Assessing home environmental hazards for older adults receiving in-home supportive services: the healthy homes...

Home- and community-based services (HCBS) assessments often fail to include environmental health hazards that can be a barrier to aging in place. This study describes the development of a tool assessing two categories of environmental health hazards found in older homes-poor chemical and physical indoor air quality (IAQ) and moisture-related mold conditions-and the evaluation of the feasibility of integrating it into HCBS assessment workflows.

The Healthy Home Assessment Tool (H-HAT) includes resident reports and HCBS care coordinator observations/reports of indoor air quality (IAQ) and moisture-related mold conditions, conducted in partnership with an area agency on aging. For preliminary pilot validation, H-HAT ratings were assessed relative to consumer-grade IAQ monitoring and mold analysis.

The sample included 41 low-income older adult households (median resident age: 76; 78% female; 31.7% African American). Care coordinators successfully fielded the tool, sharing results via standardized reports and proposing remediation strategies with residents. Mold odor was noted in 23% of residences, and water damage in 48.7%. Relative to current EPA standards, 61.0% had fine particulate matter (PM_2.5) concentrations above the recommended limit (9 µg/m³), and 21.9% had radon levels above the action level of 4 pCi/L. PM_2.5 was significantly higher in residences with H-HAT reports of smoking and a higher fungal burden in households with visible mold/mildew.

H-HAT is feasible to deliver in partnership with care management agencies. Poor IAQ and moisture/mold conditions are common and may be relevant in designing care plans and improving health outcomes.