Relevance to Centers for Independent Living (CILs)
CILs are experienced in directing people with disabilities to information, funding sources and other resources for home modification. A recent study surveyed over 200 CILs to find out more about the extent of this service for older adults. This survey was conducted by the National Resource Center for Supportive Housing and Home Modification (NRCSHHM). They found that although CILs offer information and referral about home modification, some staff had knowledge about home modification while others' knowledge was limited. For staff with limited knowledge, the NRCSHHM recommended additional training in home modification and the needs of elders.
In this section, CILs will learn that there is an increased demand for home modifications by older consumers in order to age-in-place. CILs will learn about the benefits of home modifications, environmental problems and potential solutions in relation to age-related changes, and reasonable accommodations for accessibility.
Many senior consumers do not think about home modifications until a crisis arises. They may not know where to turn for information about home modification, contractors, and financial assistance. Many seniors pay for home modifications out-of-pocket. Baby boomers are becoming more aware of accessibility problems in their homes as they are watching the difficulties their parents are experiencing. CILs can tap into this market.
Financing Home Modifications | Home Modification Resources
What does it mean to have home modifications? Generally speaking, it means making alterations to one's home so that it is more livable or "user friendly." Home modifications can involve very simple and inexpensive changes such as installing a grab bar in the bathroom or lever handles on the doors. Sometimes, home modifications can involve expensive changes such as installing elevators or modifying kitchens, bathrooms or widening hallways for wheelchair accessibility.
The main benefit of making home modifications is that they promote independence and prevent accidents. According to a recent AARP housing study (2003), "83% of older Americans want to stay in their current homes for the rest of their lives."1 But other research indicates that most homes are not designed to accommodate the needs of people as they age.
Many elderly people are injured in and around their homes each year. Most people over age 65 live in homes that are more than 40 years old. Often these older homes contain obstacles and lack features that can help prevent injuries. Falls are the leading cause of injury and death among people age 65 and over. AARP reported that most homeowners fail to prepare for aging. Although they anticipate making modifications that can help them remain in their home, only about half have actually made any changes. Linda Barrett states, "There appears to be some denial here. People are focusing on their needs in the next five years or so rather than what they will need later in life."2 Research by the National Centers for Disease Control and Prevention (2002) shows that home modifications and repairs may prevent 30% to 50% of all home accidents among seniors, including falls that take place in these older homes. As mentioned in earlier sections, chronic conditions such as arthritis, low vision, blindness, poor mobility, decreased hearing, decreased sense of touch and temperature, limited hand use, limited range of motion, and decreased balance and coordination all contribute to increased risk. These limitations not only affect the frail elderly but also the well elderly who experience the affects of aging. There may also be multi-factor and interacting causes such as poor vision, ambulation difficulties or both that contribute to a trip over a telephone cord.
Consumers can help themselves if they know where to obtain information. Several agencies have developed home safety checklists that allow the consumer to walk room-to-room and answer specific questions regarding accessibility, usability, potential safety hazards or needs for improvement. Some of these agencies include the Centers for Disease Control, AARP, Consumer Product Safety Commission and Rebuilding Together. You can find the location and name of their checklists in the resource section of this chapter.
Unfortunately, many older consumers are reluctant to change their homes. Other times, family members or caregivers can put up roadblocks to modifications to the home simply because they haven't thought about how change can be helpful. It has been noted that there are three common areas in the home that are problematic for the older resident: 1) getting in and out of the house, 2) using the bathroom, and 3) going up and down stairs. Home modifications and assistive technology can help eliminate these obstacles and promote independence, safety and quality of life.
Being able to stay in one's home even if the affects of aging diminish your ability to perform everyday activities is called aging in place. An AARP survey on housing and home modification, Fixing to Stay (1999) reported that 82% of those surveyed preferred to stay in their own homes and not move. Problems that cause difficulty were climbing stairs (35%) and walking or lack of mobility due to problems in the knees, hips legs or arthritis (15%). Safety was the reason most sited for the modifications. The majority of the modifications were financed out of pocket (62%).3
In 2001, Pynoos reports that home modifications create a supportive home environment for the elderly. He states that modifying the consumer's existing environment can provide several benefits: 4
• Promote the consumer's independence (makes it easier to do daily activities such as bathing, cooking or getting in and out of the home)
• Facilitate care giving (adequate space and features makes it easier for the caregiver to provide care when the bathroom has enough space for easier transfers)
• Reduce accidents (particularly falls by removing barriers or obstacles such as throw rugs and by installing grab bars and railings)
• Enable older adults to participate in life's activities (increase lighting for a variety of activities such as reading, sewing, cooking)
• Be cost effective by reducing healthcare costs and delay
institutionalizations. (Mann et al., 1999).5
Home modifications will always depend upon an individual's needs. It is important to find out from the individual what activities or tasks have increased in difficulty or can no longer be performed. Gradually over the years, the older consumer with age-related changes or disabilities has learned to adapt to their environment. They have not considered adapting their environment to meet their needs. Adapting the environment to the consumers' needs allows the individual remain in their home, promote independence, safety and improve quality of life. Bob Vila of the television show Home Again states, "Whether you are completely remodeling your home or using some of the readily available low-cost adaptive products, creating a safe, comfortable and accessible environment is not planning for disability - it's planning for continued independence."6
Many elderly consumers, their families and caregivers do not know where to obtain information or services. Those that live in rental properties do not know they are allowed to make modifications to the residence - and that landlords cannot say no. If the consumer is a renter, the Fair Housing Act requires that their landlord allow them to make their residence accessible. However, the landlord is not required to assist them with the cost. And the tenant will have to return the interior of the residence to its original condition when they leave. Exterior modifications, such as ramps, do not have to be removed.
It is important to plan for home modifications and not wait until frailty or injury. According to researchers, "the delivery system for home modifications is a patchwork of fragmented and uncoordinated services with significant gaps in types of services available and geographic coverage."7,8 This makes it even more difficult for consumers to know where to turn for assistance. CILs have a long history of helping individuals with disabilities obtain assistance, self advocacy skills, information and referral for resources, and knowledge about the Fair Housing Act. Also, Area Agencies on Aging have recently initiated training programs to help their staff assist the elderly in advocacy, consumer choice and self-directed services.
A survey conducted by the National Resource Center (2002) confirmed that CILs (92%) promote home modifications most commonly through referrals to providers and programs (86%), general home modification information (84%) and home modification assessment (86%). However, they found that only 16% of CILs rated their staff as extremely knowledgeable about home modifications: 40% report they are knowledgeable and the rest report low or no home modification knowledge. The National Resource Center (NRC) questioned whether CILs will be ready to assist our rapidly growing aging population. Recommendations were made for CILs and AAAs to work together more closely. This can be done by participating in task forces or local coalitions of disability and aging related organizations to promote home modifications. Phoebe Liebig, co-investigator of the NRC states, "By collaborating with one another, CILs and Area Agencies on Aging can effectively promote consumer education about home modification in their local communities. Joining forces will enable the agencies to advocate for systems change and for a greater pooling of knowledge and resources at both state and local levels among organizations serving people with disabilities of all ages."8,9
An occupational therapist (OT) has specialized training and expertise to be able to match an individual's abilities to the environment and assistive technology. Mary Becker-Omvig has identified simple steps that family members and caregivers can use to help the consumer get ready for home modifications. These steps are:10
1. Investigate and raise awareness - This can facilitate the home modification process. The family member or caregiver should build a list of trusted resources, that are reasonably priced or have been used before. Purchasing devices as a gift, like a cordless, to introduce change gradually. Check with local aging agencies for additional resources as well as ask neighbors and friends about resources.
2. Assessing - Observe the person as they perform their activities and move about their home. Is the person experiencing any difficulty such as holding on to walls when walking, forgetting to take their medications, not cleaning or repairing the home? Ask the person if they are having any difficulty doing their activities. "Are there any activities that the consumer used to do and can no longer do?" "Are they having any difficulty with bathing like getting in and out of the tub?" Some may reply, "No, it just takes a little longer, two hours to do it."
3. Consult with a professional occupational therapist - They can relieve the burden from the caregiver. The OT is able to match abilities (physical and cognitive) to the environment. It is called a person-environment interface approach. They evaluate the persons' skills, analyze the task and the environment in which the task is to be performed. They are trained to ask questions that may trigger responses that will lead to developing a plan for modifying the home. The OT identifies the environment as the main barrier to independent functioning, not the individual.
4. The process of change - It's best to plan ahead and make changes prior to the existence of a crisis. Individuals are more resistant to change if they are in a crisis situation. Change comes slowly and involve six steps:
• Pre-contemplation
• Awareness
• Information gathering
• Planning
• Action
• Maintenance
Those that work with the elderly population are aware that there are reasons this population may choose to move instead of staying in their current homes. Some of these reasons are:
• The housing is too expensive to modify and the return will not justify the costs at resale.
• Physical decline and no support system.
• Major modifications needed and the home will not lend itself to what they need structurally.
• Decide to move in with a relative.
• Neighborhood is no longer safe and is declining. Need to be near social support systems (i.e. church, cultural group, family or friends).
• One spouse is disabled and in nursing home. The other spouse needs to relocate to be nearby.
• Needs extra room to accommodate a live-in caregiver or nurse.
• Desires a new home, has more money to purchase a new
home to improve quality of life now that the kids are out (retirees).
Older consumers that choose to stay in their homes and modify to meet their needs should be aware of common environmental problems and potential solutions. Those that are involved with this population should also become familiar with these as well. The chart below lists common environmental problems and potential solutions/interventions for the home of older consumers. The chart is the result of numerous research efforts conducted by the RERC on Aging (1999).
|
Problem |
Potential Intervention |
|---|---|
|
a. Getting on/off toilet |
Raised seat, side safety bars, grab bars |
|
b. Getting in/out tub |
Grab bars, bath stool/chair, transfer bench, hand held shower, rubber mat, hydraulic lift bath seat |
|
c. Slippery or wet floors |
Non-skid rugs or mats |
|
d. Hot water burns |
Turn down hot water heater thermostat, anti-scald device |
|
e. Doorway too narrow |
Leave wheelchair at door and use walker, install off-set door hinge |
|
f. Dizziness standing at sink |
Sit on stool |
|
g. Difficulty seeing |
Adequate lighting, clear plastic shower curtain, toilet seat cover or seat that contrasts with walls and floor, adjustable mirror magnifier |
|
Problem |
Potential Intervention |
|---|---|
|
a. Open flames & burners |
Microwave, electric toaster oven, hot plates, crock pot, Meals On Wheels, frozen dinners, auto shut off |
|
b. Access items |
Install accessible wall outlets, switches, automatic fire extinguisher in range hood. Place commonly used items in easy to reach areas, adjustable height counters, cupboards, pull out drawers, lazy susans, wall storage rack, remove cabinet doors, reacher |
|
c. Hard to turn on or off faucet/stove |
Lever-style faucet, "T" turning handle |
|
d. Carrying items |
Slide across counter, use cart, walker basket or tray, bridge items surface to surface, eat at counter sitting on stool |
|
e. Difficulty seeing |
Adequate lighting, contrasting colored china, place mats, napkins, utensils with brightly colored handles, Hi Marks raised identifying marks |
|
Problem |
Potential Intervention |
|---|---|
|
a. Soft, low chair |
Board under cushion, pillow or folded blanket to raise seat, blocks or platform under legs, automatic seat lift/chair, firm armrests to push up on, back and seat cushions (Obus Form) |
|
b. Swivel and rocking chairs |
Block motion |
|
c. Obstructing furniture |
Relocate or remove to clear paths (especially glass top tables) |
|
d. Extension cords |
Run along wall baseboard, under sturdy furniture, eliminate unnecessary ones, use power strips with breakers, if possible |
|
e. Accessing and seeing light switches |
Touch sensitive switches, voice activated light switches (X-10, Radio Shack), illuminated wall switches, avoid light switch plates and sockets that blend with wall paper or paint color |
|
Problem |
Potential Intervention |
|---|---|
|
a. Rolling beds |
Remove wheels, block against wall |
|
b. Bed too low |
Leg extensions, blocks, second mattress, adjustable height hospital bed |
|
c. Getting in/out bed |
Portable bed rail, trapeze |
|
d. Lighting |
Bedside light, night light, flashlight (attaches to walker or cane), remote controlled switches (X-10, Radio Shack), lamp switch extension lever, touch lamp, touch light extension control |
|
e. Sliding rugs |
Remove, tack down, rubber back, two sided tape (hardware store) |
|
f. Slippery floor |
Non-skid wax, no wax, rubber sole footwear |
|
g. Thick rug edge/threshold |
Metal strip at edge, stripe to mark change, remove threshold, tack or tape down edge |
|
h. Far from bathroom |
Mobility aid next to bed, bedside commode, urinal |
|
i. Night-time calls |
Bedside cordless intercom, buzzer, Lifeline |
|
j. Access clothes |
Place clothes in easy to reach drawers, shelves or hangers |
|
k. Can't see clock |
Large faced clock radio, Braille alarm clock, talking alarm clock |
|
Problem |
Potential Intervention |
|---|---|
|
a. Cannot negotiate |
Stair Glide, lift (Braun Corp), elevator, ramp (permanent, portable or removable), able to bump up/down stairs on rear end in emergencies |
|
b. No handrails |
Install at least one side (check stability) |
|
c. Loose rugs |
Remove or nail down to wooden steps |
|
d. Difficult to use |
Adequate lighting, mark edge of steps with bright colored tape (at least top & bottom ones) |
|
e. Unable to use walker on stairs |
Keep second walker or wheelchair at top or bottom of stairs |
|
Problem |
Potential Intervention |
|---|---|
|
a. Difficult to reach |
Cordless; inform friends to give you 10 rings, clear path, headset cordless answering machine & call back, remote answer |
|
b. Difficult to hear ringing |
Ring amplifier, blinking lights, vibration (Silent Call, Inc). |
|
c. Difficult to hear other person |
Volume control, TDD, headset |
|
d. Difficult to hold receiver |
Headset, speaker, adapted handles |
|
e. Difficulty dialing numbers |
Preset memory dial, large buttons & numbers, voice activated dialing |
|
Problem |
Potential Intervention |
|---|---|
|
a. Laundry |
Easy to access (1st floor), sit on stool to access clothes in dryer, good lighting, fold laundry sitting at table, carry laundry in bag on stairs, use cart |
|
b. Mail |
Easy to access mailbox, mail basket on door, ask carrier to place in a specific location (same for paper), install mail-slot, use reacher, key lever |
|
c. Housekeeping |
Long-handled sponge, dustpan, lightweight vacuum |
|
d. Controlling thermostat |
Mount in accessible location, large print numbers (available from gas company in some areas), remote controlled thermostat (X-10, Radio Shack) |
|
Problem |
Potential Intervention |
|---|---|
|
a. Difficulty reading label |
Use magnifying glass, good lighting, large print |
|
b. Memory loss |
Medication organizer, automatic pill dispensers, organize in envelopes with time & date, throw out all old medications |
|
c. Difficult to open |
Pill cap opener, ask pharmacist for easy open top |
|
Problem |
Potential Intervention |
|---|---|
|
a. Can't hear/see television |
Personal listening device with amplifier (several commercial brands, compatible with hearing aids), closed captioning, TV magnifier |
|
b. Complicated remote control |
Simple remote with large buttons, universal remote control, voice activated remote control, Clapper |
|
c. Can't see or shuffle cards |
Large print cards, automatic shuffler, card holder |
|
d. Can't read small print |
Magnifying glass, print enlargement system, scanner with electronic voice output |
|
e. Glare on reading material |
Use focused light source, avoid glossy paper for reading material, black ink vs. blue or pencil |
|
Problem |
Potential Intervention |
|---|---|
|
a. Difficulty locking doors |
Remote controlled door lock, door wedge |
|
b. Difficulty opening door and knowing who is there |
Automatic door openers, intercom at door, lever door knob handles, video intercom |
|
c. Opening/closing windows/shades |
Remote controlled windows and shades, lever and crank |
|
d. Can't hear alarms, smoke detectors, ringing, or doorbell |
Blinking lights, vibrating surfaces (Silent Call, Inc). |
|
e. Access to emergency egress |
Must have alternative means of exiting home in case of emergency, fire blanket |
|
f. Lighting |
Illumination 1-2 feet from object being viewed, change bulbs when dim, not burned out, adequate lighting in stairways and hallways, nightlights |
|
g. Glare |
Light-colored sheer curtains on windows with direct sunlight, gradual decrease in illumination from foreground to background. |
Mentioned earlier in this chapter, older adults that live in apartments, assisted living facilities and retirement communities have rights under the Fair Housing Act to make reasonable accommodations to their living environment. Listed below are suggested accommodations that can be made for inside and outside areas of the older consumers' living environment.
1. Install railing on at least one side of walkway-preferably both sides
2. Patch holes, cracks and uneven pavement
3. Install motion detectors on lighting-also photo sensors, timers, etc.
4. Use reflectors/low voltage outdoor lighting along walkways and driveways
5. Follow Uniform Federal Accessibility Standards standards for parking spaces
6. Install signage
1. Install ramps (recommended 1:20 slope or less)
2. Install wheelchair lifts
3. Install railings on both sides of steps
4. Install stair treads on slippery steps
5. Illuminate doorways, doorknobs and locks
6. Install shelf or bench near door to place packages on when opening door
7. Install levered door handles/loop or push type/rubber gaskets
8. Install automatic door openers/locking systems/keyless locks (five pounds or less of force required to open door)
9. Install dead bolt locks and security devices
10. Widen door openings for wheelchair accessibility (32-36" clearance with open door)
11. Door threshold (1/4" or less in height preferred)
12. Windows along side of door to view outside for security/accessible height peep hole on door
13. Modify hinge and track doors for accessibility and ease of opening-swing clear hinges
14. Install amplification devices or light attachments to supplement bell for hearing impaired
15. Intercom system to entrances and throughout the home
16. Additional non-glare lighting
17. Mail chute at chair height (28"-36")
18. Use non-skid flooring or dense, tight short-loop carpet
19. Install kick plates along wall and door where wheelchair may cause damage
20. Remove tripping hazards, such as mats, rugs and landscaping
1. Handrails on both sides of stairs (extend at least 12" past top/bottom of stairs where possible)
a. contrast color from wall
b. top/bottom scrolled to provide directional cue
c. reinforce wall support
2. Install extendible handrails, Stair Glides, electric wheelchair lifts or elevators
3. Illuminated or contrasting reflective stair strips for the visually impaired/stair treads
4. Additional lighting, non-glare can be low to floor
1. Install levered, push or automatic door handles or use rubber gaskets
2. Modify doorways for accessibility (36"width preferred) - remove doors, install swing clear hinges, create pocket doors, use curtains, etc.
3. Level thresholds between rooms
4. Computerized Home Management Systems - Environmental controls
5. Thermostat controls on each floor at accessible height
6. Hallway width (42" - 60")
7. Low pile, dense carpeting - glued to floor; remove throw rugs
8. Non-slip surface on wood or linoleum floors
9. Contrast colors between wall/floor surfaces
10. Accessible, illuminated, pressure sensitive or rocker light switches (<42" above floor level with contrasting color switch plates)
11. Additional lighting where needed
12. Accessible electrical outlets (18-24" from floor level)
13. Accessible height telephone jacks
14. Remove low profile furniture from circulation areas
15. Light filtering window coverings/decrease glare
16. Firm, sturdy sofas and chairs with easily grasped arms - rounded edges on hard furniture
17. Avoid changes in floor levels
18. Use contrasting colors to contrast figure/ground surfaces - furniture, cabinets, floor, and walls
19. Avoid busy patterns that increase visual confusion
20. Space planning of furniture to facilitate communication in group setting
21. Sound absorption materials on walls, floors, ceilings, furniture,
window coverings
1. Additional lighting
2. Open cabinets for wheelchair accessibility/cabinets with removable fronts
3. D-ring cabinet handles/large knobs
4. Levered handles, push button or automatic control faucets
5. Water temperature (anti-scald) control devices or turn down water heater 115º or less
6. Replace drawer hardware with easy glide hardware
7. Pullout shelves and cutting boards, lazy susans
8. Shallow cabinets and sinks
9. Install height adjustable cabinets and countertops/push button control or track system
10. Accessible sinks, cook tops and ovens
11. Appliances designed for accessibility - controls in front or side (installed 30 - 42" high)
12. Side-by-side shallow refrigerator
13. Retractable water hose from sink that is accessible to stovetop
14. Flat surface induction cook top
15. Microwave at accessible height with small shelves in front
16. Angled mirror above stovetop
17. Push button, large knobs/visual/tactile cues on oven and stove controls
18. Front load washer/dryer, touch pads recommended
19. Consider turning radius for wheelchair maneuverability (minimum 60" x 60")
20. Pocket doors/swing clear hinges to open access room through doorway - eliminate swing doors
21. Use tactile cues/varying textures or raised symbols to label cabinets for contents
22. Matte surfaces/avoid glare and reflection
23. Automatic jar openers and bottle openers
24. Wall oven - vertical hinge
1. Install pocket door
2. Barrier-free roll in showers (3' x 3' transfer shower or 5' x 5' roll-in shower)
3. Non-skid flooring
4. Single levered or automatic faucet controls
5. Temperature control systems (anti-scald device)
6. Grab bars, tub rail, toilet rails, reinforced wall supports
7. Accessible toilet seats/raised, high rise, or adjustable
8. Retractable shower seat or tub with permanent transfer tub bench
9. Side, wall-mounted, accessible medicine cabinet
10. Accessible-height bidet (wash/dry features) - adaptable controls
11. Accessible laundry chute
12. Hand-held shower heads on adjustable track
13. Accessible doorway (36" width/32"clearance)/swing clear hinges
14. Specialized bathtub and Jacuzzi systems
15. Accessible water, light, and heating controls
16. Additional lighting and heating systems, night light
17. Ground Fault Intercept (GFI) receptacles
18. Lowered or angled wall mirrors
19. Reinforced walls around shower/tub and toilet areas for grab bar installation
20. Non-skid strips or mat for tub/shower floor
21. Remove sliding glass shower door and track - use shower curtain on rod or barrier-free door
22. Turning radius (5' x 5')
23. Telephone outlet for emergency/cordless /intercom
24. Remove area rugs
25. Recommend ceramic tile or rubberized surface over sheet vinyl
1. Minimize furniture barriers, use built-in dressers, etc.
2. Install accessible closet systems - adjustable and shallow shelves and rods
3. Level door threshold/accessible doorway (36" width clearance)
4. Evaluate best floor covering for safety and accessibility
5. Accessible windows that open and close with ease - automatic casement windows/crank adaptation controls (24 - 28" above floor level)
6. Direct access to bathroom
7. Intercom system
8. Large number or tactile controlled thermostats/controls on each floor
9. Direct emergency exit to outside
10. Accessible laundry room on bedroom level
11. Accessible switches, jacks and outlets
12. Pressure sensitive, or rocker, illuminated light switches
13. Reinforced ceilings for pulleys or lifting mechanisms
14. Levered door handles or rubber knob gaskets
15. Accessible height, firm mattress (may be raised on platform or sturdy blocks
16. Touch lighting and remote controls
17. Speaker with touch pad
1. Raised/cantilevered beds for wheelchair accessibility
2. Automated sprinkler system/easy access faucet hoses and controls
3. Container gardens
4. Non-toxic and edible plants
5. Long-handled or ergonomically designed garden tools
6. Accessible outdoor storage for equipment
7. Accessible play equipment and swimming pools
1. Audio and visual signal alert smoke detectors, door bells, security systems, ring, motion detectors, etc.
2. Fire extinguishers
3. Fire escape plan - visual and memorized - written map posted at key locations
4. Personal emergency plan
5. Medication management system
6. Automatic timers for lights
7. Heat sensors for stove
8. Home security systems
9. Emergency escape wheelchairs that can access stairs
10. Emergency lighting for indoors
11. Relocate fuse and breaker box to main floor
12. Outdoor view or location water, gas, electric meters
1. Partnerships
2. Alter existing room settings
3. Addition
4. Moving
Most home modifications are paid out-of-pocket. For eligible individuals, there are some programs that provide free services or reduced rate loans. Some of these agencies are listed below.
Some AAAs use funds from the Older Americans Act Title III to modify homes. To locate the AAA in your area, contact the Eldercare Locator at (800) 677-1116 or visit www.n4a.org.
Some banks will offer loans to finance home modification projects (building ramps, installing lifts, widening doors, or lowering cabinets). Reverse mortgages may be offered by some banks and lenders to help homeowners turn their home's value into cash. Contact the local banking and lending agencies in your area for more information. (The U.S. Dept. of Housing & Urban Development offers free counseling on reverse mortgages - (888) 466-3487.
Community Development Block Grants (CDBG) are used to help maintain or upgrade homes by many cities and towns. For more information contact the National Association of Housing and Redevelopment Officials (877) 866-2476 or obtain a listing of the Housing and Development Agencies at www.nahro.org/reference/internethousing.cfm
The FHA administers mortgage insurance programs that can help homeowners and home buyers obtain loans for home modifications (Title I, Section 203(k)). For additional information, contact your regional HUD field office listed in the telephone directory or call (202) 708-1112. You can find a local FHA lender by visiting www.hud.gov/II/code/IIplcrit.html
The Habitat for Humanity under its remodeling program may provide volunteer labor to construct a ramp if materials are provided. Call your local affiliate of Habitat for Humanity for more information.
These programs help low income homeowners obtain home modification that increase comfort. Both of these programs are operated by local energy and social service departments. For more information visit www.acf.dhhs.gov/programs/liheap/directry.htm
Under certain conditions, home modifications may be tax deductible. If the modification has been prescribed as medically necessary and will increase the resale value of the property such as installation of elevators or partial expense of building a ramp. It is always best to consult a tax professional to determine deductibility. You may obtain a free copy of the IRS Publication 502 for additional information by calling (800) 829-3676.
These programs may pay for ramps and home modifications on a case by case basis if the physician writes a prescription and if they are considered durable medical equipment. For more information, contact the managed care program in your area.
Anyone over 65 that qualifies for Social Security or railroad benefits qualifies for Medicare. If you do not qualify for Social Security, you may voluntarily sign up for Medicare for a monthly fee. Medicare will only pay up to 80% of expenses, and will not pay for emergency alert systems, hearing aids, augmentative communication devices and home modifications. Other sources must be found to supplement the coverage. Items covered by Medicare, such as wheelchairs, often have restrictions on costs, models and types that can be purchased. There are many special private insurance plans that are specifically designed as Medicare supplements. Programs such as Medicaid and private insurance plans can help fill the gap. For example, Medicaid offers a program such as the Home and Community-based Waiver which provides some home adaptation along with other services. Also Home Health Services provides durable medical equipment along with other services to enable older persons to stay in their homes.
Depending on the individual's or group policy terms, private insurance may pay for ramps and home modifications. These modifications are considered to be durable medical equipment by many insurance companies. You must contact the insurance company's representative for specific information.
Private organizations that can provide assistance include the Arthritis Foundation, the American Cancer Society and the Polio Remember Your Strength (P.R.Y.S.) which can supply durable medical equipment. Local churches and other organizations may be able to provide financial assistance for assistive technology.
The RHS offers various grants and loans for rural, low-income elders that may be used to rehabilitate, repair, buy, build, or improve rural homes and related facilities (RHS Section 502 Home Ownership Loans). The Very Low-Income Housing Repair Program (Section 504), provides loans and grants to low-income, elderly, age 62+ to repair, improve, or update their homes or to remove safety and health hazards. To learn more about these programs contact the USDA Rural Housing Services Programs at (530) 792-4820, (530) 792-5848 (TDD) or www.rurdev.usda.gov/rhs/Individual/ind_splash.htm.
Rebuilding Together, Inc. is a national volunteer organization. Through its local partners, it is able to assist some low income seniors with home modifications. To obtain more information contact your local AAA or Rebuilding Together at 1-800-4-REHAB-9, or visit the website at: http://rebuildingtogether.org/home_modifications.
Note: A complete list of home modification services nationwide can be found by visiting the National Resource Center on Supportive Housing and Home Modification: www.homemods.org/profile/index.html or by writing to the National Resource Center on Supportive Housing and Home Modification, USC Andrus Gerontology Center, 3715 McClintock Avenue, Suite 228, Los Angeles, CA 90089-0191 or call: (213) 740-1364.
This program provides medically necessary improvements or structural alterations to a veteran's home. Specific eligibility requirements must be met to determine how much money is allowed for the grant.
Veterans that have specific service-connected disabilities may be entitled to a grant from the Department of Veterans Affairs for the purpose of constructing an adapted dwelling or modifying an existing dwelling to meet the veteran's needs. The goal of the Specially Adapted Housing (SAH) Program is to provide a barrier-free living environment that affords veterans a level of independent living they may not normally enjoy. There are two types of grants administered by VA which are available to assist severely disabled veterans in adapting housing to their special needs. The Specially Adapted Housing Grant is available to disabled veterans who are entitled a wheelchair accessible home, and the Special Home Adaptations Grant for veterans who are entitled to adaptations because of blindness in both eyes with 5/200 visual acuity or less, or because of the loss of both hands.
Under this program, an eligible veteran may receive a VA grant for the actual cost to adapt a house, or for the appraised market value of necessary adapted features already in a house when it was purchased. In either case, the maximum grant is $9,250. Veterans who have a service-connected disability due to military service entitling them to compensation for permanent and total disability due to blindness in both eyes with 5/200 visual acuity or less or the anatomical loss or loss of use of both hands.
An eligible veteran may receive a VA grant of not more than 50% of the cost of a specially adapted housing unit up to a maximum of $48,000. Veterans who have a service-connected disability are entitled to compensation for permanent and total disability due to the loss or loss of use of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; disability which includes blindness in both eyes, having only light perception, plus loss or loss of use of one lower extremity; or the loss or loss of use of one lower extremity together with (1) residuals of organic disease or injury, or (2) the loss or loss of use of one upper extremity, which so affects the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair.
The following adaptations are considered appropriate under the Special Housing Adaptations Grant: special lighting, sliding doors, handrails, grab bars in the bathroom, smoke detectors/fire detection systems, security systems, intercom system, covered porch, swimming pool, and other adaptations such as lever-type fixtures with the approval of the VA.
The following adaptations are considered appropriate under the Specially Adapted Housing Grant: at least two ramps suitable for entry and exit, doorways at least 36 inches wide, halls a minimum of 48 inches wide, and other home accessibility features or modifications.
For more information contact: Veteran's Home Accessibility Grants: VA Office at (800) 372-7172 - VA adapted housing grant programs at http://www.housingall.com/Home/VA.htm
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