This post was originally published by the Department of Housing and Urban Development.

The nation’s population is aging at an unprecedented rate, with adults aged 65 and older
projected to constitute nearly one-quarter of the U.S. population by 2060. With aging comes an
increased risk of falls, particularly in the home, leading to hospitalizations, nursing home stays,
and a loss of independence. These incidents carry a substantial financial burden, with non-fatal
falls costing Medicare and Medicaid approximately $38 billion annually. To address this
pressing issue, the Older Adults Home Modification Program (OAHMP) was launched,
providing federal funding to state and local governments, nonprofit organizations, and public
housing agencies. The aim of this program was to implement low-cost home modifications to
enhance safety and reduce fall risks for older homeowners.

Congress tasked HUD with evaluating the effectiveness of the OAHMP, focusing on the first
round of grantees. The evaluation revealed promising outcomes: homeowners experienced
improvements in functional abilities—such as bathing and dressing—and reductions in
emergency department visits, hospitalizations, and emergency response calls. Nearly all clients
who were interviewed post-modification reported benefiting from the program. However, these
positive associations must be interpreted cautiously because the evaluation did not conduct
research to establish causality. Thus, although the modifications coincided with improved
outcomes, we cannot definitively conclude that the positive outcomes were the result of the
OAHMP.

At the same time, the evaluation exposed significant challenges tied to federal involvement.
Federal environmental review requirements for modifications beyond basic maintenance created
confusion and delays. Grantees frequently avoided certain modifications altogether rather than
navigate the regulatory waiver process or risk prolonged timelines. Moreover, eligibility
restrictions—such as the homeownership requirement—excluded vulnerable groups, such as
low-income renters and older adults living on Tribal lands, further illustrating the rigidity of
federal oversight.

These limitations underscore the constraints of federally administered programs, which must
adhere to uniform regulations that may not suit diverse local contexts. In its fiscal year 2026
budget request, HUD has not sought additional funding for the OAHMP, signaling a shift away
from federal responsibility. Such initiatives may be more effectively managed by state and local
governments, which can tailor programs to their communities’ unique needs without the burden
of federal red tape, such as environmental reviews or strict cost caps.

The findings of the evaluation highlight the potential for further research that can determine
causality between the OAHMP and observed outcomes. If such research determines a causal
positive impact, then the potential may exist for state and local leadership in this arena; with
relatively modest investments, home modification programs can yield meaningful improvements
in quality of life for older adults, confidence in avoiding falls, and the ability to age in place. The
OAHMP experience offers valuable lessons for such initiatives, demonstrating that flexibility
and local control could amplify the impact of the program.

In conclusion, although federal involvement provided a foundation for the OAHMP, further
research is needed to determine causality. The program’s limitations reveal the promise of state
and local innovation. As the aging population grows, so does the need for scalable, adaptable
solutions. This report invites researchers, as well as state and local governments, to build on the
OAHMP.

John Gibbs
Principal Deputy Assistant Secretary for the Office of Policy Development and Research
U.S. Department of Housing and Urban Development