Falls, and making the home safe

The numbers

• More than one in four adults 65+ falls each year, and fewer than half of them tell a doctor.^[1]
• CDC counts about 4.5 million fall-related emergency department visits a year among older adults: 3.1 million treated and released, 1.4 million admitted to hospital.^[1]
• Nearly 319,000 older people are hospitalized for hip fractures each year, and falls caused 88% of hip-fracture emergency visits and hospitalizations.^[1]
• About 37% of people who fall report an injury needing treatment or restricting them for at least a day.^[1]
• In a study that followed 1,103 community-dwelling people over 71 in the 1990s, those hospitalized for a serious fall injury were about ten times more likely to be admitted to a nursing home afterward. That is an association measured in one cohort three decades ago, not a rule about any one person.^[8]

What the evidence supports

Exercise is the clearest finding. A Cochrane review pooling 81 trials and 19,684 community-dwelling participants found exercise cut the rate of falls by 23%, and rated that high-certainty evidence. The same review found a 15% reduction in the number of people who fell at least once.^[2] Balance and strength work is the kind that was studied, including tai chi. Free evidence-based classes such as A Matter of Balance and Tai Ji Quan run through many Area Agencies on Aging.

The US Preventive Services Task Force recommends exercise interventions for community-dwelling adults 65 and older who are at increased risk of falling (Grade B, 2024). For broader multifactorial programs — an assessment plus some combination of medication review, vision care, gait work and home-hazard changes — the Task Force says clinicians should decide case by case rather than offer them to everyone (Grade C).^[3] That is worth knowing before you are told a package deal is proven.

So the things to raise with a doctor, none of which are guaranteed to prevent a fall:

• A medication review. Ask the doctor or pharmacist to look for drugs that cause dizziness or drowsiness.
• An eye exam. NIA suggests a dilated exam every one to two years from age 60, and keeping the prescription current.
• A look at the house: grab bars at the toilet and shower, handrails on both sides of stairs, brighter bulbs and night lights, throw rugs and clutter gone, non-slip mats. An occupational therapist's home walk-through, which a doctor can order, turns this into a list.

Our Elder Care Essentials page lists the standard gear by situation.

What the bigger modifications cost

These are market ranges from national contractor cost guides published in 2025–2026, not quotes and not a survey: installed grab bars about $100–$500 each; a comfort-height toilet $400–$1,000; converting a tub to a walk-in or roll-in shower $2,000–$7,500; a straight-rail stair lift $2,000–$8,500, with curved rails $7,500–$15,000; a wheelchair ramp about $55–$275 per foot, usually $1,100–$3,600 total; widening a doorway $700–$2,500. Prices vary by region. Get more than one bid.

Who helps pay

• Original Medicare covers durable medical equipment, and installed home modifications are not on its list of covered equipment.^[4] Some Medicare Advantage plans add a bathroom-safety benefit, though availability has been falling: KFF found 21% of individual-plan enrollees had access to one in 2026, down from 32% in 2025, with in-home support services at 10% and structural home modifications at 0.04%.^[5] Read the specific plan's evidence of coverage rather than a summary.
• Medicaid home- and community-based services waivers can pay for environmental accessibility adaptations such as ramps, grab bars and bathroom work. These are 1915(c) waivers, which means the services, the level-of-care test and the enrollment cap are all set by your state, and a waiver covering something does not mean a particular person gets it.^[6]
• Veterans: the VA's HISA grant pays for medically justified home improvements, as a lifetime benefit of $6,800 for a service-connected disability, or for a non-service-connected one when the veteran has a service-connected rating of 50% or higher, and $2,000 otherwise.^[7] Larger SAH and SHA grants exist for certain service-connected disabilities. Ask the local Prosthetic and Sensory Aids Service what benefit is actually available.
• Rural homeowners 62+: USDA Section 504 offers repair loans up to $40,000 at 1% fixed, and grants up to $10,000 — a lifetime limit — for very-low-income owners, which must be spent on removing health and safety hazards. A grant has to be repaid if the home is sold within three years.^[9]
• Local programs: many Area Agencies on Aging, and groups like Rebuilding Together, fund minor safety repairs. Ask your AAA what exists in your county.

Where the public record stops

Whether a program exists where you live, and whether your person qualifies, is decided by the agency that runs it. We cannot tell you that part. Here is who has the answer and what to ask.

Who to ask: your Area Agency on Aging (1-800-677-1116); for veterans, a Veterans Service Officer; for Medicaid waivers, your state Medicaid office.

What to ask them:

• Does our county have a home-modification or minor-repair program for older adults?
• Does the state's Medicaid waiver cover environmental adaptations, who assesses the home, and is there a waiting list?
• Can a doctor order an occupational-therapy home-safety evaluation, and will insurance cover it?
• For a veteran: do we qualify for the HISA grant, what is our lifetime amount, and what paperwork starts it?

Quick answers

How much does it cost to make a home safe for aging in place?

Small fixes are cheap. Installed grab bars run roughly $100–$500 each and better lighting costs very little. National contractor cost guides for 2025–2026 put a walk-in shower conversion at roughly $2,000–$7,500, a straight stair lift at $2,000–$8,500, and a wheelchair ramp at about $1,100–$3,600. Those are market estimates, not quotes. Programs that may help pay include state Medicaid HCBS waivers, the VA's HISA grant ($6,800 or $2,000 lifetime, depending on the disability), and USDA Section 504 grants up to $10,000 for very-low-income rural homeowners age 62 and older. [5, 6, 7]

Does Medicare pay for grab bars or a stair lift?

Original Medicare covers durable medical equipment, and installed home modifications are not on its list of covered equipment. Medicare Advantage plans sometimes add a bathroom-safety benefit, but fewer than before: KFF found 21% of individual-plan enrollees had access to one in 2026, down from 32% in 2025, and only 0.04% had a structural home-modification benefit. Check the plan's own evidence of coverage. [3, 4]

What actually prevents falls in older adults?

The strongest single finding is exercise. A Cochrane review of 81 trials and 19,684 community-dwelling participants found exercise reduced the rate of falls by 23%, rated high-certainty evidence, and the US Preventive Services Task Force recommends exercise for community-dwelling adults 65+ at increased risk of falling (Grade B, 2024). The Task Force treats broader multifactorial programs — medication review, vision care, home-hazard changes — as a decision to make case by case rather than something to offer everyone. [1, 2]

Where to go next

• Elder Care Essentials (the gear)
• Technology that helps without hovering
• Hiring in-home help
• Aging in place