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 OF CALIFORNIA 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. Additionally, program(s) with home modification or repairs include:

Older Americans Act Title III-E Family Caregiver Support Program: Supplemental Services – Minor Home Modifications
Program Description: The Family Caregiver Support Program is designed to address the needs of informal, unpaid family caregivers through supportive services. Services may include minor modifications of homes that are necessary to facilitate the ability of caregivers and care recipients to remain at home and that are not available under other programs.
Population Served: Informal caregivers of older adults and older relative caregivers with primary caregiving responsibilities for a child, or individuals with a disability.

CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES

1. California Community Transitions (CCT)
Program Description: California’s version of the federal Money Follows the Person (MFP) Rebalancing Demonstration program is known as California Community Transitions. Its goal is to facilitate a safe and successful transition from an institutional setting back to the community. The services provided include home modification, up to $7,500 maximum per lifetime.
Population Served: Medicaid-eligible individuals of all ages with physical and mental disabilities who have continuously resided in state-licensed health care facilities for a period of 90 consecutive days or longer.

2. Home and Community-Based Alternatives Waiver
Program Description: This Medicaid Waiver program provides care management services via a nurse and social worker team to persons who are at risk for nursing home or institutional placement. The care management team coordinates Waiver and State Plan services, such as medically necessary environmental accessibility adaptations, and arranges for other available long-term services and supports available in the local community.
Population Served: Medi-Cal eligible Californians who have a long-term medical condition(s) and who meet the acute hospital subacute nursing facility, skilled nursing facility B (skilled) or A (intermediate) level of care with the option of returning to and/or remaining in his/her home or home-like setting in the community in lieu of institutionalization.

3. Home and Community-Based Services Waiver for the Developmentally Disabled (HCBS-DD) 
Program Description: This Medicaid Waiver program provides home and community-based services to persons with developmental disabilities as an alternative to care provided in an intermediate care facility for people with intellectual disabilities. Services provided include environmental accessibility adaptations for individuals with a severe, chronic disability acquired before age 18.
Population Served: Medi-Cal eligible individuals with a formal diagnosis of a developmental disability that originates before the age of 18 and would otherwise receive care in an intermediate care facility.

4. Multipurpose Senior Services Program (MSSP) 
Program Description: The MSSP Waiver provides home and community-based services to Medi-Cal eligible individuals who are 65 years or older and disabled as an alternative to nursing facility placement. The waiver program includes environmental accessibility adaptations.
Population Served: Medi-Cal eligible individuals age 65 and older who, but for the provision of such services, would require the Nursing Facility level of care and who reside in a county with an MSSP Site.

CALIFORNIA STATE ASSISTIVE TECHNOLOGY PROGRAM

Ability Tools
A program of the California Foundation for Independent Living Centers.
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.

CALIFORNIA STATE FALL 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:

A Matter of Balance
Sonoma County Area Agency on Aging
Santa Rosa, California
A Matter of Balance, an evidence-based fall prevention program, is offered by the Sonoma County Area Agency on Aging. It includes classes focused on falls, fall prevention, fear of falling, and how to reduce fall risk in the home, including through home modifications. Classes are offered throughout Sonoma County.

Age Friendly Home Adaptation Grant Program
City of Sausalito Community Development Department
Sausalito, California
The Age Friendly Home Adaptation Grant Program allows Sausalito homeowners or renters (with landlord permission) who are 60 years and older, or younger residents with a disability, to obtain free or reduced cost building permits. The program covers projects of up to $10,000 to improve the safety and accessibility of residences. It makes it more affordable to obtain building permits to make homes safer and more accommodating to the changing needs of Sausalito residents.
Population Served: Sausalito homeowners or renters (with landlord permission) age 60 and older or younger residents with a disability.

ElderHelp Program
Ventura County Area Agency on Aging
Ventura, California
Program Description: The ElderHelp Program helps low-income, frail older adults maintain their independence at home by providing free, short-term assistance with activities of daily living. Program services include minor home modification and repairs and are partially funded by the Older Americans Act.
Population Served: Adults 60 years and older of Ventura County.

Fall Prevention Program
Contra Costa Area Agency on Aging
Pleasant Hill, California
Program Description: The Fall Prevention Program of the Contra Costa Area Agency on Aging provides in-home Occupational Therapist assessments and evaluations for older adults at risk of falls and/or of being institutionalized due to inadequacies in the home. The program also provides assistive devices and home modifications that help older adults to remain safely in their homes.
Population Served: Older adults of Contra Costa County.

Minor Home Repair Program
Area 12 Area Agency on Aging
Sonora, California
Program Description: The Area 12 Area Agency on Aging’s Minor Home Repair Program assists homeowners 60 years and older with repairs or modifications that improve the accessibility, safety, and livability of their homes. Available services include, but are not limited to: grab bar installation, step and handrail repairs, barrier-free door handle installation, and minor electrical or plumbing repairs. This service is available at no cost.
Population Served: Homeowners age 60 years and older.

Rehabilitation and Weatherization Home Improvement Grant/Loan Program
Karuk Tribal Housing Authority
Program Description: The Rehabilitation & Weatherization Home Improvement Grant/Loan Program provides assistance to Karuk Tribal Members who are at least 62 years of age or who have a disability and own a single family home that needs repairs and improvements to address health and safety hazards in the home.
Population Served: Eligibility is based on a household’s total income. Applicants apply for the USDA Rural Development Section 504 grant prior to receiving approval for this grant.

Residential Repairs and Modifications
Area 4 Agency on Aging
Sacramento, California
Program Description: The Area 4 Agency on Aging funds three home modification and repair programs that serve very diverse communities from urban Sacramento to very rural Sierra County. 1) FREED Center for Independent Living: (Nevada, Yuba, Sutter, and Sierra Counties); 2) Placer Independent Resource Services (PIRS) (Placer County); and 3) Rebuilding Together Sacramento (Sacramento County). FREED’s “Fix It” program removes hazards in the home by securing loose rugs, repairing loose floorboards, stairs, or decking and provides assistive devices such as handrails, grab bars for the shower or tub, raised toilet seats, shower chairs, and handheld shower heads. PIRS performs an in-home safety check to insure that homes are safe and as barrier-free as possible. They also address the needs of renters with written permission from the property owner. Rebuilding Together Sacramento focuses on filling a service gap in the community by targeting older adults who live in mobile homes, a challenging home environment due to fiberglass showers and very steep entryways. Services include home safety assessments, minor modifications and repairs, fire and carbon monoxide detectors, suggestions and tips on how to make homes safer as people age, and information about training sessions in the community.
Population Served: Older adults and people with disabilities.

Stop Falls Solano and Stop Falls Napa Valley
Napa/Solano Area Agency on Aging
Fairfield, California
Program Description: The Napa/Solano Area Agency on Aging has connected consumers with programs, services, and resources they can use to maintain and improve quality of life since 1980. The agency was created through a collaboration between Solano and Napa Counties. It contracts with two nonprofits to assess and perform the work for Stop Falls Solano and Stop Falls Napa Valley programs. Services provided include minor home modifications (e.g., grab bars, raised toilet seats, handheld showers, handrails, lever door handles); home assessments; raising consumer and/or professional awareness; advocacy for home modification policies and funding; participating in task forces/coalitions or planning activities with other agencies; integrating home modification or repairs within existing home and community-based and/or long-term care programs; and partnering with state or local non-profit home modification programs (e.g., Rebuilding Together, Habitat for Humanity). Funding sources include Older Americans Act Title IIIB and Special California funding for 2020.
Population Served: Low-income older adults, aged 60 years and over.

SAN MATEO COUNTY AREA ON AGING 

The Fall Prevention Coalition
http://www.smcfallprevention.org/  
Program Description: The Fall Prevention Coalition of San Mateo County is a countywide coalition that aims to build and maintain a collaborative network to support fall prevention and resources. It also serves as a clearinghouse for fall prevention activities throughout San Mateo County, including A Matter of Balance class that educates on fall prevention including how to reduce fall risk in the home.