Transcript of Teleconference on Home Modification / Universal Design
California Foundation of Independent Living Centers (CFILC)

ROUGHLY EDITED COPY

IBM LISA ORIGER
NOVEMBER 8, 2001
HOME MODIFICATION TRAINING
4:00-6:00 P.M. CT

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Caption First, Inc.
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>> AMY NOAKES: Hi, this is Amy. Who just popped on?
>> DAVID: David from CRIL.
>> AMY NOAKES: Anyone else here?
>> JULIE OVERTON: I am Julie Overton from the University of Southern California.
>> AMY NOAKES: Julie, at 10:07 -- or 2:07 we can get started and I am going to let you moderate. How is that?
>> JULIE OVERTON: Okay.
>> LISA ORIGER: Okay. I am on now.
>> AMY NOAKES: And you said 2:07?
>> JULIE OVERTON: Okay. What time do you have now?
>> AMY NOAKES: I have 2:02.
(Beep, beep).
>> WOMAN: Hi. Welcome to the teleconference.
>> WOMAN: Hi.
>> WOMAN: I thought I heard somebody beep in.
>> WOMAN: Yeah, who is that?
>> MAN: Steve from Modesto.
>> WOMAN: Okay.
>> AMY NOAKES: This is Amy. We are going to wait until 2:07 to make sure we have everybody on the call. We have six more people we are waiting for.
(Beep, beep)
>> AMY NOAKES: Hi. Welcome to the teleconference, if you would like to introduce yourself. >>: Colleen with Home Access Products.
>> MAN: And I am Lance with Home Access Products.
>> AMY NOAKES: Hi. We are going to start, I think, in about two more minutes.
>> JULIE OVERTON: Amy, do you think we should go ahead or do you want to -- who just came on?
>>: This is Vicky McDaniel from CFILC.
>>: Do you want to come in to the conference room with us?
>>: Oh, sorry. I didn't know you guys were on the conference call. Yes, I will come.
>>: Comedy.
>>: Ha, ha.
>> JULIE OVERTON: Yeah. Why don't you go ahead and get started in about one minute, because I have like a couple people I just talked to like literally 20 minutes ago and they are not here yet.
>> WOMAN: Okay.
>> WOMAN: So one more minute.
>> WOMAN: Okay.
(Beep, beep).
>> WOMAN: Hi, welcome to the teleconference.
>>: Hi, this is Jana from ILRC. Sorry I am late.
>> WOMAN: No problem. We haven't started yet.
>> WOMAN: Oh, good.
>> AMY NOAKES: Okay.
>> JULIE OVERTON: My name is Julie Overton and I would like to welcome you to the teleconference focused on Home Modification in Universal Design being presented to you by the National Resource Center on Supportive Housing and Home Modification in association with, of course, the California Foundation for Independent Living Center.

The National Resource Center on Supportive Housing and Home Modification is headquartered at the University of Southern California, Andrus Gerontology Center, so we are down here in Los Angeles. And we are a private, nonprofit funded by the California Endowment and the Arts Foundation.

We have three speakers today. I am one of them, and all of you should have gotten an agenda packet either e-mailed or sent to you. If you don't have it, maybe you could indicate now because I know Amy said she could e-mail it if she didn't have the material.
>> WOMAN: This is Cheryl in Concorde. Nancy and I didn't get that.
>> JULIE OVERTON: Okay. Amy, can you e-mail that?
>> AMY NOAKES: Yes. I can do that right now.
>> JULIE OVERTON: Okay, great.
>> AMY NOAKES: Anyone else?
>> MAN: Steve in Modesto does not have one.
>> MAN: David in Hayward does not have one.
>> AMY NOAKES: You need to check your e-mails. I am kidding.
>> WOMAN: Amy, can you e-mail Colleen from HAP?
>> AMY NOAKES: Yep. Anyone else? I will do that right now.
>> JULIE OVERTON: All right. Thanks. For those of you who don't have the agenda, I will quickly give you an overview of it so you know what is in store. Dr. Jon Pynoos is going to start out, and he is the Director of Our National Resource Center.

He is going to talk about what is home modification, why it is important to persons with disabilities, and he is going to provide examples of high and low tech home modifications.

We will follow that with some question and answer, which will occur after each speaker. So each speaker will give their presentation --
(Lots of noise and lost the audio).
>>: So I guess at this time I would like to get started and introduce Dr. Jon Pynoos. Again, he is the Director of Our National Resource Center on Supportive Housing and Home Modification, and he has spent about the last 20 years doing research and policy analysis on supportive environments for people of all ages. Jon?
>> JON PYNOOS: Good afternoon, everyone. Nice to have all of you from northern California here on the teleconference along with us.

I am going to cover, as Julie said, what is home modifications, why it is important, and give you some examples of low and high technology modifications along with a sense of what they might cost, part of the back drop of what the other two speakers are going to talk about.

Let me start with some sense of what the subject matter is that we are talking about.

Home modifications are adaptions to the home environment that make living easier, safer and more comfortable.

For the most part, we can relate to the structure of the house or the home or apartment, itself, and they work in conjunction often with different devices, but they are more related to the actual layout, framework, structure of living environment, and they often require fixing something in the environment or actually changing it, whereas assistive devices for the most part are slightly more mobile.

We are talking about changes that actually have to occur to the house, itself.

Some examples of major modifications could include ramps, curbless or walk-in or roll-in showers, lowered countertops, elevators.

Minor modifications are grab bars, widened doorways, rubber door handles.

Most of these are fairly commonplace in terms of people know about them, but I wish we were in a place that we could see them and touch them together because that makes a difference in terms of really understanding what we can do and the cases, their effect.

There are some principles that I think about in terms of home modifications, in terms of what they are able to do for people.

One is to make the environment more controllable. For example, thermostats or outlets at appropriate heights help persons in a variety of different situations to actually be able to control the environment.

Second is some changes can make the environment more forgiving. For example, carpeted floor surfaces or rounded edges on tables may reduce injuries from accidents such as falls.

Third is that modifications are aimed at making the environment more supportive.

Grab bars and handrails can allow someone to find more support in carrying out tasks.

And fourth clearly is the issue of accessibility. Ramps, wider hallways, walk-in or roll-in showers can give people who otherwise might find it difficult to do some things much more accessible.

There are three common areas of homes that present challenges to older persons.

They are access in and out of the home, itself; second area is the bathroom; and the third is stairs inside the home.

In the 1970s, almost one-half of the homes we built were one story. Now more than half are two story. So we are moving in the direction that more people are living in two story dwelling units, particularly ones that are single family homes, and stairs are more likely to present problems.

Other areas are entry ways, hallways, kitchens, things that encompass the entire house such as lighting.

Many of you have had experience with the Americans with Disabilities Act, public building accessibility. It is exact information about what must be done to meet the codes.

The home modification is more art. The home is a personalized environment, and the needs of residences are somewhat unique. And it is a matter of fitting the home with the needs of the person.

The design in this discussion can often fail us or design can be our friend, and just to be clear, the homes that we are going to be talking about in terms of home modifications are anywhere a person lives regardless of where it might be.

It could be a single family. It could be an apartment. It could be board and care or assisted living. It could be a mobile home, condominium. Could be living with a relative or a personal care assistant.

One of the questions is what is the prevalence of home modifications, and related to that item, we see more of them. This is a supply and demand problem.

Basically what we see is that overall there is a growing incidence of home modifications in dwelling units, but there is an even greater demand that should be met but in some ways is unstated demand. It hasn't made itself to the marketplace yet.

Evidence suggests home modifications are present in only a small percentage of the homes of persons who need them. According to the U.S. Census, there are approximately 1.1 million older persons who have unmet needs for physical modifications to their homes and that this is likely to grow in the future.

You might be surprised to hear, however, that about 7.1 million persons who live in homes have some --
(Phone ringing) -- modifications.

One suggestion I have, if you have possible interruptions occurring where you are, you might put on the mute button so that it doesn't interrupt our discussion.

Changes don't have to be expensive. Sometimes they just require problem solving, as we will discuss.

But accessibility problems are serious. They can lead people to confine themselves to living on one floor of a two story home or rarely venturing out.

There are a number of anecdotal information about people who can't get out of their homes and end up being somewhat home bound because they don't have home modifications such as ramps or an elevator or a stair lift that can get them out of their units.

Overall, there are 2.5 million persons of all ages who report unmet needs for assistive devices, so this is a somewhat serious problem.

What can home modifications do for a person? First, they can make it easier to carry out tasks such as cooking and cleaning.

Second, they can often help caregivers and service agencies provide assistance; for example, by having enough space in a bathroom to help someone assist in feeding and bathing.

Third, they can help stop an accident, whether it is falling down the stairs or slip and fall.

Fourth, they can help carry out tasks, and in this way they can help reduce the personal care assistance and help people stay in their own dwelling units.

Finally, they can allow persons to engage in major life activity, actions, tasks.

For example, some people might give up things like reading or sewing because they don't have enough lighting in their homes or apartments. The key to success for home modifications are assessment, assessments of the home, itself.

Over the last several years, there have been several developments in the area of assessments. A lot of assessments are done by consumers, themselves, or their families. Sometimes people are very good at identifying problems in their homes, especially the ones that need to be solved, but there is a sense that people may under assess the problems that their home presents, and often what people do is they change their behavior rather than realize that adaptations of the home, itself, can give them a lot more freedom.

There is also a sense that service providers may under assess the environment because sometimes it is easier to arrange for a personal care assistant than it is actually to adapt the environment, or people think that is so when it may not necessarily be true.

There are some sophisticated and detailed assessments -- some are computer based -- that have been linked with adaptations, products and services.

Some are simple checklists, the ones that most service providers use trying to find out what modifications people need and what adaptations they have already made. Some are interactive guide books, and there are a number of videos that have been developed to help people think about assessing homes.

There are even some that can be done long distance in which a consumer or a provider can help send the information off to an expert in home modification who will then send them back ideas, plans, specifications, costs.

So assessment is a key issue in terms of how we think about and deal with modifications, themselves. In relationship to solutions, often consumers can identify the problem but they may not know clearly about what the solutions are.

One example I would like to give you is we actually had several exhibitions in shopping centers about home modifications. They were approximately 3 to 4,000 square feet in which we showed a lot of modifications that people may not have been aware of, some that were more common.

People came from all over to see these because even persons who were experienced with disabilities themselves or worked with people with disabilities had a limited repertoire about what was available. We tend to deal with what we know and what we have confidence in, but this field is developing rather rapidly in terms of products and solutions, and the greater the range of solutions to think about, the better we can tailor them to individual situations.

In that vein, several web sites have been developed, including our own, one for the Center for Universal Design, which can show a lot of potential products and solutions that people might not be aware of. The strategies for modifying the home depend on several factors.One is the nature of the disability. Is it temporary? Or permanent? That will have implications for the range and types of modifications that are done.

Is the disability stable or is it progressive? If someone has a progressive disease that can call for modifications, you have to think ahead about what is going to work at one stage, what is likely to work at another stage.

A third is obviously the type of disability. Is the person using a wheelchair or are they using a walker? Do they have a hearing problem? Do they have a vision -- those are obvious types of particular disabilities that will call for certain types of modifications in the home.

The second issue is how long does the person expect to stay in the house? If they are there for a year, it may not be likely to do extensive modifications. If someone is going to live in the house, the apartment, or dwelling unit ten to twenty years, you think very differently.

Third is the cost of the changes, the resources of the person, the other types of reimbursement that might be possible to make the changes. If there is no possible reimbursement for major changes, you might go for a lot of small, less expensive ones.

The fourth is what kind of personal care assistance is available and how long is it available over the time of day because if someone has someone helping them, the changes you make maybe have to include what kind of assistance that person is going to be able to provide, whether it is in cooking or bathing, getting around.

Fifth is the goals. What type of goals does the person have? Do they want to get out of the house, have independence? And the sixth is the type of living unit, itself, the kind of problems that it presents.

In the few minutes that I have left, I want to give you some examples of primarily low cost innovations and modifications because many things can be accomplished for less than $500.

Sometimes people buy some of these through catalogs. They can be a little more costly. Some modification equipment or devices you can buy at hardware stores or electrical supply stores. It is important to shop around to find the best bargain that is available. A few for the outside environment.

Opera lighting along walkways and pathways increases securities but also assists persons with visual disabilities to locate their home or apartment safely. Motion detectors will turn on lights, and that is an approach that is much more common than it used to be on a preset amount of time. These kind of devices can cost between $15 to $40 each.

Ramps, portable ramps might be substituted for mortar or cement ramps that can cost a thousand to several thousand dollars, but if you only have a temporary disability, you can rent or buy a ramp. The portable ramps can be ordered.

Sometimes simple, small, inexpensive things can make all the difference. Contrasting color strips on exterior stairs can help with a person with low vision to identify individual steps. You can buy the kind of tape to do this for $3 per roll at the hardware store.

Handrails installed on both sides of a stairway can provide increased support for everybody. They depend on the rails. It can run several hundred dollars.

Switches for people that are placed lower in the door for people with short stature or in a wheelchair. They can be purchased for 10 to 20. They cost maybe $50 to install. Entrances, lever door handles that replace round knobs, especially useful for arthritis. They used to be very expensive. Now you can buy these lever door handles for approximately $30.

Automatic door may be more expensive. They range from $350 to $1500. Again, it depends on the person's disabilities and how long they are going to live there.

Removing door thresholds higher than one-half inch. It can be reduced to one-quarter inch or sometimes taken out entirely. The cost depends mostly on labor.

Kitchen, replacing handles with ones that are easy grip, $5 to $10 each. Pull out shelves for lowered shelving, you find a lot of these now in new housing. Costs $30 to $40 a cabinet. Removing cabinets close to the stove, oven, and under the sink can allow space for someone in a wheelchair. These costs depend mostly on labor.

Moving on to the bathroom, obvious source for problem, grab bars for showers, tubs or toilet area, they cost $20 to $40 each. Labor can run close to $50 an hour. Handheld showers cost between $50 and $125. If you need to do something more major, walk-in or curbless shower, depends on the situation of the bathroom, itself. These can cost $1,000 and up. Many of them are prefabricated. They still need to be installed. They have to -- may have to make changes in the flooring of the bathroom to have them installed.

In the bedroom, lag bolts in the ceiling above the bed that have a rope or trapeze attached to them can help people who are paralyzed or have back problems in sitting up or in rolling out over the bed. Bolts come approximately $5. Poles next to the bed or to use in the bathroom to help someone stand up. These cost approximately $100. There are a lot of other devices that are possible. They range from stair lifts outside where you can't use a ramp, because there is not enough space for a ramp. These can cost $1,000 and up. You can have stair lifts within the house for someone who can transfer to a stair lift, but can't themselves walk upstairs. Those cost $2000 and up.

I think the point that I am trying to make is there are a lot of different solutions related to the types of problems and the environment in which someone lives. Some of them are low cost in nature. Some of them are more costly.

If one needs to have these changes made, it is very important to get someone who knows how to install them to make sure that they are working. Have someone follow up.

Make sure that if a person has a progressive type of problem, they have regular assessments done so that the environment is adapted to the person as their need changes throughout their lifetime of living in that housing unit. Home modifications tend to be under utilized.

People generally don't understand the benefits that they can provide. As I have said, they often change their behavior rather than the environment, when small or large changes to the environment can enhance their independence, make their quality of life better, improve their ability to carry out tasks and to enjoy themselves, their living environments.

Thank you. I am happy to answer any questions.
>> JULIE OVERTON: Thanks, Jon. And if you have a question, if you can identify yourself and your agency, first. Are there no questions at this time? We will have other opportunities to ask questions if you think of some later on in the call. But if there are not any questions right now, move on to Dick Duncan.

Again, he is the Acting Director for the Center for Universal Design at North Carolina State University in Raleigh, North Carolina.

So he is coming to us from the east coast. Welcome, Dick.
>> RICHARD DUNCAN: Thank you. Hi, everyone. Nice to be on the phone call with folks out there.

I will talk to you for a next few minutes about Universal Design and the idea of visitability, describe and contrast them. First, a little bit about the center. I am not sure people may have heard of it.

The Center for Universal Design is part of the College of Design at North Carolina State University in Raleigh. We have been around for about 12 years, and as you can tell from our name, our whole focus is Universal Design in all of its aspects.

Our mission is to improve the built environment and related products for all users by impacting policy and procedural change, to research information, training and design assistance. So all surrounding the issue of Universal Design.

What is Universal Design? I will read you our brief and concise definition of it.

The design of all products and environments to be usable by all people to the greatest extent possible without the need for adaptation or specialized design. That is the short story.

When I tell people about what I do, when I start to describe Universal Design, a lot of folks say, oh, yeah, I know what that is about. I have heard of accessible design or I have done ADA compliant design or, yeah, isn't that barrier-free design?

Or people who may know even less may say, oh, yeah, I know about that handicap design stuff. So people do confuse it, and it is a different idea. I hope that by the end, you can understand, perhaps, what some of the distinctions are between Universal Design and some of those other ideas.

Although, truthfully, Universal Design did spring from and has sprung from the 40 years of work in design field in the areas of accessible design and barrier free design. So it is an idea that really has sprung from the platform created by those.

You may have heard other phrases that describe Universal Design. Different people and corporations, entities adapt it in different ways. General Electric Corporation, for instance, calls it real life design.

Others call it life span design. You might have heard it referred to as easy living design. In Canada, applied to housing, they call it flex home design.

We like to think of it really as just good design, and I think that by the end of this conversation, you will probably agree. Universal Design is a pretty broad concept and can be applied to a number of different design and --
>> MAN: I am on the conference.
>> RICHARD DUNCAN: Hi -- design disciplines and areas of the built environment.

Firstly, there is products. Of course, we do a fair amount of work in the area of consumer and architectural products. And I am sure people can appreciate how a better design, better working consumer product is more useful to them.

Certainly in the area of residential construction that is primarily what we will be talking about today.

Universal Design has some applicability, particularly in the area of single family homes as they are one of the last areas of the built environment that are currently substantially unregulated by accessibility codes of other kinds.

It also has applicability to the area of home applications that Jon just talked about. A lot of the features he just mentioned could be or are easily universal as well as being accessible. And if some home is adapted universally, it means that it has all of the functionality you might hope for with accessible home modification as well as some additional features which we will talk about.

Certainly Universal Design can be applied to the nonresidential environment, the whole area of the built environment that is currently controlled by, let's say, primarily the ADA or other state laws and codes is an area where Universal Design can be applied as well.

And in our opinion, people who do accessible design well in often cases come close to achieving universal outcome, and increasingly we see examples around the country of newer buildings being built where the architects and builder and owner get accessibility but also get important ideas of Universal Design perhaps without even knowing it and without even using a Universal Design label.

You may have seen it yourself, places where they have seamlessly blended accessibility features with the overall design of a building, which brings up one of the very big challenges of Universal Design.When it is done well, it is invisible.

So, okay, we have products, new construction, home modifications, and the whole nonresidential environment. We think that Universal Design can also be applied to the urban scale, and we are currently having some of our colleagues looking at the question of what does it mean to have a universal community.

How is that different from a community that is built according to ADA accessibility standards? We think it is a fruitful area for work and we are excited by some of the work that they are doing.

And, finally, one of the newest ones that is intriguing to me is we have heard more and more lately about people taking these Universal Design principles, which are meant to be applied, of course, primarily to the built environment --
>> MAN: ... conference call, would it be possible for me...
>> RICHARD DUNCAN: Hello?
>> JULIE OVERTON: Hi. We can hear any outside discussion you have, so if you could put on your mute button, that would be appreciated.
>> RICHARD DUNCAN: Okay. Thank you. This new area is the idea of Universal Design as applied to curriculum design and teaching methodology, which is really interesting and exciting because we like to see it applied to other disciplines and see how it plays out.

Okay. So those are the different areas of Universal Design can be applied. And if I can get my notes together -- oh, yeah. In our development of our work with Universal Design, and as we looked at these different areas and disciplines that Universal Design we thought could be applied in, we began to understand that we needed to develop some broader kind of umbrella strategy that we could promote Universal Design with.

And six or seven years ago, people gathering at the Center for Universal Design from around the country got together and eventually crafted and hammered out seven principles of Universal Design, which we now are applying in these areas that I have just mentioned. I will mention them briefly.You can certainly explore them more fully on several of the resources and web sites I think Julie may be mentioning later on.

First, equitable use;second, flexibility in use; third, simple and intuitive use; fourth, perceptive information; fifth, tolerance for error.

My favorite is number six, low physical effort. And seven is size and space for approach and use.

Now, these are fairly well detailed in much of the material that the Center for Universal Design has on these web sites, as I talked about, and we won't kind of take you to school on these today.

Part of the job of the Center is taking the principles and helping apply them in meaningful ways to practitioners in the case of housing, builders, designers and so on, can apply them easily and usefully to the projects they are working on, and that is part of the job that we do at the Center.

Some of you, I believe, have a handout; is that correct?
>> JULIE OVERTON: Hopefully by now most everybody should have the handouts.
>> RICHARD DUNCAN: Some of you may be fortunate to have a handout called Universal Design Features in Houses. This is our attempt at taking these Universal Design principles we just mentioned and translating them into, as you can tell, fairly detailed design recommendations for a, for instance, newly constructed house, although as I said, these can as well be applied to home modification situation.

It is eight pages worth of a lot of detail, and it can be intimidating, and we have actually created a different version of this for another audience.

When we are trying to communicate with builders, who want things in a more shorthand way and maybe don't have time to wade through some of this detail, we have created a three tiered approach, what we are currently calling bronze, silver and gold, where we have broken down the essential elements into bronze sector.

If they add a few more on, they get silver, and a few more beyond that, they get gold designation. Throughout all this detail, it boils down to really five major things that somebody can do to result in a pretty universal home. The rest is, in some cases, optional and in some cases add on to make -- have it even more universal.

I will outline these five broad areas, and then we can go into some more little detail in the package that you have got.

The first, of course, is accessible, a stepless entrance. This has continued to be the single most challenging area in all the work we do in housing. We have found that in home interiors, houses of any size, large, small, we can always result in a fairly Universal Design. It isn't as easy in entrance situations, and we can talk more about that later, but accessible or step-free entrance is certainly one critical component.

The second would be adequate interior circulation in the house. We like to see homes with 42 inch wide hallways and 36 inch wide doors. This provides terrific accessibility, of course, for anybody who might be using a piece of equipment to get around as well as endear yourself to your movers and perhaps to other people such as kids who are roaming around in the house. So that is the second key component, getting in the front door and being able to get around your house in the inside.

Third, you need to have somewhere on the first floor or the accessible level of this house a room that is a bedroom or can be converted to a bedroom. This is so obviously if someone needed to or couldn't climb stairs in the house, they could find a place that they could stay.

And right along with that, of course, is the fourth item, which is a usable or accessible bathroom on that same accessible level of the house.

And fifth and finally, the other key functions of the house have to be present on that same accessible level, which would include, of course, you know, kitchen or cooking area, or a laundry area and maybe some others depending upon the kind of housing that you are talking about, but those are the five areas that together combine to the essential elements of what a universal house is.

And as you may have inferred from my conversation a minute ago, it can be a two story house. It doesn't have to be a single story house. We are not just talking about homes that are solely ranch style, single story homes. You can have two story homes as long as they possess these five elements I just mentioned. And you can get around that seeming constraint with a couple of neat tricks, which are detailed on our eight pages here and, of course, on the web sites.

One way, of course, is to build stairways as straight as you can that are also 42 inches wide for the future installation of a seat or incline platform lift. That brings accessibility up to the second floor.

Another way that this can be dealt with is by locating closets one over the other in the house with removable floor in between. Jon had mentioned in his talk the possibility of adding elevators as a home modification.

This is quite true, and a big cost associated with homes that are modified with elevators is, of course, creating that vertical shaft way. And by cleverly locating one closet over another, one can use the closets for as long as you need to, in the state that you have perhaps built them in originally, and then convert them later on to the shaft for elevator and get the elevator installed.

Clearly not a solution for everyone since elevators are still fairly expensive, as much as 15 or $20,000, but still an area that we have heard has actually undergone conversion in homes, some homes that have had these features installed.

So there is our five basic features.

As you can see from your handout, there is a lot of detail. We do have a strong emphasis in our stepless entrance for solutions which blend with the overall terrain and the design of the house.

We don't have emphasis on, in fact discourage, the building of ramps as the first option for getting in the front door. (Background noise).

And moving through, I will just pick out a few items that we do list into our detail. We find that weather protection at the entry doorway is important, so as often as possible, to not only have that porch level with the first floor but also have a porch roof extending over that porch so that you get some protection from the elements as you are entering and exiting the home.

That is a nice feature that we think all homes or most homes should have. I mentioned our two story options. The discussion and the detail that we bring to bathrooms, I think, gives people lots of material to deal with and lots of options to include in their homes.

Jon mentioned adding grab bars as being one of the key areas that people add on in homes. In our ideal universal home, having the areas in the bathroom near the toilet and near the shower and tub area blocked as new construction makes installing those grab bars later on a much, much easier job.

And we advocate for broad blocking in that area as opposed to the more typical kind of narrow blocking around a thin band around the bathroom.

This allows for grab bars to be installed wherever they need to be, wherever the individual needs them to be, without worrying about, gee, am I hitting the stud or am I going to have this grab bar support me if I should slip and fall. So that is another key feature of a universal house and universal bathroom.

In kitchens, as I like to tell people, happily kitchen design has been coming in the direction of Universal Design for a number of years, and so we don't have to stretch quite so far to achieve a universal result there as we may in other areas.

Having maneuvering space in the kitchen is critical. Providing multiple work surface heights is often really advantageous for folks and, again, kitchens these days are coming in that direction anyway. But in our outline, in our features, and in the printed materials we have at the center, we try and detail that as much as possible so folks can understand how they can apply that.
(Background noise)

We like to think of a broad beneficiary group that results from these kinds of features in a universal home, and this may relate particularly to some of the issues that folks have. Clearly somebody who has a disabled family member or is disabled themselves can take immediate advantage of a lot of the features in a universal home.

We think that families without a disabled family member can have a real advantage. In fact, people who don't kind of consider themselves as having a disability, in fact, as most of us know, have some kind of disability without really labelling it as such and can really take advantage of a lot of the convenience and ease of usage that we have in there.

We think that families who might have a disabled family member which, in fact, is everybody can take advantage at some point in their life. And these days we talk more and more about the aging of society and the aging demographic in this country and fully older family members can take advantage of these things.

And I think a key feature we share with the disability movement is recognizing that friends, colleagues, and extended family may at some point have disability as well so they can take advantage of the features found in the home, but I mentioned before families with strollers can take advantage of these features as well as movers.

So before I step into visitability, I will just mention what I think key features are: Ease of use, flexibility, safety is key.

Aesthetics is another key component. If it doesn't look good, it probably isn't universal.

And clearly the outcomes of independence and inclusion are right there.

Now, we think that homes that have universal features, in fact, have a real value added given the demographic of society that people who buy a home or build a home now with universal features will be more likely to sell that home to a family who can recognize those features later on.

And, obviously, as Jon was alluding to, since so many of the home modifications can be expensive, if you are buying a home with universal features, the cost you are likely to incur later on is much, much lower if you should need to customize your house because of so much of what you might already be seeking is built in. So that is our brief tour of Universal Design.

I will move ahead now into visitability. If people are familiar with it, they know it is a much narrower scope than Universal Design. I mentioned the disciplines and scope that Universal Design works in.

Visitability is really about housing. And as it plays out on the ground in most places, it tends to be more about single family housing and single family detached housing, perhaps, even than multi-family, although it can be that as well. That is one key difference about it.

Another is that one of the key elements at spreading vistability around is an attempt at a regulatory and ordinance based implementation strategy.

People can go on the website of the kind of founding organization that is behind vistability, which is Concrete Change in Atlanta, and you can see listings of the various cities around the country that have adopted vistability ordinances including Atlanta, Austin, several cities in California and elsewhere.

Actually something of an international movement. And in the United Kingdom, there also is some similar kind of national ordinances requiring some features of vistability or so forth in homes, but there is an awful lot of vistability and Universal Design is the same.

As I said, the scope is the same both in the breadth of the environment that it attempts and also what it looks at in homes. It really concerns itself with two or three major areas.

The first is the zero step entrance, which is very similar to the approach we take in Universal Design.

And second, of course, is the circulation getting to a bathroom and within the bathroom. They have slightly different kind of details on that that we are looking at.

Slightly, slightly wider doors and slightly wider hallways is our ideal, and the folk who are promoting visitability are somewhat less concerned with ramp use than we are.

We are really pushing for nonramp solutions to get into homes, and that is really what visitability looks at, is those two key areas, bathrooms, getting to them, and getting in the front door of the house.

But we are very similar in what we like to see as outcomes. In fact, there is a page on the Concrete Change website that deals with myths and facts, and it is very similar.

They are talking about how accessibility -- the myth of access looking unattractive. That is a key component of Universal Design that, again, if it doesn't look good, it isn't universal. You got to make it blend in with the overall house design.

Lots of people think that either Universal Design or visitability is expensive. We have made it work in very small, very affordable housing and, of course, you can make it work without any problem in much more expensive homes.

Folks also think that perhaps zero step entrances are really only possible if you have got flat sites.

Well, if you work with us for a while, you realize that you are really looking for sites with a little bit of grade change on them so you can take advantage of them. And a lot of folks think that you can only attempt a zero step entrance if you have got a slab on grade foundation construction when, in fact, we do all the time zero step entrances with cross based foundations here in North Carolina and they do it elsewhere with full basements, so really is a lot of similarities between universal line and visitability in housing.

Small differences that you can pick out if you look through the web sites and cover our detailed discussion that we have in our Universal Design Features in Houses handout.

And I will end there and open to questions if people have them.
>> JULIE OVERTON: Thanks, Dick. If you have a question, if you could identify yourself and your agency. Okay. If there is no questions now, we will move ahead and I will give my presentation. And then when I am done, we will have time for some open discussion.
>> MAN: I have a question.
>> JULIE OVERTON: I am sorry.
>> CHRIS: I have a question. This is Chris at USC. What is the average cost of a universally designed house?
>> RICHARD DUNCAN: Ask the question again, Chris.
>> CHRIS: What is the average cost of a house that is universally designed?
>> RICHARD DUNCAN: What is the average added cost?
>> CHRIS: Yes.
>> RICHARD DUNCAN: Well, the average added cost is, in my estimation, between zero and five percent.

It can be absolutely nothing if you are fortunate enough to start far enough ahead in your designing and planning process and you have a site that is amenable to it, or it can be as much as five percent if you have a very difficult site and house style that you are starting with.

We think that the cost can remain hovering near zero if people begin early enough in the process and can adapt what they think might have been their original design scheme. We found having adapted many, many plans for other folks that it can be done, uniformly, but it is a lot easier if people free up a little bit and let us or others go with the different design schemes.

So it is very inexpensive.

Doesn't have to cost anything at all, in fact.
>> CHRIS: Thank you.
>> JULIE OVERTON: Any other questions, follow-up questions? No? Okay.

I am going to be discussing home modification and Universal Design resources, sort of the who, what and where to actually make it happen and give you some practical strategies and background on the resources.

I am going to be talking about resources such as agencies, professionals, programs and services, funding, online print and multimedia information, and coalitions, also.

So it is a lot of information to give you in a short amount of time, and I did provide you with some handouts which hopefully will supplement, and you can use as resource materials.

Is there anyone who did not receive the handouts at this point? Well, good. Okay.

I also have an outline to follow along that hopefully is at the beginning of it. I also wanted to mention we made a special link for you on our website that contains links to most of the resources that I am going to mention today.

So don't worry about having to write down resources and website addresses. We are going to have a special link for CFILC teleconference participants and our website address should be at the bottom of most of the handouts that you have. So you can refer to that later.

And then if you go to our home page, there is a section for California, and if you click that on, there will be an icon for CFILC.

And you can also e-mail me at the e-mail address that is at the bottom, or Dick Duncan or Jon Pynoos at that same homemods@usc.edu.

There is good news and bad news relative to home mod and Universal Design resource. The good news is there is a lot of resources related to home modification and Universal Design.

The bad news is that there is no home modification and Universal Design system. There is not one agency. There is not one professional type. There is not one funding source or phone number to call to find these resources, and I am sure we are all aware.
>> WOMAN: I am on a call.
>> JULIE OVERTON: Excuse me?
>> WOMAN: Sorry. I am sorry.
>> JULIE OVERTON: Oh, that is okay.

I am sure you are used to sort of playing detective as AT advocates, so hopefully today I am going to give you a bit of a road map related to home modifications and Universal Design.

I am going to start out sort of from the top, and the first handout that you should have is a list of state and local agencies related to home modification and Universal Design. Hopefully this will give you a little bit of context for how this home modification, Universal Design operates in California.

Most of the agencies on that list are involved in one way or another with home modifications and Universal Design. And, again, we have links to all of these on this special area of our website.

So I will just start there in alphabetical order and give you a brief summary. If you want more information on them, you can go to their website or contact them over the phone.

The California Contractors State Licensing Board licensing all contractors in California including those who may perform home modifications or Universal Design. They have some very useful documents of dos and don'ts that should be ask of contractors prior to hiring them, and they will also provide information on a contractor's license, what their bond status is, as well as any bending or prior legal actions they may have against them. So they are a good resource to check out professionals before using them.

The California Department of Aging or CDA have several cases -- provide case management services that include home modification. In addition, they have recently created a statewide program called the Senior Housing Information and Support Center. That provides information about housing options and home modifications to seniors and families, and their local counterparts are area agencies on aging.

The California Department of Agriculture, which you may also hear referred to as Rural Housing Services makes available various grants and loans for home improvements for rural, low income older individuals and persons with a disability that live in rural areas. Two programs you might know about or want to know about are Rural Housing Services Section 502 and 504.

And at the local level, rural development offices are responsible for administering those programs. The Department of Community Services and Development administers three programs that provide funds to weatherize the homes of low income persons to make them more energy efficient, and this is often a important home modification that accompanies other home modifications.

The three programs they administer are the low income home energy assistant program, the weatherization assistant program, and the home energy assistance program or HEAP.

And at the local level, you can contact your Community Action Agency, and we do have a directory of them on our website in California.

The California Department of Health Services coordinates local multi-purpose senior service programs or MSSP sites that provide social and health case management for frail, elderly clients who wish to remain in the community but are nursing home eligible. And an allowable housing expense under MSSP includes physical adaptations to the home.

There is MSSP sites statewide that are located within hospitals, area agencies on aging and social service agency. Be remiss not to mention the California Department of Rehabilitation, but all of you are aware of the Department of Rehab. (Laughing in the background) And among other things, it funds the CFILC wonderful AT network under the California assistive technology systems and some centers for independent living actually fund and deliver home modification services themselves.

And maybe during our discussion at the end, you can share your center's involvement in this area. The California Department of Social Services administers along with -- (noise) -- which you may be familiar with. The purpose is institutionalization of frail elderly or functionally impaired adult, age 18 years and older, and linkages include housing-related assistance including housing modifications and assistance.

The next state agency -- the good news is that the California Division of the State Architect or DSA has Universal Design on their radar screen. DSA is already incorporating Universal Design concepts into their plan review.

This just started, and DSA is establishing a universal design advisory board at the state level, also, and the Division of State Architects has regional offices that hopefully are going to make this happen, but time will tell.

The California Fair Employment and Housing Office administers the Federal Fair Housing Amendment Act of 1988, which I am sure many of you are familiar with. Requires housing providers to honor requests for reasonable modifications to house or apartment of a renter with disabilities.

And at the local level, there are fair housing offices. One of the most active agencies probably at the state level and also at the local level related to home modifications and Universal Design is the California Housing and Community Development Agency, or HCD, and HCD provides community development, housing and economic assistance to localities.

It does provide home modification funding through HUD's HOME program, and that is H-O-M-E, all capital letters, and Community Development Block Grant funds or CDBGs.

And we found consistently that CDBG funds are the most often used source to support home modification programs, but CDBG funds are decided on city and county basis, so it really depends on the advocacy within any given community as to whether CDBG pays for home modifications.

HCD also administers three programs from the state level that focus on home modifications and multi family housing. There is the multi family housing program. There is the farm worker grant program and that provides rehab funding that may include home mod costs. There is the housing preservation program. And that provides pre-development loans to create and preserve affordable housing, and the developer can include home modification costs.

A lot of times they don't, but they can include those as an allowable expense.

At the local level, again, city or county housing community development departments are great resources for home repair and home improvement programs. I am almost to the end of the state ones.

California Housing Finance Agency or HFA provides low market mortgage capital to meet the needs for affordable housing and HFA loans will finance home modifications, but only upon the developer's request.

And in a recent study that we did of State Housing Finance Agency, California has the largest overall budget of all HFAs but they fund no home modification. So they need to hear from the local level that this is an important issue to fund because they are allowed to fund it.

And then last but not least, the state Independent Living Council. As you all know, independent state agency that administers the state plan which does include some provisions and attention to accessible housing.

In terms of policies, I think Jon mentioned and maybe Dick mentioned, also, that there is no requirements that single family or other private housing be accessible or barrier free.

Most federal policy related on home modifications and Universal Design focuses on multi unit housing.

In fact, there is two policies that I sort of just mentioned related to Universal Design and home mods at the federal level.

The first is the Fair Housing Act. While it provides no funds, it makes it illegal for landlords to refuse to let tenants make reasonable modifications to their house or apartment, if the tenant is willing to pay for the changes. Depending on your experience with the Fair Housing Amendments Act, you may want to take the opportunity -- actually right now, HUD is asking for feedback on the Fair Housing Amendments Act from advocacy groups and the industry.

So we have a link in that special area of our website I mentioned that you can go to HUD, and they have a survey. And this is really kind of an open comment period right now. I am not sure what the deadline is, but this is a chance to get some advocacy going in terms of implementation.

And the Rehab Act of 1973, which I am sure you are familiar with, recipients of federal funds including federal housing providers must make programs and activities accessible, and the Rehab Act of 1973 is responsible for creating the Uniform Federal Accessibility standards or UFA act.

A lot of people get confused with the ADA. I wanted to mention four California policies that are pretty recent related to home modification and Universal Design.

Two are currently in senate appropriations to be considered in the next session. The first one is Senate Bill 533, Margett, and it creates the elderly and disabled persons revolving home improvement loan fund program. Again, it is Senate Bill 533.

Going to create the elderly and disabled person revolving home improvement loan fund program.

The Department of Housing and Community Development, HCD, is going to provide loans to low and moderate income seniors and people with disabilities to make home modifications.

The second one currently that is going to go into Senate appropriations is AB 1008, Loewenthal, and it allows the Department of Housing and Community Development -- here we go with HCD again -- to make accessibility grants to communities as a part of a pilot program that funds that in 2006, and the grants will go to local jurisdictions to establish programs that will give grants -- not loans, but grants -- to low income tenants with disabilities for making exterior modifications. So we keep our fingers crossed for that one, too.

Two recently signed by the governor in the last session, SB 370 -- originally it was just the program for injury prevention in the home environment, but it has been incorporated into a broader senior wellness act.

And if funding is appropriated in the next session, the program will provide limited home modification funding for purposes of avoiding injury in the home -- (Sound of sirens) -- and will be administered by the California Department of Aging.

A second bill recently signed by the Governor related to Universal Design and home modification is California Senate Bill 442. The bill's main purpose is to require HCD to set up a website to help identify affordable and accessible housing in California, so we will anxiously await that site.

Moving on to professionals, that would be the idea of the importance of the supportive home environment is not new and it is pretty novel. The growth of professionals who specialize in home modification and Universal Design has really only emerged in the last five to ten years.

Most professionals are involved in home modification and Universal Design as part of another job. There aren't that many people that only wear a home modification and Universal Design hat.

So even if consumers decide they need home modifications or want their homes universally designed, they don't know where to go to make the changes.

And this fact has been overwhelmingly reported in several research studies by AARP and Princeton research. So if you -- so your next handout, if you look, has a grid of the various professionals and stakeholders involved in home modification in the Universal Design, and it is just to give you a sense of the myriad of professionals and stakeholders involved.

Home modification and Universal Design fall into limbo among housing, social and health services, and none of the systems have taken on full responsibility or accurately assessing or modifying homes.

The delivery system consists of providers such as remodelers, contractors, tradesmen, plumbers, electricians, handiworkers, medical supply companies, and many providers have responsibility for only one aspect of the process. They may do assessment but they don't do the work, or they may do information referral but it stops there.

Occupational therapists and case managers tend to bring the broadest perspective to home modifications.

In addition to recommending structural changes or assistive devices, they are also likely to include functioning through behavioral changes or simply moving objects in the home. In the great majority of communities, there is no central place to find out about or obtain home modifications.

But let's talk about how you might be able to locate professional services and programs in your community. There are very few stand alone home modification or Universal Design programs or services. They tend to exist as part of larger agencies or businesses.

Some provide only minor modifications, such as grab bars, while others offer assistance with major modifications, such as a first floor bathroom or complete plans for a universally designed house.

The next handout, which is locating a home modification or Universal Design program service or professional in California, provides a list of the types of organizations and points of entry.

That is a long list and -- but the good news is that the California section of our website contains a list of home modification and repair services that we are aware of in California. It is by no means exhaustive, but at least it is a start.

In addition, we recently worked with the CDA senior housing center to put together and set up a more extensive California directory and an updated version of that will be available on their website in the next few months.

I also know that the AT network website contains home mod program listing. So even though the list I gave you is pretty long, at least there are some places you can go first.

The most likely suspects on the list are some of the local offices I mentioned earlier, such as the city and county housing and community development departments and area agencies on aging, and centers for independent living, of course.

In addition, if you haven't connected with your local Rebuilding Together program, which is formerly known as Christmas in April, you should.

This program completely modifies and rehabs the home of people with disabilities and the elderly once a year, and some of the programs of Rebuilding Together are starting to operate year around.

There has also been an increase in the development of private sector providers including builders and architects, remodelers who specialize in home modification, Universal Design.

To locate these professionals, you should contact your local remodelers council. Handyman Connection is an actual organization that exists within each community and provides referrals, or the building industry association chapters, each community should have a building industry association chapter.

I should mention that because of all this emergence of private sector providers, AARP in collaboration with the National Association of Home Builders and the National Association of the Remodeling Industry is in the process of establishing a certification process for professionals in home modification, and this is to try and monitor and ensure quality of professionals who claim they have an expertise in this area.

In addition, an organization called Prime is providing a certification program in environmental access consulting. So recipients receive what is called a CEAC credential.

So if you see that behind someone's name, that means they went through a training process in environmental access consulting through this -- it is a private organization that does this, though. It is not a government licensing at all.

So in the meantime, remember that the California contractor's state license board has useful screening information that I mentioned earlier. In terms of funding, there is no entitlement program for home mods or Universal Design.

The bottom line is it is basically a maze of funding programs that must be mixed and matched, and it is highly dependent on where one lives. As with anything, there is different eligibility requirements.

I have given you a handout, and it was a grid created by Dick Duncan and the Center for Universal Design, and lists a whole host of public and private funding sources, and not really time to go through all of them now, but hopefully this will give you some ideas to pursue.

But I did want to mention, regarding community development block grants, again, that the availability of funds like that depends on activism and local energy from the community to get the policy makers at the local level to recognize that it is an important -- home modification is an important piece of community development block grants.

And most insurance companies and Medicare do not reimburse for home adaptations.

Sometimes they will pay for medical equipment, but that is usually only following accident or illness. That is changing, though.

Some HMOs are recognizing that home modifications is preventive, and some will actually cover minor ones. Some such as GE have long-term care insurance plans that will pay for home modification.

In terms of funding, most sources of public funding are targeting home owners. Renters have very few funding resources. Especially for older home owner. They can access equity in their homes through reverse mortgages and use that for home modifications.

AARP actually keeps a list of reverse mortgage programs by state, if you are interested in that.

Quickly moving on to online and print information, in terms of online resources related to home modifications and Universal Design, there is many different types.

There is proprietary. They are trying to sell you something. Governmental regarding regulations, associations.

Dick Duncan mentioned several, and I would encourage you to visit the ones that we have listed for you guys on our website because it -- they contain a lot of really great pictures, and I think that is a big part of convincing people that this is important is to have -- actually have them see it.

Our website is Bobby approved, and if you want to, we have a plain text navigator on the home pages. Wanted to mention that.

But based on the content, there is some specific sites I want to recommend. One is the Center for Universal Design. They do have universal design blueprints. RESNA, the idea center at Buffalo, is wonderful.

They have a whole section on neat home modification and Universal Design products. They are not selling them. They are just sharing some great problem solving strategies.

Adaptive Environments, which is on the east coast, has a lot of really great information. HUD has a fair housing website that provides details on the Act.

And if you haven't accessed National Accessible Apartment Clearing House, they claim to maintain the only national database of accessible apartments with a registration of more than 46,000 units, so that might be something you might be interested in accessing.

In terms of print, there is a large number of educational materials that have been developed related to home modification, Universal Design.

So if you are out there doing community education, take advantage of publications that AARP has or the Center for Universal Design, or we have fact sheets, I am sure.

CFILC does, also. There are some wonderful consumer home assessment checklists, and we do have a lot of those materials in the library section of our website, but you can print out right from the website. And we have gotten copyright permission so you don't have to order them, and you can print them out straight from there.

And the next handout that you should have is a list of home modification and Universal Design related videos, and again the best way to kind of do consumer education is to actually show visuals of Universal Design and home modification. And there are some wonderful videos available to you, and I provided the ordering information.

I am just going to wrap up, real quickly talk about coalitions and coalitions can help support the development of home modifications in Universal Design at the local level because they bring together the professionals and agencies that represent all these different disciplines that are related to home modifications and Universal Design.

We started several home modification coalitions mostly in southern California, and each one has had a representative from the local center for independent living.

I know that Contra Costa home safety committee in northern California has three ILCs, and the Sacramento coalition which just got started has invited the ILC.

I don't know if anybody from there is on this call. But some home modification coalitions exist on their own with coordination from the lead agency.

Others emerge from fair housing task forces or ADA implementation boards, but they are basically a mechanism to try to get these issues on the agenda, as I mentioned, with community development block grants that is so important.

Dick mentioned the visitability, and a lot of those initiatives have been started through collaboration at the local level.

Our Pasadena home modification collation set up Universal Design guidelines that are administered in the permit department.

The Irvine in southern California originally addressed to issues of the ADA took it a step further and wanted to impact local new housing stock, and they devised Universal Design guidelines and got all of the builders in the local area to sign off on them, and they are given as disclosures to new home buyers now, so that is just some examples of how coalitions can really make a change in terms of long term in the community to get home modifications in Universal Design going.

So in very short amount of time, I hope I have provided you with some ideas and strategies for how you can locate and stimulate home modification and Universal Design resources in your communities.

And I think any one of the speakers at this time would be glad to take a question or comments.
>> MAN: Please.
>> JULIE OVERTON: Is anybody still there?
>> MAN: Ha, ha.
>> WOMAN: Yes.
>> JULIE OVERTON: I don't hear any snoring.
>> MAN: They are stunned.
>> WOMAN: No. It was really good information. You said all of web sites are included in the handouts, right?
>> JULIE OVERTON: In the handouts, and also if you go to our website, which is homemods.org and on the home page there is a California button. And if you click into that, we made a special icon for the CFILC teleconference participants. >> WOMAN: That is great. There is just so much information and resources, it is hard to know what to ask.
>> JULIE OVERTON: Well, and if you think of questions afterwards, I mean, any one of us would be glad to be contacted individually.
>> WOMAN: That is great. Thanks. I just started the AT job at our ILC in San Francisco, so I am really just kind of learning about stuff, but this was very informative. Thank you all.
>> JULIE OVERTON: Oh, you are welcome.
>> AMY NOAKES: Julie, this is Amy. Do you have a contact for the Prime that you were talking about?
>> JULIE OVERTON: Yeah, Ann Lewellen, and they have a website, as does everybody. I think it is primeinc.CC.
>> AMY NOAKES: Okay.
>> MAN: They are in Miramar, Florida.
>> AMY NOAKES: And then you said AARP is doing a certification?
>> JULIE OVERTON: Yes.
>> AMY NOAKES: Okay.
>> JULIE OVERTON: Any other questions?
>> MAN: Yeah, that is Lance from Home Access Products. I recall hearing something about grant dollars available. Is there a specific agency in the California or in the Sacramento office that might have some more information on that?
>> JULIE OVERTON: Are you asking related to the ones that I mentioned that recently passed or that are already in existence?
>> MAN: Actually, both, anything that you might know, because one of my struggles is that we are in Eureka, California, and we don't recognize northern California.

We are like at the tip, just before you get up into Oregon. That is one of my struggles I am running into, so if you have any information that would help me, that would be great.
>> JULIE OVERTON: Um, okay. In terms of -- it sounds like you are in a very rural area? And I would suggest -- I have a contact at Rural Housing Services, the Department of Agriculture, and they have a lot of loans and grants for home improvement for people that live in rural areas.

So if you e-mail me and give me your name and remind me of your question, I will connect you with that person.

But most of the bills that I mentioned that just passed related to loans and grants are being administered by the Housing and Community Development Department at the state level.
>> MAN: Okay, thank you.
>> AMY NOAKES: This is Amy again. What were the coalitions in Contra Costa and in Sacramento, the names?
>> JULIE OVERTON: One in Sacramento, just the Sacramento Home Modification Action Coalition and the one in Contra Costa is the Home Safety Committee.
>> AMY NOAKES: Do you know who is heading those?
>> JULIE OVERTON: Yeah. I don't have the names right in front of me, but if you want, I could e-mail them to you.
>> WOMAN: No, Amy. Nancy and I are both on that committee.
>> AMY NOAKES: Okay. I have a listing that I include in my home mods packet of the collation, and I didn't know they existed in northern California. So if you guys want to e-mail me information, I would appreciate it.
>> WOMAN: Well, they got to give us something to do, you know?
>> AMY NOAKES: Yeah. Ha ha.
>> JULIE OVERTON: Any other questions?
>> LISA ORIGER: I had a question about the housing community development programs. Do the counties have to apply to implement them in their counties or is that supplied at a state level?
>> JULIE OVERTON: Yes, the county applies through their HUD regional office plus then that request goes through the federal level and it goes through a process called the consolidated plan, and each county -- well, each city, or if it is unincorporated, it goes to the county level, submits an unconsolidated plan for any HUD related funding.

And within that plan, they have to identify priority areas so accessible housing or home modifications isn't identified as a priority area when that plan is developed, and it is updated every year, and, you know, the city housing community, the development department, can't allocate those funds for the purpose, the CDBG funds for that purpose.
>> LISA ORIGER: Okay, thank you.
>> JULIE OVERTON: Kind of important to get involved in the consolidated plans process, open hearings that people can attend and --
>> LISA ORIGER: Right.
>> MAN: Hi, that is Mark from Espinosa, ILRC Oakland. I just like to know if you have the minutes for this on line somewhere or if you can e-mail it to us.
>> JULIE OVERTON: I think Amy said that they were going to be doing that. Is that right, Amy? >> AMY NOAKES: Yeah. The captioner, Sue, e-mails them to me, and then I can e-mail them out to everyone. And we also have it on tape. So --
>> MAN: Okay. Thank you.
>> AMY NOAKES: So is that all the questions that anyone has for Julie?
>> MAN: I have a question. This is John Pynoos. In general, what kind of problems are you encountering related to accessibility and supportiveness of housing, or what are the biggest problems that you are facing?
>> WOMAN: Money.
>> WOMAN: Funding.
>> MAN: Finding people to do the work?
>> AMY NOAKES: This is Amy. The biggest question I get is how to pay for it.
>> JULIE OVERTON: Yeah, me, too.
>> AMY NOAKES: There is contractors available. It is just most of the agencies run out of the money pretty fairly quickly.
>> MAN: That is the problem we get here, too, is funding. And the other question that I get is how much time is it going to take, especially when somebody doesn't have funding.
>> MAN: And are you finding people live most in homes, apartments? What kinds of places?
>> AMY NOAKES: This is Amy. For the calls I get, it is both.
>> DAVID: This is David. It is about 50 percent either way.
>> MAN: Those in apartments, are landlords cooperative or uncooperative?
>> DAVID: Over here -- and I do a lot of work with tenants with landlords. I would say it is about 50 percent of landlords are not cooperative.
>> MAN: What do you do in those situations?
>> DAVID: It is up to the consumer. I give the consumer legal recourses. Any attorneys that I might know of, I give them legal resources.

I go to your county Bar, if nothing else, to find attorneys, if that is what you choose to do. The funding will not pay -- at least the city, county level funding will not pay for modifications if the landlords are opposed to idea.
>> AMY NOAKES: What about do you connect them to the local fair housing office because sometimes they will mediate?
>> DAVID: That one I hadn't thought of. I will add that to my list.
>> MAN: Legal services, are they ever helpful or involved?
>> DAVID: Different legal services, it really depends. Sometimes they are very helpful. Sometimes they are not helpful at all. And it is almost a -- it almost seems like it is a flip of the coin.
>> MAN: Do they use the reasonable accommodations section of the Fair Housing Amendments Act?
>> DAVID: Yeah. I have tried to use that. City and county funding, the HCD departments will not pay unless the landlord agrees no matter what the Fair Housing Act says. And most people don't have the inclination to go through a lengthy court battle with the landlords. People get scared.
>> MAN: What kinds are they trying to have changed in the environment?
>> DAVID: Primarily landlords react to ramps being built, react negatively to anything that is going to affect the external appearance of the place, followed by anything that is going to affect their perceived rentability of the apartment, such things as they consider grab bars being placed in bathroom as negatively effecting the rentability of the apartment.

Third, landlords -- and it surprised me when it came up, but it has come up a few times now. Landlords are afraid of making changes that will encourage severely disabled people to come into their apartments because they feel they are going to be responsible -- this is the excuse I have been given -- responsible if something should happen to that individual. >> MAN: Tell me your name again so we might follow up on a conversation.
>> DAVID: David with CRIL, Hayward.
>> MAN: Great, thanks.
>> WOMAN: Any other questions or information you would like to share with the group regarding the home modifications and Universal Design with your specific community?
>> AMY NOAKES: This is Amy. Maybe those who have home modification programs in their center can let others know so that we can call upon them as a resource.
>> DAVID: We do home assessments, home modification assessments.
>> AMY NOAKES: Who is that, David?
>> DAVID: Yes.
>> MAN: What does that entail? What --
>> DAVID: Entails going out doing measurements, making suggestions, coming up with creative ideas, and then, of course, looking for funding and sources to make the changes if the consumers determine that they are interested in having the changes made.
>> MAN: Those are at no cost or do they pay?
>> DAVID: What we do is no cost.
>> WOMAN: Is there a waiting list or what is the demand for that service?
>> DAVID: Um, it was -- I had about a two to three week waiting list. Right currently, I am looking to put people into my time slots again. It seems to come in spurts.
>> WOMAN: Are you the only one, David? No one else?
>> MAN: Actually I would like more information, you know, getting somebody to do assessments for consumers. That is one of the major things I have run into right now. People need, you know, somebody to go and, you know, do that and I don't know if I should do it or not.
>> WOMAN: Who is that?
>> MAN: Mark from CRIL Berkeley.
>> DAVID: We have two things, Mark. This is David with Hayward.

One, I went through specific training on accessible design, ADA requirements, such as that. And I go out and do assessments myself.

Two, we have a couple different occupational therapists who we contract with who we pay for. We have set certain of our moneys aside to do this, and we pay for occupational therapists, OTs, when called for, if it is something other than a basic building modification recommendation.
>> MAN: Thank you.
>> MAN: What is your experience in using OTs?
>> DAVID: Um, actually, fairly good. I worked with one OT once who I never would work with again. But for the most part, I find OTs are fairly -- they are quite knowledgeable as far as consumer abilities, as far as how to help consumers, you know, creative solutions with consumers, themselves, for how to do things.

As far as building modification suggestions, I find that they tend to be fairly lacking, but again it really depends on the individual OT.
>> LISA ORIGER: David, this is Lisa. Does Medicare pay for the occupational therapist to come in and do any of that, if it is directly related to their disability, covered under Medical?
>> DAVID: Depends, I know Kaiser with their Medi-Cal supplement will do it. Medi-Cal straight up, I have not seen that. I do see Medi-cal providing the durable medical equipment part of it such as grab bars -- mainly things such as grab bars.

Sometimes riser chairs -- I don't know what they are called, standing chairs, something like that, shower benches quite a bit, hand shower wands quite a bit. But that, of course, has to be with doctor's prescriptions.

I am -- I have not yet seen them providing OTs to go out and do assessments.

Now, I have seen Kaizer and I have seen Sutter health care, and another one which I can't recall the name of off the top of my head. They do have people who go out and do home assessments and those people -- it really depends on the person.
>> LISA ORIGER: Okay. Thank you.
>> MAN: So of the people that you are serving, what do you see as the greatest --
>> DAVID: The greatest what?
>> MAN: The greatest need? Is it ramps? Is it bathroom accessibility?
>> DAVID: Ramps actually is really showing itself to be the greatest need at this point because ramps tend to be a little bit more expensive than the $1,000 maximum that the community -- the HCDs out here will pay, and the Medi-Cal tends to not -- or the Kaizer version of Medi-Cal is the most recent one I just saw, but Medi-Cal tends to be reluctant to provide such things as electric wheelchairs unless a person has access to the outdoors, which are things such as a ramp. Medi-Cal doesn't have a problem typically with things like bathroom equipment but, of course, if somebody needs to have it installed, they are SOL.
>> LISA ORIGER: I have a question. This is Lisa. Has anybody accessed special circumstances grant for home modifications, and if so, is it successful?
>> WOMAN: We do at ILRC in San Francisco all the time; just for small things like grab bars and small things like that, though.
>> LISA ORIGER: Okay.
>> DAVID: I have used it most recently with a consumer who had a problem with -- who had an issue with a bed, to replace her bed.
>> WOMAN: Nancy has used it quite a bit and been very successful in getting ramps and home mods here in Contra Costa.
>> LISA ORIGER: Yeah. I haven't heard a whole lot about the funding of that program.
>> WOMAN: Right now out of funding.
>> WOMAN: Out of money now.
>> WOMAN: Yeah.
>> LISA ORIGER: Okay.
>> WOMAN: But it goes county by county. We can't even find where they have that available in Solano County.
>> DAVID: If I am remembering correctly, it is a county assigned funding thing as well. The county said how much they thought they would need for it or something like that.
>> AMY NOAKES: Actually -- this is Amy -- it is run by Department of Social Services. And there is a lot of dollar amounts, maximums. And it is run through the county, but it is actually funded by the state. So I believe, like for modifications, you can get up to $1500 for a modification.
>> LISA ORIGER: A lot of times -- this is Lisa -- they are not really advertising this program so people aren't utilizing it. So then it looks like there is no need for it because the money just sits there and a lot of people are losing out.
>> DAVID: That is exactly what is happening.
>> AMY NOAKES: I have the numbers for the special circumstances program in most counties. If you guys want those, they are in the file section on the listserv under home modifications.
>> DAVID: We have had another problem with special circumstances where they have not been efficiently sending applications to potential applicants.
>> LISA ORIGER: Like denying them before -- without even due process?
>> DAVID: Basically just not sending out the application when they are supposed to, within, say, 30 days.
>> WOMAN: That has got to be county by county because our county has been wonderful about that, about getting people out to go over the property and do the specs on it and everything. They have been great.
>> LISA ORIGER: That is good.
>> WOMAN: Who is that, Concord?
>> WOMAN: Yeah, and mostly we have used it in West County, in the Richmond area, but we have used it other places, too.
>> DAVID: Hmm.
>> LISA ORIGER: Now, I had a question. Are the MSF people connected with the special circumstances? I don't think it is, but -- and I haven't -- I don't -- not quite sure how the MSSP program is going to really work. Does anybody know?
>> WOMAN: I don't think it is connected with special circumstances, no.
>> LISA ORIGER: Okay.
>> WOMAN: But, Jon, do you know?
>> JON PYNOOS: It is not directly connected, but I don't know of any reason they can't make use of special circumstances. I would ask them that question. Good question.
>> WOMAN: One of the links on the site that we have will link to the closest MSSP site so maybe calling them directly --
>> JON PYNOOS: Wanted to share with the group one idea that we had tried out several times with some success, which was once a year in the Pasadena area there were home tours of people with disabilities who had modified their homes.

And they would open them up for two days over a weekend and invite other people or whoever wanted to come to see and talk with them about things that had worked, how much it cost, how effective they were, how much time it took, just a range of issue that otherwise they might not see, touch, and hear from.

It was a way of people sharing both their successes and problems in modifying their homes with either professionals or other consumers who wanted to come and sort of check it out on their own.

Plate is sort of filled up with knowledge for providers and consumers in a way that isn't easily done otherwise. Have any of you tried something like that?
>> WOMAN: It was also, you know, real low cost. I mean, people -- like Jon said, we had about five homes and they just opened their home for the day or for, you know, four hours of the day, and then we distributed fliers to community groups that we thought would know consumers that would like to attend as well as professionals. And then people just went from house to house.

And it was nice to hear from a lot of people, oh, I didn't even know that house had a ramp because it blends in so well with the landscaping and that kind of thing. So it was a real great kind of community awareness effort that didn't take a lot of effort.
>> LISA ORIGER: This is Lisa. I think there is a lot of myth out there that people with disabilities don't have money to spend and that, you know, that is kind of a neat way to show that, hey, yeah, people are out there, that they are interested in the Universal Design, and kind of connecting to what is really out there to the people who need it.
>> WOMAN: Yeah. One of our most popular homes that is on the tour every year is a doctor who is a quadriplegic as a result of an accident, and he has got a big insurance settlement. I mean, I know that is not always common that people have so much money to make such big changes, but his home is this Spanish hacienda style and he lives upstairs, has a full wheelchair lift going up a spiral staircase, and it was really -- you know, people were kind of taken aback, but just to see, you know, these kinds of things can be pretty and attractive and, you know, then we have the opposite extreme of just simple changes, too, but definitely was a good way to educate people about it.
>> AMY NOAKES: So Julie -- this is Amy -- if people are interested in doing that in their local communities, can they contact you directly for some ideas on how that was conducted?
>> JULIE OVERTON: Sure, yeah.
>> AMY NOAKES: Okay.
>> JULIE OVERTON: We would be happy to do that. Any other questions or comments?
>> AMY NOAKES: Okay. It doesn't sound like -- this is Amy. They can e-mail you, directly, right, though?
>> JULIE OVERTON: Yeah.
>> AMY NOAKES: Okay. So if anyone has any further questions that they can't think of right now, you can e-mail Julie. What is it, homemods@usc.edu?
>> JULIE OVERTON: Should be at the bottom of most of my handouts.
>> AMY NOAKES: It is. I would like to thank everyone for attending, and really like to thank Julie and Jon and Dick for participating, and letting us know more about home modifications and Universal Design.

I will be e-mailing everyone an evaluation form, so if you could get that back to me in a timely manner, I would sure appreciate it. All right. Talk to everyone later. Thank you.

(Teleconference ended at 6:00 p.m. CT)