Home Modifications and Outdoor 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

The Fall Prevention Center of Excellence is supported by the Archstone Foundation 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

The Fall Prevention Center of Excellence is supported by the Archstone Foundation Sources of Funding for Home 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

The Fall Prevention Center of Excellence is supported by the Archstone Foundation Sources of Funding for Home Modifications Individuals continued  Equity financing--mortgage refinancing, home improvement loans, equity lines of credit  Reverse equity loans  Tax deductions

The Fall Prevention Center of Excellence is supported by the Archstone Foundation Sources of Funding for Home 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)

The Fall Prevention Center of Excellence is supported by the Archstone Foundation Types of Home Modification Providers Government A 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)

The Fall Prevention Center of Excellence is supported by the Archstone Foundation 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

The Fall Prevention Center of Excellence is supported by the Archstone Foundation 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

The Fall Prevention Center of Excellence is supported by the Archstone Foundation 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

The Fall Prevention Center of Excellence is supported by the Archstone Foundation Falls due to modifiable conditions  Poor lighting  Debris from trees  Poorly maintained sidewalks  Unmarked hazards  Uneven steps  Unsafe stair design (lack of handrails) Outdoor Falls: What is the Problem?

The Fall Prevention Center of Excellence is supported by the Archstone Foundation What Can We Do to Reduce Outdoor 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

The Fall Prevention Center of Excellence is supported by the Archstone Foundation 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