Resistance to change and credentialing issues hold everyone back
by Liz Carey
October 26, 2017

Without the home accessibility industry, more people would have no choice but to move; however, ensuring accessibility in the home can present a complex set of needs that aren’t always easily met.

Truly accommodating the mobility and care needs of individuals requires a range of specialties, from architecture, senior living interior design/space planning, construction expertise and project management, and home medical device and equipment supply and expertise.

Easy Access, Barrier-Free Living

Families may seek to modify an existing home, widening doorways where possible; expanding the allowances and capabilities of the home to accommodate a wheelchair or rollator; removing obstacles from entryways and in the interior rooms; and repositioning cabinetry and countertops for usability. They often start by adding a wide variety of tools, such as grab bars, handles and lifts (inside or outside). Then there are high-tech tools, such as touchpad flushing toilets and programmable shower and bath controls.

In northeast Ohio, just west of Cleveland in the suburb of Lakewood, housing stock consists of pre-World War II era homes. There is little room for expansion. Rooms are small, and bedrooms and bathrooms reside on the second floor. These homes have served their families well through the years, but as homeowners age, they begin to have accessibility issues.

Beth Glas presents educational and demonstrational workshops showing residents how to make their homes more accessible, “proactively,” she says. Through the years, Glas with Maximum Accessible Housing of Ohio, has gained insight from experience
in providing housing for people with disabilities.

Proactively Speaking, The Big Hurdle

Among residents there is a general resistance to accepting life change of this sort.

“Our homes require us to work harder than we realize,” Glas says. She points to hard-to-reach pots and pans, and cabinetry that can put us in awkward positions—at any age.

“So many seniors are quick to say, ‘I don’t need accessibility features yet.’ Getting people to be open to these conversations is one of our biggest challenges. We try to help people understand that these needs are not a sign of weakness; we tell them about safety and show them products with cool features.”

These are hard conversations, though, and Glas says she looks for new conversation starters.

“Pull-out shelves, walk-in curbless showers…these are labor saving amenities—easier to use, less maintenance—that when you begin to develop arthritis become really helpful. We want people to make these changes sooner so that when needs become greater there are fewer projects to worry about, more money for other projects. And, if modifications like these mean an extra one or two years of taking care of yourself in your home, that’s a really big deal.”

The people behind Lakewood’s home accessibility education program emphasize the rules around properly installing accessibility products. More insight comes from real estate agents who Glas says have the data to know what people are looking for and what can help a home’s value.

Real estate agents make up some of the professional audience participating in the educational sessions, as well as occupational therapists and physical therapists; social workers are coming soon.

An easy starting point for homes, Glas says, is to install swing-clear hinges for wider doorways.

Growing Opportunity

Supplying the tools and services to make staying in the home possible represents a growing opportunity for HME providers. Home modification extending from product offerings has become a way to diversify revenue streams, add value and help people in the community.

For about 20 years, Birmingham, Alabama-based Medical Equipment Outfitters, Mobility Central, has provided standard aging in place products, but 10 years ago the company planned and prepared to take on additional home accessibility services. During
the past six years, demand has increased, says Chris Leggett, who leads the company’s home modification program.

“We saw a lack of senior housing and lack of level entry; there was just not enough housing out there for the population. We evolved into a one-stop shop for seniors and people with disabilities,” Leggett says, adding presenting finished product to see and test in the showroom makes all the difference.

Home accessibility and modification makes up about 35 to 40 percent of Mobility Central’s business, and the company views the category as a high-growth area, Leggett says. “Building relationships—not just relationships with customers—with referral sources takes time. Our target market covers a broad spectrum.” Marketing efforts include senior and specialty organizations, therapy and health care providers.

Access to Independence in Ravenna, Ohio, which serves Cleveland, Akron and Youngstown, has been in the home accessibility and modification business since the early ’90s. CEO Vince Pelose says today the category makes up 70 percent of his single-location business.

“There’s still nothing like touching and feeling a product and trying it for yourself,” Pelose says. The showroom has become a draw with its 9,000-square-foot home modification showroom. Another 6,000 square feet is dedicated to medical equipment.
“It was a natural transition to get into home modifications,” Pelose says. “We are in the home a lot because of other products. We know the relationship between products and disabilities.”

Using vignettes, Access to Independence provides working-model ceiling track systems, stair lifts, vertical platform and modular ramps, walk-in tubs, and smaller products that address fall prevention. “The showroom has been a key for us. We talk to customers about what their needs are. It’s really focusing on the individual’s needs and matching them up with products. Every month we look at adding another vendor and another product line.”

Pelose emphasizes growing personal experience and credentials toward mastering accessibility and home modification. “I want to see our industry grow so that people start to understand that there are people out there who are experts.”

There is no shortage of heavy duty and light duty accessibility products; the main obstacles to overcome are in the lack of credentialing and training, says Jim Greatorex, vice president of Accessible Home Improvement of America (AHIA), soon to go by VGM Live at Home.

The Industry and Its Credibility

“This niche industry has a tremendous opportunity but on the medical equipment side, we need to make sure we professionalize ourselves with the appropriate standards and measures. When we go and ask the government to help us as a funding source, we have to have the infrastructure to show we are trustworthy,” Greatorex says.

“The biggest opportunity in the marketplace is the Safe at Home senior market, and the easiest way for people to get a bad name is to not treat that consumer with their best interests at heart,” says Greatorex, who stresses knowing a body of standards and credentials that work for consumers, manufacturers and providers.

AHIA offers the Certified Environmental Access Consultant (CEAC) credential. Other credibility boosters include the National Association of Home Builders’ Certified Aging in Place Specialist (CAPS) credential. The National Association of Home Builders, in partnership with the AARP and NAHB Research Center, created the CAPS program, which includes training and education on essential technical, business management and customer service skills essential. (Read “Breakdown of a CAPS Assessment” on page 56 for more information.) A newer credential comes from the Senior Living Institute and goes by CLIPP, or Certified Living in Place Professional. With universal design a buzzword in home accessibility, the National Association of the Remodeling Industry (NARI) provides classes in UD. Finally, the most rigorous of certifications is from the Center for Health Design, called EDAC, or Evidence-Based Design Accreditation and Certification.

For home modifications, Greatorex recommends taking at least two certification programs to gain a foundation, to understand the objectives, and to be able to help solve the accessibility issues a customer may have. His organization’s CEAC credential, and the CAPS credential are widely regarded as a solid start.

On the less complex end of work, aspects of home accessibility conversion consist of such projects as: installing a ramp leading into exterior and sometimes interior entryways; grab bars and support poles; installing a vertical lift and removing thresholds where possible. Many more elements form the large picture, including meeting modern building codes.

A Community of Care

Occupational therapists are trained to assess someone, their environment and how they interact within a specific environment to perform the daily tasks they may need and want to do. Dr. Tracy Van Oss is an occupational therapist with a specialty certification in environmental modification, who has been working in homecare for 20 years.

“Each person must be individually assessed for any past medical related issues or current conditions that may progress to a decline in function over time. Occupational therapists are able to make the holistic connection between the human abilities and the built environment,” Van Oss says.

Wanda Gozdz works as a master instructor for the National Association of Home Builders (NAHB). She was named the NAHB’s CAPS Educator of the Year for 2014 and teaches courses for builders, remodelers, occupational therapists, interior designers, durable medical equipment specialists and other professionals who serve the Aging in Place market.

“Knowing a person’s needs requires an intense assessment in order to determine what the older adult really needs,” Gozdz says.

Using home design to support aging in place provides peace of mind for caretakers, seniors and families, says Casey Hite, CEO of Aeroflow Healthcare.

“Knowing that a loved one is less likely to experience accidents or falls can reduce the need for assisted living arrangements for many families,” Hite says.

“Even seniors with walkers or wheelchairs, who typically have less options, can benefit from thoughtful home modification and move throughout their home safely and easily. In many cases, the cost of aging in place design pales in comparison to the cost of assisted living facilities. In New Jersey, for example, the median monthly assisted living cost is nearly $6,000 per month,” Hite says. “That adds up to about $72,000 per year, and if the resident is in assisted living for an extended period of time—say 15 years—that’s about $1.1 million.

Realizing the Potential

If providers rely solely on third-party paid home modification, funding for the work is currently limited to state waiver programs, workers’ compensation claims and the VA.

Greatorex adds:

  • 18 percent of the population is eligible for the Medicaid waiver program.
  • 9 percent (approx.) has substantial financial means to successfully age in place.
  • The rest have a combination of caregiver, family, friends and financial resources to help them age in place.

“The worker’s comp and VA revenue streams are finite if you are looking to capture those markets. The greatest opportunity is in capturing that largest market,” Greatorex says.

In April 2017, AHIA was encouraged by the introduction of HR 1780, the Senior Accessible Housing Act, that if passed would amend the tax code to allow people over the age of 60 to use up to $30,000 of their funds to modify their home to enhance their ability to remain living safely and independently. If HR 1780 is successful, consumers will get a discount on home modifications and a blessing from the government saying this is a wise investment. If HR 1780 is unsuccessful this year, it will likely be reintroduced.

Ask the Experts

What have you learned from your customers? What do your customers learn from you?
Customers and their children or family members—they walk into this situation blindly, where somebody has had a fall and they’re no longer mobile. We try to be a voice of reason and bring them practical and safe solutions. I look at myself as a provider of solutions, and we want to be a resource to the community. Customers appreciate the honesty and the help.
—Chris Leggett, Mobility Central, Medical Equipment Outfitters, Birmingham, Alabama

What has made the difference for Access to Independence?
Space and selection. In May 2015, we kicked off a dedicated aging in place showroom in a 9,000 square foot space. We solicited major manufacturers who wanted to be a part of it, a number of vendors bought in, Bestbath being the first. That first year, when we showed a product, we saw a 93 percent close rate. Today, we see a 91 percent close rate.
—Vince Pelose, Access to Independence, Ravenna, Ohio

What advice do you have for providers?
Make yourself known to the people who provide services to the senior population. If you look at the cash market, that is evolving, so you are going to be able to create your own customer. Grow your business from the cash market first, and then look into the VA or the Medicaid waiver. If you build a solid cash foundation, you’ll be able to handle the rest of those opportunities in the ways that they’re going to be expected to be handled.
—Jim Greatorex, AHIA, VGM Live at Home