Abstract
Many older adults intend to live out their lives in their homes, but most of their homes lack the necessary accessibility features for when residents’ functional abilities change. In metro Detroit, Metro In-Home Solutions, a collaboration between four nonprofits and faith-based organizations, came together to provide quality and affordable home modifications that enable older adults and persons with disabilities to live safely, independently, and comfortably in their homes. Since 2016, MIHS has retrofitted homes for eighty-seven elders.
Key Words:
Metro In-Home Solutions, Detroit, accessibility features, aging in place, community
Mrs. S is a lifelong Detroit resident who worked many years in a service career. She enjoys hosting family and friends in her home, which she has worked hard to maintain and decorate. Mrs. S also enjoys taking warm bubble baths. But it now has become difficult for her to get out of the bathtub. One evening, unable to get out of the tub, she felt stranded and she panicked. While Mrs. S had worked diligently to keep up her home and had planned to stay there for the rest of her life, she hadn’t realized that it could become a danger to her.
Like Mrs. S, many older adults across the country intend to age in their homes and communities. Most of these elders’ homes, however, lack the necessary features to render them safe and accessible—especially if these residents’ functional abilities change. A Bipartisan Policy Center task force examined the connection between housing and health for older adults and noted that just 3.8 percent of housing units in the United States are suitable for individuals with moderate mobility difficulties (Bipartisan Policy Center, 2016).
Suitability for an older person means that a home would have a stepless main entry, a bathroom and bedroom on the first floor (or an elevator to a second-floor bed and bath), no steps between rooms (or if there are steps, there should be rails or grab bars alongside), and an accessible bathroom with grab bars. Falls, the task force noted, are one particular risk of living in an inaccessible home. Annually, approximately one in three older adults falls, mostly in the home setting, resulting in about 2.5 million emergency-department visits, 700,000 hospitalizations, and approximately $34 billion in healthcare costs.
Home Inaccessibility in Detroit
In the metro Detroit area, there are more than 100,000 homeowners, ages 55 and older, who live in homes that require accessibility modifications—such as a ramp, chair lift, walk-in tub, or grab bars—in order to live safely and independently. Not surprisingly, leaders from four of Detroit’s prominent aging and community service organizations had heard many stories similar to Mrs. S’s, about older homeowners whose homes lacked much needed accessibility features, or that were falling into disrepair, thus jeopardizing these residents’ safety.
Only 3.8 percent of U.S. housing is safe for people who have moderate mobility issues.
The homeowners often faced two primary barriers to addressing these concerns. First, many could not afford to pay for major home renovations or repairs. Although there were some programs to help support modifications, such as through the Medicaid waiver program, the programs often were limited by available funding, and had waiting lists. Second, homeowners were having difficulty finding trusted contractors to do the modification work. Contractors who did not finish jobs, or did poor-quality work, scammed many homeowners. Other older adults could not find contractors who were willing to work in their neighborhoods.
The Genesis of Metro In-Home Solutions
In 2015, the following four organizations came together to explore how they could collaboratively address these problems:
- Hartford Community Development Corporation: A subsidiary of Hartford Memorial Baptist Church that has redeveloped underused commercial and residential properties to support economic and employment needs of local residents.
- Jewish Family Service of Metropolitan Detroit: A nonsectarian organization serving the tri-county area through comprehensive services for older adults, outpatient mental health, and safety net services for individuals and families.
- Presbyterian Villages of Michigan: A faith-based organization providing housing and community-based services to older adults throughout Michigan.
- Southwest Solutions: A nonprofit organization providing human services, affordable housing, and economic development in southwest Detroit.
To get started, the partners applied for a grant from the Community Foundation of Southeast Michigan to support a feasibility study; this would help them to fully understand the needs in their service area around home modifications and repairs, identify gaps in addressing the needs, and determine what organizations could do in response. Informed by this work, the four partners jointly established Metro In-Home Solutions, LLC (MIHS) to provide quality and affordable home modifications that enable older adults and persons with disabilities to live safely, independently, and comfortably in their homes.
‘MIHS helps the homeowner to secure funding to complete the desired work.’
The organizations contributed funds and in-kind staff time to hire an executive director and received a grant from The Harry and Jeannette Weinberg Foundation to help support the development of MIHS’s operational infrastructure and capacity. MIHS is overseen by a board of governors (comprising a representative from each founding organization), which meets quarterly, and a management team, which includes the CEO and at least one staff person from each organization and that meets monthly. Daily operations are managed and executed by a full-time executive director and a part-time staff member. Fees earned through third-party funding sources and grants support ongoing operations.
How MIHS Works
MIHS has used a largely grassroots process to get the word out about the program and to receive referrals. The group conducted several educational events at Northwest Activities Center, an anchor community hub in Detroit. In addition, the four partner organizations work with a broad network of aging services organizations and professionals and get the word out to and receive referrals from those connections.
When a homeowner requests assistance from MIHS, the executive director, who has experience as a builder and certifications in aging-in-place and home modifications, assesses the home and identifies potential modifications to help make the home safer for the homeowner.
Next, MIHS helps the homeowner to secure funding to complete the desired work. Thus far, MIHS has worked with the Federal Home Loan Bank of Indianapolis’ Accessibility Modification Program (AMP). This program provides up to $11,000 in grant funding for accessibility modifications for eligible older homeowners and owner-occupied households housing a person (or persons) who has a permanent disability. Eligible households must have at least one resident age 62 or older, or an occupant of any age who has a permanent disability and is receiving permanent disability benefits.
The residents must also have a combined household income below 80 percent of the area median income, which in 2019 was $42,750 for a one-person household in the Detroit metro area. A range of accessibility modifications is covered—e.g., ramps, chair lifts, walk-in showers, lowered kitchen cabinets, and widened doorways, among others—and a portion of funds may be used for deferred home maintenance repairs, such as to roofs or windows.
AMP funds are distributed through local Federal Home Loan Bank of Indianapolis bank members who choose to work with the program. One of MIHS’ LLC members served as a community partner with two Detroit-area banks, which meant they were responsible for doing outreach to the community about the program and supporting applicants to complete their applications. The AMP application is extensive and often difficult for homeowners to complete. Applicants must provide multiple sources of income verification and proof of homeownership, as well as two estimates for the modification and repair work. The community partner assists clients with gathering all the required documentation and getting the two required estimates. MIHS also performs a home assessment, which includes developing a scope of work for preparing the estimates, and also provides applicants with a work estimate.
After it was established, MIHS fielded a Request for Proposal to identify quality contractors who could work with them as subcontractors. It vetted the respondents and established a set of high-quality contractors who could perform the home modifications. Homeowners can choose to work with MIHS and its subcontractors, or choose their own contractor, but most have chosen to work with MIHS. In these cases, MIHS serves as the general contractor overseeing the work until project completion.
Outcomes and Hopes for the Future
Since launching in 2016, MIHS has assisted eighty-seven older adults with retrofitting their homes and helped to support these residents’ ability to age in place—including Mrs. S.
MIHS’s ability to serve more homeowners is limited only by available funding sources. The AMP funding accessed through its local bank partners is capped each year, which has not allowed MIHS to grow its business model. A key priority for the organization is to expand partnerships with third-party payers, such as other banks, managed care plans, health systems, or government agencies to increase the number of homeowners who can be assisted.
MIHS hopes to build awareness about the connection between home modifications and in-home risk reduction for older adults—a strategy that can prevent hospitalizations and-or unavoidable moves to institutional settings that provide a higher level of care. MIHS also may consider expanding to serve homeowners who can pay privately for modifications, as this group also could benefit from the program’s work with trusted contractors and its project oversight.
As four organizations long-vested in Detroit’s residents and communities, the LLC members hope to protect the health of aging homeowners and, by extension, the stability and vibrancy of the neighborhoods in which they live.
Yuliya Gaydayenko, M.S.W., is chief program officer, Behavioral Health and Older Adult Services, at Jewish Family Service of Metropolitan Detroit, in Michigan. References Bipartisan Policy Center. 2016. Healthy Aging Begins at Home. Washington, DC: Bipartisan Policy Center.
