Aging Services enhances the lives of older adults by providing services and resources to assist them in remaining independent. 

• Appliances or appliance repairs (e.g., furnaces, garbage disposals, etc.)
• Emergency repairs or services
• Cosmetic repairs (e.g., painting, carpet cleaning, siding, mobile home skirting, etc.)
• Household chores (e.g., laundry, dishes, vacuuming, mopping floors, etc.)

Interested individuals may begin the application process by completing this form. Program staff will follow up regarding program eligibility. 

Aging Services and its programs will consider this application without regard to race, color, creed, religion, national origin, gender, sexual orientation, disability, age, marital status, public assistance status, genetic or family medical history, or any other protected classification under local, state or federal law.

Financial assistance is available for those who would like help in covering the cost of any potential projects. Aging Services utilizes a sliding contribution scale to determine any possible assistance and copay. To be considered, you would need to complete a financial assistance application and provide a complete copy of a recent bank statement for all accounts (checking, savings, etc.) to verify eligibility.

If you indicate below that you are interested in applying for financial assistance at this time, you will be sent the financial assistance application upon completion and submission of this application form. 

If you are not interested in financial assistance, you would be responsible for the full cost of any projects you request. You would be offered an estimate for the full cost of any requested projects which would need your approval before any work would done.

Financial assistance can be applied for at any time by completing a financial assistance application and providing a copy of a recent bank statement. Financial assistance applications are available from our office.

Prohibition on Re-disclosure

This form does not authorize re-disclosure of medical information beyond the limits of this consent. Where information has been disclosed from records protected by federal law for alcohol/drug abuse records or by state law for mental health records, federal requirements (41 D.F.R. Part 2) and state requirements (Iowa Code ch. 228) prohibit further disclosure without the spe‐ cific written consent of the patient, or as otherwise permitted by such law and/or regulation. A general authorization for the release of medical or other information is not sufficient for these purposes. Civil and/or criminal penalties may attach for unauthorized disclosure of alcohol/drug abuse or mental health information.

This form does not authorize re-disclosure of medical information beyond the limits of this consent. Where information has been disclosed from records protected by federal law for alcohol/drug abuse records or by state law for mental health records, federal requirements (41 D.F.R. Part 2) and state requirements (Iowa Code ch. 228) prohibit further disclosure without the spe‐ cific written consent of the patient, or as otherwise permitted by such law and/or regulation. A general authorization for the release of medical or other information is not sufficient for these purposes. Civil and/or criminal penalties may attach for unauthorized disclosure of alcohol/drug abuse or mental health information.

The goal of the Aging Services Home Repair & Accessibility program is to help older adults remain safely in their home. We make every attempt to ensure the safety of our participants and will attempt to fix original home repair requests to the best of our ability. Unfortunately, in our experience, we have found that it may be difficult to find a contractor that has the tools necessary to complete home repairs satisfactorily due to the age, materials, and/or structure of some homes.

The services you are receiving is paid for entirely or partially by funds from the federal Older Americans Act and the State of Iowa. Your responses on this form are confidential. This information is used to comply with reporting requirements and research the needs of older Iowans. Thank you.