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

MASSACHUSETTS EXECUTIVE OFFICE OF ELDER AFFAIRS (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. Efforts by the Executive Office of Elder Affairs (EOEA) related to home modification or repairs include:

1. Area Agency on Aging Support: EOEA provides support for home modification/repairs via Area Agencies on Aging (AAAs) and the Older Americans Act Title III, the Family Caregiver Support Program and Home and Community Based Waivers. It engages in activities to raise awareness through engagement with the AAAs and Aging Disability Resource Consortia and leveraging other state agency home modification/repair programs through the Massachusetts Rehabilitation Commission.

2. Home Care Program
Program Description: This state funded in-home services program provides services to help eligible residents of Massachusetts age in place by supporting daily tasks. Services may include home safety, independence evaluations and adaptive housing.
Population Served: Massachusetts residents 60 years and older or under 60 with a diagnosis of Alzheimer’s Disease and in need of respite services. Residents must live at home or in the home of a caregiver.

MASSACHUSETTS REHABILITATION COMMISSION

Home Modification Loan Program
Program Description: This program provides 0% interest, deferred payment loans to modify the primary permanent homes of older adults and children with disabilities so that they may live more independently. Six agencies in Massachusetts administer the program. A one time loan of $1,000 to $50,000 may be borrowed by property owners; $1,000 up to $30,000 for mobile home owners. The modifications to be made to the residence must be necessary to allow the beneficiary to remain in the home and must specifically relate to their ability to function on a daily basis.
Population Served: Any homeowner who has a disability or is an older adult, has a household member with a disability, or rents to an individual with a disability (in a building with fewer than 10 units).

MASS HEALTH: MASSACHUSETTS MEDICAID AND CHILDREN’S HEALTH INSURANCE PROGRAM

1. MA Acquired Brain Injury (ABI) Non-Residential Habilitation Medicaid
Program Description: This Medicaid Waiver provides services and supports to help individuals with acquired brain injuries live in community settings instead of in institutional settings. Services include home accessibility adaptations.
Population Served: Recipients must have been in a skilled nursing facility or hospital for at least 90 days; acquired a brain injury at age 22 or older; need ABI waiver services; be able to be safely served in the community within the terms of the ABI waivers, and meet the financial requirements to qualify for MassHealth Standard in the community.

2. MA Traumatic Brain Injury (TBI) Waiver
Program Description: Provides homemaker, individual support and community habilitation, residential habilitation, respite, supported employment, adult companion, day services, home accessibility adaptations, shared living – 24 hour supports, specialized medical equipment, transitional assistance, and transportation.
Population Served: Individuals with a traumatic brain injury age 18 and older.

3. Moving Forward Plan (MFP) Community Living Waivers
Program Description: This Medicaid Waiver program helps Massachusetts residents who have been in a skilled nursing facility or a long-term care hospital for at least 90 days to move back into the community. Services are identified and coordinated by a case manager/service coordinator and may include home accessibility adaptations.
Population Served: Recipients must have been in a skilled nursing facility or hospital for at least 90 days; either be age 18 or older and have a disability, or age 65 or older; need MFP waiver services; be able to be safely served in the community within the terms of the MFP waivers; and meet the financial requirements to qualify for MassHealth Standard in the community.

4. MA Frail Elder Waiver
Program Description: This home and community-based services Medicaid Waiver program provides services to Massachusetts residents age 60 and older with needs ranging from basic to intensive levels so that they may live in the community. Environmental accessibility adaptations are included as a service support.
Population Served: Medicaid-eligible individuals with a physical disability age 60 years and older.

MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES

1. MA Adult Supports Medicaid Waiver
Program Description: This Medicaid Waiver serves individuals who require at least one home and community-based waiver service per month and do not require the levels of support provided under either the Community Living Waiver or the Intensive Supports Waiver. Services are provided in family homes, adult foster care, or independently in community settings. Participants receive services through the waiver that are needed in order to remain safely in the community, including home modifications and adaptations.
Population Served: Individuals with intellectual disabilities age 22 and older.

2. MA Community Living Medicaid Waiver
Program Description: This Medicaid Waiver provides services to individuals who meet the eligibility criteria and require at least one home and community-based waiver service per month. Recipients need more support than services provided in the Adult Supports Waiver, but less than those in the Intensive Supports Waiver. Services may be provided in the family home, adult foster care, with a live-in caregiver, or independently in these community settings and can include home modifications and adaptations.
Population Served: Medicaid-eligible individuals with intellectual disabilities age 22 years and older.

3. MA Intensive Supports Waiver
Program Description: The Medicaid Intensive Supports Waiver provides services to individuals who meet the eligibility criteria and require supervision and support 24 hours a day, seven days a week due to significant behavioral, medical and/or physical support needs. Services are provided through the waiver that are needed in order to remain safely in the community, including home modifications and adaptations.
Population Served: Medicaid-eligible individuals with intellectual disabilities age 22 and older.

MASSACHUSETTS STATE ASSISTIVE TECHNOLOGY PROGRAM

MassMATCH
MassMATCH is the Commonwealth of Massachusetts’s initiative to Maximize Assistive Technology (AT) in Consumers’ Hands.
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.

MASSACHUSETTS STATE FALL PREVENTION COALITION

Massachusetts 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:

BOSTON COMMISSION ON AFFAIRS OF THE ELDERLY IN BOSTON, MA
Senior Home Repair
The agency visits the homes of potential clients to determine the types of repairs needed. They also help individuals apply to the City’s Senior Home Repair Program. The Boston Home Center also helps estimate the cost of repairs and prioritizes emergency repairs needed.

Home Safe Home: Home Safety Assessment
Minuteman Senior Services: Area Agency on Aging
Bedford, Massachusetts
Minuteman Senior Services, an Area Agency on Aging, offers personalized assessments and interviews by a ‘Minuteman By Your Side Care Manger’ to assess circumstances or concerns in the home. For a flat fee of $195, a detailed evaluation of the home is carried out to identify areas that present accident or fall risks. Areas assessed include: the exterior entrances and exits, interior doors, stairs and halls, bathrooms, kitchens and dining rooms, living rooms, and bedrooms.

SOMERVILLE-CAMBRIDGE ELDER SERVICES IN SOMERVILLE, MA
In-Home Support
Home Care and Senior Care Options/One Care Services staff identify unmet needs and coordinate services to help individuals remain safely at home. Services may include “Home Safety Adaptations.”

Revitalize CDC
Springfield, Massachusetts
Revitalize CDC, a non-profit, provides repairs, home modifications, and rehabilitation on the homes and non-profit facilities of low-income families with children, the elderly, military veterans and people with special needs. They work with donors, grantors and volunteers to provide services that help to stabilize neighborhoods, strengthen the tax base, and support the ability of older homeowners to age in place through accessibility modifications.