Abstract
Home modification has been recognized as essential for successful aging in place, yet it remains underutilized, especially among low-income older adults and people with disabilities. The central problem is that systems often fail to make home modification accessible, affordable, and actionable for those who need it most. This article identifies three interconnected barriers. First, limited access to services, particularly in rural and underserved communities, restricts who can pursue modifications. Second, financial constraints place many interventions out of reach for low-income households. Third, inadequate education and programmatic support leave older adults without the guidance needed to understand, pursue, and implement changes.
Key Words
Aging in place, home modifications, health inequity, housing accessibility
In the United States, the aging population has been growing rapidly, a significant demographic transformation without precedent in the nation’s history. With more than 1 in 5 Americans aged 65 or older by 2030, the U.S. will soon be one of the most super-aged societies in the world (U.S. Census Bureau, 2018). By 2060, the population of adults 65 and older is projected to nearly double, rising from roughly 52 million today to 98 million (Colby & Ortman, 2015). This shift will critically shape every dimension of public life including health care, transportation, community, and, above all, housing. There are many important questions to be answered about how to care for an aging population, but among these the central questions are where and how older adults will live as they age successfully.
The U.S. offers a broad continuum of housing options for older adults, including continuing care retirement communities (CCRCs) and 55+ communities designed specifically for aging populations. Despite this range of alternatives, the most common preference expressed by older adults is to remain in the homes they already occupy. According to AARP, 87% of adults 65 and older prefer to stay in their current home and community as they age rather than relocate to a care facility (Binette & Farago, 2024). Aging in place—defined as the ability to live independently, safely, and comfortably in one’s own home regardless of age, income, or ability—reflects not only a personal preference but, for many, a financial and social necessity (Hwang et al., 2011). However, the challenge for successful aging in place is that homes do not automatically adapt to the changing needs of their occupants across the lifespan. Approximately 80% of older adults live with at least one chronic health condition and 50% manage two or more (Watson et al., 2025). As functional capacity changes, the home environment can become an obstacle. For example, a single step at the front entrance poses little difficulty for a healthy adult but can become a barrier for someone who is reliant on a walker or wheelchair. A standard bathtub that served a household for decades can become a significant fall risk as residents’ balance and strength decline. A mismatch between the needs that arise as part of the aging process and the static nature of most homes and their amenities is not a rare exception; it is the common trajectory of aging in place.
Research consistently demonstrates that well-designed home modifications reduce fall-related injuries, improve daily functioning, and lower the demand on caregivers and health systems alike, which help older residents to achieve successful aging in place.
Many older adults must consider whether to either leave their home and a find more accessible place to live, or make their current home more accessible. Home modification aims to update a physical environment to better support safe and independent living. Research has consistently demonstrated that well-designed home modifications reduce fall-related injuries, improve daily functioning, and lower the demand on caregivers and health systems alike, which help older residents to achieve successful aging in place (Hwang et al., 2011; Stark et al., 2017).
And yet home modification remains underutilized, particularly among the older adults who need it most, including those with low incomes, physical disabilities, and limited access to home modification services. This article discusses three interconnected reasons why home modification fails vulnerable older adults. First, accessibility barriers, particularly in rural and underserved areas, limit who can realistically pursue modifications. Second, financial constraints place many interventions out of reach for low- and middle-income households. Third, the absence of meaningful education and programmatic support leaves older adults without the guidance needed to understand, pursue, and implement changes to their homes.
The Access Problem: Who Can Actually Get Help
In general, enacting home modifications requires a systematic process. For example, an occupational therapist or Certified Aging-in-Place Specialist (CAPS) may conduct a home assessment and make recommendations to support older residents’ unique characteristics. Then, professional contractors work to make the home more accessible. However, in rural and non-metropolitan communities, these resources may be absent. The main issue is not just older adults choosing not to modify their homes, but that the infrastructure for home modification is not accessible.
National data shows this disparity more clearly. An analysis of the 2019 American Housing Survey found that older adults in non-metropolitan areas completed significantly fewer home modification projects than their metropolitan counterparts (Kim et al., 2024). This might suggest that rural homes require less modification, but the data tells a different story. Homes in non-metropolitan areas were significantly older, with nearly one third built before the 1950s, and non-metropolitan households had higher rates of disability than metropolitan ones (U.S. Census Bureau, 2023). Older housing and higher disability rates suggest a greater need in non-metropolitan areas, not a lesser one. The gap reflects barriers to action, not absence of necessity.
Also, older adults in non-metropolitan areas were more likely to rely on self-completed home modifications, which may reflect broader rural barriers such as limited-service infrastructure, transportation constraints, and reduced access to home-modification support programs (Semeah et al., 2023). For example, bathroom modifications, among the most critical safety interventions for older adults, require skilled professionals with specialized knowledge. When those professionals are unavailable or unwilling to travel long distances for a single project, older adults must either attempt the work themselves or leave needed modification undone.
The timing of modifications in non-metropolitan areas is another dimension to consider. Older adults in rural areas were more likely to modify their homes only after a disability had already emerged, rather than making proactive changes in anticipation of declining function (Barbakoff et al., 2024). In metropolitan areas, modifications occurred regardless of disability status, suggesting that accessible services and professional outreach prompted earlier action (Kim et al., 2024). The reactive pattern in rural areas signals the absence of any proactive support infrastructure. Without someone to prompt, assess, and connect older adults to services, modification happens only when a health crisis forces the issue, often too late to prevent the avoidable fall or injury that may have triggered the health crisis.
The Financial Problem: Who Can Actually Afford Help
Even for older adults who can access home modification professionals, financial issues remain an immediate obstacle. Home modification can create financial burdens for older adults, even when they involve minor accessibility upgrades. For many older adults on fixed incomes, essential expenses such as housing, medication, and food leave little room for the added cost of home modifications. In 2024, 15% of U.S. adults aged 65 and older lived in poverty under Supplemental Poverty Measure, indicating persistent economic vulnerability among older Americans (U.S. Census Bureau, 2025). Moreover, low-income older adults are less likely to own their homes, more likely to live in older or physically inadequate housing, and more likely to have chronic conditions or functional limitations that require environmental support (Federal Interagency Forum on Aging-Related Statistics, 2020; Joint Center for Housing Studies of Harvard University, 2023). This population sits at the intersection of greatest need and least capacity.
This burden may be heavier for renters. Homeowners with limited resources may draw on home equity, take on home-improvement debt, or apply for housing rehabilitation assistance. Renters, by contrast, have limited financial and legal control over the dwelling (Mehdipanah et al., 2021). Older renters may face additional barriers because landlords can be unresponsive to modification requests, delay approval, or have limited incentive to invest in accessibility upgrades (Aplin & Peterson, 2023).
Without someone to prompt, assess, and connect older adults to services, home modification happens only when a health crisis forces the issue, often too late to prevent the avoidable fall or injury that may have triggered the health crisis.
The consequence shows up in the data: Community-dwelling rental units had significantly more environmental barriers on average (M = 6.73) than subsidized senior housing units (M = 3.92) in a home assessment study of low-income renters (Kim et al., 2019). Federal housing programs help reduce rent burden, but they do not fully close the accessibility gap. Housing Choice Vouchers and Section 202 supportive housing can make housing more affordable, but they are not primarily designed to fund modifications to existing units. As a result, an older renter may receive rental assistance while still living with environmental barriers such as unsafe steps, narrow doorways, or bathrooms without grab bars. Without dedicated modification funding or landlord incentives, cost remains a major barrier for older renters who have limited control over their housing conditions.
Older adults living in manufactured housing are often overlooked in aging-in-place research and policy discussions. In February 2022, approximately 3.2 million adults ages 60 and older lived in mobile homes in the United States (Consumer Financial Protection Bureau, 2022). This group is disproportionately vulnerable: Older mobile-home residents are more likely than older adults in other housing settings to have incomes below $25,000 and to report significant mobility-related disability. These vulnerabilities are especially important because manufactured homes may present distinct modification challenges, including narrower circulation paths, nonstandard door widths, and older construction that may predate current accessibility expectations. Yet empirical research on home modification needs and barriers in manufactured housing remains limited (Al-Rousan et al., 2015). Treating manufactured housing as a central site of aging-in-place policy is therefore necessary to reach a low-income older population with substantial environmental risk and limited capacity to address it.
The Knowledge Gap That Isn’t: Why Education Alone Cannot Fix a Structural Problem
Older residents are frequently described as unaware of how home modification can support their safety and independence, and low awareness is often treated as the primary explanation for low rates of home modification. This perspective, however, misdiagnoses the problem. Awareness alone does not predict action, and focusing on individual knowledge gaps obscures the deeper issue: A system that consistently fails to make home modification accessible, affordable, and actionable for those who need it most.
That said, limited awareness plays a contributing role and cannot be dismissed entirely. Many older adults do not recognize common environmental hazards as direct contributors to fall risk. Because the relationship between the home environment and functional independence is rarely explained to them, they often do not consider home modification until after a fall or health crisis has already occurred (Kim, 2021). Research has indicated that home safety modifications, including grab bars, wider doorways, lever handles, improved lighting, and removal of tripping hazards, can reduce fall-related injuries among high-risk older adults, extend functional independence, and support older adults in aging where they choose (Cha, 2025; Kim & Portillo, 2018).
The persistence of this knowledge gap is partly attributable to how older adults receive information about home modification. Healthcare providers, occupational therapists, and community health programs highlight the importance of home modification, but that information does not reach many older adults. Information travels instead through informal networks of family, friends, and neighbors. These channels are not without value, but relying on informal social ties for guidance on structural home safety reflects an institutional gap, not a community or individual-level failure.
Home modification plays a pivotal role in supporting older adults’ successful aging in place by improving safety and independence.
Addressing the awareness problem therefore requires various informational strategies. Given that passive and one-time lectures are insufficient to change older adults’ perception about home modification, more consistent and multi-faced engagement strategies can help normalize home modification as a standard component of healthy aging. This includes integrated, participatory workshops held in accessible venues, such as local farming exhibitions or community centers, particularly in rural areas where professional resources may be scarce.
Conclusion
Home modification plays a pivotal role in supporting older adults’ successful aging in place by improving safety and independence. A low rate of home modification is not a product of individual indifference or ignorance. It is the predictable outcome of a system that has failed to make modification accessible, affordable, and actionable for those who need it most.
The three barriers examined in this article are not independent. Closing the gap requires more than awareness campaigns or incremental program expansion. It requires coordinated investment in the professional infrastructure that connects older adults to services, more accessible and sustained support for home modification, and proactive outreach models. The reactive pattern documented in rural communities is not a cultural tendency; it is a structural condition produced by the absence of proactive support.
Aging in place is a widely shared preference and, for many older adults, a financial and social necessity. The homes these older adults occupy, however, are not adapting to meet the needs of their residents. Addressing that mismatch is not a niche concern. It is one of the most consequential challenges of an aging society, and it deserves a response equal to its scale.
Daejin Kim, Ph.D., CAPS, is an Associate Professor of School of Design at Florida State University. His research examines how the built environment can promote health, safety, independence, and well-being, with a particular focus on aging in place, healthcare environments, environmental gerontology, and evidence-based design. He has published more than 20 peer-reviewed journal articles and has presented his research at numerous national and international conferences. He earned his Ph.D. in Interior Design from the University of Florida and is a Certified Aging-in-Place Specialist.
Photo credit: Shutterstock/Rido
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