Blue Print for ACTION

Executive Summary

"Too often older or disabled people live limited lives or give up their homes and neighborhoods prematurely because standard housing of the past cannot meet their needs."

Ronald L. Mace, FAIA, Architect and Product Designer, The Center for Universal Design

Our society's changing demographics include the aging of our population and a greater number of persons with disabling conditions. As a result, many people experience obstacles in their homes that are inconvenient, limiting, and dangerous. They are beginning to realize that their homes can better support their needs through home modifications; that they can remain in their homes and neighborhoods rather than move to more institutional settings.

The number and types of individuals who need home modifications will grow dramatically over the next 20 years -- families with children with disabilities, adults with disabilities, middle-aged couples planning for the future, families who accept aging parents into their homes, and an increasingly older population aging in place. All are seeking homes that are attractive and offer them convenience, safety, ease-of-use, continued independence, and retained value.

The ability to meet this growing need for home modifications is hampered by lack of information, limited funding, and inadequate services. Because these barriers are interlinked, a complex scenario evolves that negatively affects the availability of home modifications.

In response to these issues, The Center for Universal Design convened the "First National Conference on Home Modification Policy" in November 1 993. This conference addressed the growing gap between the need and available assistance for home accessibility. The conference brought together policy makers, professionals, and consumers with a common interest in bridging this gap. The conference resulted in a commitment to continue exchanges among the participants and work toward a national agenda for increasing the availability and funding for home modification services.

A second national conference, "A Blueprint for Action: The Second National working Conference on Home Modifications Policy," took place on April 22-23, 1996 in Washington D.C. Over 60 of the nation's leading experts in disability, aging, housing finance, remodeling, design and construction, community development, and long term care participated. Planned by the National Home Modifications Action Coalition, this conference provided the opportunity to develop home modification agendas at community, state, and national levels. Participants shared service delivery strategies and models that have proven successful in diverse communities.

The conference was organized around four key themes-Consumer Knowledge, Funding, Service Delivery, and Systems Change. This report, A Blueprint for Action, was developed from the background papers written on the four themes, discussions, and working groups at this second conference. Portions of the papers are excerpted. This report includes a discussion of barriers and recommendations for national, state, and community change. Its use is intended to increase the availability and affordability of home modifications for individuals of all ages. A Blueprint for Action reflects the diverse perspectives and approaches of the many experts who have contributed to the conference and the papers. Most importantly, A Blueprint for Action is an action plan for promoting home modifications through coalition building and sustained and coordinated activities.

RECOMMENDATIONS

The major recommendations fall into five areas. Initiatives can be established at the national, state, and community levels.

I. Leadership and Coalition Building

Forming a national, state, or local coalition with specific goals and objectives is an effective way to promote the availability of home modifications.

A critical first step is the presence of an organization(s) willing to lead a coalition whose priority is increasing the availability of home modifications.

A small working group should be formed that can share leadership and costs and give credibility to the coalition.

This leadership group should conduct research and draft a status report of needs and barriers to home modifications in the geographic area.

Finally, an action plan that includes both a 5- to 10-year time frame and shorter term objectives should be developed.

II. Research

Coalitions should assess needs, determine the status of services and resources, and demonstrate effectiveness of home modifications. Results of this research should be brought to policy makers and program developers to shape future legislation, regulations, and certification rules.

Research should identify:

Consumer characteristics and needs

Resource gaps
Level of consumer knowledge
Remodeler, health, or social service worker expertise
Awareness on the part of elected officials
Level of inter-agency coordination

Old man and Wife reading a magazine Research should indicate the best methods of service delivery, Evaluation studies can detail how home modifications are cost effective and how they positively affect quality. The added value of universal design needs to be demonstrated if remodelers and consumers are to get more involved in increasing home modifications.

III. Education

Education, marketing, and promotional efforts should:

Stimulate educated consumers to demand quality products and home modifications;

Allow remodelers, program staff, medical personnel, and aging advocates to provide effective advice and services; and
Inform policymakers such as funders, program managers, lenders, medical insurers, and legislators about the need, broad constituency, and the cost effectiveness of home modifications.

Information and referral centers should be established as central places for consumers, service providers, and policymakers to get timely research and home modifications information. These centers should:

Publish an annually-updated funding, finance, resource, and organization directory for both professionals and consumers;

Establish a toll-free information and referral service;
Establish housing design awards programs, linked with industry awards, and document and publicize notable success stories; and
Develop Internet websites to disseminate information.

High impact training programs and materials should be developed to cross-train social service, health care, and building professionals, as well as consumers. These training programs can help professions adopt continuing education requirements in home modifications and universal design.

IV. Funding

Funding and financing efforts should focus on developing new sources and reshaping and fully accessing existing sources.

Pencil & paper Representatives from funding and financing agencies and organizations should be part of the coalition, such as banks, housing finance agencies, and public and private medical insurers.

Coalitions should encourage health care payers, including Medicare, to continue paying for existing equipment and assistive devices and cover additional home modifications that help prevent accidents or forestall institutionalization. Existing expenditure caps and restrictions in the Medicaid Waiver program should be lifted.

Coalitions should advocate for private insurers to allow medical insurance payments or reimbursements for home modifications. Research data should be collected to determine cost effectiveness.

State housing agencies should add accessibility as a contributing feature to the application criteria of competitive funding programs. This will encourage communities who wish to access block grant funds from the U.S. Department of Housing and Urban Development or the U.S. Department of Health and Human Services to add modification features to their programs.

Members of the Federal Home Loan Bank (which includes most commercial banks, Savings and Loans, and others) should partner with non-profits to obtain funding for special financing for accessible housing projects.

The Community Reinvestment Act (CRA) requires most banks to make loans to underserved members of their community which can include persons in need of home modifications. Organizational rather than individual approaches to banks can help take advantage of the CRA.

Housing Finance Agencies may be in a good position to promote home modification programs for low- and moderate-income households. The number and variety of their possible funding sources and the flexibility in their use holds great promise.

Coalitions should guard against over reliance on federal funds. As needs grow, additional funding streams from states' general revenues should be tapped. A few states, notably Massachusetts and Kansas, currently have pending legislation to promote home modifications through state tax allocations and tax incentives.

Approach organizations such as Habitat for Humanity and Christmas in April chapters to have them add home modifications to their activities.

Create Community Housing Development Organizations (CHDO) with a home modification/home repair focus. The CHDO can seek funding from a variety of sources including designated HOME funds from the U.S. Department of Housing and Urban Development.

V. Service Delivery

Service delivery efforts should concentrate on developing practitioner expertise by promoting uniform and accurate assessments and producing successful home modification projects that demonstrate quality and efficacy.

Coalitions should target and educate health care professionals (e.g., physicians, nurses, hospital discharge planners, home health workers), social service personnel (e.g., case managers), and workers in the building industry (e.g., remodelers) to become more aware of how to assess problems environments present for their clients.

Consumers, remodelers, medical staff, and professionals in the housing sector need to be convinced that modifications can add and retain value to homes and reduce the need for future remodeling. Successful models illustrating best practices make it easier for other programs to avoid pitfalls and develop more rapidly. if costeffectiveness can be proven, health plans would be encouraged to form contractual alliances with product suppliers and home modification service programs, potentially leading to reduced prices for adaptations.

Both challenges and possibilities lie ahead for home modifications. The National Home Modifications Action Coalition has developed A Blueprint for Action to stimulate the thinking and activities of professionals and organizations to take action; to increase the availability and affordability of home modifications for individuals of all ages.

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