Blue Print for ACTION

Importance of Home Modification

"Less than 10% of the 100 million existing residential units have modification features in them."

The Status of Home Modification

Modifying existing homes, building new universally designed homes, producing more usable products, and providing a variety of home-directed services all enhance our ability to live and remain in our homes as long as possible. Until our supply of universally designed homes increases, home modifications will occupy a unique position in the above mix of approaches for the next 50 years or more.

Handicapped person by a house picture The number of people who can benefit from home modifications grows annually and is not expected to peak until the mid-21st Century. As of 1992, there were more people over the age of 65 than under the age of 25 for the first time in our nation's history (Pirkl, 1992). By the year 2000, fully one-third of the country's population will be either disabled, chronically ill, or over 65 years old (Mueller, 1990). There is ample evidence of the current and growing need for accessible and adaptable housing that includes on-grade entrances, wider doorways and hallways, bathrooms with maneuvering room and blocking in the walls for grab bars, and kitchens with manueuvering room and multiple work surface heights. However, neither housing regulations nor market demand are creating many newly-built accessible or universally designed residential units each year. Less than 1O% of the 100 million existing residential units have modification features in them (LaPlante, Hendershot and Moss, 1992). Few of the over one million new units that are produced each year have significant access features (Duncan, 1994). If housing and demographic trends continue, the current gap between the number of Americans who would benefit from accessible housing and the number of accessible housing units available will grow even larger. For many households, this housing gap may result in a huge expense when when remodeling their homes for accessibility. Others may be forced to move, unwillingly, to other units, other towns, or long term care facilities because their houses have become an impediment or an actual danger to them. By moving , they may have to give up their neighbors, communities, and public and private services that have taken years to establish While Americans move frequently, experience tells us that few choose to move willingly because of access or safety problems in their homes. Still others, with neither the means to modify nor the money to move, will live constrained and unsafe lives because of their homes

Old man and a baby reading picture Proponents of home modifications believe that health care cost reductions are possible if home modifications proliferate. In a preventative manner, they help people avoid injuries and reduce their use of medical services or institutional care. Recent trends have individuals returning home from the hospital with more acute conditions. Accessible, safer homes make it possible for some to leave rehabilitation or nursing settings to homes that support their recovery and lessen additional injuries or secondary disabilities, saving money, too.

Organizations with diverse and critical constituencies recognize the importance of home modification availability. The American Association of Retired Persons (AARP) has designated home modifications as one of five focus areas in their Connections for independent Living program. In their 1996 national summit on disability policy, The National Council on Disability prominently featured accessible housing, home modifications, and assistive technology in their policy recommendations, which included the areas of tax policy, business incentives, research, and universal design. The National Association of the Remodeling industry has added a Universal Design Award to their Contractor of the Year Awards program, recognizing well-des'gned universal remodeling projects. The American Occupational Therapy Association has developed new instructional materials and resources for assessing the home and teaching practitioners about home modifications. While this recognition signifies the seriousn ess of home modifications issues, these organizations must remain focused, and others need to join in efforts to spread information and promote home modifications.

Finally, the usefulness of home modifications may be tied to the availability of other homeand community-based services. Households that can benefit from changes in the home may need other assistance, too. Modifying homes or using assistive technology are just two of several related efforts that may be needed to maintain people's independence and safety and foster community integration. Additional efforts include the use of home health, homemaking, and home maintenance services, as well as access to transportation. For example, people whose vision prevents them from seeing the controls of a microwave may benefit from additional lighting, auditory alerts, or tactile controls throughout the home. Their vision may prevent them from driving, too. Going to the grocery store, getting to work or to a doctor may be difficult or impossible. Their home may have been adapted but their access to community services may be unresolved. Despite a nicely modified home, they may be forced to mo ve closer to those services or where these services are available at home. Thus, the goal of maintaining people in their homes can be met when home modifications are considered along with the availability of related services.

The Need for Home Modification

AARP's annual member surveys consistently reveal a strong preference by seniors to remain in their homes-to "age in place" (AARP, 1 996). In 10 years of surveys, over 80% of respondents expressed this preference. Households of all ages have roots in their communities and strong emotional ties to their homes. They prefer to remain where they are. Few people want to move solely because their house no longer fits their needs.

The problems faced by older individuals are compounded by the fact that they live in the oldest housing stock. These homes may have deferred maintenance, with roof or plumbing leaks, heating deficiencies, or dangerous electrical problems in addition to a lack of adequate lighting, railings, storage, and other accessibility concerns. Modification needs may get lost among many other pressing maintenance items, prolonging dangerous arrangements that may lead to falls and malnutrition or isolation within the home or the community.

The large and growing population of seniors and people with disabilities is increasing faster than the growth of the general population. This group is growing in absolute numbers and as a percentage of the total population. Baby Boomers will increasingly enter the ranks of older Americans over the next 40 years until, by the year 2030, people over the age of 65 will number 55 million and comprise over 18% of the total population (McLeroy and Crump, 1994), up from approximately 26 million and 11% respectively in 1980. Reasons for this increase include improvements in nutrition and health care of adult and older citizens, the improved health care and survival of infants and young children (McLeroy and Crump, 1994), and the aging of the Baby Boomer generation. Improvements in medical technology will allow more persons to survive serious accidents and illness with disabling conditions and live for long periods of their life with disabilities.

The Americans with Disabilities Act (ADA) asserts that 43 million Americans, about 17% of the population, have disabling conditions. Varying estimates abound, according to the definition of disability or the methodology of the study. Studies yield figures ranging from 8 to 92 million people with disabling conditions (Elkind 1990, LaPlante 1993, Pope and Tarlov 1991). Current census-based estimates suggest a midrange figure of around 50 million people or about 18% of the population.

Woman on Crutches picture These striking figures under-represent the number of beneficiaries because they do not account for an individual's need for supportive environments over the life span. Zola (1993) rejects an over-reliance on demographic figures, discounting almost all attempts at quantifying as inaccurate and arbitrary. He uses the virtual inevitability of everyone's eventual acquisition of a disabling condition as the rationale for characterizing those without a current disability as merely "temporarily able-bodied." For Zola, the question of disability "...is not whether but when, not so much which one but how many and in what combination." if the numbers are not persuasive, perhaps the nearly universal likelihood of a disability, permanent or temporary, during one's life span is convincing. Everyone is likely to benefit from a modified home at one time or another.

Supply

Households faced with the decision to modify their existing home or buy one that can be more easily adapted (the "improve or move" choice) are likely to find few accessible or substantially accessible homes to choose from. Limited codemandated or market-based accessible new construction usually yields a small pool of potential homes in most communities. Fewer than 10% ol the 100 million existing units are accessible or adapted (LaPlante, Hendershot and Moss, 1 992). At the same time, there are few providers, programs, or experienced remodelers who can help modify existing homes.

New Accessible Housing Since 1988, all Americans have benefited from significant and well-publicized federal legislation. While the ADA principally affects non-residential construction, the 1988 Fair Housing Amendments Act (FHAA) focused on the provision of newly built, accessible housing in multiunit developments and put a single national umbrella over various state and federal housing accessibility laws. This legislation offered the promise of many new usable units becoming available annually. Unfortunately, for those who need accessible housing, the effect of the FHAA has been relatively small. Limited jurisdiction results in far less inan 20% of residential new construction each year failing under FHAA design guidelines (Duncan, 1994). Anecdotal evidence shows that, even with those units that should conform, compliance records are disappointing.

Un-Regulated Housing over 80% of all new housing produced each year is built without failing under federal, state, or local access requirements. As a result, few of these units have any accessible features. For this new market-driven housing, access features and products will be added only through buyer demand. Builders indicate that the home buyer has yet to demand accessible new homes, thus, they do not currently view supportive features as useful selling points. There are promising signs in the increase of homes with first floor bedrooms and bathrooms, but it is not clear that this is because of an appreciation of long term usability. Few additional universal features are being included. Developers are not building universally-designed speculative projects and few consumers can afford the custom housing that might result in more supportive homes.

Demand

Households have few Options for universallydesigned homes in the new housing sector, but despite growing need, few consumers seem to be requesting home modifications, either. Why are the many people who could benefit from modifications not demanding access features? First, the demographics are skewed. The population of people with disabilities is, in reality, a very diverse group. The group encompasses those with physical, sensory, as well as cognitive disabilities. it includes those with mobility impairments, grasp and reach limitations, and vision and hearing problems. They represent all ages, income levels, family types, and residential locations. They do not represent a large homogenous group that can be targeted with a single marketing or design concept because the home modifications and products they are seeking span an extremely wide range.

Second, it is a mistake to confuse the population of people who could benefit from more universal housing with those who recognize housing design as an issue and who will seek it out in the marketplace. Relatively few people, at any point in time, have serious enough impairments to seek products or a housing change. The one million people who use wheelchairs (LaPlante, 1992) represent a fraction of the population of people with disabilities. However, these individuals and others with severe impairments are most likely to recognize their needs and act to make changes. They are few in number. The otherwise independent person who may benefit from a grab bar or stair railing is not acutely aware of his or her needs.

Ramp walkway picture Third, lack of information and lack of awareness, not lack of need, contributes to low demand. Most people still do not know about home modifications and assistive technology. They do not know where to buy quality products, where to get financial assistance, where to tap other resources, and where to find skilled practitioners. As a result, they do without, move away, or put up with ugly, inappropriate, inadequate, or unsafe alterations.

For a household needing a more supportive living environment, the limited amount of universally-designed existing homes to choose from means that modifications can be an important alternative. Constant attention to information dissemination will push many of those who can benefit from modifications into demanders of high quality products, and design and modification services. If those who manufacture products and provide services are prepared to meet the demand, a more successful supply-demand cycle will result.

Continue