Home Modification and Health Services Utilization by Rural and Urban Veterans With Disabilities

Luz Mairena Semeah, Shanti P. Ganesh, Xinping Wang, Diane C. Cowper Ripley, Zaccheus James Ahonle, Mi Jung Lee, Tatiana Orozco, Jennifer Hale-Gallardo, Huanguang Jia

Research output: Contribution to journalArticlepeer-review


Inaccessible home environments that create barriers to the enjoyment and the approachability of the living space impact some U.S. Veterans. Injuries acquired while serving in the military or developed through the aging process complicate matters for Veterans with disabilities. Home modifications (HM) afforded by the Home Improvements and Structural Alterations (HISA) program can increase accessibility. We examine the difference between urban and rural Veterans in their health service utilization (hospitalization versus outpatient encounters) 12 months before and 12 months after their HISA use. All the study patients were Veterans with disabilities who use the HISA program. There is a significant decrease in hospitalization post-HM as compared with pre-HM provision for all HM users. There is a significant increase in outpatient encounters post-HM as compared with pre-HM provision for all users. Rural vs. urban status was only significant in outpatient encounters 12 months pre-provision of HM. Provision of HM is associated with favorable clinical outcomes such as decreased hospitalization and increased preventative outpatient care visits. Our findings suggest some subset of hospitalizations could be prevented or delayed if timely and appropriate outpatient care is accessible to patients along with HM. Increasing the provision of HM services such as HISA can free up hospital beds, reduce cost to both individuals and institutions, decrease the risk of hospital acquired morbidity, and promote community integration.

Original languageEnglish (US)
Pages (from-to)862-874
Number of pages13
JournalHousing Policy Debate
Issue number6
StatePublished - 2021


  • Hospitalization
  • health service utilization outcomes
  • home modification
  • outpatient encounters
  • rurality

ASJC Scopus subject areas

  • Development
  • Urban Studies
  • Management, Monitoring, Policy and Law


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