Helping Older Adults Age Safely in Place

With the aging of the U.S. population, the number of older adults living if affordable housing is growing and the average age of residents is increasing. Assisting residents to age in place safely is good for both property owners and residents. People typically want to live independently for as long as possible and stable tenancy reduces operational costs. However, as older adults age and their ability to live on their own changes, the features and configuration of their home can present challenges to living safely. Simple modifications can improve the comfort and safety of older persons, allowing them to live on their own much longer.

Home modification refers to converting or adapting the environment to make it easier for older adults (or people with disabilities) to manage basic activities more easily and more safely. For many, the term “home modification” leads to images of structural modifications, such as converting tubs to roll-in showers or widening doorways. But, modifications can be as simple as installing tub benches, rearranging furniture, fixing uneven flooring, or improving lighting. Many simple, low-cost modifications can make a huge difference to the health and safety of older adults.

Modifications that the Residents May Make

Residents themselves can make many changes to their living environment to immediately improve the quality of their lives, including –

• Remove clutter from the floor and increase storage;
• Secure cords to walls or floors;
• Remove or secure throw rugs with gripper pads or gripper tape;
• Mark uneven thresholds with contrasting tape or paint;
• Install nightlights in the bedroom and bathroom;
• Stick motion sensor LED lights on baseboards;
• Purchase a shower seat, place adhesive anti-slip treads on shower or tub floors; and
• Add seating to the bedroom to assist with dressing and in the kitchen for cooking prep.

Low-Cost Improvements that Site Staff can Make

• Replace knob style door and faucet handles with lever style handles;
• Securely install grab bars around tubs, showers, and toilets and raise toilet seats;
• Install adjustable hand-held shower heads and anti-scald water devices;
• Replace bulbs with bright, non-glare lighting;
• Replace traditional light switches with rocker switches; and
• Install double hinges to widen doorways (this can widen doorways by up to two inches).

Still more improvements may be made by professional installers – if permitted by project budgets. These include –

• Widen the frames of entryways and doorways;
• Remodel bathrooms to include a shower with supports and no threshold;
• Install slip resistant flooring in bathrooms; and
• Create level flooring by removing thresholds and other uneven areas.

Home Modification & Fall Prevention

Increasingly, research is showing that, in addition to helping older adults live more comfortably and independently, home modifications (including home hazard removal) can reduce the fall risk for individuals. It is estimated that one in four older adults falls each year, with more than half of all falls occurring in the home. Injurious falls can force people to move to institutional settings. Home modifications can reduce fall risks and may promote longer residency in traditional apartments, and less unit turnover.

Multifamily Owners’ Responsibility for Modifications

Owners of HUD and Rural Development-Assisted multifamily housing are subject to Section 504 of the Rehabilitation Act of 1973, which provides rights to people with disabilities in federally-funded programs. Under Section 504, owners have a responsibility to provide reasonable accommodations to residents with disabilities who need such accommodations to be able to participate fully in the housing. While the Fair Housing Act requires all owners to provide such accommodations, Section 504 requires that owners pay the cost of home modifications – unless it is unreasonable to do so.

Resources to Assist with Home Modification

Increasingly, programs and funding are available to help renters modify their home environments to support independent living. Service coordinators can help residents of HUD multifamily housing access these resources, and owners of conventional properties (including the Low-Income Housing Tax Credit) can provide information on these resources to residents. Some of the best resources follow:

• Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs), and Centers for Independent Living (CILs). These agencies maintain information and resources on home accessibility and available programs to finance home modifications. The programs are funded by the U.S. Administration for Community Living (ACL). To find the AAAs and ADRCs in your area, visit the eldercare locator website (https://eldercare.acl.gov/) or call 1-800-677-1116.
• The Department of Veteran’s Affairs offers Home Improvement and Structural Alteration grants to veterans and service members for medically-required home modifications. Renters are eligible for the grants if they have a signed and notarized statement from the property owner authorizing the improvement or structural alteration.
• Many communities offer comprehensive home modification programs, often operated through nonprofit organizations, that help older adults determine the environmental modifications they need and then carry out the modifications free of charge. Some of these programs include a visit from an Occupational Therapist or Nurse to ensure the modifications meet the needs of the resident and are part of a comprehensive approach to helping the resident live independently. The www.homemods.org website provides a directory of home modification and repair programs by state.
• Medicare Advantage Plans may pay for home safety inspections conducted by a qualified health professional and safety devices, such as shower stools, hand-held showers, grab bars, and raised toilet seats, to prevent home injuries.
• Medicaid home and community based services provide opportunities for Medicaid recipients to receive services in their own home or community rather than institutions or other isolated settings.
• When prescribed by a doctor, or as part of a discharge plan when returning from a hospital stay, residents may receive in-home visits form an occupational therapist, physical therapist, or nurse. During these visits, the professionals often identify specific equipment and environmental modifications that residents need for safety and independence. HUD encourages service coordinators to work with the health professionals (and residents) to ensure the residents needs are met.

Owners of properties for older persons would do well to become familiar with the resources available to assist resident in remaining independent in their homes. This is good for the emotional and physical well-being of the residents as well as the financial well-being of the properties.