Library

This paper describes the design of a project evaluating the effects of using a research-based strategy for managing housing adaptations (HAs); the evaluation targets clients’ perspectives in terms of activity, participation, usability, fear of falling, fall incidence, use of mobility devices, and health-related quality of life, and determines the societal effects of HAs in terms of costs.

This article summarizes seventy-seven studies from 16 countries to examine how home modifications evidence is measured.

This 2013 document of the Department of Justice and the Department of Housing and Urban Development provides guidelines regarding the persons and structures that are covered by the accessible design and construction requirements of the Fair Housing Act.

An easy to read online book that gives tips on making a home accessible. The site also has an architecture section with more information on accessible homes and healthcare architecture.

These 2010 Standards were set for newly designed and constructed facilities that fall under the purview of the ADA to be accessible and usable by persons with disabilities.

Aging and Accessible Homes Infographic developed by the U.S. Census Bureau, American Community Survey that includes statistics on percentages of homes with certain accessibility features and percentages of older adults with difficulty completing specific activities of daily living.

This compilation of assessment tools provides examples of evaluations that can be helpful with determining home modification needs of consumers.

A fact sheet developed by the Fall Prevention Center of Excellence on the benefits of assistive devices and how to obtain them.

This Data Brief highlights key findings from the 2019 National Survey of Area Agencies on Aging on how Area Agencies on Aging (AAAs) 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.”

This paper presents the rationale and design for a clinical trial of a new interdisciplinary program aimed to reduce disability among low income older adults; the outcomes included decreased disability in self-care (ADL), improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization.

A fact sheet developed by the Fall Prevention Center of Excellence on Simple Steps to Prevent Falls.

A brochure in Spanish by the Centers for Disease Control identifying hazards and suggesting changes in the home to reduce the risk of falling

This Centers for Disease Control checklist, organized by area of the home, aims to help identify and eliminate fall hazards in the home.

By using a multi-phase process, this article analyzes the complex clinical process that allows occupational therapists to deliver complex interventions while delivering home modification services.

This paper determines the effect size and acceptability of a multicomponent behavior and home repair intervention for low-income disabled older adults. The results found that the Community Aging in Place Better Living for Elders (CAPABLE) intervention was acceptable to participants and feasible to provide and showed promising results.

This document from The American Journal of Occupational Therapy provides a description of complex environmental modifications and highlights the role of occupational therapy practitioners as providers of service within this area.

Comprehensive Assessment and Solution Process for Aging Residents (CASPAR).This assessment tool, developed through two Small Business Innovation Research grants by researchers at Georgia Tech and the company Extended Home Living Solutions, enables practitioners to identify a client’s aging in place needs by collecting information that can be used by building professionals and health care professionals (e.g., occupational therapists) to specify the most appropriate modifications. This assessment considers the home environment, the resident’s abilities and preferences, and the interaction between the two, combining the specific concerns of consumers, building professionals, and occupational therapists in performing home modification assessments.

This extensive list of consumer materials focused on home modifications was created by the USC Fall Prevention Center of Excellence as part of an Administration for Community Living Project.

This paper estimates the cost benefit of the modifications from construction costs and published reports of effectiveness and cost of treating falls in Hawaii. The average cost of home modifications was $800 and the average annual averted medical cost of falling was $1728.

This article outlines cost-effective fall prevention interventions.

This is the first randomized controlled trial to examine the benefits of home modification for reducing fall injury costs in the general population. The results show a convincing economic justification for undertaking relatively low-cost home repairs and installing safety features to prevent falls.

List of special grants for veterans needing home modification.

This article discussed interventions that demonstrated greater efficacy to improve occupational performance. Implications for occupational therapy practice, education, and research are also discussed.

The results of the study indicated that the rate of decline in the frail elderly can be slowed through certain in-home personnel costs, reduced through a systematic approach to providing Assistive Technology and Environmental Interventions.

A multifactorial fall prevention program with exercise intervention may reduce the risk of falls in the short-term but not necessarily in the long-term. Awareness is key to reduce falls.

A fact sheet from the Albuquerque area southwest tribal Epidemiology Center

This resource is a copy righted document and its content, specifically the photographic portrait images belong to the AASTEC Tribal Injury Prevention Program.

This article investigated the role of environmental and behavioral factors surrounding fall incidents in a senior living community. Falls occurring in the bathroom can cause severe damage; three types of activities and five behavioral factors related to falls are identified.

This paper assesses the effectiveness of an environmental falls prevention intervention delivered by qualified occupational therapists or unqualified trained assessors. The study found that an environmental assessment prescribed by an occupational therapist significantly reduced the number of falls in high-risk individuals whereas that prescribed by a trained assessor did not.

Evaluation Basics for Fall Prevention Coalitions and Programs, Gretchen Alkema, PhD & Phoebe Liebig, PhD

This article aims to provide reliable and consistent practice guidelines to help prevent secondary falls in elderly adults. The guidelines include home and institutional assessment guidelines as well as recommended interventions.

A one-page companion piece to the Home Modification Checklist, developed by the National Home Safety and Home Modification Work Group.

As part of the Administration for Community Living-funded project, Promoting Aging in Place by Enhancing Access to Home Modifications, the University of Southern California Leonard Davis School of Gerontology and ADvancing States created this Technical Assistance Brief. The Brief outlines various funding sources State Units on Aging and other state agencies might consider in implementing policies and programs. The goal is to increase access to and the availability of home modifications and repairs.

Home Modification and Repairs for Older Adults

As the aging population in the United States increases, the number of older adults living in HUD-assisted housing also continues to grow rapidly. Both property owners and residents benefit from supportive home environments. For instance, residents typically want to live independently for as long as possible and stable tenure reduces management costs. Even so, as older adults capability’s change, configuration of their homes can present many challenges to living safely and independently. Adaptations of the living environment, called home modifications, help improve the comfort and safety of older persons, allowing them to flourish in independent housing and age-in-place.

Home FAST is a home assessment tool designed to identify older people at risk of falling because of hazards within their home environment. The tool consists of 25 items that include a range of indoor and outdoor environmental and functional concerns. A dichotomous assessment, the user marks whether or not a hazard is present. A higher score indicates a higher risk of falling.

A brief introduction to home modification, a list of everyday situations that pose risks for falls.

Includes a review of types and costs of the most prevalent of home modifications, funding streams at the federal and state levels, and an Appendix listing recommended home modifications for specified conditions related to military service.

This August 2021 Data Brief shares the results of a survey by USC and n4a of 276 Title VI programs serving Native American elders across the United States. It identifies the home modification needs of this diverse population, the challenges of the housing stock, and strategies used by local providers to ensure supportive home environments.

This inventory features home modification and repair activities conducted by Area Agencies on Aging and may be used to inform professionals, providers, and policymakers of programs in their state and communities for possible replication. Each state listing contains descriptions and web site information for select home modification and repair programs of Area Agencies on Aging across the country.

This inventory features home modification and repair activities conducted by agencies serving Native American elders and may be used to inform professionals, providers, and policymakers of programs in their state and communities for possible replication. Each state listing contains descriptions and web site information for select home modification and repair programs of Older Americans Act Title VI grantees and other agencies serving Native American elders.

Designed to illuminate the range of home modification and repair activities conducted by state-level agencies across the U.S., this compilation may be used to inform professionals, providers, and policymakers of programs and funding sources in their state, and the activities of other states for possible replication.

This report by the USC Fall Prevention Center of Excellence and ADvancing States reports on a national survey of home modification and repair efforts of State Units on Aging

A list created by the National Multiple Sclerosis Society of state programs and tax credits that help finance accessibility improvements to homes.

Hosted by the University of Buffalo, this site features archives of monthly online discussion on various aspects of home modifications.

Now, more than ever, it is important to consider the safety and support of homes. We are “safer at home” when it comes to the new Coronavirus, but our homes can have fall hazards such as throw rugs or poor lighting that could make it difficult or even dangerous for residents and guests of various ages to move about. We created a fact sheet “Home Modification Service Delivery During COVID-19” that contains tips for professionals and consumers to consider when making changes to the home during these challenging times.

This inventory of state tax credits that include home modifications was created by the University of Southern California Leonard Davis School of Gerontology as part of the Administration for Community Living project, “Promoting Aging in Place by Enhancing Access to Home Modifications.”

A  fact sheet by the USC Leonard Davis School of Gerontology with recommendations on how to make the home safer and more supportive, many of which are low or no cost.

This study tested the safety benefits of home modifications such as handrails, grab rails, outside lighting, edging and more. The findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population.

This 2008 report from the US Department of Health and Human Services outlines the use of home modifications by older adults.

This article determines the health gain, cost-utility and health equity impacts from home safety assessment and modification (HSAM) for reducing falls in older people. Findings include: the provision of a HSAM intervention produces considerable health gain, is highly cost-effective, and provides a promising initial approach among older people.

With the aim of reducing falls among older adults, this self-assessment consists of a home safety assesment checklist and solutions, illustrations of common fall hazards and solutions in ten indoor and outdoor areas of the home, assistive devices and other recommended products to prevent falls, and “how to” home improvement instructions. In addition to assessing for risk factors, the HSSAT aims to raise awareness. For example, some users may not be aware that clutter is a fall risk until they see it on the list. By reviewing each risk item, users may be able to match the risks listed with identified risks in their own home environment. The HSSAT has been translated into several languages.

This evidence based study illustrates the effect of home visits by Occupational Therapists on the prevention of falls. It shows that home modification and behavioral changes involving OTs can improve safety in the living environments by reducing the risk of falls.

The AARP HomeFit Guide was created to help people stay in the home they love by turning where they live into a “lifelong home,” suitable for themselves and anyone in their household.

This report focuses on the housing needs of the elderly population. Most seniors wish to age in place but have to face the consequences of aging, and thus are restricted in their housing choices. The report examines the housing needs of America’s senior population, and urges the housing industry and public policy makers to respond with home modifications, supportive services, and housing alternatives. It also projects the demographic and economic profiles of the next generation of seniors and examines their likely housing choices, labor force participation, and lifestyles.

This 2012 report from the Urban Land Institute examines the housing market changes impacted by the baby boom generation and older as they make housing choices.

This study explores the ways in which people with dementia and their carers adapt their homes, including the barriers and use of available information. The most significant barriers to making home adaptations were lack of knowledge and maintaining familiarity. Having more information and making home modifications earlier might enable individuals with dementia to adjust to their adapted environment.

Impact of Home Modification Services on Ability in Everyday Life for People Aging with Disabilities. Petersson, Ingela; Lilja, Margareta; Hammel, Joy; Kottorp, Anders. This study examines the impact of home modifications on self-rated ability in everyday life from various aspects for people aging with disabilities.

This document, created by the Joint Center for Housing Studies at Harvard, features recent remodeling trends and includes discussions and data about the potential for growth in the accessibility remodeling market for older persons and persons with disabilities.

The In-Home Occupational Performance Evaluation (I-HOPE) targets activities performed in the home that are essential for aging in place. The purpose is to measure the effects of an incompatibility between a person’s abilities and the environment or the “person-environment misfit” of older adults and their homes. The I-HOPE helps therapists measure client’s in-home activity performance and observe changes in person-environment fit before and after home modification interventions. It considers the client’s perspective and satisfaction while recognizing the role of the environment on performance. It is a multistep assessment that is conducted in the home of an individual. It takes approximately 60 minutes to conduct. A kit includes all necessary materials to conduct the assessment’s three steps: 1) An assessment of current in-home activities is conducted using a set of 44 cards of images depicting older adults participating in daily activities. An overall score for activity performance is then calculated; 2) Priority activities are identified for intervention and given a subjective performance and satisfaction score; 3) Performance-based rating of barriers’ influence on performance. The I-HOPE yields four sub-scores that can be used individually or as a profile of performance (activity, performance, satisfaction, total barrier severity).

This paper assesses the effects of interventions designed to reduce the incidence of falls in older people living in the community and finds that group and home-based exercise programs as well as home safety interventions (and more) reduce rate of falls and risk of falling.

A webinar for LGBT consumers and providers with home safety tips and inexpensive home modifications to assist LGBT older adults to safely age in place.

A series of booklets on lighting written in collaboration between AARP and the Lighting Research Center at Rensselaer Polytechnic Institute.

The LRC developed three guidelines that address the needs of health care professionals, designers and builders, and the general public, including older adults and their families.

This paper investigates the longitudinal impacts of home modifications on the difficulty of performing everyday life tasks for people aging with disabilities, and whether other factors had any additional impacts. The results found that home modifications are effective in decreasing difficulty in performing everyday life tasks up to six months after the installation and to be effective they need to be installed in a timely fashion.

The 2019 Home for the Holidays campaign, a partnership of n4a and the University of Southern California Leonard Davis School of Gerontology, aims to ensure that older adults and their caregivers are aware of home modification services and programs available to support them as they modify their homes for successful aging.

A searchable listing provided by the University of Southern California Leonard Davis School of Gerontology of public and private home modification and repair service providers across the United States.

he National LGBT Elder Housing Initiative advocates against housing discrimination, trains eldercare providers to be LGBT culturally competent, provides education related to housing rights, and assists builders across the country with strategies to replicate LGBT-friendly housing.

The University of Southern California Leonard Davis School of Gerontology/homemods.org partnered with the National Council on Aging (NCOA) to compile and feature home modification and home safety programs falling in the categories of evidence-based, best practices, and innovative. Over 150 organizations from the aging, disability, housing, and health care sectors nationwide contributed to this inventory of home modification programs and practices.

A review of assessment tools for the home environment by the University of Southern California and the National Council on Aging.

Developed by the University of Southern California and the National Council on Aging, this extensive inventory of housing, lending, social, health care, tax, and non-profit funding sources can be used to support home assessment and/or modification and repairs.

The new CDC publication, “The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk”, in the American Journal of Preventive Medicine is the first to show that evidence-based fall prevention interventions delivered by U.S. healthcare providers have the ability to prevent thousands of falls, thereby improving the health and well-being of older Americans.

Pathways to Sustaining Fall Prevention Activities, Emily B. Nabors, MSG, Gretchen Alkema, PhD & Phoebe Liebig, PhD

This article presents preliminary data from Community Aging in Place, Advancing Better Living for Elders (CAPABLE), a model funded by the CMS Innovation Center and designed to overcome the functional and home environmental barriers of older adults. 

Home interventions, such as assessing environmental hazards and suggesting potential modifications, alongside technical trainings were found to be effective in reducing the risk of falls among seniors with a fall history.

Tips to stay safe in the community.

Exercise or physical therapy and vitamin D supplementation are suggested by the USPSTF to reduce falls for seniors who live in community settings

Shows data from Community Aging in place, Advancing Better Living for Elders (CAPABLE), a model designed to overcome the functional and home environmental barriers of older adults. Initial findings demonstrated that daily living limitations improved in 79% of the first 100 people who completed the intervention.

Discusses how HARP will implement home modification strategies throughout the aging services network as common practice for older adults in the effort to reduce falls Nationwide.

This study explores the effectiveness of three interventions (group based exercise, home hazard management, and vision improvement) on decreasing the risk of falls in older adults living at home.

This list was developed to identify fall hazards, home safety, and accessibility issues for the homeowner and family members. Home safety, fall prevention, and accessibility modification interventions are included on the reverse side of the list.

Recruitment of Fall Prevention Coalition Members, Katie Mack, MPA, MSG and Julie Overton, MSG/MHA

Grow SJ, Robertson MC, Campbell AJ, Clarke GA, Kerse NM. 2006 Oct;12(5):296 – 301.

Results of a 2015 survey conducted by the Hartford Center for Mature Market Excellence and University of Southern California Davis School of Gerontology of Baby Boomers’ interest in universal design and home modification.

This guide, created by The Hartford Center for Mature Market Excellence, is organized into two sections – Kitchen and Bathroom – with a checklist of universal design features to consider for inclusion when remodeling the home.

This study examines the effectiveness of an occupational therapy home modification intervention program by examining differences in self-reported occupational performance before and after intervention in a population of community-dwelling older adults with disabilities. Overall, the mean scores on the satisfaction and performance subscales indicated an improvement in performance and satisfaction with occupational performance.

An overview of housing challenges faced by older adults living in rural areas, including housing quality and accessibility.

SAFER HOME v3 assesses a person’s ability to safely carry out functional activities in the home. It can also be used to evaluate the effectiveness of an intervention and changes following an intervention. Using interview and observation of client participating in activities, SAFER HOME assesses 74 items around the home divided into 12 domains. Level of safety concern is rated on a 4- point (0–3) scale.

Strategic Planning for Coalitions, Katie Mack, MPA, MSG and Julie Overton, MSG/MHA

This bill summary explains the introduction of a plan that amends the Internal Revenue Code. It aims to grant adults aged 60 and over up to $30,000 in nonrefundable credit for modifications made on their home to help them live safely, independently, and comfortably.

This paper explores the impact of fall prevention programs and home modifications on falls and the performance of community dwelling older adults. The most impactful results were found for multifactorial programs including home evaluations and modifications, exercise, education, medication checks and assistive technology.

Six reviews/inquiries into housing adaptations/home modifications processes occurred in Wales between 2004 and 2015. One resulted in the removal of the means test for children’s Disabled Facilities Grants. This research investigated families’ and professionals’ experiences of the adaptations/home modification process to gain an understanding of their views and experiences.

Muhammad Hibatullah Romli1,2, Lynette Mackenzie1, Maw Pin Tan3, Meryl Lovarini1, Lindy Clemson1

The HE instrument assesses a person’s functional limitations and the home environment for physical barriers that may threaten accessibility. It includes a three-step assessment and analysis procedure: 1) a dichotomous assessment of a person’s functional capacity (12 items on functional limitations and two items on dependence on mobility devices); 2) a dichotomous assessment of the physical environmental barriers in the home and the close exterior surroundings (161 items); 3) the calculation of an overall magnitude of accessibility problems score. Physical environmental barriers can also be rank-ordered based on their contribution to the total accessibility problems score (Iwarsson et al. 2012).

This article discusses the strain on caregivers due to home modification interventions and how to better support caregiver populations. The goal is to modify these projects in order to adapt home modification interventions to better support informal caregivers.

This interactive resource of the University of Southern California Leonard Davis School of Gerontology includes photos of design features and products in actual homes that have been modified.

This helpful directory provides information to aging network, services, and housing providers, and consumers about programs that modify and repair homes for elder people.

A discussion of the prevalence of falls among seniors 85 years and older, and the acute and preventative services required

This CDC publication is the first to show that evidence-based fall prevention interventions delivered by U.S. healthcare providers have the ability to prevent thousands of falls, thereby improving the health and well-being of older Americans.

A report of the National Council on Disability that includes an evaluation and recommendations of and for public laws, policies, and program initiatives affecting housing for Americans who have accessible housing needs.

Developed by the National Center on Injury Prevention and Control, this document contains selected model programs that use home assessment and modification, can serve as a guide for organizations that wish to develop fall prevention programs for older adults.

This article investigates the effectiveness of fall prevention programs for community-dwelling older adults. The comprehensive critical analysis of the literature found: (1) multifactorial fall prevention programs appear to be more effective for older individuals with a previous fall history versus a nonselect group; and (2) medication and vision assessment with appropriate health practitioner referral should be included in a falls screening examination and more.

This article has findings including those with less education, income, and social support are less likely to have home modifications.

This article will help better understand the suitable approach to older adults on assistive technology.