Home ModificationsHome Modificationsandand

Outdoor FallsOutdoor FallsJon Pynoos, Ph.D.

Co-Director, Fall Prevention Center of ExcellenceUSC Ethel Percy Andrus Gerontology Center

3715 McClintock Avenue, #228Los Angeles, California 90089-0191

www.stopfalls.org

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 forHome 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 forHome 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 forHome 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 ModificationProviders

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

55%

23%

22%Inside the house

Outside, but near, thehouse

Away from the home

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 ReduceOutdoor 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