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What home and/or community strategies or modifications are most important to reduce the risk of falling and how can policymakers encourage their widespread adoption? View the full forum.

By Kathleen Cameron

Falls present a real and growing risk to older adults’ health, quality of life, and independence. Falls result in significant costs to our nation’s health care and long-term services and supports systems, amounting to $34 billion in 2013. The good news is that many falls can be prevented. Through its Administration for Community Living-funded National Falls Prevention Resource Center, the National Council on Aging (NCOA) is engaging health care and aging network professionals, as well as older adults and caregivers in awareness, education and prevention efforts.

In April, NCOA hosted the national Falls Prevention Summit, a White House Conference on Aging event that brought together experts in aging, falls prevention, health policy, and environmental design, among others. The purpose of the Summit was to update the 2005 Falls Free National Action Plan. The new National Falls Prevention Action Plan provides a framework for action for falls prevention and envisions older adults experiencing fewer falls and fall-related injuries, maximizing their independence and quality of life.

The updated Plan includes 12 broad goals, 40 strategies and over 240 action steps focusing on increasing physical mobility, improving medication management, enhancing home and environmental safety, increasing public awareness and education, and funding and expansion of falls risk screening, assessment, and evidence-based programs to prevent falls.

A key component of the Plan is improving home safety to reduce home hazards, improve independent functioning, and lower the risk of falls. Home safety efforts include information dissemination and education, assistive technology/equipment, home assessments and home modifications, such as installing grab bars, roll-in showers, and stair lifts, improving lighting, raising toilet seats, and widening doorways.

A major barrier to these efforts has been lack of funding in general and disparate funding sources across the country. For example, local Area Agencies on Aging may offer home modifications as part of the services under Title III and the Family Caregiver Support Program of the Older Americans Act. Each state and local jurisdiction may offer a slightly different array of services and qualifying criteria for participants that may vary significantly from one service area to another.

The U.S. Department of Housing and Urban Development awards Community Block Development Grants (CBDG) to eligible city and county housing and community development departments to revitalize neighborhoods and improve community facilities and services. Communities develop their own funding priorities, and some choose to provide home modification programs with part of their CBDG funds.

State Medicaid programs also vary in their approach. Most states offer Home and Community Based Services (HCBS) through a waiver program; home modifications are one of the services states can offer through waiver programs. The amount of funding available for the home modification services may vary by state, age, diagnosis, and income. In addition, Medicare beneficiaries who have had a change in functional status may qualify for an occupational therapy evaluation and intervention plan under the Medicare Part B. Part of the services recommended may include home modifications but Medicare will not pay for the actual home modifications.

Building on these and other funding sources, the 2015 National Falls Prevention Action Plan calls for greater Medicare and Medicaid coverage for home assessment and modification services, including approaches such as “money follows the person” that provide consumers with more discretion in the use of Medicaid expenditures for purposes such as home modification, the inclusion of home modifications as a benefit under managed care and other new models of service delivery, and greater insurance reimbursement of home modifications (e.g., long term care insurance). In addition, the Plan advocates for greater private/public partnerships to fund tool development, dissemination, educational programs, and outreach initiatives for home safety efforts.

The National Falls Prevention Resource Center seeks to collaborate with and involve key stakeholder organizations to further disseminate and implement the National Falls Prevention Action Plan’s strategies and action steps, including those focusing on home safety. We welcome the opportunity to partner with others who wish to reduce the burden of falls on the lives of older adults and their caregivers and society as a whole.

For providers wishing to learn more about home modifications, the University of Southern California Davis offers a certificate program in home modification. The next series begins in January 2016.

Kathleen Cameron is the Senior Director of the National Falls Prevention Resource at the National Council on Aging.


Welcome to the BPC Health and Housing Expert Forum. Each month contributors from different parts of the health and housing sectors will be invited to respond to a discussion topic. Have a question you’d like us to consider? Please leave it in the comments.

Any views expressed on this forum do not necessarily represent the views of the Senior Health and Housing Task Force, its co-chairs, or the Bipartisan Policy Center.