Page Reviewed / Updated - Aug. 2019
Home modifications are physical changes made to one’s home to accommodate for the changing needs of the elderly or disabled, to enable aging in place. As we age, our mobility and physical strength diminish and many aspects of a home that were once functional become difficult. Home modifications can be as simple as changing water faucet handles from knobs to levers or as comprehensive as the construction of an accessory apartment or elder cottage on the property.
There are many different types of modifications that can be made to accommodate for aging challenges. While not comprehensive, the following list is included to give readers an idea of common changes.
While it is possible and tempting for the non-professional to assess the modifications required to make a home both accessible and safe for the elderly, the use of a professional occupational therapist can be worth the additional effort and is sometimes paid for by Medicare. There are two major considerations. First, it is important to recognize that aging is a progression, and modifications to accommodate needs today might not be sufficient for needs two years in the future. Being able to project how one’s needs will change is of critical importance if one hopes to make lifelong modifications in a single project.
Second, knowledge of assistive technologies is critical. There are many devices on the market today and importantly, a flood of new options become available each year. To make the most cost-effective modifications, one needs to be aware of the full breadth of products on the market today, but also the tools that will be available in the near future.
Fortunately, there are many sources of assistance for making modifications to one’s home to accommodate elderly and/or disabled persons. Prior to discussing these, it is helpful to distinguish between the types of assistance that is available.
1. Low Interest Loans - Some organizations, mainly governmental, offer low interest loans for home modifications or guarantee loans so that banks are less restrictive with their lending requirements. These are loans, and therefore, need to be paid back.
2. Home Improvement Grants - These grants are typically one-time, available for a specific home modification purpose, and do not need to be re-paid.
3. Free Labor - Another form of assistance is free labor to make home improvements. This is commonly offered by non-profit organizations or charities. Materials are not covered. The building of a wheelchair ramp is a common example.
4. Equipment Loans - Some organizations make free, long term loans of home modification materials. As an example, a portable wheelchair ramp that does not need to be returned until the borrower moves from their home or no longer requires use of it.
Most people immediately think of Original Medicare as a potential source of financial assistance. Unfortunately, Original Medicare typically does not pay for the cost of home modifications. However, there are some exceptions to this rule. Medicare may pay for assistive technology devices that are part of the modification process provided they are required for medical reasons and prescribed by a doctor. One might also receive assistance from Medicare in determining what home modifications are medically required. Medicare Part B will pay for an occupational therapist to evaluate a home and determine what changes are required. In fact, in 2018, Medicare lifted the caps on occupational therapy. Finally, in some rare instances, Medicare will pay for bathroom modifications and walk-in tubs. Learn about more paying for walk in tubs or stair lifts specifically. However, to be clear, the vast majority of home modifications for the elderly are not paid for by Original Medicare. If assistance is provided, it will be for the hardware associated with the modification, not for the construction component.
However, there is good news when it comes to Medicare Advantage (MA) plans, which are available via private insurance companies. Also called Medicare Part C, MA plans offer all of the same benefits as does Original Medicare, but also commonly offers additional benefits that Original Medicare does not. Beginning in 2019, the Centers for Medicare and Medicaid Services, abbreviated as CMS, allowed MA plans to offer supplemental health benefits, which could include home modifications, for recipients that demonstrated a medical need. Taking it a step further in 2020, MA plans will be able to further expand their supplemental benefits to include non-medical benefits for chronically ill persons. However, the benefit must provide “a reasonable expectation of improving or maintaining the health or overall function” of the person receiving the benefit. It is our belief that home modifications will be an available benefit via more MA plans beginning in 2020. However, it is important to note that MA plans vary by state, and even the plans within a particular state do not offer identical supplemental benefits.
Medicaid is a federal and state insurance program that offers assistance to low income seniors. The program was originally intended to help the elderly who require nursing home level care to afford nursing home care. Now most states have Home and Community Based Services (HCBS) Waivers or offer at-home services through managed Medicaid programs or Medicaid State Plans. These programs provide assistance to help qualified individuals avoid nursing home placement and remain living at home. As such, in many states, they pay for home modifications which increase an individual’s ability to live independently. Each state has different waivers and programs with different eligibility requirements and benefits. See a complete list of Medicaid programs that cover home modifications. Note that in Medicaid-speak, home modifications are often referred to as Environmental Accessibility Adaptations.
There are home modification assistance programs available to veterans from both the Veterans Administration and from unassociated, non-profit organizations that serve veterans. The VA provides multiple grants including SAH Grants, SHA Grants, and HISA Grants for this purpose. Also available are Veterans Directed Home and Community Based Services (VD-HCBS). This program provides veterans with financial assistance to help them remain living in their homes and provides them with a certain amount of discretion to use those funds as they see fit. Making home modifications to accommodate for a disability would be an acceptable use of funds regardless of whether or not their disability was connected to their military service. Learn more about Veterans Directed programs. Veterans pensions, such as Aid & Attendance, offer one-time bonuses for “unreimbursed medical expenses”. Should a home modification be a medical necessity, veterans receiving a pension can receive a temporary increase in benefits to cover the cost. Finally, the national, non-profit organization, Rebuilding Together, offers home modification assistance both in the form of labor and some materials to U.S. veterans through its Heroes at Home Program.
Many state governments and several agencies within the federal government have programs that help seniors with home modifications. The Department of Housing and Urban Development offers HUD Home Improvement Loans, and the U.S. Department of Agriculture has Rural Repair and Rehabilitation Grants. Many states have a category of assistance programs referred to as nursing home diversion programs. These programs, as their name implies, are intended to prevent or delay nursing home placement, and as such, they offer financial assistance and support services to help the elderly remain living at home. Some of these programs include home modifications as a benefit. A complete list of those that do is available here. Unfortunately, not all states offer programs.
Many non-profits and other organizations offer assistance in the form of financial aid or volunteer labor to help seniors with home modifications. One of the most noteworthy is the organization Rebuilding Together (originally called Christmas in April) which offers 3 programs: Safe at Home, Heroes at Home, and National Rebuilding Day. Another option is community building projects, which provide seniors with volunteer labor to help them make home improvements.
Reverse mortgages are an option for home modifications to enable aging in place. However, these only make sound financial sense in certain situations. If the homeowners move from their residence for a period of 12 consecutive months, a reverse mortgage becomes due. Therefore, it only makes economic sense to use a reverse mortgage in order to make home modifications that will enable a senior (or their spouse) to continue living at home for a minimum of several years. Homeowners should be aware that in some circumstances the cost, or a portion of the cost, of home modifications for the elderly are tax deductible. Read more about this and other miscellaneous home modification assistance resources.
While the cost of a home modification can range dramatically depending on the type of modification, what many people fail to realize is that the cost can, and should be thought of, as having two components: the labor cost to make the modifications and the materials cost. This is an important distinction because materials for a modification can often be classified as durable medical equipment (DME), and if so, a different category of financial assistance becomes available. For example, when adding a stair lift (or stairglide), there is the cost of the chair and the sliding track, and there is the cost to install it. The stair lift may be covered as durable medical equipment, while the labor to install it most certainly would not be covered. Read more about financial assistance for DME.