WATERLOO, IA – Home access and/or home modification tends to be an issue that everyone readily understands, but action often comes quickly in response to a medical event. Foresight is not always in the equation, at least not often enough.
There are a few different ways to think about the issue and Jim Greatorex, vice president of VGM Live at Home has devoted a lot of time and effort to the cause. Medtrade Monday sat down with Greatorex to learn about the evolution of home access, where it stands today, and where it could and should go in the future.
Medtrade Monday: How are people thinking about home access these days?
Greatorex: There’s three parts to it. There’s what’s going on in the consumer world, what’s going on in the contractor world, and what’s going on in the legislative or payer world.
In the consumer world, 95% of what we would consider to be home accessibility projects are done as a reactive sale. In other words, there’s been a medical event or a deterioration of condition and somebody must have something done to be able to live independently in the home.
Medtrade Monday: How tough is it for providers to be proactive instead of reactive?
Greatorex: There’s a lot of people who want to be in the proactive market, but they haven’t been successful in trying to market themselves that way.
Medtrade Monday: How can the medical community help?
Greatorex: The medical community needs to step up and educate consumers on how they can make their home safe, because they’re not engaging in it enough.
Medtrade Monday: Where does much of the marketing and/or education come from?
Greatorex: Most of the marketing is done through digital marketing, and that’s the dominant force. Adult children realize that mom is climbing up the stairs, or dad fell down in the bathtub, and the marketing may convince them that something must be done.
Medtrade Monday: Why is input from the medical community so important?
Greatorex: Adult children may call somebody to remodel a bathroom or install a stair lift. However, mom and dad may fight it left and right and the home access professional walks into a family feud. In turn, the ‘close rate’ can suffer. People with frequent falls or those who’ve gone into rehab are in a certain medical category where home modification makes sense. We believe that 80 percent of the time, people in that condition are going to need some type of home modification.
Medtrade Monday: What should medical professionals do in this situation?
Greatorex: We want them to send in an occupational therapist who has been trained in home accessibility. These OTs can educate clients on what their risks are, and then they can bring a home access professional to come in and show them what their options are to mitigate those risks.
Medtrade Monday: And seniors may respond more favorably to that medical professional?
Greatorex: Yes. When you’re a senior and your son or daughter says you need something, it can be an argument. I went through it with my mom and it was more than an argument. She just didn’t agree. But when a physician says, ‘I’m going to send somebody in because I feel like you may have safety hazards,’ it’s a different matter. Then it’s, ‘Oh my doctor says I need it and the conversation changes. The OT can come in and clinically explain to seniors and tell them the ‘why’ of the situation. The OT is a home access professional who comes in as an invited guest instead of stepping into a conflict.
Medtrade Monday: What about the payor/legislative side of the equation?
Greatorex: One thing we learned in 2022 and into 2023 is that Congress isn’t ready to act on a project for this yet. It’s in some legislation but it’s very vague. We had legislation that would have specifically addressed it. It was very broad-based and viewed by Congress as extremely expensive. Members of Congress do not like offering benefits that are based on tax deductions or credits. Because of that we’re looking to do more work on a state level. It’s a lot easier to get a state bill passed than it is a federal bill. And in many cases, your argument to the state gets extremely well received.
Medtrade Monday: What legislation are you aiming at?
Greatorex: We’re looking to make legislation income-defined. The people at risk for not getting work done because of finances are middle income folks. Low income people have programs. High income people can pay. Middle income people sometimes need help and maybe some financing options.
Medtrade Monday: Is there specific legislation brewing right now?
Greatorex: We have a bill right now in Massachusetts that would give people a $5,000 dollar grant that was within 120 percent of the median income in their county toward improved home access. If we can get that one passed, that would give us a model that we could take all over the country. It resonates with states.
Medtrade Monday: Beyond injury, what are the consequences of not acting on home modification?
Greatorex: When middle income people figure out they can’t live in their house safely, they sell their assets. They end up in congregated senior housing, run out of money in three years, and now they’re a ward of the state and they are very expensive to care for. The choice of where to live is gone and they live where they’re put—and maybe with people they don’t want to live with.
Medtrade Monday: How well does the medical community appreciate the problem of unsafe homes?
Greatorex: They know it’s a problem. They just don’t know how to solve it. We have to bring them solutions. I don’t think they realize that there are experts in most markets. We need more people doing it, but there are people. In the last couple of years, some health systems have tried to make relationships with contractors and have been burned. Jobs were not finished.
That’s why we’re trying to build a network of vetted home access companies. If we got a physician group or a health system to allow us to do a pilot program, I think we would be able to show them the value that we would bring, and they actually would also see cost savings. If we could just eliminate 10 percent of the falls, we’ll save five billion dollars to the health care system annually.
Medtrade Monday: Are payors showing interest?
Greatorex: Some of the Medicare advantage plans are also now starting to take a closer look at home accessibility. In some cases they’ve been offering I think $400 dollars toward home accessibility. That’s really not going to amount to much. Somebody might put in a grab bar or two and that’s it. But we’re hearing now that they’re looking to maybe fund $2,000 dollars per client or per household on home accessibility. Now that’s showing that there’s value. It would give people a boost towards getting something like that paid for. Those are all encouraging things that are happening. Consumers should be able to spend $15,000 to $20,000 and maybe increase the ability to live in a home for five to ten years longer. They would save so much money doing that if we just help them.
