Home Modifications Overview
As seniors age, they may struggle with many aspects of daily life. These struggles can present themselves in many ways, and oftentimes seniors feel frustrated with their newfound impairments. In some cases, these individuals choose to move from their homes into long-term care facilities, but there are some solutions for those who wish to continue living at home.
For those who want to stay at home and prefer aging in place, it may be possible to make various home modifications to accommodate some impairments. These home modifications can help with a wide array of functional difficulties at home and can be worth considering for many older adults.
What Are Home Modifications?
Home modifications are structural adaptations designed to accommodate an individual’s changing needs and abilities. Many seniors choose to have their home modified as an alternative to moving to a long-term care facility. This allows the individual to age-in-place and causes fewer disruptions to their everyday life and independence.
Many home modifications are simple. Some seniors add grab bars in bathrooms or pull-out shelves in kitchens to accommodate mobility or strength impairments. Other conditions require more extensive home modifications, however, most home modifications involve simple changes to address functional challenges.
The main goal of any affordable modification is to enhance an individual’s safety and independence by providing a comfortable option for aging in place in one’s own personal residence. Such modifications enable an individual to care for themselves more effectively at home.
With the right home modifications, an individual may not need to live in a care facility which results in significant financial savings. In addition, if a loved one is opposed to living in a care facility, home modifications may be a way for them to live safely, actively, and independently at home.
Types Of Home Modifications
Home modifications address safety and/or functionality concerns in the home. For example, an individual may have grab bars installed to prevent falls or push handles installed on doors to improve accessibility. There are many ways an individual can modify their home and planned changes should begin with issues that pose the greatest threat to safety and one’s ability to complete activities of daily living (ADLs).
Home Modifications To Prevent Falls
Falls are an ever-present threat to many seniors living independently. As an individual ages, they become more susceptible to injuries from falling which makes falls prevention an even greater priority for older adults. Many seniors fear to live alone as they age because they are aware of the dangers of falling and they are afraid of falling and not having anyone to help them should this occur.
Falls in the home are a more common occurrence for seniors and some of the first home modifications seniors and their families make are to help prevent falls.
Grab bars, handrails, and other equipment can help reduce one’s fear of falling and give one peace of mind about living independently. Common modifications for preventing falls include:
- Adjustable height shower headers
- Roll-in showers, hand-held shower, and a walk-in shower
- Walk-in tubs
- Non-slip rugs and mats in areas with tile or hardwood flooring
- Grab bars installed in roll-in showers, baths, and near toilets
- Nightlights in each room and hallway
- Wheelchair ramps
- Non-slip surfaces in all rooms and bathrooms
- Placing non-skid strips in bathrooms
- Lamps next to sitting areas and beds
- Light switches at the tops and bottoms of stairways
- Handrails on stairs and in hallways
- Walkway repairs (to fill holes and cracks) outside the home
Improving Accessibility In The Home
Many types of home modifications improve an individual’s accessibility to their home environment. For example, perhaps a loved one has trouble climbing stairs or is unable to reach food in cupboards without assistance. If an individual is having difficulties accessing and using various parts of their home, the following home improvements may help:
- Widen doorways and walkways to allow for wheelchairs and walkers
- Install automated doors powered by conveniently-placed push buttons
- Install wheelchair ramps to make stairways more manageable
- Ensure floors are smooth to allow wheelchair navigation
- Install walk-in tubs and shower benches
- Ensure fixtures and appliances are easily reachable (e.g. consider large light switches or adaptable handle faucets)
- Replace all door and cabinet knobs with levers or handles
- Ensure counters and furniture have rounded corners and edges
- Install stair lifts to eliminate any need to climb stairs
- Use transfer benches to independently move from a wheelchair to another seat or bench
- Consider using home automation systems that permit easy use of locks, lights and other fixtures
- Install roll-out shelving to allow better access to closets and cabinets
It is not uncommon for some seniors to move in with their families as they age. Some families choose to build accessory homes or apartments for an aging loved one to create a safe environment for them to facilitate independent living. Accessory apartments can be built with fall prevention and accessibility in mind making them a popular choice for families who have an aging loved one living with them. This allows an individual to live independently while still having caregivers close enough to address problems quickly. Many accessory homes are considered to be “home modifications” and can qualify for coverage using some payment options.
When Are Home Modifications Necessary?
Determining when minor home modifications are necessary can be challenging. Unless an individual needs home modifications as the result of an injury, their needs may not be apparent. An individual may not be forthcoming about the difficulties they are having in their own home and they may wait until an accident happens before they express any concerns.
Many seniors want to preserve their independent living for as long as possible and are not aware of the many options available that can help make this happen. As a caregiver or family member, it is important to ask a loved one about any difficulties they may be having at home so these can be discussed with their current healthcare provider. Sharing this information with their healthcare provider can help address problems early and prevent future issues.
Questions to ask yourself as you observe a loved one include:
- Are they struggling to get up from their seat or the toilet on their own?
- Can they reach their cabinets with ease?
- Are their faucets easily accessible to them?
- How long are they able to comfortably stand?
- Are they able to climb stairs safely?
- Can they walk with ease or are they struggling to navigate their home?
- Is it a challenge for them to open doors?
- Can they see well in their environment or is their vision impaired?
If you have concerns about their abilities in any of these areas, be sure to discuss these with both your loved one and their current healthcare provider. Planning some affordable home modifications to address these concerns could prevent a serious injury and even save their life.
How Much Do Home Modifications Cost?
To determine how much home modifications will cost, it is important to consider what modifications need to be done including the cost of equipment and labor and whether or not any equipment requires professional installation.
Home modifications to accommodate people with disabilities can cost as little as $100 (for a portable wheelchair ramp) up to $6,000 (for a shower stall). The American Disability Association notes that a bathroom is the room most frequently remodeled to accommodate a disability with a $9,000 national average cost to remodel. However, prices also vary by supplier and geography.
In addition to materials and equipment, many home modifications must be installed by a professional as noted above. Carpenters typically charge up to $70/hour, plumbers up to $65/hr., and electricians as much as $85/hour. Again, these rates can vary greatly from one geographic area to another. If a loved one requires significant modifications to their home to accommodate any difficulties with accessibility or functionality, they may be looking at thousands of dollars in remodeling costs.
Who Pays For Home Modifications?
Although even minor home modifications come at a significant cost, there are different resources available to help pay for these costs.
For many seniors, Medicare is the first resource they look to for financial assistance with home modifications. Unfortunately, Medicare’s basic coverage packages do not pay for home modifications. There are ways an individual can seek coverage for home modifications through their Medicare plan but these are an exception.
Many seniors make home modifications without the guidance of a physician and although these changes may greatly improve their safety, Medicare will not cover them because they are not prescriptions.
If an individual has Medicare Part B, they can use their plan to cover the costs of planning home modifications. For example, this could include the costs of hiring an occupational therapist to review one’s home layout and functionality and suggest potential improvements. This can help offset some of the planning costs of home modifications making the process more affordable.
To determine if a loved one’s home improvements are eligible for Medicare coverage, be sure to speak to their current healthcare provider. Only a licensed doctor or therapist can prescribe assistive technology devices or durable medical equipment, making them your primary resource for information. If a loved one’s physician doesn’t determine their desired solution as medically necessary, Medicare will not pay for it and the individual must pay for it on their own.
Low-income seniors who need home modifications may qualify for coverage with Medicaid. Medicaid operates differently in each state but many states offer Medicaid waivers to pay for age-in-place solutions. The most common programs are Home and Community-Based Services (HCBS) Waivers which are available to seniors in most states.
Medicaid created HCBS waiver programs to give seniors better access to home-based health care. Home modifications may qualify as home health care if they meet certain criteria. Federal guidelines govern HCBS programs but states can impose their own rules to regulate waivers as well. Whether or not an individual qualifies for an HCBS waiver depends on their condition, what they need covered, and where they live.
To qualify for an HCBS waiver, an individual must provide documentation that they require home-based care. Because Medicaid’s main purpose is to cover skilled nursing care, an individual must prove they are seeking an HCBS waiver as an alternative to facility-based care. Therefore, their healthcare provider must identify what home modifications are medically necessary before they can successfully apply for the program.
Not all states have HCBS waiver programs and those that do may vary in the criteria required for acceptance. Additionally, many states put a limit on how many people may receive HCBS waivers each year. Even if an individual meets all of the criteria and qualifies for a waiver, Medicaid is not obligated to provide an HCBS waiver to any individual since these waiver programs are not considered entitlement programs.
To learn more about HCBS waiver programs in your state, contact your local Medicaid office. Not all states offer HCBS waivers, but if an individual lives in a qualifying state and meets the necessary criteria, they could receive substantial assistance paying for home modifications.
The Department Of Veterans Affairs (VA)
The Department of Veterans Affairs (VA) offers numerous benefits to seniors with the goal of making health care more easily accessible to elderly veterans. One of the benefits they offer is home improvement loans and grants that are primarily used to pay for home modifications.
If an individual served on active military duty or if they are the surviving spouse of a veteran, they may qualify for a home loan or grant through VA. Typically, grant programs are preferable because they do not need to be paid back, however, applicants may need to meet a stricter set of criteria to receive these grants. Loans are awarded on different criteria and are more easily accessed, however, they operate like most loans and require repayment with interest.
VA offers 3 primary grants to elderly and disabled veterans:
- the Specially Adapted Housing (SAH) grant,
- the Special Housing Adaptation (SHA) grant, and
- the Home Improvements and Structural Alterations (HISA) grant.
Each grant has its own set of eligibility requirements and an individual may qualify for multiple awards if they meet certain criteria. However, there is a maximum dollar amount allowed for each grant. Grant recipients are not allowed to receive more than the maximum allowable amount in award money.
Specially Adapted Housing (SAH) Grant
Each type of grant is designed with a primary purpose. The SAH grant is intended primarily for senior veterans who need wheelchair access in their homes. Recipients may use the grant to modify their current home or they may build a new accessory home with their award.
To qualify for a SAH grant, applicants must have a service-related disability that impairs their mobility. This includes loss of function in at least one arm or leg or the amputation of a limb as a result of one’s service.
Not all elderly veterans who served on active duty are eligible for a SAH grant. Only elderly people with disabilities relating to their service may qualify for a SAH grant meaning many elderly veterans cannot receive this grant. It is important to note, however, that there is no statute of limitations on this grant meaning an individual may qualify if they suffered a service-related injury during their youth that becomes worse over time. The maximum amount allowable for this grant is $77,307 for senior veterans who own and reside in their own home and $33,937 for senior veterans who live with a family member.
Special Housing Adaptation (SHA) Grant
Much like the SAH grant, the SHA grant is only available to disabled veterans with service-related impairments. However, the SHA grant provides for different disabilities than the SAH grant and the two can be combined if an individual meets the criteria for both grants.
Rather than wheelchair accessibility, the SHA grant provides financial assistance to veterans who suffer from blindness, substantial respiratory issues, severe burns, and dexterity impairments. The SHA grant is primarily used to modify a veteran’s existing home but it can also be used to purchase a home with modifications already installed.
To qualify for an SHA grant, an individual must have served active duty in the U.S. military and sustained injuries such as blindness, loss of function in one’s hands, severe burns, or injuries to one’s respiratory system as a result of service. Similar to the SAH grant, there is no statute of limitations on qualifying for an SHA grant. Recipients may receive a maximum of $15,462 if they live in their own home or $6,059 if they live with a family member.
Home Improvements And Structural Alterations (HISA) Grant
Perhaps the most easily accessible VA assistance for elderly veterans is the Home Improvements and Structural Alterations (HISA) grant. Unlike the SAH and SHA grants, a HISA grant does not require recipients to have service-related disabilities. Rather, it is open to any elderly veteran who suffers from disabilities and meets the qualifying criteria meaning elderly veterans with age-related impairments can also apply.
The HISA grant does not specify which impairments a recipient must have. To qualify, recipients may receive a HISA grant to assist with any medically necessary home modifications. These modifications may include installing handrails and/or shower benches, widening hallways and doorways, improving lighting, installing easy-to-use light switches, and many other home improvements. As long as an applicant is a veteran and a VA physician determines that specific home modifications are medically necessary, an individual would be eligible to receive a HISA grant.
To be considered for a HISA grant, an applicant must submit a prescription from a VA physician outlining their need for home modifications. To qualify, they may live in own their own home or they may live in a family member’s home, however, they will require authorization from the homeowner stating permission is granted to modify the premises.
The maximum limit for a HISA grant depends on whether a recipient's disability is service-related or not. Recipients with service-related disabilities are eligible for up to $6,800 in benefits while recipients with disabilities unrelated to service are eligible for up to $2,000.
Housing And Urban Development (HUD) Home Improvement Loans
Also known as Federal Housing Authority (FHA) loans, Housing and Urban Development (HUD) Home Improvement loans are another financial resource for seniors looking to age-in-place. These loans are made possible by the Federal Housing Administration (FHA) which ensures private loans given out by private lenders. This protects consumers from default making it easier for individuals without perfect credit to qualify for loans.
These loans are not subsidized by HUD and are issued from private lenders and are treated like private loans. HUD insures these loans so lenders are more likely to approve applications they would otherwise reject. When a loan is protected against consumer default, lenders may be more lenient in approving loans.
To qualify for a HUD Home Improvement loan, an individual needs to meet the program requirements and the requirements of the HUD-approved lender. HUD requires all applicants to own the home they intend to modify or they must have a current lease extending at least six months past the loan repayment date.
Once these criteria are met, an individual needs to determine which lender meets their needs and attempt to gain loan approval. Eligibility requirements for lenders vary, however most lenders typically require a certain credit score or amount of monthly income to approve a loan.
If an individual qualifies for a HUD Home Improvement loan, they may borrow up to $25,000 to modify a stand-alone house or up to $12,000 for an apartment, townhouse, or condominium. They may use the loan proceeds to pay for any modifications that make their home safer and more accessible.
Rural Housing Repair Loans And Grants
Similar to the HUD Home Improvement loan, the U.S. Department of Agriculture also offers a financial assistance program to disabled seniors in need. The Rural Housing Repair Loans and Grants program offers financial solutions to low-income seniors living in rural areas.
While these loans are available to people of all ages, these program grants are only accessible to individuals 62 years or older. Grants in this program do not require repayment while loans must be repaid over 20 years at 1% interest. Loan applicants may borrow up to $20,000 for home modifications while RHRR grants are capped at $7,500. Those who qualify for both a loan and a grant may receive a total of up to $27,500.
If awarded a loan or grant, the recipient may use the loan or grant to pay for any changes made to their home to improve safety and remove hazards. To apply for a Rural Housing Repair loan and/or grant, visit the Department of Agriculture’s website for more information.
Community And Non-Profit Assistance
It is common for communities to offer non-profit assistance programs to help disabled individuals access equipment they need. Carpenters, plumbers, and electricians may offer their services free-of-charge or the organizations may offer grants and other types of financial assistance. These programs vary by location and are generally governed by local regulations.
Rebuilding Together sponsors three main programs: Heroes at Home, Safe at Home, and National Rebuilding Day. Each program has its own set of qualifications and criteria and is typically targeted at helping low-income families. The Sears’ Heroes at Home program provides assistance to veterans and their families allowing them to make their homes more wheelchair accessible. The Safe at Home Program assists primarily low-income seniors who are living in unsafe homes and require home modifications to make their homes more habitable. This program generally covers small improvements such as the installation of handrails or shower benches.
Another Rebuilding Together initiative is National Rebuilding Day which happens each year in April. The event lasts between one and three days during which volunteers from around the country offer their service to modify homes for the disabled. These non-profit remodels are reserved for low-income families, seniors, and adults with disabilities. They typically target single-day remodels which include projects such as the installation of grab bars or changing of door handles, however, they do not assist with more complex home improvements.
To learn more about Rebuilding Together and the assistance programs they offer, visit this website.
Personal Injury Settlements
If an individual was recently injured as a result of someone else’s negligence, they may be entitled to a personal injury settlement. Many seniors are injured as a result of poor care and if they choose to file a personal injury lawsuit, they may include the costs of their home modifications as part of their lawsuit.
For example, if an individual may have been mistreated during a respite stay in a nursing home or assisted living facility. As a result, they may need to use a wheelchair to compensate for their impairment. In this situation, they would be able to sue for the cost of the wheelchair and the costs of remodeling their home to accommodate the wheelchair.
Personal injury cases and settlements are not applicable to everyone but for those who find themselves in this unfortunate situation, it may assist in covering some relevant home improvement costs.
If the costs to complete home modifications are very high, they may consider applying for a reverse mortgage. A reverse mortgage can cover tens of thousands of dollars in remodeling costs but are not as easily accessible as many of the other payment options available to seniors. In addition, they often carry high-interest rates.
Reverse mortgages allow individuals to take out a loan against the equity of their home. These loans enable individuals to access large amounts of money in a lump sum but these loans must be repaid once the borrower sells their home. Alternatively, the loan also becomes collectible if the borrower moves away from their home for twelve continuous months. Therefore, an individual must carefully consider the implications and conditions of a reverse mortgage prior to applying for one.
While reverse mortgages are not for everyone, they can provide financial assistance for those who need significant home improvements to accommodate their needs. They are generally not a viable option to pay for small remodels.
Home Modifications FAQs
1. Can my loved one modify a rental unit?
Disabled residents of apartments and other rental dwellings are protected by the Fair Housing Act and are allowed to modify their homes to reasonably accommodate their disabilities. Changes must only be made within reason, which may limit some individuals from fully renovating their units. For example, a landlord cannot prohibit a resident from installing a grab bar in a bathroom, however, they do not have to permit installation of a new shower or bathtub. There are legal guidelines to protect a resident’s right to reasonable accommodation, however, your loved one should discuss any renovation plans with their landlord to clarify what is allowed before beginning.
2. Will home modifications allow my loved one to live independently long-term?
It is impossible to know the future of your loved one’s health, however, home modifications are an effective way to reduce their risk of injuries and maintain their independence. Some older adults are able to live their remaining retirement years at home as a result of a home remodel while others may require professional assistance despite the home modifications they have made to accommodate their needs. Whether your loved one can live at home long-term as a result of home modifications or not depends on their health and ability to live independently, the equipment they choose to install, and how effectively the equipment helps them live independently.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.