Expanding Home Accessibility Services: 

Strategies for Sustaining Cross-Sector 

Collaborations

November 16, 2023

Webinar
Welcome

Webinar is hosted by the 

Housing and Services Resource Center (HSRC)

Facilitator

Charlene Allen, Senior Management Analyst, Office for 

Interagency Innovations, Administration for Community 

Living (ACL)

2
Instructions for Zoom

Audio Options

• Use your computer speakers, OR dial in 

using the phone number in your 

registration email.

• All participants are muted.

Questions and Comments

• Please actively use chat throughout the 

meeting, especially for your comments.

• To ask a presenter a question, please use 

the Q&A function.

Or, send your question or comment via email 

to HSRC@ACL.HHS.GOV 

3

This event is being 

recorded.
Accessibility

Maximizing view of ASL interpreters

• Enlarge view of ASL interpreter by “pinning” them: 

Click on their video window and select the Pin icon.

Screen Reader Users: Reduce unwanted chatter

• Request speech on demand: 

Insert, Spacebar, “S”

4
Poll

What types of partnerships do you have that support 

home accessibility and housing stability?

– We partner with aging organizations

– We partner with disability organizations

– We partner with housing organizations

– We partner with health organizations

– None - here to learn more about building partnerships

5

Agenda

• Importance of sustaining 

partnerships for accessibility 

and housing stability

• New Action Guides to support 

cross-sector collaborations in 

home modification, repair, and 

AT 

• Featured programs: 

– Orange County Home 

Preservation Coalition

– Green & Healthy Homes 

Initiative (GHHI)

• Q & A

• Closing

7
Poll Results

Chat: Describe how your 

partnerships support your 

aging, disability, health, 

and/or housing service 

delivery.

8
The Role of Accessibility in Housing Stability

• Home modifications, repairs, and weatherization can improve 

older adults and people with disabilities' ability to live in their 

homes.

• Home modification services can reduce the need to leave the 

home because one cannot function in it.

• Home repair services can reduce the need to leave the home 

because one cannot manage the upkeep.

• Weatherization services can reduce the need to leave the 

home due to inadequate temperature control and other 

inhospitable conditions

9
Lack of Accessible Housing

• 23.1 Million -- American households with accessibility needs.

• 40% -- American households in which a person lives in a 

home that does not have the accessibility features they need 

to live safely and successfully in the community.

• In 47% of homes, climbing up or down stairs to enter the 

home is required.

 Just 14% of households that include persons with accessibility 

needs reported having a ramp or lift of some type.

SP Group LLC. (2021, March). Accessibility in Housing: Findings from the 2019 American Housing Survey. 

[Online complete report]. Retrieved from HUD PD&R website: 

https://www.huduser.gov/portal/publications/Accessibility-in-Housing-Report.html

10
Accessibility Solutions

• Home Modifications

• Home Repairs

• Assistive Technology (AT)

• Weatherization

11
Benefits of Partnerships for Home 

Modification, Repairs, AT, and Weatherization

• When an organization operates alone, it may experience 

challenges of limited reach, resources, and perspectives.

• Partnerships can yield greater benefits than a single organization 

may be able to accomplish by itself.

• Working together can improve communication, coordination, and 

service delivery between organizations from different sectors that 

support the same population. 

12
Home Modification Action Guides

• ACL-supported efforts to advance home modifications, AT

• For aging, disability, health, housing, and community-based organizations

1. Tools for building cross-sector partnerships

– Potential partners, data sources to demonstrate the need, collaborative 

activity examples, and how-to tips

2. Approaches to build partnerships with the housing sector

– Step-by-step instructions, examples of partnerships for improved service delivery

13
Action Guide: The Power of Cross-Sector 

Partnerships to Advance Home Modifications

14

• Tools for building cross-sector 

partnerships for home modification

• Potential partners

• Data sources to demonstrate the need

• Collaborative activities: publicity, service 

delivery, education, advocacy

• Partnership resources
Action Guide: Partnering to Expand Access to Home Modifications, 

Repairs, and Weatherization for Community Living

15

• Partner with the housing sector to gain 

access to funding, expertise, and the 

housing perspective

• Step by step tips on building 

partnerships with housing organizations

• Partnership examples

• Resources
Strategies for Sustaining Programs

• Secure commitment from partner agency leaders

• Use data to communicate the need for services to partners and 

funders

• Integrate activities and personnel into existing agency budgets 

and operations

• Use data to demonstrate impact on health, cost savings

• Identify funding and in-kind resources to braid or leverage 

16
Featured Presenters

Orange County Home Preservation Coalition

• Ryan Lavalley, PhD, OTR/L, Primary Lead, UNC 

Department of Health Sciences Community Practice Lab 

(CPL)

• Leiha Edmonds, MPP, PhD Candidate in Geography & 

Environment, CPL Lead Housing Fellow, Orange County 

Home Preservation Coalition

17
The Orange 

County Home 

Preservation 

Coalition: 

Preserving Homes in Partnership

Dr. Ryan Lavalley, PhD, OTR/L 

Primary Lead | UNC Department of 

Health Sciences Community Practice Lab (CPL)

Leiha Edmonds, MPP

PhD Candidate in Geography & Environment 

CPL Lead Housing Fellow November 16th, 2023
19

Coalition takes Partnership
20

History of 

Coalition
21

Current 

Model
22

Strategies for Sustainable Partnerships

Supports

• Consistent Commitment

• Abundance Mindset

• Regular Individual Check-Ins

• Listening Intentionally

• Accessible Technology

• Readiness: Little Chasing

Challenges

• Staff Turnover

• Amount of Demand

• Complexity of the Systems

• Organizational Priorities

• Differing Org. Processes
23

Strategic Data 

Use

Solve problems • Using data to better understand 

pain points and service 

(mis)alignments

Inspire engagement • Offering access to the database, 

visualization, analysis, 

and aggregation to bring partners 

to the table

Inform advocacy • Bringing together the narratives 

and numbers that show OCHPC's 

successes and tell a strong story of 

how to grow the work
24

Leveraging Program Evaluation

Internal learning and 

improvement

External accountability
25

Always 

Evolving
26

Thank You!

Dr. Ryan Lavalley, PhD, OTR/L 

Primary Lead | UNC Department of 

Health Sciences Community Practice Lab (CPL)

Leiha Edmonds, MPP

PhD Candidate in Geography & Environment 

CPL Lead Housing Fellow

Connect with us!

https://go.unc.edu/cpl
Featured Presenters1 of 2

Green & Healthy Homes Initiative

• Ruth Ann Norton, President & CEO

27
Making the Case for Accessibility: 

Strategies for Sustaining Cross-Sector 

Collaborations

Ruth Ann Norton, President and CEO

Green & Healthy Homes Initiative

November 16, 2023
Mission

GHHI is dedicated to addressing the social determinants of 

health and the advancement of racial and health equity 

through the creation of healthy, safe and energy efficient 

homes. By delivering a standard of excellence in its work, 

GHHI aims to eradicate the negative health impacts of 

unhealthy housing and unjust policies for children, seniors 

and families to ensure better health, economic and social 

outcomes in historically disinvested communities – with an 

emphasis on communities of color.
GHHI Model: Aligning Resources to 

Advance Holistic Retrofits

Align

Services & funding

Braid

Relevant resources

Coordinate

Service delivery
How does home safety and accessibility contribute to 

housing stability?

Home safety allows adults to stay in their homes by:

Improving accessibility for enhanced quality of life as residents age

Preventing injury that would force residents to move

Easing financial burden on residents

Poor housing conditions is one of four dimensions of housing instability (other dimensions are 

unaffordability, crowding, and forced moves)1

Recent survey in St. Louis after home repairs for older homeowners found2:

71% of homeowners "a lot more likely" to stay in their homes after repairs

67% felt "much more positive" about quality of life, citing improved accessibility

78% reported that their finances had become easier

72% reported that their house had become a more valuable asset

References: 

1Routhier, G. (2019). Beyond worst case needs: Measuring the breadth and severity of housing insecurity among urban renters. Housing Policy Debate, 

29(2), 235-249.

2University of Missouri-St. Louis, Community Innovation and Action Center. No Place Like Home: The Need For and Effectiveness of Home Repairs Among 

Older Homeowners in St. Louis. May 2023.
Hubs for Social Determinant of Health Service Delivery 

(GHHI serves this role in NC working with BCBS of NC) 

A health connection hub could help efficiently overcome barriers to partnership between 

sectors, saving time and money for both partners and incenting new investment

Health 

Connection 

Hub

MCOs & hospitals CBOs addressing SDOH

Potential roles

• Coordinate data sharing & ensure privacy

• Coordinate referral process

• Draft & hold contracts between partners

• Coordinate payments between partners

• Serve as translator & expert in both sectors
North Carolina Fall Prevention Program Process

Intake - GHHI Program - Service Provider Partners

Enrollment begins with completion of Home Visit 1.
Key Performance Indicators
Total cost of care stays high even 2 years after a significant fall

Medical index event (first IP stay or 

ED visit) occurs at Month 0

• TN Medicaid claims data from 27,666 

members 60+ in Shelby County 

• 5 years of claims data totaling $3 billion

• 800 members per year had an IP fall

• 2,400 member per year had an ED fall

Cumulative cost increase after a fall 

resulting in inpatient admission or 

emergency department visit:

• IP: $41,536 (green shaded area)

• ED: $17,536

This suggests that there is an opportunity for 

an Aging-in-Place program to help reduce 

costs by preventing avoidable falls. 
Savings from avoiding nursing homes (Habitat Survey data)

25 Aging-in-Place clients per year report they would have been 

destined for a nursing home within the year. 

This equates to $2.1 million (semi-private) to $2.3 million (private) in TN taxpayer 

savings each year.

6% 5%

16%

2%

7%

53%

11%

Where would you have gone?

Nursing Home Assisted Living

With Family New Home

Low Income Housing No Option

Homelessness

Nursing Home: 6%

Assisted Living: 5%

With Family: 16%

New Home: 2%

Low Income Housing: 7%

No Option: 53%

Homelessness: 11%
Housing Upgrades to Benefit Seniors (HUBS) - Baltimore

Initial investment in 2015 by Stulman Foundation and Hoffberger philanthropies. 2017 capital expansion 

through Weinberg Foundation and the City of Baltimore DHCD. National HUD Secretary award in 2018. 

Producing AIP housing interventions at scale. $10.6 million in public-private funds committed for 2021-

2024.

Founding Organization

Organizes referral process, develops 

trainings for partners, and hosts leadership 

meetings

1

Leadership Team

Performs home remediation and 

installs fall prevention measures

2

HUBS

Provides referrals into HUBS, conducts 

individualized needs assessment and 

assists with service referral process

3
The Challenge HUBS is Addressing (1 of 2)

Baltimore City’s 60+ population 

will increase by 24% in 30 years

2010: 121K 

2040: 150K

1⁄4 of owner-occupied homes 

are owned by older adults

17% of all older adults in 

Baltimore City live below the 

poverty level

fixed income 

+ limited mobility

housing

deterioration
The Challenge HUBS is Addressing (2 of 2)

Family Background: Low-income senior homeowner raising three adopted daughters; older adult 

encountering balance issues

Housing Assessment: Roof leaks, poorly weatherized, mold, pests, malfunctioning furnace, numerous 

safety hazards including trip and fall hazards, poor lighting, lack of handrails

GHHI HUBS and Maryland Energy Administration funded interventions by GHHI:

• HVAC replacement; Weatherization intervention including air sealing and insulation; Attic repairs

• Tub grab bars and handheld shower head installed, shower stool and toilet safety frames provided

• Installed stair treads and removed damaged carpets

• Interior and exterior handrails installed, and other handrails repaired

• Dryer and bathroom vented; Mold remediation in basement

• Integrated pest management conducted 

• Exterior lights and interior stairwell lights installed; Gutters and downspouts installed

GHHI assisted client through City LIGHT Program process to receive:

• Roof replacement
Clean air, safe home, better life

Ms. Billips is a retired state employee

• Inoperable gas boiler

• Unvented gas stove

• Plumbing leaks

• Inadequate insulation

• Multiple trip and fall hazards

• Replaced boiler with electric heat 

pump and mini-splits for A/C

• Replaced gas stove with electric 

convection oven

• Replaced washer and dryer with 

Energy Star electric appliances

Utility bills dropped $100 in first 

month after interventions; indoor air 

quality improved
HUBS Clients’ Home Repair Needs Windows 1%

Roof 31%

Accessibility (ramps, wheelchair lifts, stair lifts) 19%

Electrical 3%

Environmental-Asbestos 0%

Environmental-Mold 1%

Furnace 9%

Gutters 0%

HVAC 1%

Issues with Adjoining Property 0%

Minor Home Repairs 3%

*Category illegible

Painting 0%

Pest Remediation 1%

Plumbing 10%

Porch Roof 2%

Structural 9%

Water Damage in Basement 0%

Water Heater 1%

Waterproofing 0%

Weatherization 3%
Value to Healthcare of Home Modifications

Health plans can demonstrate leadership in healthcare innovation by preventing falls 

and empowering members to age in their homes

Reduce healthcare utilization and cost by preventing future falls and unintentional 

injury

Work with members to understand Medicaid / Medicare benefits, including Long Term 

Supports and Services

Leverage existing housing support services available through housing partners

Connect with members who may be harder to engage
Other GHHI Home Injury / Fall Prevention / Aging in Place Work

• Stepping On plus home repairs in Cincinnati. Partners include People 

Working Cooperatively who conduct services including home repairs and 

Molina health plan that identifies at-risk members. GHHI’s role is to design 

the evaluation of the program including efficacy and cost-effectiveness 

analysis.

• Habitat for Humanity of Greater Memphis. GHHI is a partner on a newly 

awarded grant from the Tennessee Department of Health to construct 20 

new homes designed to meet the accessibility and other needs of older 

adults and people with disabilities

• Johns Hopkins Center for Injury Research and Policy. GHHI is partnering 

with Hopkins to build off of an existing model for home assessment and 

remediation of injury risks for children to design a model specific to older 

adults.
Be Strategic in Building Relationships with Healthcare 

Partners

• Connect with staff at different levels of health plan; healthcare has frequent turnover

• Look for opportunities to advocate for policies together 

• Invite health plans and providers to participate in stakeholder meetings

• Consider what existing or potential partners might have additional resources to help expand the 

program
Ruth Ann Norton

Ruth Ann Norton

President & CEO

Green & Healthy Homes Initiative

ranorton@ghhi.org

@HealthyHousing GHHInational healthy_housing
Q & A
HSRC Website

47

acl.gov/HousingAndServices 
Help Us Improve

Tell us what you want the HSRC to 

feature in the next webinar. 

Please complete our short feedback form:

https://www.surveymonkey.com/r/SGFCBWR

48
49

We want to hear from you! 

Please email us at hsrc@acl.hhs.gov

Stay Connected
Acknowledgments

This presentation was supported by the U.S. Administration for 

Community Living through a contract with New Editions Consulting, 

Inc. (Contract number 47QRAA19D003X) which subcontracted the work 

to the USC Leonard Davis School of Gerontology. The views expressed 

do not necessarily represent the positions or policies of the 

Administration for Community Living / Department of Health and 

Human Services.