314 Home Modification and Repair Services | HCBS-5300-MANUAL

This chapter establishes the requirements for home modification and repair services funded in whole or in part with non-Medicaid federal and state funds managed by the Area Agency on Aging (AAA), and any associated matching funds. These requirements may act as guidelines for a fee-for-service model.

According to the Older Americans Act (OAA), the purpose of this program is:

The requirements apply to home modification and repair services funded in whole or in part with non-Medicaid federal and state funds, managed by the AAA, and any associated matching funds. Modifications may include installation of adaptive and assistive devices and structural alterations to improve accessibility and mobility both within and outside the residence.

Repair services are designed to reduce or remove structural or environmental hazards by returning the dwelling to as safe a condition as possible, allowing the resident to continue living in the community. Repairs and modifications shall be of quality workmanship and provided at a reasonable cost in accordance with state and local building codes.

Repairs and modifications are provided with the program resources only when there are no other public or private resources available to pay for the repair/modification home assessment, materials, equipment, supplies, labor, and any necessary inspections.

Whenever possible, adaptive equipment and modifications are planned and installed in such a manner that they may be recycled and made available to other clients, when no longer needed in the residence of original installation.

For individuals requiring repairs on rental properties refer to Section 314.

Home modification and repair services are offered to:

AAAs should follow additional criteria specific to fund sources. If funding is not sufficient to serve all eligible consumers requesting services, the Older Americans Act and Client Prioritization guidelines, found in MAN 5300, CH 118 provides for giving preference to specific persons:

Individuals must have an impairment(s) and/or unmet need(s), as indicated by his/her DON-R score. AAAs should prioritize individuals who have impairment and/or unmet need in any of the domains with scores of 2 or greater.

AAAs will not provide home modification and repair services in a nursing home, personal care home, or other setting where the provision of this service is included in the cost of care.

An efficient service delivery system is characterized by person-centered approaches and cost-effective outcomes for both consumers and the community. Therefore, DAS supports the implementation of a conflict-free service delivery system.

MAN 5300, 202 Program Guidelines and Requirements includes the key elements included in the design of such a system.

Home modification and repair(s) activities must be planned with input from the client, whenever possible, caregiver or a representative, based on an assessment of their needs and the degree of physical and/or cognitive impairment of the care receiver.

Assessment/evaluation fees is an allowable service activity in the provision of home modification and repair services.

The types of repairs or modifications may include:

Refer to Appendix A for additional examples of repair work/modifications.

Non-reimbursable activities include the following:

AAA staff shall screen individuals including identifying problems that he/she experiences in daily life and that he/she hopes are eliminated or diminished as a result by home modification and repair services.

AAA staff shall discuss with potential clients how home modification and repair services can:

The AAA staff will initiate service delivery, refer clients to provider organizations or other resources (e.g., occupational therapist, Center for Independent Living, certified aging in place specialist, etc.), or place them on a waiting list for services.

For information regarding screening through Aging & Disability Resource Connection, see MAN 5200, Section 5025. The AAAs will maintain and manage waiting lists for the services, as necessary. See Manual 5200, Section 5038 “Waiting List Management”.

Not every applicant will request, require, or benefit from home modification and repair services. Each AAA will clearly identify in its Area Plan how services will be coordinated and how resources will be allocated and managed to optimize the effectiveness and efficiency of home modification and repair services.

Refer to MAN 5300, 114 Guidelines for Client Assessment

AAAs may provide directly or contract for the provision of home modification and/or repair services with private non-profit organizations or commercial businesses that have the capacity to perform the tasks necessary to improve residential environments and increase the safety and independence of community-dwelling older adults and adults with disabilities.

Businesses that contract with the AAA to provide modification and/or repair services shall meet all professional standards, including licensure and certification (if applicable according to state/county/municipal codes) or any state training requirements. AAAs also may establish contracts/working agreements with individuals or other organizations such as community and social service agencies and area technical schools, which demonstrate expertise in providing modification and repair services, using either paid or volunteer staff, or both, or who agree to act as an intermediary for developing working agreements with commercial concerns. Qualified providers may include:

License Requirements:

Insurance Requirements:

Additional Requirements:

Appropriate assessment tool(s) (such as STEADI, DON-R, home safety assessment, etc.) administered by trained personnel (OT, contractor, certified aging in place specialist, etc.) may be used to identify and/or recommend home modification and repair services.

During the screening process, the Stopping Elderly Accidents, Deaths & Injuries (STEADI) (Appendix C) may identify a client at risk for falls. Clients at risk for falls should be referred to qualified professionals for home assessment to identify/make recommendations for any home modification/repair to reduce any falls risks. Such clients should also be referred to evidence-based falls prevention workshops such as Matter of Balance, Tai Chi for Health, etc.

Home repair/modifications must be justified in the service/care plan on a qualified residence and can only be performed after an on-site evaluation/assessment of the home by a case manager, occupational therapist, CAPS, or other provider staff has been made prior to work being performed. There is a bidding process, and the client will obtain two bids to determine the lowest bid. See Appendix B for suggested client contract guidance.

Two scope/bid quotes are required for home modifications. Scope/bid quotes must come from qualified service providers and scope/bids must separate charges for labor and materials. Quotes from contractors must be based on using standard materials. Any materials used beyond basic/standard materials will be subsidized by the property owner.

OR –

AAA can request RFP’s to qualifying contractors to assess, make any appropriate repairs/modifications, obtain any necessary permits. Two scope/bids are not required if a AAA has an established contract with a home modification/repairs services provider.

Contractor scope/bids must be itemized by area modified (i.e. bathroom), itemized by task (i.e. remove toilet and install new Americans with Disabilities Act (ADA) toilet) and provide a breakdown of materials and labor. Grand total of labor + materials must be included in the scope/bid. The winning scope/bid is typically the lowest bid, but not required if justification is presented and accepted for a more costly bid.

Modifications cannot exceed the budget of $2,000.00 when using Title IIIB funds. Georgia’s State Unit on Aging (SUA) Director can authorize up to an additional $1,500, as individual situations warrant. Other funding sources maybe used, if available. Home modification and Repair service workers may not perform all tasks identified as necessary through an assessment due to budgetary constraints. Information regarding those needs should be referred to appropriate AAA staff for a referral to other community resources.

Both quotes obtained by client must be submitted to appropriate AAA staff and the winning bid indicated. Supporting documentation includes the scope/bid quotes from qualified provider and notarized permission letters from owners/landlords. AAA staff will collect and review all supporting documents.

All home modifications and repair services must comply with local building codes and permitting processes. All structural modifications, such as the installation of ramps, zero-step entries, widening of doorways, etc. shall conform to minimum Americans with Disabilities Act (ADA) standards.

AAA staff will approve home modification/repairs and will coordinate with the client and contractor the start of any repairs/modifications.

Upon completion of modifications/repairs, verification is required to ensure work was done in a satisfactory manner, and if/how repairs/modification are impacting the individual’s quality of life.

Residential repair/modification services on rental property/units are not allowed without prior approval by the Area Agency on Aging or its designee. The AAA or service provider must verify that needed repairs or modifications to rental property are not the responsibility of the owner, landlord, management company or housing authority prior to authorizing the work to be done by referring to a provider.

If work is performed on rental units, the residential repair services provider shall obtain a signed and notarized agreement from the landlord, or other entity controlling the property, authorizing the repairs and/or modifications and stating that the tenant:

The primary goal of home modification and repair services is to aid older adults, persons with disabilities to maintain their homes in conformity with minimum housing requirements to ensure their ability to remain in their home and/or to adapt homes to meet the needs of older individuals who have physical disabilities.

The AAA should ensure that each client record contains emergency contact information (name and telephone number(s) at a minimum).

It is the explicit intent of DAS to serve clients in greatest need and to maximize the efficiency and effectiveness of the Aging Network.

DAS anticipates that during the span of service delivery to a consumer, the consumer’s needs, supports, and resources will change. Based upon the ongoing process of assessment and reassessment, the AAA may determine that the individual is receiving maximum benefit from home modification/repair services and initiate discharge according to DAS policy (see MAN 5300, CH 202).

Staff must include proper documentation in the DDS system that includes the reason for discharge and whether any reusable modification was collected, and/or re-utilized.

AAAs and provider agencies will assure that all consumers, or their caregivers, receive a written copy of their rights and responsibilities as program/service participants upon their admission to services. See MAN 5300 Appendix E for the suggested “Client’s Rights and Responsibilities”.

AAAs will establish written client complaint procedures for use by each provider. Procedures should include the minimum requirements outlined in MAN 5300, CH 202. In addition, the complaint procedures must include:

AAAs will establish written appeals procedures for use by each provider and are consistent with MAN 5300, 110 Grievance Procedures for Individuals in Non-Medicaid HCBS Programs.

AAAs must assure that providers employing persons having direct contact as primary, secondary or alternative job duties conduct a criminal records investigation, according to state law and current policy of the Department of Human Services in MAN 5600, 3036 Criminal History Investigations.

AAAs or providers, at a minimum, must comply with all volunteer management procedures found in MAN 5600, 4020 Volunteer Management Procedures.

The provider agency or individual contractors shall have the necessary legal authority to operate in conformity with federal, state, and local law and shall maintain the following:

The following documentation of activities must be accomplished each program year to certify the delivery of services:

Businesses, agencies and individuals providing assistive technology services shall practice sound and effective fiscal planning and management, financial and administrative record keeping and reporting.

General information about data collection and reporting are described in CH 202. The AAA may require additional information systems at its discretion but may not fail to meet the minimal standards required by DAS. The AAA must retain relevant information not captured in the DAS data system in paper files according to DAS program policies.

Specific programmatic/service requirements for collection and/or reporting of data include:

The AAA staff will use data from the DAS data system, at a minimum, to facilitate quality improvement and data analysis.

Providers must establish and implement written policies and procedures for the maintenance and security of client records, specifying who will supervise the maintenance of records, which will have custody of records, to whom records may be released, and for what purposes in compliance with MAN 5600, 3012 Area Agency on Aging Records.

Each client record must include the following information about home modification/repair services in the manner that DAS requires:

Each AAA/provider is encouraged to offer in-home services as a fee-for-service enterprise to enhance the sustainability of the Aging network. In doing, the AAA must follow all requirements of the Older Americans Act and MAN 5600, Sections 2025-2028, “Fee for Service System”, “Cost Share”, “Voluntary Contribution”, and “Private Pay Services”.

Home modification and repair services provided to consumers as a fee-for-service should not differ in quality from service provided to consumers funded through public funds.

Refer to MAN 5300, 202 Program Guidelines and Requirements

Refer to MAN 5300, 202 Program Guidelines and Requirements

The Area Agency will make follow-up contacts to recipients of modification and repair services to determine their satisfaction with the work performed and the degree to which their safety and independence is enhanced or improved.

The Area Agency also will monitor provider records regarding work performed at least once annually to assure compliance with all applicable codes and regulations. The AAA shall provide written feedback to contractors on the findings and provide any necessary technical assistance for continuous quality improvement where appropriate.

Older Americans Act Of 1965: 2020 Reauthorization

DAS Manual 5200, Section 5025 - Service Availability and Access

DAS Manual 5200, Section 5038 - Waiting List Management

DAS Manual 5300, Section 114 - Guidelines for Client Assessment

DAS Manual 5300, Section 118 - Prioritizing Clients

DAS Manual 5300, Section 202 - Program Guidelines and Requirements

DAS Manual 5300, Section 316 - Caregiver Services

DAS Manual 5600, Section 1060 - Technology and Data Management

DAS Manual 5600, Section 2025 - Fee for Service System

DAS Manual 5600, Section 2026 - Cost Share

DAS Manual 5600, Section 2027 - Voluntary Contribution

DAS Manual 5600, Section 2028 - Private Pay Services

STEADI Falls Risk Assessment

Appendix A: Examples of Home Modifications/Repairs Appendix B: Client Contractor Guidance

Appendix C: Stopping Elderly Accidents, Deaths, and Injuries (STEADI) - Falls Risk Assessment