Home Modifications for Seniors in North Dakota

A parent's home becomes the biggest risk factor as they age — the bathroom that worked fine at 60 becomes a fall trap at 80. In North Dakota, environmental modifications and adaptive equipment are covered benefits under both the Medicaid HCBS Waiver and SPED, but most families do not realize they can get these modifications funded until after a fall has already happened.

What Qualifies as an Environmental Modification

Environmental modifications are structural changes to the home that make it safer and more accessible for an aging or disabled adult. North Dakota's covered modifications include:

• Grab bars in bathrooms, showers, and near toilets
• Wheelchair ramps at entrances and between levels
• Walk-in showers or tub-to-shower conversions to eliminate fall-risk step-overs
• Widened doorways for wheelchair or walker access
• Improved lighting in hallways, stairways, and high-traffic areas
• Non-slip flooring in bathrooms and kitchens
• Handrails on interior and exterior stairs
• Lever door handles replacing round knobs for arthritic hands

These modifications must be medically necessary and documented in the care plan. The HCBS Case Manager authorizes specific modifications based on the clinical assessment and a home safety evaluation.

Adaptive Equipment

Adaptive equipment covers devices that help your parent perform daily activities independently:

• Raised toilet seats and toilet safety frames
• Shower chairs and transfer benches
• Bed rails and adjustable bed frames
• Reachers and dressing aids
• Personal Emergency Response Systems (PERS) — electronic monitoring devices with emergency call buttons

PERS equipment is authorized under chore services through SPED, Ex-SPED, or the HCBS Waiver. The program covers the equipment setup and monthly monitoring fees for parents who live alone and are at high risk of falls or medical emergencies.

Funding Through the HCBS Waiver

The Medicaid HCBS Waiver covers environmental modifications as a plan-of-care service. Your parent must meet Nursing Facility Level of Care criteria and have assets below $3,000. The case manager includes modification requests in the service plan, and the state authorizes payment to licensed contractors.

The waiver has a per-project cap — major renovations like full bathroom remodels may require prioritizing the most critical safety improvements first. Grab bars and ramps are typically approved quickly because they directly prevent falls, the single largest cause of injury-related hospitalization for North Dakota seniors.

Funding Through SPED

If your parent's assets are between $3,001 and $50,000, SPED can fund environmental modifications on a sliding fee scale. The functional criteria are different from the waiver — your parent must be impaired in at least two ADLs or four IADLs.

SPED modifications follow the same process: the case manager evaluates the home, identifies needed modifications, and authorizes the work. The sliding fee means your parent may pay a portion of the cost based on their income, but the out-of-pocket amount is far less than paying a contractor directly.

Getting Started

Do not wait for a fall to request modifications. If your parent is enrolled in any home care program or is applying for one, ask the case manager to conduct a home safety evaluation during the initial assessment. The most effective modifications — grab bars, adequate lighting, and non-slip surfaces — are inexpensive and can be installed in a single day.

If your parent is not yet enrolled in a program, you can request a home safety evaluation through the ADRL (1-855-462-5465). The evaluation identifies risks and serves as documentation to support a modification request when the care plan is established.

The North Dakota Home Care Guide includes a room-by-room home safety audit checklist and the modification request process for both waiver and SPED programs.

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