Home Modifications and Outdoor Falls

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Home ModificationsandOutdoor Falls
Jon Pynoos, Ph.D. Co-Director, Fall Prevention
Center of Excellence USC Ethel Percy Andrus
Gerontology Center 3715 McClintock Avenue,
228 Los Angeles, California 90089-0191 www.stopfa
lls.org
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Home Modification Delivery System

• Fragmented
• Under funded
• Geographic gaps
• Gaps in coverage
• Programs have different eligibility requirements
• Difficulty in securing professional assessments
  by OTs and PTs

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Sources of Funding forHome Modifications

• Individuals
• Out of pocket
• Medicaid waivers
• Long Term Care Insurance
• Veterans Affairs
• HMOs
• Civic, advocacy, trade groups (money, donated
  materials/labor
• Kiwanis, disability groups (e.g., Multiple
  Sclerosis), building supply companies

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Sources of Funding forHome Modifications

• Individuals continued
• Equity financing--mortgage refinancing, home
  improvement loans, equity lines of credit
• Reverse equity loans
• Tax deductions

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Sources of Funding forHome Modifications

• Programs
• Community Development Block Grants
• Administration on Aging Title III grants
• Medicaid Waivers
• State Rehabilitation Services Programs
• Job Corps, Youth Build
• Donated labor/materials
• (e.g., Rebuilding Together)

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Types of Home ModificationProviders

• Government A variety of auspices
• AAAs
• City Housing, Community Development
• Departments
• Redevelopment Agencies
• Community Action Agencies
• Housing Authorities
• Energy Conservation/Weatherization
• Injury Prevention Programs (e.g., CHIPPS)

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Non-Profit Home Modification Providers(usually
with funds from government)

• Neighborhood Housing Services
• Centers for Independent Living
• Voluntary/Charitable
• Rebuilding Together, Habitat for Humanity, Jewish
  Family Services, Rotary Clubs, etc.
• Sometimes provide specialty services such as ramp
  building

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Private Home Modification Providers

• One-stop home modification providers (e.g.,
  Access Design and Consulting, Santa Monica)
• Medical supply companies (e.g., grab bars, bath
  benches)
• Specialty companies (e.g., stair glides, lifts,
  elevators)
• Individual providers (some who are NAHB Aging in
  Place Specialists or have taken USCs Executive
  Certificate in HM program)
• Remodelers, Contractors, Handworkers, Architects,
  OTs, PTs

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Outdoor Falls What is the Problem?

• Although reporting is inadequate, about 45 of
  falls occur outside, with about 23 near the
  house (e.g., backyard, sidewalk) and 22 in the
  community

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Outdoor Falls What is the Problem?

• Falls due to modifiable conditions
• Poor lighting
• Debris from trees
• Poorly maintained sidewalks
• Unmarked hazards
• Uneven steps
• Unsafe stair design (lack of handrails)

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What Can We Do to ReduceOutdoor Falls?

• Collect Better Data Identify hazardous
  conditions
• Improve Conditions
• Replace faulty lighting and add more
• Remove tree debris
• Provide more benches, respite islands
• Mark hazards (curbs, steps, parking stops)
• Improve maintenance (sidewalks, tree wells)
• Offer yard service and suggestions for private
  owners
• Install ramps, handrails, lifts in places such as
  private buildings
• Plan more livable communities based on Universal
  Design

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What Groups Should be Involved?

• Health (ER, Paramedics)
• Recreation and Park Departments
• City Street, Sidewalk, and Tree Management
  Departments
• Engineering/Public Works/Transportation
  Departments
• Risk Management Personnel (reporting)
• Business Improvement District Representatives
• Zoning/Code Enforcement
• Transportation providers (MTA, Dash, etc.)
• City Planning and Redevelopment Agencies