by Darcey Trescone
In the early '90s, Louis Tenenbaum was one of the first contractors to focus his remodeling business on aging in place. Curious why home modifications for aging in place were not encouraged, Tenenbaum wrote the white paper, Aging in Place 2.0: Rethinking Solutions to the Home Care Challenge, published by the MetLife Mature Market Institute. He later founded The HomesRenewed™ Coalition, recognizing that good messages, subsidies, and incentives are critical to market development.
In a recent interview with Tenenbaum, we discussed the work of the HomesRenewed™ Coalition. Specifically, we asked him why we need to work across the care continuum to identify methods and support legislation that will assist in ensuring homes accommodate patients' needs as they age, as well as to protect home care staff.
Tenenbaum: Workforce retention and allowing individuals to stay in their homes as they age are intertwined. Updating a house is a critical factor that can impact both areas. HomesRenewed™ Coalition has been working to get legislation passed that incentivizes homeowners to choose home modifications that support aging in the home when remodeling.
Focusing on the patient side, a person often leaves the home due to safety issues, seeking services within a facility. Falling, the inability to perform ADLs, and complex transfers pose risks to the patient, the family caregiver, and the paid caregiver. Healthcare facilities must be wheelchair accessible and have the appropriate equipment to care for patients, but homes do not have to meet such requirements.
In The Cost Efficiency of Home Modifications to Reduce Healthcare Cost, a paper written by Dr. Jesse M. Abraham, Research Director, HomesRenewed Resource Center, he says,
"Relying on a patient's existing network of home services for even a handful of months that delays a move to institutional care can make renovations cost-effective. Eriksen (2015) finds that accessibility features lower move-out rates leading to a 10 percent reduction in nursing home stays during their 2-year observation window. Tinetti (1997) draws a direct link from serious falls to an increased likelihood of moving to a skilled nursing facility. When a home is not modified to appropriately care for a patient, it is difficult for the caregiver and could result in injuries on the job."1
Retention of the in-home care workforce is a constant struggle. We lose experienced and reliable employees daily because the caregiver role is challenging. Employees value organizations that focus on improving their work environment and patient safety, which can help with recruiting. It is well known by home care and hospice leadership that losing caregivers is detrimental to the aging population.
Tenenbaum: First, today's designs are magazine-worthy, beautiful home improvements. They provide accessibility and safety features that are subtle yet functional. Showers are beautiful and provide wheelchair accessibility, so the patient and caregiver are not transferring in a potential slippery area. Many modifications that support aging are available, but some common examples are wider doors, no-step entries, and handrails. Unlike in the past, home modifications easily blend into the environment while still providing safety. Encouraging people to think about beautiful home modifications that allow for aging in place is a win for healthcare and the individual.
A lot of research dollars are spent on healthcare design that does not apply to houses, even though that is where healthcare is being delivered more often. In Dr. Abraham's paper, according to the US Census Bureau's 2019 American Housing Survey, of the 14 million households headed by someone 75 or older, 46 percent had acknowledged accessibility problems (entering the home; getting to the bedroom, kitchen or bathroom; or using the bedroom, kitchen or bathroom).1 For those 65 to 74, it was only 22 percent.
Tenenbaum: I think the big picture is that the home was already on a steady path toward becoming the main location of healthcare delivery. COVID required this to occur sooner. People were quarantined in their homes, and healthcare workers did not always have access. Homes are not equipped for the elderly today, and we need to change this.
Almost one-third of Americans over age 65 fall each year, with one-third of those falls requiring medical treatment at an estimated price tag of $30,000 per hospital stay. Medicare and Medicaid shoulder 75% of those costs. Accessibility remodeling, costing approximately $4,400 per house, could reduce the number of falls by 20% for those over 65 and 40% for those over 75.2
HomesRenewed™ Coalition connects technology groups, home modification groups, and healthcare entities, such as home care and hospice organizations. We envision a broad-based Home Modification Tax Exemption (HMTE), which could achieve widespread adoption over the next ten years. We have legislation being reviewed presently to allow individuals to utilize savings and retirement funds tax-free for home modification. It is simple: if you are going to do any home remodeling and include home modifications that promote safety for the homeowner as they age, savings/retirement funds could be utilized tax-free.
The homeowner saves a couple thousand dollars, making the topic worth discussing. The government benefits because safety issues resulting in falls, leading to hospitalization and facility care, cost substantially more than the tax the homeowner would have paid. This incentive encourages individuals to upgrade their capital and personal infrastructure, allowing for a safe environment and cost savings during their retirement. We believe the net effect to the government is about a 20 percent loss of tax revenues on those dollars.
There are multiple policy options that Tenenbaum and his team outline in their strategic white paper, The Next Crisis: UnSafe Housing for an Aging America.2
TAX INCENTIVES
WAIVERS OR OTHER MODIFICATIONS TO REGULATIONS
Tenenbaum added that people over 50 spend about $150 billion on home remodeling. Statistics show that people spend more dollars on home remodeling after becoming empty nesters because they plan to remain in their home. Still, the home modifications they choose often do not support aging. This can be changed through education and advocacy. The public needs education and guidance on home modifications that promote safety. Post-acute care organizations can help patients, and their own businesses, if they discuss home safety initiatives with patients and their families.
Additionally, the dynamics of the care continuum are an essential consideration. Individuals are not static, and needs change as health status evolves. As we age, different healthcare entities are involved in maintaining our health. Solutions that support aging in the home and accommodate the various services required could remove a significant burden for the family and reduce overall healthcare costs.
Establishing a national policy to empower and encourage individuals to update their homes — through tax credits, waivers, or other fiscal policy — is a realistic strategy to achieve that end. We have also seen that incentivizing individuals to update their homes will boost local economies and expand the marketplace for many businesses — from construction to food delivery — that support aging in place. In addition, there is a precedent that these mechanisms will work based on the success of similar incentives, such as solar power and hybrid cars.2
1 Homesrenewed.org. 2021. [online] Available at: homesrenewed.org/wp-content/uploads/2021/11/HomesRenewed-Gov-save-money-on-remods-for-aging-in-place.pdf [Accessed 3 December 2021].
2 Homesrenewedcoalition.com. 2021. [online] Available at: <homesrenewedcoalition.com/wp-content/uploads/2021/03/HRC-Whitepaper-FINAL-3-2.pdf> [Accessed 14 December 2021].
ABOUT HOMESRENEWED™ COALITION
The Coalition's mission is to significantly increase the number of American homes prepared for residents to live through the modern lifespan. We promote the establishment of consumer incentives for home updates on Wall Street, Main Street, and Capitol Hill. Updated homes are the missing link needed to avoid a crisis in housing and care for older Americans that threatens the long-term solvency of the social safety net. This broadly based coalition uses education and advocacy to promote market-based solutions to reduce medical costs, improve the delivery of services, and increase the dignity, choice, and independence of older Americans living in their homes in their communities. By crossing sectors and unifying voices, we are launching an "Aging in Place Industry."
[Editor's note: As a complement to the coalition's advocacy efforts, there are several organizations that provide the actual modification design and construction, such as "Seniors Home Services," a sponsor of this publication.
Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at darcey@tresconeconsulting.com.
©2021 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com