Barriers to the Initiation of Home Modifications for Older Adults for Fall Prevention

Abstract

Introduction: Home modifications are associated with decreased risk for falls and facilitate safe aging in place. The purpose of this study was to identify barriers to procurement of home modifications for older adults. Materials and Methods: Cross-sectional interviews by 2 separate (1 male and 1 female) researchers in a Midwestern city of home repair (“handyman”) and construction businesses within 15 miles of the areas of interest (neighborhood with a high socioeconomic status and neighborhood with low socioeconomic status) with a publicly listed phone number (n = 98). Estimated cost, earliest date of installation, and duration for a home modification project (installation of 3 grab bars) were collected. Results: At least 1 response was attained only 43% of the time (n = 42), and residential grab bar installations were not provided by most businesses (n = 24). The average quote for materials and labor was $394.31 (range $125-$1300). Five of the 7 businesses that responded to both researchers with the same representative differed in cost estimates, generally offering a reduced quote for the low socioeconomic status neighborhood by as much as $300. Quotes provided to the female researcher were also higher than those obtained by the male researcher by about $30 regardless of socioeconomic status. The average wait for home modifications was 23 days and the average anticipated duration of the project was 2.6 hours. Discussion: There are financial and procedural barriers to accessing home modifications for older adults who independently attempt to acquire them. There is a need for pathways in clinical and community settings to reduce barriers to home modifications to reduce the risk of falls. Conclusion: Home modifications are a promising tool to reduce falls and fall-related injuries in older adults. However, further work to identify cost-effective and timely options to reduce acquisition barriers is necessary to leverage the preventive power of home modifications.