How do you get a home ready for the disabled or elderly?

What Changes Should be Made First?

Modern Health Talk features dozens of articles on how to get a home ready for the disabled or elderly. (See https://www.mhealthtalk.com/tag/getting-ready/.) Some of the best ideas are included here.

Focus on Safety before convenience, Easy before difficult, Temporary before permanent, and Affordable before extravagant.

Making homes safe and friendly for seniors can include major considerations like eliminating stairs, expanding doorways, building a first-floor bedroom/bathroom suite, and making sinks, counters and appliances wheelchair-accessible. But there are also smaller projects that can go a long way toward improving mobility and the ability to safely live independently.

Just remember that as we get older, or suffer an injury or other disability, our sore joints, weakened muscles, and a lack of balance, dexterity and vision make simple tasks difficult, including reaching, bending, lifting, and moving about. This can contribute to accidents and affect our personal hygiene, nutrition, and well-being. So remember what Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” With planning and preparation, you can help prevent falls and injuries rather than react to them.

FIRST, AVOID FALLS – This may be the single most important objective, because here are the statistics:

• Each year in the United States, one of every three persons over the age of 65 will experience a fall. Half of them are repeat fallers.
• Falls account for 87% of all fractures among people over the age of 65 and are the second leading cause of spinal cord and brain injury.
• For people aged 65-84 years, falls are the second leading cause of injury-related death; for those aged 85 years or older, falls are the leading cause of injury-related death.
• Half of all elderly adults (over the age of 65) hospitalized for hip fractures cannot return home or live independently after the fracture.

So, remove loose rugs since they’re a primary cause of falls and broken bones. That’s free. Then, add cheap bath mats to the tub or shower floor, or apply slip resistant coatings that leave an invisible anti-slip finish. SolidStepCote is one of the slip resistant coatings that can be applied to any flooring for a clear, safe and easy to maintain surface. (See https://www.mhealthtalk.com/2013/04/slip-proofing-your-home/)

GET A GRIP – Replace rocking chairs and unstable furniture, because seniors may try to use them to steady themselves. Also install levered faucets and door handles, as well as grab bars in showers and near toilets with raised seats. Even a portable shower seat at the right height, along with the right hand-shower and grab bars, can make getting clean an easier and more enjoyable experience. (See https://www.mhealthtalk.com/2012/08/singing-in-the-shower-more-than-accessibility/)

DE-CLUTTER & REORGANIZE – Clean house and discard everything that’s not needed, remembering to reuse (donate) and recycle where possible. Organize the things that remain so objects used daily are within easy reach, add knobs to cabinet doors, and include cabinet accessories such as pull-out draws and lazy Suzans.

LIGHTEN UP – Replace heavy pots, pans, vacuums, and trash cans with lightweight models.

What Problems Might Homeowners FORGET to Consider?

SEE THE LIGHT – Bright lighting is important to people with poor eyesight, so replace existing light bulbs with the new compact fluorescent or LED variety. They not only save energy, but they last much longer. Take advantage of natural light as much as possible, since it improves visibility, saves energy, and requires less artificial lighting. When artificial lighting is necessary, make sure it’s bright and within easy reach, with no cords running across pathways. Remote controls, like those used for the TV and cable box, make it easy to control lights, window blinds, and fans too – all while seated or from the bedside. Use night lights between the bed and the bathroom and front door to avoid falls when getting up from bed at night. In winter, leave curtains open during the day to let the sun in, then close them at night to hold in the heat. In summer, close curtains during the day to block the sun, then open at night to let any heat escape.

Wayne Caswell, founder of Modern Health Talk, wrote and submitted this article in response to a survey of eLocal Experts. A related article, Home sensors enable seniors to live independently, describes the medical use of traditional home sensors for motion, contact, etc. It’s consistent with articles I’ve written on automation and smart homes.

STAY WARM – Seniors can get cold when not moving around, so cut the chills with attic insulation and weather stripping to eliminate drafts, and add ceiling fans for use during summer months.

PHONE HOME – Cordless phones can be put in any room, or every room, but look for models that are easy to use. Mobile phone access away from home is a safety issue in my book, but rather than look for the simple models with big buttons for seniors, consider smartphones and the benefit of apps designed for seniors.

FRIENDLY FURNITURE – Consider adjustable beds and chairs that recline easily, but avoid cushiony furniture that’s hard to get in and out of.

APPLIANCES – Front-loaded appliances are easy for someone in a wheelchair to use. Top-loaded models are not. But get the extensions that raise the washer/dryer to make them easier to load.

PERS – Personal emergency response systems ($50 install, $15-35/month monitoring) provide a wearable pushbutton for summoning help. They are often available as accessories to existing monitored home security systems.

DOORWAYS – Remove doors that serve no useful purpose, and make doorways wider (at least 36”) so people can get around with canes, walkers or wheelchairs.

STAIR RAMPS – Make sure all stairs and outside steps have sturdy handrails, and for wheelchair entry, replace or cover steps with ramps. They can be made permanent or temporary.

STAIR LIFTS – If your two-story home lacks a bedroom and full bath downstairs and you can’t remodel, then consider a stair lift ($3,000-$12,000). They can be purchased or rented, and you can often find good refurbished models. They can even traverse a spiral staircase. (See https://www.mhealthtalk.com/2011/06/managing-stairs-the-stair-lift/)

DO YOUR CHORES – In addition to any professional medical help that’s needed, consider the relatively inexpensive cost of weekly maid service, lawn care, and Meals on Wheels.

SAVE MONEY AND THE ENVIRONMENT – Purchase wisely, buy second hand, recycle, and donate.

OTHER OPTIONS – Add up the total costs of adding a room downstairs, remodeling a bathroom, or reconfiguring cabinets and counters to add knee space and pull-out shelves. You may find that remodeling is more expensive than moving.

How can People Building Homes FROM SCRATCH Plan for the Possibility of Adapting their Home Later?

UNIVERSAL DESIGN – The concept is to design homes and products for use by anyone regardless of age or ability. Doing that broadens the market appeal and increases your home’s value. Wide doorways and zero-step entryways, for example, are just as useful for a young couple with a baby stroller as a road warrior with wheeled luggage or a disabled person with a walker or wheelchair. It’s a lot easier to make the right design decisions up front, because the cost of doing a complete kitchen or bathroom remodel, replacing a tub with a walk-in shower, for example, can be quite expensive and cost over $30,000.

CAPS – The National Association of Home Builders has a Certified Aging-in-Place program to teach contractors about building and remodeling for aging-in-place. This training gives them an appreciation of the problems faced by the elderly and disabled, as well as the various solutions available. But be sure to check out your contractor, since some states have laws that shield builders and contractors from lawsuits and accountability.

INDEPENDENT FOR LIFE – There are many good references for designing homes and neighborhoods, and one is this book coauthored by Henry Cisneros, the former HUD Secretary under Clinton. (See https://www.mhealthtalk.com/2012/08/make-life-long-homes-a-priority/.)

LOW MAINTENANCE – An important part of aging in place is making caring for a home more manageable. Cut down on grass that needs mowing by making your yard more natural, with low-maintenance native plants and trees that also provide shade and can cut cooling costs. Driveways and walkways made of gravel, pavers or other permeable systems not only allow rain water to reach the ground, but they can offer seniors a safer, less-slippery walking surface if well maintained. When building from scratch or remodeling, ask your contractor to use materials that are low-maintenance and support our environment for future generations. Examples are wood species that rapidly renew such as bamboo, finishes that are low in volatile organic compounds, and recycled-content materials in carpeting, siding, concrete, decks and fences.

BLOCKING – Even if you decide not to install grab bars, it’s a good idea to include wood blocking behind the sheetrock in showers and by toilets, similar to what builders already do for the future installation of ceiling fans.

CHANNELING – When your lot or zoning dictates a two-story design, consider having the architect include a channel between floors that can be used initially as closet space but converted later to a shaft for a home elevator if needed. (See https://www.mhealthtalk.com/2012/07/home-elevators-a-rising-trend/.)

Are There Any Changes that AREN’T WORTH the Cost?

Even a $50,000 remodel for wheelchair accessibility can be financially better than the nursing home alternative, which can cost over $100,000 per year for a private room and shorten one’s lifespan. Because of the much lower cost of home healthcare, if that’s an alternative, and the fact that most remodeling projects can be entirely funded with home equity, remodeling can help save the family estate. On the other hand, you might want to question the value of permanent and expensive improvements that don’t add value to the home, especially improvements that scream, “I’m old and frail.” But if you get good advice and plan carefully, you should be able to avoid that problem.

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Wayne Caswell submitted this article in response to a question posed to its eLocal panel of experts and was recognized with a “Most Creative” award.