g., Rebuilding Together, Habitat for Humanity).

Residential Repairs
Area Agency on Aging of the South Texas Development Council
Laredo, Texas
The Residential Repairs program of the Area Agency on Aging of the South Texas Development Council offers repairs or modifications of dwellings occupied by older individuals that are essential for the health and safety of the occupant(s).

SOUTH PLAINS ASSOCIATION OF GOVERNMENTS, AREA AGENCY ON AGING

Care Coordination Program
The Care Coordination program provides assistance to senior citizens 60 years and older who are in need of services that include minor residential repair, emergency response services, eye exams and eyeglasses, hearing aids, prescription medications, limited dental services and durable medical equipment such as walkers, and lift chairs.