Home safety, accessibility, and elderly health: Evidence from falls

This article presents estimates of the impact of home safety and accessibility features on the prevention of serious, non-fatal falls for elderly widowed individuals. As these features are not randomly assigned across homes, we develop an instrumental variable (IV) strategy that relies on the differential decline in the health and functional status of spouses to identify impacts. Specifically, we use the deceased spouse's functional status when alive, as measured by limits to Activities of Daily Living (ADLs), as an IV for the presence of home safety and accessibility features for the surviving spouse in the years after widowhood, and then estimate the effect of these features on the likelihood of a serious fall for the widow using rich longitudinal data from the Health and Retirement Study. The presence of such features reduces the likelihood of a fall requiring medical treatment by 20 percentage points, a substantial effect. However, falls are not the type of health shock that is a main driver of housing tenure transitions among the elderly. Although somewhat speculative, cost-benefit estimates suggest that investments in home safety for the elderly may generate in the short run as much as a dollar-for-dollar reduction in medical expenditures.