Home Modifications and Outdoor Falls

1. 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.stopfalls.org

2. 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

3. 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

4. Sources of Funding forHome Modifications Individualscontinued • Equity financing--mortgage refinancing, home improvement loans, equity lines of credit • Reverse equity loans • Tax deductions

5. 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)

6. Types of Home ModificationProviders GovernmentA variety of auspices • AAA’s • City Housing, Community Development Departments • Redevelopment Agencies • Community Action Agencies • Housing Authorities • Energy Conservation/Weatherization • Injury Prevention Programs (e.g., CHIPPS)

7. 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

8. 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 USC’s Executive Certificate in HM program) • Remodelers, Contractors, Handworkers, Architects, OTs, PTs

9. 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

10. 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)

11. 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

12. 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