Home modification has traditionally been a difficult niche within HME. Building ramps, installing elevators and lifts, and just generally making homes safer intuitively makes sense, but this service and product category has suffered from a lack of Medicaid coverage, uneducated consumers, and a high cost of doing business.

Reinforcing bathroom walls when building allows more options in grab bar placement.

However, population trends, such as the aging Baby Boom generation and greater life expectancy, are on the side of home modification providers. Those businesses that have remained committed to this field are confident of a bright future, and their work history supports this belief.

Dallas-based AABCO Equipment and Supplies deals in bath aids, stair lifts, home elevators, vertical lifts, inclined lifts, and ramps. It does installations throughout Texas, Oklahoma, and Louisiana. According to AABCO salesman Joe Williams, the demand for accessibility equipment in the home has increasingly steadily over the past 20 years and these products and services now make up 70% of the company’s business.

“We are still a full-service HME store; that’s how we started, but we have experienced this gradual shift over the years due to client demand,” Williams says. “People didn’t know who to go to for these types of supplies, especially elevators. Our customers came to rely on us for other equipment through the years, and now we do their lifts and elevators too.”

Nashville, Tenn-based Life@Home is into its fourth year of providing home modification services. Its core business is modifying thresholds and selling and installing grab bars, handrails, and bedrails. Home modification makes up 68% of Life@Home’s business, with another 7% to 8% coming from related consulting work.

Good Neighbors
Both of these companies have realized that their specialization not only brings them a niche clientele, but also makes it possible for them to work on friendly terms with other HME providers. While AABCO does offer grab bars, Williams notes that another company in town has built a very good business in that specialty. “Another just does bathroom renovations,” he says. “There are a lot of different niches to get into, and I think the whole market is moving in that direction rather than into a general provider market.”

Life@Home also has a good relationship with other local HME providers because it does not compete for their core business, says company vice president Ella Chadwell. “Some HMEs in our area send us all the grab bar work and we send them all the wheelchair business,” she says. “You have to have that ability to get along in the same town to be successful.”

AABCO relies on referrals from previous or long-time customers for its business, although it also runs an advertisement in the yellow pages. Life@Home’s major marketing tool is its presentations to rehabilitation groups, hospital support organizations, and agencies that are in contact with people who have different maladies, such as the Multiple Sclerosis Society.

“I think what has been most successful for us is getting to know the home health industries and hospitals, because they are working with our future clients,” Chadwell says. “We try to communicate to discharge planners what our business is about, and we do an educational series of roundtables in our office once [every fiscal] quarter when we look at different people serving our clients.”

Another element that has helped companies like Life@Home and AABCO maintain their success is growing public awareness about home modification. New buildings are using “universal design” principles to become very handicap accessible, and aging Baby Boomers who care for infirm parents have driven up public interest.

“Awareness has increased a lot, especially in people who are building homes and planning for accessibility issues later in life,” Williams says. “It used to be that we would set up a residential elevator at our trade show and people would laugh. Now many will stop and say that’s what they need for their mother or their aunt or even for themselves. Others come to us with building plans and want to do it in the future in their own homes. Many of us have our parents coming to live with us today so this type of thinking is becoming much more commonplace.”

Building for the Future
Chadwell agrees. “This is a new and growing market, and the aging population is soon going to demand it,” she says. “We are attempting to help people survive in their entire house and not do anything to limit mobility.”

To that end, the first thing Life@Home does with each client is a site assessment. The focus is on the primary area of concern for the caregiver, which most often is the bathroom, followed closely by the entryways, then the bedroom.

“Our clients basically want to know if it is physically possible to make these changes,” Chadwell says. “A lot of the time our recommendations are simple tips, such as moving the laundry room upstairs to the main floor, or removing a rug in the entryway that poses a slipping hazard. Anything that presents the opportunity to cause a fall should be addressed. For instance, stairs can be fine for 50 years, then become a struggle as [the resident’s] mobility changes.”

The common sense nature of the majority of recommendations made by home modification providers also brings up an issue that Chadwell feels would greatly impact her entire business: Educating people about their environment before problems occur.

“We are usually called to the home after something has happened,” Chadwell says. “There is not a lot of preventive thinking in society today, and I would like to change that because people could stay in their homes longer and be safer. That would also grow our business faster.”

One simple preventive measure is to install a handicapped-height toilet in every house, Chadwell says. These toilets are easier on people having trouble with their back or knees, and they will not harm the overall value of the home.

Foresight during construction could also make many future changes less costly and inconvenient for homeowners. One example is preparing for the future installation of bathroom grab bars by putting reinforcements between bathroom-wall studs. When placed 33 to 36 inches from the ground, these reinforcements would allow for more options when placing grab bars.

“The reinforcements also will ensure that the grab bar will stay up if the person using it goes down,” Chadwell says. “It is a quick trick to know, and these kinds of shortcuts make things a lot easier down the line.”

She also recommends installing a phone jack in the bathroom and making a few different methods of showering available, such as a handheld shower head with a diverter so that the home’s residents can sit to take showers, if they need to. Slightly bigger shower stalls will accommodate a caretaker who may need to assist with bathing.

Finally, higher electrical outlets are easier to reach for seniors with limited mobility. “When people get older and bend to do things, they start falling,” Chadwell says. “How many people do you know who are going to tell you they fell because they tried to plug in a lamp? They feel stupid. All these tips are attempts to restore or maintain a person’s dignity within the framework of their home.”

Worth the expense
The fact that many people do want to stay in their homes has helped home modification businesses manage the hurdle of covering costs. While virtually no home modification is covered by Medicare, both Chadwell and Williams say they have had few problems with clients balking at paying out of their own pocket.

“We know that 50% of them are going to ask if this is covered by insurance, and we tell them that we are really a private business,” Chadwell says. “We don’t try to hide the fact that Medicare does not pay for things or apologize for it, and there is no sense in making people think Medicare will cover it. In spite of that, out of 10 inquiries, only one or two people use that as a deterrent not to do anything to their home.”

Sometimes clients are undeterred because the changes can be done for a fairly reasonable cost and with little inconvenience. “Ceiling track lifts can be done inexpensively and require very little or no modification to the home,” Williams says. “Stairway lifts are by far the easiest because they do not mount into the wall at any point. These also are the most common modification, and can be installed within a few hours.”

As a general rule, home modification providers take the installation process upon themselves, whether that means hiring installers or finding resources for their clientele. “Our company was born out of a construction company, so we have a lot of resources in this area,” Chadwell says. “We have someone we use all the time to install grab bars, we do some demo in-house, and if we are doing a full bathroom, we contract with a licensed plumber or a tile expert.”

AABCO usually contracts out with select local carpenters who have been specially trained. However, if a customer already has a contractor they like, AABCO will work with that person. “We initially went through a lot of installers,” Williams says. “To get the right ones with technical expertise and people skills is a lot to ask, and you have to compensate them in order to keep them. A lot of people don’t have the right stuff to do the job.”

The lack of people with the right stuff goes for the home modification niche in general. While Williams says he has seen more people become involved in it over the years, there are still few competitors. “They have to make a commitment to doing this type of work,” he says. “That commitment has to be financial and has to involve having the right personnel who are sent to the factories to learn how to install. The sales staff has to know the code issues, plus you need more equipment to do these installations, including vehicles. As the business grows, you then need greater financial resources to keep your cash flow in good shape, especially with elevators.”

In spite of the benefits of less competition and the obvious challenges of the home modification business, Chadwell says she would like to see more people learn the methodology.

“No, there is not much competition today, and the result is that it is surprising what people will buy over the Internet,” she says. “For instance, we have one client in Denmark whose mother is in Chicago, and I am their provider of products and advice. The bad part about [the lack of competition] is that, if we did have competition, the education level would be higher on the subject.”

With few companies in the field, home modification providers also miss out on valuable networking. “I would love to know who else is doing this type of business so we could share information, such as who is a good supplier of products,” Chadwell says. “This is a niche market, so there is not a strong networking system set up. With that in place, we could share our sorrows and our successes, because obviously none of us are really competing in terms of territory.”

So, if you are thinking of adding home modifications to your business offerings, be cautious but unafraid. According to AABCO and Life@Home, now is as good a time as any to enter this niche.

Liz Finch is a contributing writer for Dealer/Provider.