Your mom has lived in the same two-story house for 40 years. Since her hip replacement, the front steps scare her, the tub is impossible, and the only full bathroom is upstairs. She won't hear of moving. You want to make the house work, but you don't know what's worth doing, what insurance might cover, or who to hire.
This guide focuses on choosing and paying for modifications. It uses the CMS Medicare Benefit Policy Manual, Medicare.gov, USDA Rural Development, IRS Publication 502, VA and the Administration for Community Living. We don't list prices, because they vary widely by home and region. For a room-by-room checklist, see our aging in place guide.
What to change first
Focus on the places where falls and daily struggles happen most: the entrance, stairs, the bathroom and the path between bed and toilet at night. Small, inexpensive changes often make the biggest difference, such as grab bars, handrails on both sides of stairs, brighter lighting, removing loose rugs and a handheld shower. See fall prevention for the elderly.
Bigger projects can come later or in stages: a ramp or zero-step entry, a curbless shower, wider doorways, a stair lift, or moving a bedroom and bathroom to the main floor. Think about where your parent's health is likely to go, not just where it is today. If your parent may use a walker or wheelchair in the future, plan door widths and turning space now. For a parent with sore hands and knees, see arthritis in the elderly. For grab bars and shower seats, see bathroom safety for seniors.
Get a home safety assessment
Before spending money, ask your parent's doctor for an occupational therapy evaluation. An occupational therapist watches how your parent actually moves through the day, getting out of bed, using the toilet, bathing and cooking, and recommends specific changes and equipment. That keeps you from paying for changes your parent doesn't need and helps you avoid missing ones they do.
If your parent is getting Medicare home health services after a hospital stay, ask whether the therapist can include a home safety review. Area Agencies on Aging can also point you to local home assessment and repair programs6. Sealing drafts helps prevent hypothermia in older adults. For lighting and contrast tips, see macular degeneration.
What Medicare does and doesn't cover
Original Medicare pays for durable medical equipment (DME) that a provider orders for use in the home, such as walkers and commode chairs, after the Part B deductible and with your parent paying a share78. Depending on the item, your parent may rent or buy it7.
Medicare does not pay for most home modifications. The CMS Medicare Benefit Policy Manual says equipment that mainly serves comfort or convenience, such as elevators and stairway elevators, isn't medical equipment, and it treats self-help devices such as safety grab bars as nonmedical1. Ramps, wider doors and bathroom remodels aren't DME either, so families usually pay for them another way.
Some Medicare Advantage plans offer extra benefits beyond Original Medicare. If your parent has a plan, call and ask whether it covers bathroom safety items or home modifications and what the rules are. See does Medicare pay for home health care.
Grants and programs that can help
- USDA Section 504 Home Repair. In eligible rural areas, USDA offers low-interest repair loans to low and very-low-income homeowners and grants to very-low-income homeowners 62 or older to remove health and safety hazards. Your parent must own and live in the home, and grants must be repaid if the home is sold within three years2.
- Older Americans Act services. Federal law lets Area Agencies on Aging fund services that adapt homes to meet the needs of older adults with physical disabilities, along with residential repair projects9. Ask what's available locally through the Eldercare Locator6.
- Medicaid home and community-based services. Many state Medicaid waivers cover some home accessibility changes for people who would otherwise need nursing home care. Rules vary by state, so ask your state Medicaid agency or Area Agency on Aging.
- VA benefits. See the veterans box below3.
- Local and nonprofit programs. Cities, counties and nonprofit groups often run volunteer repair days or small grant programs for older homeowners. Your Area Agency on Aging usually knows which ones are active.
Apply early. Many programs have limited funding, waiting lists and inspection steps before work can begin2.
The tax rules
IRS Publication 502 lets you include in medical expenses the cost of special equipment installed in a home or improvements whose main purpose is medical care for you, your spouse or your dependent5. If an improvement raises the home's value, only the cost above the increase in value counts. If it doesn't raise the value, the entire cost can count5.
The IRS says certain changes to accommodate a disability usually don't increase a home's value and can be included in full. Its list includes entrance ramps, wider doorways and hallways, bathroom railings and support bars, lowered kitchen cabinets, porch lifts, modified stairways, and handrails or grab bars anywhere in the home5. Only reasonable costs count, not extras for looks5. Keep receipts and a note from the doctor or therapist. See claiming an elderly parent as a dependent.
Other ways families pay
Most families pay at least part out of pocket, often splitting the cost among siblings. Some use savings, a home equity loan or, after careful thought, a reverse mortgage. If you're considering borrowing against the home, read our objective reverse mortgage guide first, including the risks.
Doing the work in stages can spread out costs. Start with safety items that prevent falls, then plan larger projects as funding comes through. If your parent might need Medicaid later, keep records showing that money spent on modifications went to their own home and needs, and ask an elder law attorney before family members pay large amounts or take ownership interests.
How to hire well
- Use the assessment as your plan. Give contractors the occupational therapist's written recommendations.
- Look for experience with accessibility. Ask for examples of ramps, curbless showers or grab bar installs they've done.
- Get several written estimates. Compare the scope of work, materials and timeline, not just the total.
- Check licenses and insurance. Your state or city licensing office can confirm a contractor's license.
- Make sure grab bars are anchored correctly. They need solid backing, not just drywall anchors.
- Pay in stages. Avoid paying most of the cost before the work starts.
Be cautious with door-to-door offers or high-pressure sales pitches aimed at older homeowners. If something seems off, pause and talk it over with family. See elder financial abuse.
If your parent rents
Renters can still make changes. Many modifications, like a tension-mounted pole, a shower chair, a raised toilet seat or plug-in night lights, don't require permanent work. For bigger changes, talk with the landlord before starting and get any agreement in writing. Local fair housing or disability rights organizations can explain your parent's rights to reasonable modifications.
Making main-floor living work
When stairs become the main barrier, families often choose between a stair lift and moving daily life to the main floor. A stair lift keeps the whole house usable but doesn't help if your parent later needs a wheelchair, and Medicare won't pay for it1. Converting a dining room or den into a bedroom, and adding or enlarging a main-floor bathroom, costs more up front but can serve your parent much longer.
If a full bathroom isn't possible right away, a commode chair can bridge the gap. Medicare covers commode chairs as durable medical equipment when a provider orders them8. Ask the occupational therapist which option fits your parent's condition and the layout of the house.
If your parent has dementia
Memory loss changes what a safe home looks like. Beyond grab bars and lighting, think about wandering, confusion and safety around the stove. Common steps include motion-sensor night lights on the route to the bathroom, stove knob covers or an automatic shutoff, door chimes or alarms, and locking away medicines, cleaning products and tools.
Keep changes simple and familiar. Large remodels can be disorienting, so make one change at a time and keep furniture in the same places. Contrasting colors, like a dark toilet seat on a white toilet or tape on step edges, can help a parent with vision or depth perception problems (see vision loss in the elderly). For more, see dementia wandering and when a parent with dementia refuses to shower.
Common mistakes families make
- Skipping the assessment. Changes that don't fit how your parent moves waste money.
- Assuming Medicare will pay. Stair lifts and grab bars aren't covered DME1.
- Waiting for a fall. Simple safety changes are easier before a crisis.
- Buying towel bars instead of grab bars. Towel bars aren't built to hold body weight.
- Missing the tax break. Keep receipts for qualifying improvements5.
It also helps to revisit the plan once a year, or after any hospital stay, since needs change.
An example of how it fits together
Margaret, 79, lives alone in a rural county. After a fall, her occupational therapist recommends grab bars, a handheld shower, a raised toilet seat, railings on both sides of the porch steps and a ramp. Her doctor orders a walker and commode chair, which Medicare covers78. Her son contacts the Area Agency on Aging, which connects them to a volunteer repair program for the railings9. Because Margaret owns her home and has very low income, she applies for a USDA Section 504 grant for the ramp2. Her children cover the bathroom work and keep receipts for their taxes5.
This is an illustration, not advice. Your parent's options depend on where they live, their income and their coverage.
Getting help
Start with your parent's doctor to order an occupational therapy evaluation and the Eldercare Locator for local programs6. For the full picture of staying at home, see aging in place and transportation for seniors.
