Abstract:

This chapter notes the previous overlooking of home modifications and repairs in social service/community based long-term care policy. Some agencies have been developed to tackle the necessary home modifications for those with disabilities. In this chapter, the writers discuss the types of funding, services, programs and characteristics of the provided services, in order to better understand the service operation to improve service delivery. This is done by reporting on the first national survey of home modification and repair programs (1990-1991). The chapter discusses the history of home modifications and housing programs and their prevalence, including general characteristics. The existing programs have varying foci, including energy conservation, maintenance and upkeep or repairs. Most services were non-profit, focusing on aging/social services and serving mainly low-income clients and clients over 60. A variety of funding sources are used to support the home mods/housing programs, including Federal, State, Local and Non-Government funding. These programs often dictate what services are provided by the programs and who the targets of these services will be - which can make the organisation of service provision difficult. Service provision is usually provided in one of four ways - on staff work crew, subcontractors, use of volunteers or an integrated approach. The integrated approach is most often used. The chapter discusses each form of service provision and the ways in which it is used - including limitations and appropriate methods of organisation in order that the service delivery functions well. The complexity of providing home improvement services is discussed, particularly with regard to safety and ongoing support. The process of assessing homes for modifications is discussed - using both functional and environmental assessments - with the types of assessments used varying depending upon the type of agency (ie:social service or housing). Occupational Therapists were rarely used in the assessment process, and assessments were biased according to who undertook them - causing concern. The types of services provided are considered in terms of repairs, modifications, maintenance and upkeep, and safety and security - with details of specific services considered under each. Most commonly, service providers did both repairs and modifications, with repairs reported as the greatest area of unmet need. Co-ordination of services to enable better and more appropriate service delivery is discussed, with referrals to other agencies, co-ordinated interagency activities, working with partner agencies and relationships with the aging network valued. The education and training of program staff is favoured as important, with housing agencies a valued source of information on home modification issues. Home mods and repair is thought to be a major issue for the future and long term care policies, and recommendations are made for improving existing programs, overcoming policy barriers, future research into private-sector and personal home modifications and universal housing objectives. It is concluded that public housing and policy must remain high on the public agenda.