Updated: Nov 29, 2018
According to America’s biggest association of people over the age of 50, AARP, more than 85 percent of people age 65 and older want to stay in their homes and communities as they age. Whether they can actually do that safely is a matter of design, financial resources, and available services such as home health care agencies, home companion agencies, transportation, and accredited geriatric physicians.
Let’s say you have the financial resources to modify your home so that you can safely age-in-place. What do you need to know?
“Horizontal” homes such as a ranch style or a one-story bungalow are always easiest to convert. Stairs are the nemesis of aging-in-place because your biggest challenge as you age will be your ability to walk easily and to climb stairs effortlessly. Therefore, town-homes, split-level homes, condos without elevators, historic two-story homes, and floating homes are close to impossible to economically adapt and almost always mean that you will be confined to one room on one level should you choose to stay.
Just 1% of Homes Are Conducive to Aging-in-Place
First Area of Concern For Any Homeowner: The entrance to your home is the very first place to start your assessment of your home’s ease of access. This issue almost always arises when there is a medical emergency. The ambulance is called; the crew has to be able to get their equipment including a gurney into your house easily and effortlessly. Hoarders aside, if you are a “collector” and have lots of stuff impeding easy access to you as you lay waiting for help, you have a problem. Keep the outside and interior pathways to your home free of unnecessary clutter and well lit.
Once you return home from your medical emergency, you will need to be able to get out of a vehicle and transition onto a flat, level walkway and be able to get into your house. If you have stairs leading up to your front door, you’re looking at your next hurdle to gaining entry back into your home. If you are in a wheelchair or using a walker you will need at least two people to carry you up your front stairs. The good news is that if your injury is short term, ramps may be supplied to you free of charge when available by local Lions Clubs. If you are a veteran, the Veteran’s Administration will supply you with a ramp. However, you or your caregiver need to be aware of this generous community service so that you can arrange for its installation before your arrival home.
Second Area of Concern: The next consideration is circulation inside the home —hallways, doorways and rooms (including bathrooms) all must be wide enough to allow wheelchair maneuverability. The optimal door opening is 36 inches. Next is assessing kitchens and bathrooms. Making those accessible whether you are walking or in a wheelchair is critical and may include lowering countertops, installing pull-down cabinets and other systems to improve accessibility and safety. This is called “Universal Design”; a concept that was developed at the Andrus School of Gerontology at the University of Southern California in the 1970s when I was doing my graduate work. I was fortunate enough to be an intern with the design team.
While there is a lot of information to help you assess your home for its adaptability and utility as you age, it is best to consult with an architect who is certified and specializes in universal design so that you have a holistic design for your home that allows it to be adaptable while keeping it homey and beautiful.
The very best resource for you to begin thinking about changes to your home is Home Matters, a nonprofit based in Washington, D. C., www.homemattersamerica.com, that is committed to increasing the country’s affordable and accessible housing. Home Matters along with AARP and the AARP Foundation, recently sponsored a national competition for retrofitting a home for aging-in-place along with Wells Fargo, the Home Depot Foundation and Dwell magazine. The winning entry can be found at https://www.homemattersamerica.com/designchallengetoolkit/videos/ (see the YouTube video for winning entry) and Redefining Home: Home Today, Home Tomorrow.
To make sure your home is more amenable to a long-term vision, think about how you can start adding features like these, suggested by the experts involved in the Redefining Home initiative:
· Stairless entries
· A gradual outdoor incline up to the entry instead of ramps
· Low or no thresholds at doorways
· Doorways wide enough to accommodate wheelchairs and walkers
· Widened hallways
· Lever-style doorknobs
· Lever-style faucet handles
· Shallower countertops to put items in easier reach
· Curb-less shower stalls
· Open-concept floor plans that provide better lighting, shorter hallways for easier movement
· Single-floor living that includes a kitchen, bathroom, bedroom and laundry on the same floor
· Flexible living spaces that can change size or be used for more than one purpose
· Slip-resistant floors and lighter-color floors for greater visibility
· Lower placement of light switches and higher placement of electrical outlets
· More windows for better indoor light
Also consider the following as you retrofit your existing home so that you, too, can age-in-place.
All installed flooring should also be slip resistant. Avoid highly polished finishes so people are less apt to slip and fall. As people age, they develop a variety of visual impairments that are exacerbated by shiny surfaces under their feet. You will notice that older adults always look down as they walk, however, with age come changes with our depth perception. Your choice of flooring is critical to your safety are you age. Remember, shiny doesn’t mean clean, it means glare. There is a growing number of flooring products available today with non-skid, non-shiny surfaces.
Bathrooms. Entry doors have to be wide enough to allow an individual to get themselves into the room in a wheelchair. The bathroom also has to be wide enough to allow a wheelchair to turn completely around. New plumbing fixtures like doorknobs, certain faucets, and showers may become difficult for older people to use due to arthritis. Consider purchasing Americans’ with Disabilities Act-compliant plumbing fixtures, especially heightened toilets and sill-less showers.
Showers. One of the most helpful design changes to allow older adults to age-in-place include a walk-in, sill-less shower. Older residents may not be able to step over the side of a bathtub or even over a door sill to get into a shower. Place Grab bars and resting points (seats) at strategic locations in the shower. Have blocking and studs strategically placed in the walls. Anything designed to support a person’s weight needs to be anchored properly to avoid damage to the walls and/or injury to the person. And, while you are refitting the bathroom install radiant heat under the tile floor. Older people with circulation problems are particularly vulnerable to hot and cold so monitor all heating and cooling continually.
A first-floor master suite. If you convert a room on the first floor to a bedroom, there are minimum requirements for livability, including two means of egress. The first-floor master suite should eliminate unnecessary doors to closets (use sliding doors), include an accessible laundry room nearby, and include a sitting area equipped with chairs that are easy to get in and out of; consider the seat height and use chairs with sturdy arms.
Access between floors. In designing a new home or making modifications, many homeowners are requesting an elevator between floors or a mechanical lift along the staircase to get from one floor or area to another. An elevator, whether in a new home or retrofitted, can cost $30,000 to $50,000 or more.
Door lever handles instead of knobs. As seniors lose dexterity and develop arthritis in their hands, making doors easier to open can help improve their mobility in the home. Door lever handles are best to replace doorknobs.
Relocated electric outlets and light switches. Bringing electrical outlets up to an easily accessible level (instead of near the floor) and bringing light switches down so they can be reached from a wheelchair easily are small improvements that can make a big difference.
Improved lighting. As people age, they lose their ability to see clearly due to cataracts and macular degeneration, so adding more lighting is a really good upgrade to consider. However, standard bulbs produce too much glare, especially LED bulbs. Replace all bulbs with “day-light” bulbs. This will enable you to see accurately and easily.
Blu-Tooth equipped televisions. Most older people develop decreased ability to discern conversation and have hearing difficulty in general. New hearing aids are Blu-Tooth equipped and can be calibrated to Blu-Tooth equipped televisions, radios (Alexa), and telephones.
Considering moving a loved one into your own home? Some families are making the decision to buy a home large enough for an in-law suite or a property large enough for an in-law flat (stand-alone small cottage) including a second bedroom and bathroom for a caretaker. Your aging parent doesn’t want to lose their independence any more than you do. They want their space and privacy.
If you decide to renovate or buy a home with space for your parents to live, it’s important to consider everyone’s activities, privacy preferences, noise tolerance and ways of living. The very first consideration is asking your parent(s) what they want and finding out their needs; don’t assume or presume.
Zoning codes vary in every town in terms of what’s permitted — the style of kitchenette (East Hampton Town does not permit kitchenettes for example), how separate dwellings are attached on the property and more. Again, working with an architect is strongly recommended to ensure code compliance, safety, and adaptive design.
Smart Technology. Unless you or your loved one was born before smart devices were a routine part of daily life don’t assume that you can teach “old dog’s new tricks.” Nonetheless, smart technologies like voice activated appliances via Smart devices like Alexa which can also be programmed to dial 911 and get help, Smart phones, etc., are here and relatively inexpensive. Build them into the design (and wiring) of your new or renovated home. They may save a life.
Finally, consider the average cost of a nursing home or assisted living center in your area when you balk at the cost of retrofitting a home or building an in-law cottage. On average in the New York metro area the cost of a nursing home begins at $156,585 annually or $429 per day. The cost of assisted living is not much less after they charge for add-on services. Those costs increase depending upon the facility, the level of care, and the availability of a facility near to family and friends. Memory Units are considerably more expensive and often do not provide enhanced care, provide special services, have enhanced staffing, or the appropriate environmental design.
For the east end of Long Island, the availability of a quality nursing home or assisted living facility is sparse and not likely to improve given real estate costs and the availability of qualified staff at all levels of care. This situation is highly unlikely to improve.
Finally, if you have long-term care insurance many of the costs of care at home may be covered in your policy. If your parent is on Medicaid check with your local Department of Social Services. In some cases some costs are covered for home care services.