Home Modification Gains Steam in Competitive Home Care Market

About 76% of those 50 and older want to live in their homes as long as possible, according to a 2018 AARP survey. But the current U.S. housing industry isn’t set up for that to happen.

As such, home modification among seniors is becoming increasingly popular — and of growing importance to home-based care providers looking to stay relevant in a highly competitive market.

Among its benefits, home modification can help keep agences’ clients and caregivers safer. On top of that, home modification can also present new business opportunities for providers willing to offer renovations themselves.


“There’s an opportunity to think about investment in the home as directly related to people’s health and well-being,” Jennifer Molinsky, lead researcher on aging at Harvard University’s Joint Center for Housing Studies, told Home Health Care News.

The reward from that investment is two-fold. On one hand, adding relatively inexpensive features such as grab bars and ramps can reduce a senior’s risk of falling.

Falls are the most common cause of injury and death among seniors, according to the Centers for Disease Control and Prevention (CDC). In fact, the U.S. Department of Housing and Urban Development (HUD) projects falls will kill 40,000 seniors and cost $60 billion in 2020.


Secondly, at-home care providers could soon be reimbursed for certain home modifications. For example, the Centers for Medicare & Medicaid Services (CMS) recently announced Medicare Advantage (MA) plans would have permission to cover an expanded set of supplemental benefits in 2020.

The new rules will allow plans to cover benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions. This could include home modifications.

“Long-term care insurers are taking a look at what kind of home modifications they might fund because it’s definitely cheaper to keep people in their homes than moving them into a more intensive care setting,” Molinsky said. “These [modifications] are also going to be important for caregivers. If you’re making it safer for an older adult you’re also probably making it safer for someone who’s doing assistance with [activities of daily living] like showering.”

Building home modification offerings

Currently, only a small portion of U.S. homes are primed for aging in place, according to HUD data compiled by the Harvard’s Joint Center for Housing Studies.

Researchers found that only about 3.5% of the entire U.S. housing stock offers all three of the following: no-step entry, single-floor living and hallways and doorways wide enough to accommodate a wheelchair.

On top of that, less than 1% of homes offer those three features in addition to accessible light switches and door handles.

A growing number of companies are capitalizing on those lackluster statistics.

As of Q4 2018, more than 75% of professional remodelers were taking on aging-in-place projects, according to survey data from the National Association of Home Builder’s (NAHB), who also offers Certified Aging in Place Specialist (CAPS) courses.

One such company is Cincinnati-based handyman franchise House Doctors, who says about half of all its renovation clients are 55 or older.

While House Doctors doesn’t offer in-home care, the company is experiencing steady double-digit annual growth, in part thanks to the specialized aging-in-place services it offers, CEO Jim Hunter told HHCN.

“Aging in place services is a growing market for us,” Hunter said. “Homes were never built for the aging population, so there’s a real need.”

Currently, the franchise system is giving away grab bars for Mobility Awareness Month.

But you don’t have to be a construction company to win home modification business.

Take Newton, Massachusetts-based HouseWorks LLC, for example.

The private-pay home care company started out as a home modification company about 20 years ago. Today, HouseWorks’s home modification arm makes up about 10% of the company’s revenue, according to CEO Andrea Cohen, who expects that figure to grow in the years to come.

“What we’re seeing lately is an increase in the number of home care clients who really want home adaptation and are asking for it,” Cohen told HHCN.

In addition to about 350 caregivers, HouseWorks employs about 15 handymen, all of whom are trained to deal with seniors, and some of whom are certified dementia specialists.

HouseWorks most often does small jobs for clients. Some examples include everything from adding shower chairs and grab bars to widening doorways and hallways to decluttering homes and doing heavy cleaning. The agency sometimes also works with contractors on larger projects, such as elevator installation.

“We do about 7,800 jobs per year,” Cohen said. “We service about 2,800 clients per year, and the average cost of the job is around $300, although it really varies.”

Another perk: HouseWorks enjoys internal referrals. About 20% of its clients receive both home modification and home care services, Cohen said.

On top of that, Cohen anticipates growth in fall prevention renovation jobs in years to come, which is one reason she encourages other home care providers to dip their toes into the home modification water.

“I would start small, and I would say let’s focus on choosing a specialty,” Cohen said. “It could be adaptive equipment. It could be this idea of heavy cleaning or decluttering. It could be … four or five pieces of equipment they want to offer to their clients.”

Rennovation roadblocks

Because of pricing, home modification isn’t always financially viable for seniors, specifically those who are middle income.

Low income seniors can sometimes receive government assistance for home modification or subsidized housing, while wealthy seniors can often pay for renovation or housing expenses out of pocket.

“It’s the middle of the income spectrum where we’re going to see a lot of need because there aren’t as many choices for where to move, but there’s also going to be a lot of financial constraints.”

While MA plans may open doors for some seniors to renovate for aging in place, others have pointed to legislation as the solution.

For example, in 2016, a house bill called the Senior Accessible Housing Act (H.R. 5254) proposed creating a nonrefundable personal tax credit of up to $30,000 for seniors to modify their homes for aging in place.

The bill was referred to the House Committee on Ways and Means in May 2016. No further action was ever taken.

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