Homeless Survey Template: Accessibility Modifications

This survey template supports organizations providing accessibility modification services to low-income homeowners and renters, particularly elderly individuals and people with disabilities who are at risk of losing their housing due to functional limitations. Accessibility modifications such as installing grab bars, wheelchair ramps, stair lifts, widened doorways, and roll-in showers allow people to remain safely in their homes and maintain their independence. Gathering client feedback helps ensure these programs are meeting the real needs of the people they serve.

People with disabilities and older adults on fixed incomes face a unique set of housing challenges. Without accessible home features, even minor functional limitations can make daily living unsafe and unsustainable, often forcing individuals into institutional care or homelessness. Accessibility modification programs are a cost-effective way to preserve housing stability and community integration for vulnerable residents. Client feedback is essential for ensuring modifications are completed correctly, safely, and with sensitivity to the individual's specific needs and dignity.

This template gathers homeowner and renter perspectives on several dimensions of the service experience, including the responsiveness of intake and scheduling, the clarity of communication about what modifications would be made and why, the quality and craftsmanship of the completed work, whether modifications fully addressed the client's accessibility needs, and the professionalism and respectfulness of contractors and program staff.

Organizations can use survey data to monitor the quality of contractor work, identify common accessibility needs in the community that may inform program expansion, and strengthen the client intake assessment process. Tracking feedback over time supports continuous improvement and helps programs demonstrate that accessibility modifications are a meaningful investment in keeping vulnerable residents safely housed a key strategy in the broader effort to prevent homelessness among people with disabilities and aging populations.