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RUNNING HEAD: HOME MODIFICATIONS
Aging in place through home modifications:
Evaluating barriers and policy recommendations
Andrea Chin
GERO 505

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Abstract
How can we assure that the vast majority of Americans who wish to grow old in their own homes are able to do so? This paper investigates how the aging in place movement can be enacted through home modifications that increase accessibility, improve resident safety, and address mild to moderate functional limitations that might otherwise necessitate institutional long term care placement. Implementing home modifications requires collaboration and coordination among older homeowners, home improvement providers, and the public sectors to assess, finance, and install necessary modifications. Policy recommendations include raising public awareness about home modifications, legislating mandatory visitability features in new housing units, and providing home contractors financial incentives to make modifications in pre-existing buildings, and better enforcing the legal rights of older tenants who request modifications.
Aging in Place
Despite popular culture portrayals of older Americans growing senile in nursing homes,
95 percent of older adults are living in the community at any given point (U.S. DHHS, AoA &
AARP, 1995). Even among individuals aged 85 years and older, nearly 75 percent still live in their own homes (White, 2010). The majority of older adults affirm their wish to continue living in their own homes for as long as possible. In one nationally representative study of 907 adults age 65 and older, 87 percent stated that if they needed others to care for them, they would prefer the caretaking to be given in their current homes (Barrett, 2008). The author found that 90 percent of this sample who had significant difficulty performing or inability to perform ADLs or IADLs would prefer care to be provided in the home; 87 percent stated that they would be willing to give up some privacy to continue living in their homes. These attitudes are encapsulated by aging in place, an emerging international phenomenon progressively gaining currency in public policy.

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Aging in place values remaining in one’s own home to the longest feasible extent possible; it can also refer to residing in a residential setting within one’s community (AARP Public Policy
Institute, 2009; Pynoos, 2010).
Enabling aging in place honors the personal preferences of the aging majority while saving the public millions of dollars. The government has become the largest payer of long term care in the US, but the unprecedented growth in long term care expenditures threaten Medicaid and Medicare’s financial viability. In 2008, Medicare paid $23.9 billion for skilled nursing facility care (CBO, 2009), while Medicaid has become the biggest payer of long term care, with
69 percent of its total benefits for older adults paying for long term care (SCAN Foundation,
2010). States spent an average of $26,096 per Medicaid beneficiary living in a nursing facility in
2005, compared to $9,459 per Medicaid beneficiary receiving home and community-based services (Family Caregiver Alliance, 2009). An estimated 11 million older Americans need long term supportive services, though only 27 percent of Medicaid’s reimbursement for long term care goes to home and community based services (HCBS; AARP Public Policy Institute, 2009). HCBS services are ultimately more cost effective and will help reduce the growth rate of Medicaid expenditures if states are willing to increase how many nursing home eligible beneficiaries. The same AARP report found that the cost of providing nursing home care for one person is equivalent to providing HCBS services for three. Though there will always be a segment of the aging population that needs the intensive 24/7 care provided in long term care facilities, home and community based services allow individuals needing supportive services to keep living at home.
Why Home Modifications?
Unfortunately, most of us are unable to continue living in our own homes in their current state. 90 million out of the 100 million housing units in the US are estimated to be inaccessible for

HOME MODIFICATION POLICY 4 people with disabilities, and most of these housing units will not be replaced in the near future
(Duncan, 1998). Over a million older adults with disabilities have difficulty meeting their daily needs due to barriers in their own homes (Salomon, 2010). Environmental hazards are common hinder the ability of older individuals to safely navigate their homes, regardless of functional status (Carter, Campbell, Sanson-Fisher, Redman, & Gillespie, 1997; Sattin, Rodriguez, DeVito,
& Wingo, 1998). Bathrooms, kitchens, bedrooms and entryways to rooms are the most problematic areas for older adults performing everyday tasks (Gitlin, Mann, Tomit, & Marcus,
2001). The absence of first floor bathrooms or bedrooms can also be problematic for those with
ADL deficiencies in bathing, toileting, and transferring from surfaces (AARP Public Policy
Institute, 2009). Home modifications can address a wide variety of structural issues hindering everyday functioning, though they vary fro simple to complex in implementation. Some simple modifications include adding nonslip strips to bathroom floors or other smooth surfaces, improving lighting, providing telephones with large numbers and letters, and installing grab bars and lever door handles. More complex (and expensive) modifications include installing ramps, stair glides, widened doorways, chair lifts, Hoyer lifts, roll-in showers, and lowered countertops.
Home modifications are critical to ensure that the environment supports individuals’ evolving functional capabilities, yet most older adults do not live in homes with such modifications. This is particularly hazardous as older adults with functional impairments may maladaptively change their behavior as they encounter barriers in their homes, which puts them at greater risk for falling (Pynoos, 2010). In one study, 26 percent of the sampled adults aged 50+ said that they had a condition causing them significant difficulty with a basic physical activity such as walking, climbing stairs, reaching, carrying or lifting (Barrett, 2008). For households containing at least one older adult with at least one ADL or IADL limitation, 51 percent had no

HOME MODIFICATION POLICY 5 home modifications, while 23 percent reported one modification (Kochera, 2002). The most common home modifications are extra handrails and grab bars, wide doors and hallways, and bathroom accessibility adaptations (Kochera, 2002). A number of older adults, however, already live in homes that do not require extensive modifications to allow them to age in place. AARP’s
Fixing to Stay Survey found that 40 percent of adults age 65 and older lived in a home where residents would be able to live on the ground floor, while approximately a third lived in a home with handrails on both sides of the stairs or steps (Kochera, 2002). The majority of older adults, however, have not prepared their current homes to accommodate potential age-related functional declines.
As difficult as it can be to quantify the psychological attachment to remaining in one’s home, researchers have found evidence for the emotional benefits of aging at home . The three most common reasons for homeowners to make home modifications are for better safety features, to increase accessibility for all family members, and increase their ability to live independently
(Bayer & Harper, 2000). Making such environmental adaptations can address core psychological needs for security, autonomy, and social interaction. Living at home promotes older residents’ health, self-esteem, and quality of life (Maisel, Smith, & Steinfeld, 2008). Tanner, Tilse, & de
Jonge (2008) have found that home modifications alleviate caregiver stress and improve caregivers’ quality of live, supporting social role continuity for both residents and their caregivers. Home modifications affect more than just functionally impaired individuals; such environmental adaptations also support family caregivers, who themselves are aging, to continue providing in-home care.
Evaluating Home Modifications
Barriers to Home Modifications

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Older, larger homes are more difficult to modify as they are more difficult to keep up to code and tend to require more modifications to begin with (Salomon, 2010). Older adults unable to make home modifications themselves generally will not find someone else to do it; one of the biggest concerns of older homeowners is the reliability of home contractors and repair providers
(Bayer & Harper, 2000). This anxiety could be assuaged by requiring a standard state license examination and annual registration process for home improvement contractors, as is the case in
South Carolina (Salomon, 2010). Stricter state regulations of home modification providers would better protect older homeowners, who are more vulnerable to fraud but less likely to pursue action against fraudulent providers (Hermanson & Moag, 1999).
Researchers have found that intervention teams must evaluate individuals’ functional status, physical, psychosocial and financial barriers, and their ability to follow through on care and home modification recommendations. If these expert teams provide financial and manual assistance, home modifications are more likely to be properly implemented. Home modifications can enable older individuals to continue living in their current residences for as long as possible, but not everyone is willing to make such changes. Barrett (2008) found that 84 percent of respondents would be willing to pay less than $50 a month to use home safety devices such as fall detection sensors and monitors detecting changes in activity. Homeowners’ barriers to implementing home safety devices include the belief that they are not currently necessary, instillation and maintenance costs, stigma, and privacy concerns. Given the concerns about finances and stigma, it may be more difficult to convince older adults to make more visible and costly home modifications. At the same time, little is known about health and social service providers’ attitudes to incorporating these assistive technologies into their service delivery system, which shapes older adults’ access to such devices (Barrett, 2008). In the words of Duncan

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(1998), “If cost effectiveness can be proven, health plans would be encouraged to form contractual alliances with product suppliers and home modification service programs, potentially leading to reduced prices for adaptations.”
Other buildings to be targeted are new and currently existing housing developments not covered by the FHAA, Section 504 of the Rehabilitation Act, and other laws requiring at least some degree of accessibility ( Maisel, Smith, Steinfeld, et al., 2008 ). Visitability legislation on the federal level has been proposed four years in a row since 2002 but has yet to be passed. H.R.
4202, the Inclusive Home Design Act of 2007, would have required all newly constructed, federally assisted, single-family houses and town houses to meet minimum standards of visitability for persons with disabilities; unfortunately, the bill has been indefinitely referred to the
Subcommittee on Housing and Community Opportunity. Enacting visitability in housing projects receiving federal funds is a key step to enhance accessibility in all housing units. For maximum effectiveness, funding must be available for modifications in public housing regardless of when they were built, pre- or post-FHAA (Pynoos, Nishita, Cicero, and Caraviello, 2008). Again, advocates must persuade legislators of the financial benefits of diverting funds to increasing the accessibility of existing housing stock so that older individuals can continue living in their own homes, instead of in nursing homes, where Medicare and Medicaid pay the majority of these expensive bills.
Other criticisms include the focus on aging in place in single family homes. For older individuals living in older public housing projects, such as section 202 housing, it can be more difficult to request and implement home modifications for fear of being evicted. They also must cover the costs of “reasonable modifications” out of pocket, further disincentivizing low income renters who may be living off of SSDI benefits. Those living in communal residential buildings

HOME MODIFICATION POLICY 8 built after 1991, though, benefit from the standard visitability features required by the Fair
Housing Act; these features include sufficiently wide doorways and hallway for wheelchair access and reinforced bathroom walls that allow for future installation of grab bars (Salomon,
2010).
Evaluating Cost Effectiveness
Kochera (2002) analyzed a potential $4.8 billion home modification intervention for 2.4 million community-dwelling older adults identified as having at least one ADL or IADL limitation that specifically put them at risk for falls. Assuming an average home modification cost of $2000, the total estimated cost for home modifications for all potential participants would be
$4.8 billion (Kochera, 2002). The costs of effective home modifications widely range depending on the nature of the individual’s functional impairments. Such home modifications ranged from therelatively inexpensive (installing brighter lights) to installing a stairlift, which costs upwards of
$2000. Bathrooms, steps leading to the front entrance, and interior stairs to another floor tend to be the most problematic areas (Pynoos, 2009).
This proposed intervention reduced medical costs specifically for fall-related injuries by
$2.7 billion over five years, amounting to a net cost of $2.1 billion, with each prevented injury saving $8,319. Other researchers, however, have found that home modifications addressing identified environmental hazards may not significantly reduce the incidence of falls (Gill,
Williams & Tinetti, 2000; Peel, Steinberg, & Williams, 2002). Home modification is most effective as a fall prevention technique when employed in conjunction with other interventions focusing on the individual’s unique health needs and functional abilities (Tinetti et al., 1994).
Financing Home Modifications

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According to AARP’s Fixing to Stay survey, 36 percent of older adults do not make home modifications because they cannot afford it (Bayer & Harper, 2000). Individual homeowners can receive financial assistance and tax breaks from a number of federal sources depending on their eligibility. Title III of the Older Americans Act funds community block grants, while other local communities have housing departmental grants that can be used for discretionary purposes
(Pynoos, 2009). Specifically, Community Development Block Grant and HOME Investment
Partnerships Program funding, which are two large, flexible block grants administered by the U.S.
Department of Housing and Urban Development, could be tapped to support home modification programs (Salomon, 2010) . Other programs have more specific criteria. The Accessible
Customized Environments Program (ACE), according to Infinitec, Inc. (2008), “locates, purchases, rehabilitates or modifies homes that have been pre-sold to qualified families who have a member with a physical disability.” Veterans with disabilities should be informed of their eligibility for the Veteran's Administration Home Adaptation Grant Program. Rural dwellers over the age of 62 can apply for low interest home repair loans from the Department of Agriculture’s
Rural Development Home Repair Loan and Grant program . Some states allow for Medicaid home and community based services (HCBS) waivers to subsidize home modifications addressing medically necessary condition. This would be more feasible if federal government provides a greater Medicaid match to the states in reimbursing HCBS (AARP Public Policy Institute, 2009).
To offset the costs of home modifications, state and municipal authorities should offer tax deferrals for older homeowners and streamline home improvement permit process (Salomon,
2010). Salomon reported that home-owning Virginians are eligible for a tax credit for enacting modifications that make their homes more accessible. The author also recommends that
“expediting the approval process for modifications that improve home accessibility can reduce

HOME MODIFICATION POLICY 10 project delays and expenses for the homeowner.” At the federal level , the IRS considers certain modifications to be counted as potential medical deductions; such modifications include installation of ramps, widening doorways, modifying kitchen cabinets and equipment, moving or modifying electrical outlets and fixtures, fire alarms, and smoke detectors (Infinitec, 2008).
Educating accountants and home contractors about these existing tax incentives is necessary for older citizens to learn about their financial options for modifications; Area Agencies on Aging and senior centers receiving OAA funds would be best equipped to launch such an educational campaign in local communities.
Given the current fiscal crisis, it is unclear how feasible it would be for housing and area agencies on aging to further distribute grants and waivers to older individuals. Many federal sectors separately offer small-scale assistance to individual homeowners, but funding is relatively uncoordinated and thus difficult to access. Funding could be more effectively and efficiently disbursed if a central agency, such as the Administration on Aging or the Office on Disability, collected and administered all these grants and coordinated related tax breaks. The myriad organizations overseeing these various funding streams, however, might resent such centralization and potential cuts to their individual organization’s budgets. In the meantime, non profit housingrelated organizations help to fill in the need gap. Volunteer organizations such as Rebuilding
Together help ease the burden on low-income residents to retrofit their existing homes; in particular, Rebuilding Together’s network of 245 affiliates, has repaired and rehabilitated more than 105,000 houses and nonprofit facilities in all 50 states ( Maisel, Smith, Steinfeld, et al.,
2008 ). Encouraging community participation in these volunteer programs, even potentially directing federal stimulus funds for temporary “shovel ready” projects, would be even more effective.

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Alternatives to Home Modifications in Increasing Accessible Housing Stock: Visitability and
Universal Design
Home modifications are integral to aging in place by improving accessibility and reducing potential hazards in the home environment. Ensuring that new housing stock is accessible from the start, however, cost effectively allows future generations to age in place. Inspired by the civil rights movement, visitability is a set of principles allowing individuals with disabilities to safely access and maneuver around others’ homes. The minimum requirements for visitability are zero step entrances, minimum 32-inch wide doors, and a half bathroom on the main floor ( Maisel,
Smith, Steinfeld, et al., 2008 ). Other visitability features include reinforced bathroom walls and raised switches and outlets (Salomon, 2010). Universal design broadens the scope of visitability through its holistic focus on accessible design so that anyone, regardless of their functional capabilities, can access a building. The visitability and universal design movements arose from the recognition that the majority of private and pre-ADA public buildings were inaccessible to those with functional impairments. The Center for Universal Design organized the First National
Conference on Home Modification Policy in 1993 to address the limited funding, inadequate housing services and lack of information about home modifications (Duncan, 1998). Five states and ten cities and counties have voluntarily mandated visitability as of 2003, while universal design has yet to make significant legislative headway.
Until visitability and universal design gain greater currency in the housing construction industry, home modifications are the most effective method of increasing accessibility for the majority of the population. Reluctance to enacting visitability in private housing stock partially stems from confusion as to what features it entails. Maisel, Smith, Steinfeld, et al. (2008) contend that t he International Code Council and the American National Standards Institute must clarify

HOME MODIFICATION POLICY 12 and codify technical standards for visitability so that builders are on the same page on enacting visitable features such as zero step entrances. Ideally, visitability features would be automatically included new housing units and homes to increase accessibility, thus avoiding the need for modifications that are more expensive and difficult to incorporate later on. Influential housing interest groups such as the National Association of Home Builders, however, support voluntary visitability policies, and are hindering the passage of legislation such as the Inclusive Home
Design Act that would mandate visitability features.
Visitability advocates, however, contend that mandatory policies are necessary to increase the limited number of accessible new housing units from the private sector ( Maisel, Smith,
Steinfeld, et al., 2008 ). Local policies mandating visitability for all new housing have created more visible homes than voluntary policies - 30,000 vs. fewer than 1,300. Visitability advocates contend that communities with such mandatory home access policies have generally been flexible in accommodating site or other problems, though many builders have created innovative solutions for difficult sites. There is no federal or even state legislation mandating visitability, though, so visitability efforts are contained to relatively limited community efforts. Federal subsidies and tax breaks could increase builders’ willingness to include visitable features, while streamlining the permit application process for homes incorporating visitability or universal design would be another significant incentive.
Policy Recommendations and Concluding Thoughts
Builders, home improvement contractors, legislators, and the aging network must collaborate to make home modifications more accessible to those in need, particularly low income and disabled older individuals. Given their duty to the Older Americans Act for information and referral, local Area Agencies on Aging are critical in educating the public about the variety of

HOME MODIFICATION POLICY 13 home modifications and disseminating information about local resources and builders who can assist in home modifications (Salomon, 2010). Remodeling contractors surveyed in 2007 reported performing 60 percent more home modifications to facilitate aging in place compared to the previous year, indicating that older homeowners are interested in this service. Incorporating home assessments into interdisciplinary care assessments is a necessary first step to publicize how environmental modifications can enhance aging in place ( Gitlin, Mann, Tomit, & Marcus, 2001 ).
Service providers, however, must take the time to listen to their clients’ needs in order to install appropriate home modifications or else residents are at risk for decreased health and well-being
( Tanner, Tilse, and de Jonge, 2008 ).
The time is ripe for public awareness campaigns targeting all of the above groups about the necessity for home modifications, visitability, and universal design. Joining coalitions with the sustainability and affordable housing movements has helped promote the accessible home agenda
( Maisel, Smith, Steinfeld, et al., 2008).
Maisel et al. found that some new green certification programs incorporate visitability and universal design; for example, the recently initiated
Leadership in Energy and Environmental Design – Neighborhood Design certification includes a credit for universal accessibility, while Earthcraft certification, to which Habitat for Humanity subscribes, requires visitability features. Though these nonprofit community resources assist in fulfilling the need gap, legislators need to provide creative financial incentives homebuilders and renovation contractors to do so on a greater scale.
Policymakers must codify the most effective design features so that they can be integrated into all new housing units at their inception. Legislation such as the FHAA and Section 504 of the
Rehabilitation Act must actively enforce builders’ compliance with the spirit of accessible modifications as well as ensure that older tenants requesting modifications are protected from

HOME MODIFICATION POLICY 14 retaliation or eviction. In the meantime, current financial resources for home modification must be better publicized and coordinated for older homeowners, while older tenants asking their landlords for such adaptations must receive better legal protection of their rights. Amending local property tax policies is an effective way to reduce homeowners’ (and potentially rental managers’) financial burden, through methods such as the h omestead exemption, used in many states to reduce the portion of a property’s assessed value that is subject to taxation, or property tax deferral program that allows older homeowners to postpone payment of all or part of their property taxes until the sale of their property or death (Salomon, 2010).
Most importantly, while home modifications are a critical element of aging in place, they are insufficient in enabling most older adults to keep living in their own homes. Aging in place requires entire communities to find creative solutions to serving their citizens’ needs over the lifespan. Walkable communities, affordable housing, accessible public transportation, and availability of supportive servies, amenities and healthcare resources are just a few other components of aging in place (Pynoos, 2010). An important first step to ensuring the availability of sufficient housing options incorporating universal design features (including more affordable, congregate housing projects, and accessory units to single family homes) would be revising local zoning laws (Salomon, 2010). Real estate developers, transportation providers, and urban planners must collaborate to design neighborhoods where services are physically accessible by multiple means of transportation. Service providers and insurers, private and public, continue to experiment with new ways of ensuring that healthcare and supportive long term care services are financially viable and available for those who need them. If aging in place is to become an option available to all individuals, we must start preparing now to ensure that our homes can accommodate our needs across the lifespan.

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References :
AARP Public Policy Institute. (2009). Providing more long-term support and services at home:
Why it’s critical for health reform
(Fact sheet). Washington, D.C.: AARP.
Alexander, B. H., Rivara, F. P., & Wolf, M. E. (1992). The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health ,
82, 1020-1023.
Barrett, L. L. (2008). Healthy at home . AARP Foundation Knowledge Networks et al.,
AARP Foundation, Washington, D.C.
Bayer, A. and Harper, L. (2000). Fixing to Stay: A National Survey of Housing and
Home Modification Issues . Washington, DC: AARP Knowledge Management.
Carter, S.E., Campbell, E.M., Sanson-Fisher, R.W., Redman S., & Gillespie W.J. (1997).
Environmental hazards in the homes of older people. Age and Ageing , 26,195-202.
Choi, H., Trent, R. B., Nishita, C. M. & Pynoos, J. (2007). Falls among older adults in
California: Public health surveillance issues (Report). Los Angeles: University of
Southern California, Fall Prevention Center of Excellence.
Congressional Budget Office (CBO). (2009). The Long-Term Outlook for Medicare, Medicaid, and Total Health Care Spending. The Long Term Budget Outlook. Washington, DC:
CBO.
Donald, I. P., & Bulpitt, C. J. (1999). The prognosis of falls in elderly people living at home.
Age and Ageing , 28, 121–125.
Duncan, R. (1998). Blueprint for action: The national home modifications action coalition.
Technology and Disability , 8, 85-89.
Duncan, R. (1998). Funding, Financing and Other Resources for Home

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Modifications. Technology and Disability , 8, 37-50.
Family Caregiver Alliance. (2009). Making the Case: Saving Your State’s Caregiver Support
Programs. San Francisco: National Alliance for Caregiving.
Gill, T., Williams, C., & Tinetti, M. (2000). Environmental Hazards and the Risk of
Nonsyncopal Falls in the Homes of Community-Living Older Persons. Medical Care , 38,
1174-1183.
Gitlin, L.N., Mann, W., Tomit, M., & Marcus, S.M. (2001). Factors associated with home environmental problems among community-living older people. Disability and
Rehabilitation , 23(17), 777-87.
Hausdorff, J. M., Rios, D. A., & Edelber H. K. (2001). Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation , 82, 1050–1056.
Hermanson, S. & Moag, K. (1999).
Home Improvement Contractors ( Fact Sheet Number 75).
Washington, DC: AARP Public Policy Institute.
Hornbrook, M. C., Stevens, V. J., Wingfield, D. J., Hollis, J. F., Greenlick, M.R., & Ory, M. G.
(1994). Preventing falls among community-dwelling older persons: Results from a randomized trial. The Gerontologist , 34, 16–23.
The Inclusive Home Design Act of 2007. S, 110th Congress. (2007).
Infinitec, Inc., United Cerebral Palsy Association of Greater Chicago, and United Cerebral Palsy
Associations, Inc., Washington D.C. (2008). Home modification - how to pay for it?
Retrieved April, 29, 2009 from http://www.infinitec.org/live/homemodifications/homefunding.htm
Kochera, A. (2002). Falls among older persons and the role of the home: An

HOME MODIFICATION POLICY 17 analysis of cost, incidence, and potential savings from home modification (Issue Brief 56).
Washington, DC: AARP Public Policy Institute.
Maisel, J. L., Smith, E., Steinfeld, E., et al. (2008). Increasing home access: designing for visitability (Publication No. 2008-14). Washington, DC: AARP Public
Policy Institute.
Peel, N., Steinberg, M., & Williams, G. (2000). Home Safety Assessment in the Prevention of
Falls Among Older People. Australian and New Zealand Journal of Public Health , 24,
536-539.
Pynoos, J. (2010, Sept. 21). Aging in place. Lecture presented at the University of Southern
California.
Pynoos, J. (2010, Sept. 28). Aging in place, universal design, and assistive technology. Lecture presented at the University of Southern California.
Pynoos, J., Nishita, C., Cicero, C., and Caraviello, R. (2008). Aging in place, housing, and the law. The elder law journal , 16, 77-105.
Salomon, E. (2010). Home modifications to promote independent living (Fact sheet: 168).
Washington, D.C.: AARP Public Policy Institute.
Salomon, E. (2010). Housing policy solutions to support aging in place (Fact sheet: 172).
Washington, D.C.: AARP Public Policy Institute.
Sattin, R.W., Rodriguez, J.G., DeVito, C.A., and Wingo, P.A. (1998). The Study to Assess Falls
Among the Elderly (SAFE) Group: Home environment hazards and the risk of fall injury events among community-dwelling older persons. Journal American Geriatric, 46 , 669-
676.
Tanner, B., Tilse, C., & de Jonge, D. (2008). Restoring and Sustaining Home: The Impact of

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Home Modifications on the Meaning of Home for Older People. Journal of Housing for the Elderly , 22(3), 195-215.
Tinetti, M., Baker, D., McAvay, G., Claus, E., Garrett, P., Gottschalk, M., et al. (1994). A
Multifactorial Intervention to Reduce the Risk of Falling Among Elderly People Living in the Community. The New England Journal of Medicine , 331, 821-827.
Wardrip, K. (2008). Strategies to meet the housing needs of older adults. Washington, D.C.:
AARP Public Policy Institute.
White, M. (2010, Sept. 3). Demographic overview of aging America. Lecture presented at the
University of Southern California.
White, M. (2010, Sept. 23). Long term care demographics and projections. Lecture presented at the University of Southern California.
U.S. Department of Health and Human Services, Administration on Aging, & American
Association of Retired Persons. (1995). A profile of older Americans. Washington, DC:
American Association of Retired Persons.