The Home Improvements and Structural Alterations Benefits Program: Veterans With Disabilities and Home Accessibility

Abstract

Inaccessible home environments can negatively affect the health-related quality of life of individuals with disabilities, increase the number of home accidents, diminish activities of daily living, and increase avoidable institutionalization. Appropriate home modification (HM) can change the home environment by making it more accessible. Accessible environments can be approached and used independently by individuals with diverse disabilities. This article provides a general overview of the Home Improvements and Structural Alterations (HISA) program, a Veterans Health Administration (VHA) program within the U.S. Department of Veterans Affairs (VA). Established in 1973, HISA provides HM for Veterans with disabilities, facilitates continued treatment, and promotes access to essential facilities within the home. The program is unique given the decisive role medical practitioners and nonmedical persons play in the process of facilitating accessibility for Veterans with disabilities. However, little is known about the HISA benefits program. This article describes the structure and process of the HISA program, compares the program with other VA HM programs, and discusses potential research needs in VA’s HM applications. This explanation can inform both VA and non-VA health care professionals about the benefits and challenges of an innovative HM program and suggest ways to further advance HM policies.

Keywords

accessibility home modification VA housing accessibility policy veterans with disabilities specially adaptive housing

Get full access to this article

View all access options for this article.

References

Ahn

Hegde

A. L.

(2011). Perceived aspects of home environment and home modifications by older people living in rural areas. Journal of Housing for the Elderly, 25, 18–30. doi:10.1080/02763893.2011.545735

Bakker

(1999). Elder design: Home modifications for enhanced safety and self-care. Care Management Journals, 1, 47–54.

Bo’Sher

Chan

Ellen

Karfunkel

Liao

(2015, March 19). Accessibility of America’s housing stock: Analysis of the 2011 American housing survey (AHS). Retrieved from http://www.huduser.gov/portal/publications/mdrt/accessibility-america-housingStock.html

Braubach

Jacobs

D. E.

Ormandy

(2011). Environmental burden of disease associated with inadequate housing: Methods for quantifying health impacts of selected housing risks in the WHO European region (Summary report, World Health Organization). Retrieved from http://www.euro.who.int/en/publications/abstracts/environmental-burden-of-disease-associated-with-inadequate-housing.-summary-report

Congressional Research Service. (2013). VA Housing: Guaranteed loans, direct loans, and specially adapted housing grants. Retrieved from https://www.fas.org/sgp/crs/misc/R42504.pdf

Congressional Research Service. (2014). A guide to U.S. military casualty statistics: Operation Inherent Resolve, Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. Retrieved from http://www.fas.org/sgp/crs/natsec/RS22452.pdf

Corkery

(2005, November 16). More apartment landlords are likely to face disability-access suits. The Wall Street Journal. Retrieved from http://www.wsj.com/articles/SB113210355050598391

DeJong

(1979). Independent living: From social movement to analytic paradigm. Archives of Physical Medicine and Rehabilitation, 60, 435–446.

Erickson

(2015). Estimates based on analysis of the 2013 American Community Survey (ACS) Public Use Microdata Sample (PUMS) data. Ithaca, NY: Cornell University Employment and Disability Institute (EDI).

10.

Evans

G. W.

(2003). The built environment and mental health. Journal of Urban Health, 80, 536–555. doi:10.1093/jurban/jtg063

11.

Foreman

M. L.

Jefferson

de La Viez

Park

J. K.

Reilly

Quarterman

(2000). Sharing the dream: Is the ADA accommodating all? A report on the Americans With Disabilities Act by the U.S. Commission on Civil Rights. Retrieved from http://www.usccr.gov/pubs/ada/main.htm

12.

Gillespie

L. D.

Robertson

M. C.

Gillespie

W. J.

Sherrington

Gates

Clemson

L. M.

Lamb

S. E.

(2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007146.pub3/pdf/

13.

Gitlin

L. N.

Mann

Tomita

Marcus

(2001). Factors associated with home environmental problems among community-living older people. Disability & Rehabilitation, 23, 777–787.

14.

Johnson

D. E.

(1973). Administrator of Veterans Affairs annual report. Washington, DC: U.S. Government Printing Office. Retrieved from http://www.va.gov/vetdata/docs/FY1973.pdf

15.

Joint Center for Housing Studies. (2013). The U.S. housing stock: Ready for renewal. Retrieved from http://www.jchs.harvard.edu/research/publications/us-housing-stock-ready-renewal

16.

Joint Center for Housing Studies. (2014). Housing America’s older adults: Meeting the needs of an aging population. Retrieved from http://www.jchs.harvard.edu/sites/jchs.harvard.edu/files/jchs-housing_americas_older_adults_2014.pdf

17.

Joint Center for Housing Studies. (2015). America’s rental housing: Expanding options for diverse and growing demands. Retrieved from http://www.jchs.harvard.edu/sites/jchs.harvard.edu/files/americas_rental_housing_2015_web.pdf

18.

Kaboli

P. J.

J. T.

Hockenberry

Glasgow

J. M.

Johnson

S. R.

Rosenthal

G. E.

Vaughan-Sarrazin

(2012). Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals. Annals of Internal Medicine, 157, 837–845. doi:10.7326/0003-4819-157-12-201212180-00003

19.

Keenan

T. A.

(2010). Home and community preferences of the 45+ population. Retrieved from http://assets.aarp.org/rgcenter/general/home-community-services-10.pdf

20.

Kochera

Straight

Guterbock

(2005, May). Beyond 50.05: A report to the nation on livable communities: Creating environments for successful aging (AARP Research Report). Retrieved from http://assets.aarp.org/rgcenter/il/beyond_50_communities.pdf

21.

Larson

Lakin

Hill

(2012). Behavioral outcomes of moving from institutional to community living for people with intellectual and developmental disabilities: U.S. studies from 1977 to 2010. Research and Practice for Persons With Severe Disabilities, 37, 235–246.

22.

Levy

Turner

Santos

Wissoker

Aranda

Pitingolo

(2015). Discrimination in the rental housing market against people who are deaf and people who use wheelchairs: National study findings. Retrieved from http://www.huduser.gov/portal/publications/fairhsg/hds_disability.html

23.

Maisel

J. L.

(2006). Toward inclusive housing and neighborhood design: A look at visitability. Community Development, 37, 26–34. doi:10.1080/15575330.2006.10383105

24.

National Association of Realtors. (2015, February 19). Aging housing stock will increasingly required spending for renovation [Web log post]. Retrieved from: http://economistsoutlook.blogs.realtor.org/2015/02/19/aging-housing-stock-will-increasingly-require-spending-for-renovation/

25.

Peterson

D. B.

Aguiar

L. J.

(2004). History and systems: United States. In Riggar

T. F.

Maki

D. R.

(Eds.), Handbook of rehabilitation counseling (pp. 50–75). New York, NY: Springer.

26.

Portnoy

Sublett

Kennedy

Grimes

(2014, May). Using home environmental assessments for effective patient care: A panel discussion. Proceedings from presentation at National Healthy Homes Conference, Nashville, TN.

27.

Pynoos

Nishita

C. M.

(2003). The cost and financing of modifications in the United States. Journal of Disability Policy Studies, 14, 68–73. doi:10.1177/10442073030140020201

28.

Pynoos

Steinman

B. A.

Nguyen

A. Q.

(2010). Environmental assessment and modification as fall-prevention strategies for older adults. Clinics in Geriatric Medicine, 26, 633–644. doi:10.1016/j.cger.2010.07.001

29.

Satariano

(2006). Epidemiology of aging: An ecological approach. Burlington, MA: Jones & Bartlett Learning.

30.

Semeah

L. M.

(2013). Rental housing search and occupancy experiences of veterans with disabilities (Doctoral dissertation). Retrieved from http://scholar.lib.vt.edu/theses

31.

Semeah

L. M.

Beamish

J. O.

(2009, November). Housing legislations: Meeting the needs of individuals with disabilities. Paper presented at the 2009 annual conference of the Housing Education and Research Association, Santa Fe, NM.

32.

Semeah

L. M.

Beamish

J. O.

Schember

T. O.

Cook

L. H.

(2016). The rental housing needs and experiences of veterans with disabilities. Administration & Society, 1–26. doi:10.1177/0095399716666355. Retrieved from http://aas.sagepub.com/content/early/2016/09/07/0095399716666355.abstract

33.

Serlin

(2015). Constructing autonomy: Smart homes for disabled veterans and the politics of normative citizenship. Critical Military Studies, 1, 38–46.

34.

Stineman

M. G.

Ross

R. N.

Maislin

Gray

(2007). Population-based study of accessibility features and the activities of daily living: Clinical and policy implications. Disability & Rehabilitation, 29, 1165–1175. doi:10.1080/09638280600976145

35.

U.S. Access Board. (n.d.). Uniform federal accessibility standards. Retrieved from http://www.access-board.gov/guidelines-and-standards/buildings-and-sites/about-the-aba-standards/background/ufas#intro

36.

U.S. Department of Veterans Affairs. (2008). Veterans Health Administration handbook: Home improvements and structural alterations (HISA) program. Retrieved from http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1681

37.

U.S. Department of Veterans Affairs. (2014a). America’s wars. Retrieved from http://www.va.gov/opa/publications/factsheets/fs_americas_wars.pdf

38.

U.S. Department of Veterans Affairs. (2014b). Compensation: Service-connected disability or death benefits in VBA Annual Benefits Report Fiscal Year 2013. Retrieved from http://www.benefits.va.gov/REPORTS/abr/ABR-Compensation-FY13-09262014.pdf

39.

U.S. Department of Veterans Affairs. (2014c). Home Improvements and Structural Alterations (HISA) benefits program. Final rule. Federal Register, 79, 71658.

40.

U.S. Department of Veterans Affairs. (2015). Loan guaranty: Specially adapted housing program [Fact sheet]. Retrieved from http://www.benefits.va.gov/BENEFITS/factsheets/homeloans/sahfactsheet.pdf

41.

U.S. Department of Veterans Affairs. (n.d.). M26–12: Specially adapted housing grant processing procedures, loan guaranty operations for regional offices. Retrieved from http://www.benefits.va.gov/WARMS/M26_12.asp

42.

U.S. Department of Veterans Affairs, Veterans Health Administration. (2014). Blueprint for excellence. Retrieved from http://www.va.gov/HEALTH/docs/VHA_Blueprint_for_Excellence.pdf

43.

U.S. Department of Veterans Affairs, VHA Freedom of Information Act Office. (2014). Budgetary obligation for fiscal year 2007 and 2014: Home Improvements and Structural Alterations Benefit Program (Freedom of Information Act request No. 15-00943-F). Unpublished raw data.

44.

U.S. Department of Veterans Affairs, VHA Freedom of Information Act Office. (2015). Numbers of veterans served between 2004 and 2014 by the Home Improvements and Structural Alterations Benefits Program (Freedom of Information Act request No. 15-04572-F). Unpublished raw data.

45.

U.S. Government Accountability Office. (2009). Veterans affairs: Implementation of temporary residence adaptation grants (GAO Publication No. 09–637.R). Retrieved from http://www.gao.gov/assets/100/96150.pdf

46.

U.S. Government Accountability Office. (2010). Opportunities exist to improve potential recipients’ awareness of the temporary residence adaptation grant (GAO Publication No. 10–786). Retrieved from http://www.gao.gov/products/GAO-10-786

47.

University of Washington, Disabilities, Opportunities, Internetworking, and Technology. (2015, August 20). What is the difference between accessible, usable, and universal design? Retrieved from http://www.washington.edu/doit/what-difference-between-accessible-usable-and-universal-design

48.

Wilner

M. A.

(1994, April). Fix it! A report from the national conference home modifications policy. Symposium conducted at the National Conference on Home Modification Policy, Raleigh, NC.