Evaluation of the HUD Older Adult Home Modification Grant Program - Final Report: Cohort 1 (Fiscal Year 2021) Grantees

Author(s): Reddy, Amanda L.     Beatley, Noreen     Williams, Ashley     Healthy Housing Solutions Inc,     Breysse, Jill     Dixon, Sherry     Wilson, Jonathan     Bloom, Christopher     National Center for Healthy Housing    

The nation’s population is aging at an unprecedented rate, with adults aged 65 and older projected to constitute nearly one-quarter of the U.S. population by 2060. With aging comes an increased risk of falls, particularly in the home, leading to hospitalizations, nursing home stays, and a loss of independence. These incidents carry a substantial financial burden, with non-fatal falls costing Medicare and Medicaid approximately $38 billion annually. To address this pressing issue, the Older Adults Home Modification Program (OAHMP) was launched, providing federal funding to state and local governments, nonprofit organizations, and public housing agencies. The aim of this program was to implement low-cost home modifications to enhance safety and reduce fall risks for older homeowners.

Congress tasked HUD with evaluating the effectiveness of the OAHMP, focusing on the first round of grantees. The evaluation revealed promising outcomes: homeowners experienced improvements in functional abilities—such as bathing and dressing—and reductions in emergency department visits, hospitalizations, and emergency response calls. Nearly all clients who were interviewed post-modification reported benefiting from the program. However, these positive associations must be interpreted cautiously because the evaluation did not conduct research to establish causality. Thus, although the modifications coincided with improved outcomes, we cannot definitively conclude that the positive outcomes were the result of the OAHMP.

At the same time, the evaluation exposed significant challenges tied to federal involvement. Federal environmental review requirements for modifications beyond basic maintenance created confusion and delays. Grantees frequently avoided certain modifications altogether rather than navigate the regulatory waiver process or risk prolonged timelines. Moreover, eligibility restrictions—such as the homeownership requirement—excluded vulnerable groups, such as low-income renters and older adults living on Tribal lands, further illustrating the rigidity of federal oversight.

These limitations underscore the constraints of federally administered programs, which must adhere to uniform regulations that may not suit diverse local contexts. In its fiscal year 2026 budget request, HUD has not sought additional funding for the OAHMP, signaling a shift away from federal responsibility. Such initiatives may be more effectively managed by state and local governments, which can tailor programs to their communities’ unique needs without the burden of federal red tape, such as environmental reviews or strict cost caps.

The findings of the evaluation highlight the potential for further research that can determine causality between the OAHMP and observed outcomes. If such research determines a causal positive impact, then the potential may exist for state and local leadership in this arena; with relatively modest investments, home modification programs can yield meaningful improvements in quality of life for older adults, confidence in avoiding falls, and the ability to age in place. The OAHMP experience offers valuable lessons for such initiatives, demonstrating that flexibility and local control could amplify the impact of the program.

In conclusion, although federal involvement provided a foundation for the OAHMP, further research is needed to determine causality. The program’s limitations reveal the promise of state and local innovation. As the aging population grows, so does the need for scalable, adaptable solutions. This report invites researchers, as well as state and local governments, to build on the OAHMP.

John Gibbs
Principal Deputy Assistant Secretary for the Office of Policy Development and Research
U.S. Department of Housing and Urban Development

Publication Categories: Publications     Rehabilitation and Preservation     Housing for Persons with HIV/AIDS, Disabilities, and Seniors/Elderly