Simple Home Modifications Can Improve People’s Lives & Save Taxpayers Money

By Anna Meyer, Graduate Student at the University of Missouri-St. Louis

Everyone should be able to move safely and easily through their homes. But that’s not always easy for Missourians living with disabilities—especially those living in private homes.

Public buildings have accessible entrances and other features that make it safe for residents with disabilities to navigate, but private homes rarely have any of these features. In fact, roughly 90% of homes are not accessible to someone in a wheelchair. As a result, people with disabilities and the elderly are often unable to stay in their homes and are forced to move into expensive skilled care facilities.

We can address this problem by using Medicaid funds to pay for personalized home modifications that make it as easy as possible for Missourians with disabilities to live in a safe, comfortable home.

Wider doorways, ramps, stairlifts, and handrails are simple solutions that can have a huge impact on the safety and comfort of a home. Implementing each of these solutions is easier than moving into a new house, and—for most people—preferable to moving into a nursing home. Individuals who remain in their homes as they age show improved cognition, reduced depression, and higher success with activities of daily living.

Missouri’s current approach to increasing home accessibility is tax incentives. Tax credits are available for individuals who make accessibility modifications to their homes. Unfortunately, these often can’t help those who need modifications most. Many individuals don’t have the money to pay for modifications out of pocket, and they may not pay income tax—so a tax credit won’t help them. Moreover, each step of the home modification process takes resources that many Missourians living with a disability lack. Residents must invest time, knowledge, energy, and money up front as they determine what modifications are needed, find a contractor, and negotiate prices.

This is why I recommend Missouri try a new approach to home modifications: funding and helping residents in need arrange modifications to their homes. Specifically, Medicaid recipients would be able to sign up to receive visits from occupational therapists (OTs) who would assess their individual goals and needs. OTs would then create a work order for a contractor to make necessary changes to the patient’s home, working with a budget of up to $1,500 per patient. After the changes are made, the OT would return to discuss with the individual how to use their new tools and help them develop plans for safely navigating their home.

This strategy would reach Medicaid recipients all over the state and remove several barriers that currently make it difficult for Missourians with disabilities to access home modifications. It would allow occupational therapists to expertly direct and personalize a patient’s modifications. It would remove the burden of choosing a contractor, negotiating prices, and directing construction from the individual with the disability. The government can work with contractors to ensure fair pricing across the state, adding a layer of protection against senior scams.

A program like this would also save taxpayer dollars. Studies have shown that an individual aging in place can save almost $1,600 in Medicare and Medicaid costs each month compared to those in nursing homes. That means for each person who is able to remain in their home, Medicare and Medicaid save over $19,000 each year! A one-time $1,500 expense for minor home improvement could pay for itself in less than a month.

A similar program called Community Aging in Place, Advancing Better Living for Elders (CAPABLE), implemented in Baltimore from 2012-2015, proved to be a success. On average, participants significantly improved in their ability to complete daily activities, which enabled them to continue safely living at home instead of moving into a nursing home. Research showed that the program even decreased depressive symptoms as independence and safety improved.

We have the strategies and resources we need to ensure all Missourians have an opportunity to live in homes that are safe and comfortable. If you want to both improve quality of life for the elderly and people with disabilities and save taxpayers money, tell your elected representatives that you support bringing CAPABLE to Missouri.


Anna Meyer is a graduate student at the University of Missouri-St. Louis who is studying public policy administration and nonprofit management. She is especially interested in policies relating to individuals living with disabilities.


Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.

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