RD890 - Needs Assessment Report: In-Home Services and Home Modifications for Older Adults – December 1, 2022

Executive Summary:

According to American Community Survey data, Virginia is home to 1,566,250 adults aged 65 and older, making up roughly 18.5% of Virginia’s total population. When reviewing similar figures for Virginians aged 60 and older, it grows to 2,085,580 or 24.6% of the population.(*1) Recognizing the current population statistics and the future growth trends, it is no surprise that in 2020, the Joint Commission on Health Care (JCHC) directed staff to examine strategies to support aging Virginians in their communities. In conducting the study, JCHC staff examined inhome services provided by area agencies on aging (AAAs) and the local departments of social services (LDSS) as well as the limited availability of home modification services.

In-home services, a term inclusive of homemaker, personal care, companion, and chore services, assist older adults with completing instrumental activities of daily living (IADLs; such as meal preparation, shopping for personal items, housework, and yard maintenance), and with activities of daily living (ADLs; such as dressing, bathing, walking, and eating). Home modifications include a range of services and projects, such as home repairs, pest control, installation of grab bars or handrails, and installation of ramps or roll-in showers, which are intended to improve the accessibility and livability of the home.

While the JCHC staff reported that there seemed to be a high unmet need for in-home services and home modifications, there was limited data available from the Department for Aging and Rehabilitative Services (DARS), the AAAs, and the LDSS to pinpoint that exact need. At the December 7, 2021 meeting, and with the JCHC Aging in Place report in hand, the JCHC voted to adopt a recommendation to provide funding and direct DARS to complete a needs assessment and provide a report to the JCHC and the Chairs of the House Appropriations and Senate Finance and Appropriations Committees the following year. This recommendation was ultimately achieved through Item 331 L of the 2022 Appropriation Act.

In implementing this needs assessment, DARS used a multi-method approach to determine the unmet need and potential service costs. DARS’ process included surveying older adults directly, surveying staff with the AAAs and LDSS, reviewing AAA reporting data and the DARS Adult Protective Service (APS) Annual Report services and financial data, researching national standards regarding poverty, and conducting an environmental scan of existing programs that provide home modification-type services to Virginians.

At a high-level, the following needs were identified:

• Just over half of older adult survey respondents (54%) indicated that they intended to stay in their homes and 21% would move to a new area or new home in their current area. Almost 2 in 10 (or 18%) reported that they wanted to stay in their home but were concerned they would not manage to, and 8% said they wanted to move but did not have the resources.

• In the same survey, those in lower income brackets were more likely than those with higher incomes to report that they would like to move but don't have the resources to do so, or that they want to stay in their current home but are concerned they won't be able to.

• Of those older Virginians indicating concerns about the ability to age in place in their current homes, financial reasons (52%) and health reasons (44%) were identified as the top concerns in the older adult survey. The third top concern was that the home was not suited for aging in place (27%).

• From the survey, 22% of Virginians aged 65 and older stated they had a major or moderate need for homemaker services, 6% stated they needed personal care services, and 41% stated they needed chore services.

• The older adult survey also found that 37% of Virginians aged 65 and older indicated a major or moderate need for home repairs or home maintenance assistance, 18% needed assistance with maintaining the minimum housing standards, 18% needed minor home modifications, and 16% needed major home modifications.

• In 2021, approximately 10.3% of older adults lived in poverty, an increase from 8.9% in 2020, according to the U.S. Census Bureau.

• In a survey of LDSS across Virginia, staff estimated that an additional 3,468 adults needed LDSS in-home services beyond the 4,415 clients that were served in SFY (State Fiscal Year) 2021.

• In examining the biggest challenges, every Department of Social Service (DSS) region of the state indicated finding in-home service providers in their area was the main problem.

• All LDSS who responded to the survey reported that an increase in the allocation for inhome services is needed for LDSS to be able to serve more adults.

The current provision of in-home services and home modifications for older adults is limited by extensive funding constraints and increasing costs to provide services. In addition, data from the most recent years has been affected by the COVID-19 pandemic and the additional influx of time-limited federal funding to support some aging services.

Despite some report limitations, DARS believes that the final estimates and accompanying policy options provided in this report would result in meaningful increases in the Commonwealth’s capacity to serve older adults in their homes and their communities. To this end, DARS notes the following needs as identified as policy options:

• AAA In-Home Services: Provide between $1.5 million and $6.2 million in increased state funding for AAA in-home services, which could result in an increase of between 425 and 1,700 older Virginians served.

• LDSS In-Home Services: Provide between $1.9 million and $7.8 million in increased state funding for LDSS in-home services, which could result in an increase of between 1,000 to 4,400 older adults and adults with disabilities served.

• AAA Home Modifications: Provide between $500,000 and $5 million annually in new state general funds for AAA home modifications, which could result in home modification services for between 100 and 1,000 older Virginians.
(*1) American Community Survey (ACS) Special Tabulations, 2015 - 2019, Retrieved from AGID Data Porta: https://agid.acl.gov/ on August 8, 2022