Supportive environmental features (SEFs) are attributes of homes that help people overcome activity limitations. Evidence suggests that SEFs may facilitate aging in place. However, real-life SEF implementation patterns are not fully understood. This study examined associations between SEFs and disability/mortality status. We analyzed the first cohort of the National Health and Aging Trends Study using multinomial logistic regression. SEFs were operationalized using indicators of home accessibility, including bathroom home modifications (BHMs) and supportive housing features (SHFs). Basic activities of daily living (ADL) and instrumental ADLs (IADL) were used to quantify disability status. Changed SEF status and disability status, combined with mortality, served as dependent variables. At baseline, BHM/SHF did not predict changes in disability. Disability burden predicted lower likelihood of SEF addition. Greater baseline SEF predicted future additions of SEFs. Raising awareness of SEF in the context of increasing ADL/IADL limitations is key to promoting SEF implementation among older adults.

Aging in place continues to be the preference for most people, but the majority of homes are not equipped to handle their evolving care needs. Although home modifications and assistive devices can enable people to stay in their homes, previous research indicates that minority groups, who often have a stronger inclination to age at home, are less likely to modify their home environment. This issue is often compounded by the shortage of culturally tailored products and services. To explore how perceptions of home modifications and assistive devices are relevant to cultural backgrounds, this pilot qualitative study focuses on older Chinese Americans. Using person-environment fit and cultural adaptation as a framework, we conducted seven semi-structured, in-depth interviews in 2024 with four older Chinese Americans (aged 70 to 95) who made home modifications or used assistive devices and three of their caregivers. Using thematic analysis to examine the interview notes, we identified four themes: (1) Helpfulness. Interviewees generally appreciated supportive features that improved daily living and independence; (2) Learning Curve. Both older adults and caregivers noted the efforts required to adapt to the changes; (3) OT Support. Older adults who made home modifications acknowledged the instrumental role of occupational therapists. (4) Cultural Influence. People prefer designs that reflect their culture. Our findings suggest that, while some aspects of home modifications and assistive devices are consistently valued among older minorities, an improved cultural competency in product design and service delivery can help create person-centered solutions.

Abstract Home modification services have become more widely available in response to the aging population’s growing need for accessible home environments. Despite this growth, the home modification service delivery process is not well-defined, leading to services that do not adequately meet the needs of older adults. To address this gap, the Service Delivery Subcommittee of the National Home Safety and Home Modification Work Group, led by the National Council on Aging and funded by the Administration for Community Living, developed a Home Modification Service Delivery Model. Using an iterative, consensus building approach, this group of interdisciplinary practitioners and researchers developed a model to describe the ideal home modification service delivery process based on evidence and expert perspectives. The model outlines the value of working in a transdisciplinary team, describes key providers and professionals to involve on the team, and their respective roles in the home modification service delivery process (i.e., intake, assessment, completion of modifications, and follow-up). An understanding of the complexity of home modification and awareness of the types of providers that can and should be involved across all phases of home modification can increase the likelihood that consumers will receive the right services at the right time to adequately meet their current and future needs, regardless of their background and point of entry to the process. The Home Modification Service Delivery Model sets a critical foundation for future research and implementation efforts in the community. This session will review the model, describe the development process, and highlight next steps.

Abstract With the rapid growth of the aging population, private homes have increasingly become an alternative setting for the provision of long-term care (LTC). For many, LTC needs increase during recovery from acute medical events and subsequent rehabilitation services. An estimated 20% of older Americans undergo physical rehabilitation services, including physical therapy, occupational therapy, and speech therapy, that can help to promote function and improve their ability to carry out daily activities. Often, rehabilitation therapists may recommend that older adults receiving their services make home modifications (HMs) to facilitate their recovery and improve home accessibility and safety. Nevertheless, it is unclear to what extent receiving recommendations is associated with decisions by older adults to install HMs. Guided by Andersen’s healthcare utilization model, which assesses factors that lead to the use of health services, we hypothesized that those who received recommendations from rehabilitation therapists would be more likely to modify their homes to accommodate disability. We analyzed data from the most recent round (2022) of the National Health and Aging Trends Study (NHATS). We used multivariate logistic regression to estimate the relationship between the recommendation and implementation of shower/tub and toilet HMs. Results indicated that older adults who received recommendations to modify their showers/tubs had 158% higher odds of installing shower/tub HMs, whereas those who received recommendations to modify areas around their toilets had 160% higher odds of installing toilet HMs. Findings suggest that older adults may be especially motivated to implement HM regimens when directed by rehabilitation professionals.

Abstract A significant proportion of older Americans experience chronic conditions, functional impairments, participation limitations, activities of daily living (ADL) and instrumental activities of daily living (IADL) disabilities that could impact their capacity to live independently in their homes. Home modifications (HM) implemented to promote safety and access can support aging in place by improving environmental fit with health characteristics of older individuals. We conceptualized health dimensions using the International Classification of Functioning, Disability, and Health (ICF) to estimate risk profiles for implementing shower/tub and toilet HMs. We analyzed data from the National Health and Aging Trends Study (NHATS) using Cox regression, to examine associations between each ICF health dimension (i.e., personal characteristics, chronic conditions, functional impairments, social participation, ADL and IADL disability) and the probability of community dwelling older adults implementing HMs over a five-year period (2011 to 2015). Results indicated that being older age, married, having more functional impairments, greater social participation, and greater ADL and IADL disabilities are each independently associated with a higher probability of acquiring both types of HM. For example, each additional functional limitation was associated with a 12% increased risk of implementing toilet modifications and a 4% increased risk of implementing shower/tub modifications. Additionally, compared to non-Hispanic Whites, Hispanics are less likely to implement either type of HM. Implications of this study are that older individuals choose to implement HMs in response to different need profiles and that some age-related changes may be more impactful in decision making than others.

Occupational therapists have long been interested in helping people to live well in their home environment but have not always had access to the funding, services, or resources to meet the home modification needs of their consumers. However, toward the end of the 20th century, a range of home modification services and resources were developed that enabled occupational therapists to access a selection of public and private services to address those needs. A number of factors have influenced the development and delivery of home modification services. This chapter aims to provide therapists with an understanding of those factors the various demographic, legislative, policy, and service delivery traditions that have influenced, and will continue to influence, the development and delivery of home modification services and the associated implications for occupational therapists and consumers of these services.

Abstract Aging in place remains a high priority of older adults. However, the home environments in which they reside often have hazards and lack supportive features, putting them at risk of falls and making it difficult to carry out daily activities. People who need home modifications the most (i.e., vulnerable populations) are the least likely to have them. In response to the needs of the growing population of older adults, there has been notable progress in the field. Now, with an increasing recognition of the impact of housing on health, there are new opportunities to move the field forward. Highlighting Powell Lawton’s contributions as a foundation, this lecture will: 1) review major developments in research, service delivery, policy, and consumer education, and 2) discuss recommendations for action that practitioners, researchers, policymakers, and advocates could undertake to realize Lawton’s vision of home environments that support aging for all.

Rooted in the person-environment-fit theory, home modification has been tested as an intervention to support older adults to age safely at home by improving functioning and reducing fall risks. Home modification is often a complex process, involving multiple steps and various stakeholders. As such, proper implementation is important to its effectiveness. However, limited research has focused on how to implement home modification from a comprehensive perspective. To advance the implementation science of home modification for older adults and achieve a better understanding of promising practices, we conducted a scoping analysis of review articles, referred to as umbrella review, to identify strategies that have been found effective in implementing home modification. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P), after performing a thorough literature search from six electronic databases, including MEDLINE, PubMed, Embase, CINAHL, Web of Science, and Cochrane Review, we identified 16 highly relevant review articles from 1,310 articles retrieved. From these, we derived a set of practical strategies for service delivery professionals and developed an implementation matrix with the strategies clustered under two dimensions: (1) types of home modification based on demands of effort and level of evidence, including evidence-based practices, best practices, emerging practices; and (2) the critical stages of home modification, including preparation, home assessment, installation, follow-up visit. Our findings highlight the importance of maintaining cohesion between different stages of home modification and sustaining consensus among service delivery professionals and residents when implementing home modification for older adults.

Abstract Older adults living in rural areas have particular challenges to accessing critical supportive services such as home modifications to promote functioning and safety. Conducting remote home assessments through telehealth has the potential to reduce time spent and overall cost that occur in conducting in-person assessments. During the pandemic, providers turned to telehealth to preserve continuity of assessment services with few research-based practices to guide them. With support from a NIDLRR SBIR grant, Thrive for Life LLC in partnership with the USC Leonard Davis School of Gerontology conducted research to develop a remote home assessment that aims to connect health and home modification providers with rural older adults (65+) with disabilities, a population that may not receive home modifications otherwise. Research included a literature review, key informant interviews with five experts in the field, and individual phone interviews with 30 rural older adults who have disabilities. The literature was analyzed and used to inform the interview questions. Key informant interview responses were analyzed for models, potential challenges, lessons learned, and opportunities to impact priority needs. Consumer interview responses were analyzed for needs, preferences, concerns, and challenges related to technology use. Findings demonstrate common barriers such as lack of access to broadband and smart technology; circumstances in which remote assessments are, and are not, likely to be successful; and the potential value of conducting remote home assessments in rural areas to ensure equity of access to home modifications for older adults with disabilities during the pandemic and beyond.

This literature review provides a framework for understanding the development of residential care in California, including state licensing, federal funding, and state and local planning policies for the development of facilities. It discusses the history, planning, and licensing of residential care as a home and community-based service in California. It examines the historic and innovative federal programs supporting assisted living in public or affordable housing, the public equivalent of residential care. Finally, it describes how the California housing crisis has prompted a new and sweeping set of state and local planning policies encouraging its development.

Abstract Home modification (HM) can promote older adults’ functioning as their needs change, reduce fall risks, and support caregivers. A supportive home environment is increasingly important as homes become healthcare delivery sites for home and community-based services (HCBS). HM is funded and administered by disparate agencies, often hindering access to HM services for at-risk older adults who need them the most. The Aging Network (State Units on Aging (SUAs), Area Agencies on Aging (AAAs), and Title VI organizations serving Native American older adults) plays an important but not well understood role in HM. To address this lack of research, the USC Leonard Davis School of Gerontology, ADvancing States, and the National Association of Area Agencies on Aging in cooperation with Scripps Gerontology Center conducted three national surveys, with support from the Administration for Community Living: 1) directors of the 56 SUAs with an 89% response rate; 2) directors of the 618 AAAs with a 79% response rate; and 3) directors of 276 Title VI programs with an 84% response rate. Exemplary practices included HM advocacy through interagency coalitions; state and local plan priority setting; creative HM financing with housing, disability, and health care sectors, including partnerships with Medicaid agencies; and integration of HMs into state and local HCBS, including nursing home transition and caregiver support programs. Findings on the types of HM activities, service delivery barriers, funding sources, collaborations, and targeted populations will inform HM policy and practice for the Aging Network’s critical state and local agencies serving low-income older adults.

Older persons have long been major beneficiaries of federal housing policy. Analysts have identified five types of housing related problems: the physical condition of the dwelling unit, crowdedness, affordability, suitability, and linkages with services. Housing conditions remain a problem for particular segments of the elderly population whose dwelling units are in need of substantial structural repair and maintenance. Over time the federal government has developed a range of housing policies and programs that have assisted older persons. While supply-side programs have assisted many fewer persons than overall tax policy, they have been more targeted towards low- and moderate-income persons. A full-fledged housing allowance program has not yet gained political support, in part hindered by its expected costs, recent concerns about its potential savings, and continued disagreements about the merits of demand-side vs. supply-side programs.

Abstract Home environments are important to older adults and can help to preserve independence in every day functioning when they are supportive. Nevertheless, over time, the quality of “fit” between individuals and their homes can decrease because of age-related physical changes. A significant proportion of older Americans experience sensory impairments that impact their capacity to perform daily living activities necessary to remain independent at home. Home environments designed to support access and safety have potential to ameliorate disability associated with declines in sensory status. Data from the National Health and Aging Trends Study (NHATS) were analyzed to assess the role of supportive home environments in mediating the relationship between self-reported measures of vision impairment, hearing impairment, and dual vision-hearing impairment and related ADL/IADL outcomes in community-dwelling older adults. Guided by the International Classification of Functioning, Disability and Health (ICF), regression models included covariates for sociodemographics, chronic conditions, mobility functioning, and participation. Supportive home environments were operationalized using indicators of whether participants had access to homes from the outside without having to use stairs; presence of a bedroom, kitchen, and full bathroom with a shower or tub on the same floor; and whether bathroom fixtures had been modified with features such as grab bars. Results suggest a statistical relationship between sensory function and disability that is explained in part by the lack of supportive home features. Implications are that older adults with sensory impairments can benefit greatly by improving environments in areas of the home that are known to cause difficulty.

Abstract With aging populations and cost constraints, state home and community-based care (HCBC) systems are increasingly being challenged to support older adults at home. Home modifications (HMs), changing the home environment to support health, safety and independence, has been found to be cost effective, improve quality of life, and help prevent falls. While the passage of the Older Americans Act in 1965 made State Units on Aging (SUAs) the designated state-level agencies responsible for developing and administering assistance to older adults, little is understood about the extent to which they prioritize, implement, and fund HM services. In the last decade, new developments have elevated HM on the public agenda, yet the creation of policies and programs depends on a solid knowledge base. Funded by the Administration for Community Living, the University of Southern California and ADVancing States conducted a survey of the 56 SUAs to ascertain HM efforts, targeting, Older Americans Act fund allocation for HMs, collaboration with other state entities, needs and challenges, legislation, and accomplishments. With a response rate of 91% SUAs (N = 51), the survey revealed: 88% of SUAs engage in HM efforts with most (61%) integrating HMs within HCBC and long term care programs; 74% work with their State Medicaid Office on including and delivering HMs via waivers; and the most pressing needs as funding and more HM providers. Analysis showed great variation of SUA involvement in HMs based on the state size, SUA location within the state government, and connections with other state agencies.

PurposeThe world was facing significant aging challenges. Aging in place has long been advocated which reflected the preference of older people to stay in their own home as long as possible. A huge amount of older people resided in private buildings that consist of both indoor settings (i.e. individual unit flats) and outdoor settings (i.e. common areas like lobby and corridor). The effect of indoor environment on the quality of life of the older people has been investigated, while this paper aims to examine the different effect of common areas environment for the older people.Design/methodology/approachA questionnaire survey was administered among over 300 older people living in private buildings. Multiple statistical techniques, including reliability test, correlation coefficient and multiple regression models, were used to analyze the collected data to determine the interactions between facilities management of the common areas in private buildings and the environment domain of quality of life for older people.FindingsThe final results were concluded based on the congruence of all the statistical results, which covered the identification of facilities management factors in common areas of private buildings that could influence the environment domain of quality of life for older people, including overall environment, health-care accessibility, information acquisition and transportation aspects; the overall environment was positively predicted by space and security in common areas of private building; health-care accessibility was positively affected by space, barrier-free facilities and recreational facilities; the information acquisition was only positively predicted by security; transportation was positively predicted by distance and recreational facilities; and building services of common areas in private buildings had no effect on the environment domain of quality of life for older people.Originality/valuePractical recommendations have been made to improve the facilities management of common areas in private buildings to ensure the quality of life for older people, including provision of walking assistance, motion or infrared controlled systems and so on. This study contributed to enhance current understanding of the interactions between the older people and their living environment.

Although permanent supportive housing (PSH) has been credited with a decline in the number of chronically homeless adults in the United States since 2007, the extent to which PSH can accommodate the needs of a prematurely aging population, including reducing the likelihood of falls, is unclear. The objective of this study is to examine the prevalence and correlates of falls with a sample of 237 tenants (45- to 80-year olds) from two PSH programmes in Los Angeles from 1 January 2017 to 10 August 2017. We also explore the location and severity of fall-related injury using a subsample of 66 tenants. Standard surveys queried demographics, health status, history of homelessness and falls. Multivariable logistic regression assessed the correlates of falling in the past year. More than half of the sample had fallen and more than 40% had multiple falls in the past year. Functional impairment, frailty and persistent pain were all associated with increased fall risk. For the 66 tenants who provided more detailed fall information, more than 40% fell at home and of those nearly half fell in their bathroom. Fall-related injuries were common, with more than one-third of the subsample experiencing serious injury. These findings suggest that fall prevention is needed in PSH but that more research is needed to understand the degree to which individual and environmental risk factors are contributing to falls.

Abstract The overwhelming preference of older adults is to stay in their homes for as long as possible (AARP). However, most housing lacks supportive features and presents barriers that jeopardize residents’ ability to successfully age in place. Only 1% of houses have five key features to ensure accessibility: no-step entry, single-floor living, lever door handles, accessible electrical controls, and extra-wide doors and hallways (Harvard Joint Center for Housing Studies), making the vast majority unsuitable for persons who use wheelchairs and problematic for the growing number of people with activity limitations. Persons least likely to have such features in their homes need them the most: old-old, low income, frail, and residents in older housing stock. Although home modification can support people as their needs change and preclude the need to move, often to institutional settings, the majority of older adults lack these supports. Recent studies have demonstrated the role of home modification in health, safety, and cost effectiveness. This symposium will convene a panel of researchers to share evidence-base in home modification, recent cost-saving innovations including the CAPABLE Program, and policy change to improve service delivery.

Cities and neighborhoods shape the experience of older adults, supporting or hindering age-friendly efforts and quality of life. Where older people live determines care supportiveness, perceived well-being, and access to resources. The presentations in this panel use a combination of national and city-level data to examine differences in neighborhood quality, access to residential care, environmental factors related to health and longevity, and residential mobility among older adults. The collection of presentations in the panel underscore how gaining insights into geographical disparities in city and neighborhood characteristics can help local agencies and jurisdictions plan and develop more equitable and age-friendly urban environments. Cicero and colleagues introduce an interdisciplinary framework for identification of at-risk geographies or lifespan improvement districts, drawing upon findings from the USC Age-Friendly Los Angeles Practicum, including interventions, policy initiatives, and further evaluation opportunities aimed at improving quality of life among older adults in the Los Angeles area. Frochen and Ailshire demonstrate spatial disparities in the distribution of residential care facilities in Los Angeles and California, showing the location of small and large clusters of facilities and analyzing differences in care capacity among older adults, using California Department of Social Service and American Community Survey census tract data. Stokes discusses neighborhood and demographic factors predicting neighborhood quality and life satisfaction, using three waves of panel data from the Midlife in the United States (MIDUS) Study. Ailshire, Frochen, and Rodnyansky show why older adults move to different locations, including reasons related to family, health, housing, neighborhood, and economy.