For Boomers & Their Aging Parents
I’m currently working with two different clients with a
similar problem. They each have a
family member who is unable to manage stairs, yet they live
in homes that have elevated front entrances. The front door in one house is about 4’ above
the ground, and the other home’s front door sits about 3’ above the ground. If they were to install ramps to bridge the
elevation difference between sidewalk and front door that still retain a
comfortable slope, the ramps would need to extend anywhere from 36’ –
40’. A ramp that long in a small front
yard would most likely take up the entire area in front of the house.
There is an alternate option when dealing with elevated entrances: the porch lift (aka the vertical lift). A porch lift is a type of vertical platform
lift which is normally installed outside to provide access to a porch or deck
for a wheelchair or scooter user. Porch
lifts are equipped with a short metal ramp at the lift’s entry point, which folds up when the lift is raised to provide a safety barrier that
prevents the user from rolling off the lift platform while in use.
The user rolls onto the lift platform, presses the lift
button to rise to the porch level, and then rolls off the lift onto the porch.
Porch Lift Features
Size and Capacity:
Not all lifts are built equal when it comes to the weight they can
hold. Before choosing a lift, know both
the weight of the user, the weight of the wheelchair or scooter, and allow for any
caregiver that might be along for the ride.
Most lifts have a 600 lb capacity, although a few will carry as much as
Travel heights: There
are lifts that allow for only 3’ of travel and those that will allow for as
much as 10’ of travel. Generally, you
only need to purchase the shortest unit possible which will still give you the
amount of travel height you need. Since
these lifts need to sit on concrete pads, if you are within a couple of inches
of a lift’s travel height, select the
shorter lift and thicken the concrete
Enclosures: While these
lifts are built to be used outside regardless of weather, most customers want an
enclosure to keep the lift and the user out of the weather while in use. Some of the lift companies offer enclosures,
but it’s really much more practical to install some covering yourself – either a
roof or awning over the lift itself or a full enclosure. Building codes will
dictate the structure you can build.
Safety: When the lift platform is in the lowered
position, there will be a dangerous drop off to the lift where the porch
railing has been opened. A self-closing
gate needs to be installed to prevent anyone from accidentally falling off the
Controls: Porch lifts
have small control panels on the lift platform itself that usually house an
emergency stop switch, an up and down switch and a key switch which turns the
power on. Because the unit will not work
without the key being turned on, others cannot use the lift without the owner’s
Some porch lifts include an option for call/send switches.
These switches can be installed at the bottom and the top of the lift’s travel.
Having a switch at the top allows the lift to be sent down when not in use to
prevent debris or snow buildup under the platform. Having a switch at both ends
is useful if there is more than one person using the lift.
A porch lift is a simple accessibility solution that doesn’t overwhelm your living environment or require extensive construction. It’s certainly an option worth investigating.
Today I need
to rant a bit. I just came from yet another
home where the homeowners spent good money to replace their bathtub with a “walk-in”
or “curb-less” shower. The problem is
that the showers I saw were anything but walk-in, since to enter the shower one had
to step over a curb or threshold - sometimes 4” high, sometimes 5” or more. This
might not seem like a big deal when you have no physical ailments, but many, many
of the seniors I see have difficulty maneuvering anything they have to step
over, let alone a 5” shower curb. When
I asked these homeowners how they came to this shower design, they each told me
that that’s what the contractor built when they asked for a walk-in shower.
The homeowners themselves didn't have enough information to direct their contractors and consequently accepted whatever design was suggested. It seems that even though more consumers are
requesting curb-less showers, contractors are reluctant to build a shower
without some curb for fear that if
built otherwise, water will flow onto the bathroom floor and their customers
will find fault with the installation. Only
after the jobs were finished did these homeowners realize that they still had some difficulty
getting in and out of their new showers. At the stage that I met them, most of these people were mobile.
It’s easy to imagine the difficulties ahead should any one of them
require a walker or wheelchair as they age.
Replacing a conventional
tub with a shower is a great bathroom renovation, but only if it’s done
properly. The shower floor should be at the same level
as the bathroom floor with nothing to step over when you walk
from bathroom to shower. The question
then is: How does the water stay in the shower if there is no barrier, like a curb, to
stop it? Answer: The water can be contained when a trench drain is positioned at the shower’s entrance and the shower floor is sloped to the drain. A trench drain is a long, narrow trough,
covered with a stainless steel, fiberglass or plastic grate. Water is directed into the trough and into a standard drain. Alternately,
you could install a trench drain along the back wall of the shower and pitch the
floor to that wall instead. One of the benefits of trench drains is that other barriers to a shower layout, such as half walls or curbs, can be eliminated since
these drains become an in-floor water barrier all by themselves.
You also can eliminate multiple slopes; a single slope to the drain is
It’s easy to
understand people’s reluctance to accept a true barrier free shower since it's not been the way we've built residential
showers in the past. But then again, it's not until quite recently that we've thought about how we can adapt standard building and design elements to more universal design. As the aging population swells, architects, designers, and contractors are taking a much closer look at floor plans and features that will meet the needs of this consumer group. Trench drains
have been used in the United States for a number of years in other applications
(around swimming pools, patios and sidewalks, in commercial kitchens and labs) and they are commonly accepted in residential
applications throughout Europe. And now
that the trench drain is becoming more accepted for interior residential use
here, manufacturers are becoming creative and offering choices in drain covers so that the floor
drain itself can integrate into a bathroom’s design.
that something as boring as a shower drain could become such a style statement?
picture of a sloping trench drain as barrier between the wet shower floor and
the dry bathroom floor.
another trench drain, seamlessly integrated between the shower and bathroom so that
a chair can easily roll over the drain.
Want to make a color statement? Not a
There’s even a trench drain available, QuaRTZ, that has an option to
LED lights attached to the back side of the
grate. When water is present, the lights go on in whatever color you choose.
When the water stops running into the drain, the lights go off.
of the color or style you choose, trench drains are an important component of
designing a true walk-in shower that you’ll be able to use comfortably for
however long you remain in your home.
In a previous blog I wrote about available funding sources for
home modifications. At the time, I avoided a discussion about
reverse mortgages given the loss of equity many people experienced during the
market meltdown. I do believe, however, that reverse mortgages are a
viable product for older homeowners who want to use some of the equity in their
homes for aging-in-place style renovations . The caveat being that you must first do your
homework, consider all your options, and realistically assess your short and
long term financial needs so as to understand the financial consequences of this
type mortgage loan.
Reverse mortgages are administered by the U.S. Department of
Housing and Urban Development (HUD) and the program is called the Home Equity
Conversion Mortgage (HECM). Before obtaining a reverse mortgage, it is required
that you receive consumer information from an approved HECM counselor.
So how does a reverse
mortgage work? Reverse mortgages allow you to borrow on the
equity in your home. Your home is used as collateral
to get cash and instead of you making payments to the lender, the lender makes payments to you. Payments can be made as a lump sum, monthly
for as long as you live in your home, set up as advances when needed through a line of
credit, or any combination of the above. The loan plus interest is paid
off whenever the property is sold - even
if the sale price is less than the amount owed the lender. By law,
lenders cannot go after a homeowner’s other assets or his/her estate if the home sells for less than the
reverse mortgage amount. Instead HUD
backs up these mortgages and pays back the difference.
Who qualifies for a
reverse mortgage? To qualify you must be 62 or older, own the
property, live in the home as a primary residence, and make the reverse
mortgage the first mortgage, meaning any existing mortgages will be
paid off by the proceeds of the reverse mortgage. You must also keep current on taxes,
insurance and maintenance. The borrower’s
credit history is irrelevant and FICO scores do not come into consideration.
What are the
advantages of a reverse mortgage? 1)
It will pay off the current debt on your home.
2) You take cash from your home’s equity without having to pay anything
monthly. 3) The loan proceeds can be
used for any purpose. 4) Money not
withdrawn immediately can be drawn via several different payment options. 5) Lenders cannot force you to sell the property
to pay back the loan so reverse mortgages guarantee that you can remain in your
home for as long as you live, even if the mortgage loan and interest exceed the
What are the
disadvantages of a reverse mortgage?
1) The fees for this type of mortgage are higher than fees for a conventional
2) Since a reverse mortgage enables you to use a portion of your
home's equity, future equity is reduced. 3) Substantial equity is
usually required in order to qualify for a reverse mortgage.
Unfortunately, there seem
to be many misperceptions about reverse mortgages. If you have some reason for
considering this type mortgage, the smartest approach is to
investigate it for yourself and then decide. Reverse
mortgages potentially provide valuable income, cash reserves, or debt
relief. The money received from a
reverse mortgage might be the only way you could afford to modify your home in
order to age in place. Research reverse mortgage options carefully and get sound, professional advice from your legal or financial advisors. Understanding the truth about reverse
mortgages will enable you to make a rational, well-informed decision about
whether or not the program is right for you and your circumstances.
have a guest bathroom that our parents use when they visit. We’d like to install grab bars in the bathtub
and shower area. How do we decide what size grab bars to use
and where to place them?
Answer: Many older adults
prefer a grab bar that is 1” – 1 ¼” in diameter as it’s easier to grip,
especially for those with a reduced hand grip. And while grab bars come in
smooth or textured finishes, those that are textured help prevent soapy hands
from slipping. Some grab bars even have
specialty slip resistant designs, like finger grips on the underside of the bar,
to aid in maintaining a firm grip.
While the placement of wall mounted grab bars depends on the
wall structure, plumbing layout, whether bathing or showering, and the
user’s height and range of reach, there are general guidelines you can follow.
On the shorter side wall opposite the showerhead –
Locating a bar here will aid in balance when stepping in or out of a tub or
shower. You can either install a bar vertically or
horizontally on this wall. I prefer a
vertical bar at this location, 18” in length, installed no more than 9” from
the outside edge of the tub wall. The
bottom of the grab bar should be approximately 32”-36” above the floor. If you prefer to place the bar horizontally,
install a 24” bar, approximately 33”-36” above the floor.
2. On the longer wall – Locating a bar here
offers support while standing in the bath or shower. If placing the bar horizontally, use a 24” –
48” bar (depending on the length of the shower area), 33”-36” above the
floor. The horizontal placement assists a user when facing in either direction but is limited to a fixed height. Alternately,
you can install the bar at a 45 degree angle which allows individuals of different heights to access the bar comfortably and will help when getting up
from a shower chair or from the bathtub floor. A diagonal bar also allows for a more natural
and functional hand placement with less stress on the wrist. The lowest end of
the bar should sit approximately 9” above the tub rim and slope upwards towards
The safest way to install a grab bar is
either directly into the studs, into plywood blocking that has been installed
behind the wall, or with special fasteners that meet the requirement of
sustaining 250 lbs. of dead load force. Grab
bars should never be installed with only plastic anchors and screws directly
into tile and wall board since they may not hold up if pulled on during a fall.
Question: We’ve seen suction style grab bars and grab
bars that mount on the tub. Are these
safe to use?
Answer: There are companies that offer grab bars that
suction, clamp, or screw onto the side of the tub wall. I would not recommend using these style bars
as I have witnessed how easily they can shift or completely detach when being
used to get in and out of a tub. Maybe, when used properly, these bars can help
to stabilize balance BUT one has to be extremely careful not to
pull on them. Installing a grab bar is not
a place to skimp and what appears to be an easy, inexpensive solution could wind
up being quite costly. With the new
fasteners available today, there is little reason not to securely mount a standard grab bar
on the wall, or to use a flip down bar or floor to ceiling pole instead.
Several months ago I wrote a couple of posts about new trends in housing. I focused on Accessory Dwelling Units, The Med Cottage, and the Tiny House, all twists on small, often mobile, freestanding dwelling units. I continue to be intrigued with this trend. There’s something very appealing about minimal, jewel box homes and certainly something to be said for simplifying once the kids
are grown and retirement is on the horizon. Acceptance
of little dwelling units might still be in its infancy, but it's easy to see the
application of a small house model to the aging Boomer market. When I wrote the earlier blog posts, I received a number of comments and questions about both the interior floor plans and exterior designs of tiny homes. I recently came across a short PBS video entitled Living Large: A look inside the tiny house movement. It's a wonderful glimpse into the tiny house, the
people who live in them, and the varied architectural styles and layouts that
are being built today. I think it’s a piece worth watching. Susan Luxenberg
design makes working in the kitchen easier and more pleasant for everyone. For those who want to age in place however,
good kitchen design is an integral part of maintaining independence. So what features should you consider when planning a
kitchen that will optimize your ability to use the space comfortably
as you age.
1. Allow 4’ of floor space between base cabinets and a kitchen island for ease of
2. Place your upper cabinets 48” above
the floor and lower cabinets 6” above the floor.
This will limit the stretching and bending
needed to reach dishes and pots and pans.
3. Install cabinets with adjustable
upper shelves. Also available are
cabinets that move up and down with the push of a button, or
motorized shelves that
can be installed into your existing cabinets.
4. Lower cabinets should have slide out shelves
and full extension drawers that pull out
further than normal drawers.
5. Install easy to
grip knobs or pulls
6. Provide for adjustable cabinetry and removable base cabinets
1. Select colored or patterned borders
at counter edges to provide visual orientation to
workspaces; choose counter edges that are
rounded rather than squared
2. Vary the height of your counter
tops. Consider a counter that is 28”-32”
height) for someone who wants to sit while cooking, preparing food
or washing dishes.
3. Allow for open, under counter seated work areas, minimally 30” wide
4. Select counter top materials that are
smooth enough so you can slide heavy pots and
are heat resistant. Install a pull out shelf under the counter
adjacent to the stove
or microwave so there is a place to put down hot dishes
5. Design sufficient counter space for placing dishes adjacent to or opposite all appliances.
1. Purchase a side-by-side or drawer refrigerator. These refrigerators are easier to
those who use a wheelchair since the chair can be pulled up closer to the
shelves. Refrigerators with adjustable shelves also
easily accommodate a number of
physical disabilities. Lower shelves are easier for those with
difficulty lifting their
arms and higher shelves work well for those who have
2. Choose a cook top with either front
or side controls and with burners that aren’t set
in a straight line. This will allow you to adjust a control or
turn on another burner
without having to reach across a hot stovetop. Check to make sure the controls are
easy to read.
3. Mount a wall oven so you don’t have to
bend. If you select a model with a door
swings to the side rather than pulls down you will avoid having to lean
across a hot
door when taking items from the oven.
4. Microwave ovens should be placed either at counter height, in the wall, or in drawers.
5. Look for the newest trends in pull out
dishwashers. These appliances are fit into
pull out just like all the other drawers in base cabinets. If you prefer
a standard dishwasher, install
it 8” off the floor to minimize bending.
An Aging in Place specialist is someone who is trained and certified in helping people remain in their homes
beyond retirement. These professionals have developed skills to assess the needs of seniors and evaluate their home environments for
potential modifications designed specifically for changing
Aging in Place professionals are trained to listen carefully
to clients and their caregivers, and to observe the physical conditions of a
home. They have the knowledge and
experience to provide practical, individualized solutions to a problem. They do not bring a generic approach to home
modifications but rather select from any number of relevant options. Aging
in Place professionals are not only trained in the physical issues of aging but
also in those products on the market designed to aid in those issues.
Aging in Place professionals have been taught the techniques
and strategies for designing barrier-free living environments. Their goal is to
modify or remove any architectural feature in a home that would interfere with safety,
comfort or independence while at the same time maintaining an attractive
environment suited to their client’s lifestyle.
Sometimes it is a combination of structural renovations along with
specialized equipment that alters the home environment sufficiently so as to
allow an individual to age in place.
While an Aging in Place specialist may be a contractor, not all contractors are Aging-in-Place
professionals. You might call in a
contractor to install a grab bar, but the question of which shape/sized grab
bar is best, where it should be located for your specific ailment, or whether a
grab bar is even the correct solution is not something a contractor is trained
So what special training does an aging-in-place professional
get? There are actually a number of certification
programs throughout the country geared specifically towards training
professionals in the field of aging-in-place. People come from a number of different
professions and perspectives – occupational therapists, remodelers and builders,
geriatric care managers, architects, nurses, interior designers, and medical equipment suppliers to name a few.
The programs vary widely in scope and duration. I’m familiar with two of the programs as I,
myself, have completed both the University of Southern California’s Home
Modification Certification and the National Association of Home Builders’
CAPS program. Please note that I am not suggesting that the
three programs listed below are the only programs available – they are just the
ones I am aware of.
University of Southern California offers an Executive Certificate in Home Modification
through its National Resource Center on Supportive Housing and Home
program is designed for professionals who work directly or indirectly in the
field of supportive home environments. This is a five month course that
includes home modification research, product and design
layouts, common modification issues, case studies, funding strategies, ethics, and
Georgia Tech offers a Certificate
in Workplace Accommodations and Home Modifications. Coursework is geared to applying assistive
technology and accommodation strategies in home, work, educational, and public
settings and to identifying needed assistive technology and environmental
accommodations for individuals with disabilities. The Program consists of eight
courses ranging from fundamental strategies for workplace and home
modifications to universal and accessible design for public spaces .
CAPS (Certified Aging in
Place Specialist) is accreditation earned through the National Association
of Home Builders. In three days of coursework, the CAPS curriculum
incorporates a variety of information tailored to aging-in-place home
modifications, including: background on the older adult population;
communication techniques; common aging-in-place remodeling projects; marketing
to the aging-in-place market; common barriers and solutions; codes and
standards; product ideas and resources; and business management.
If aging-in-place is something you’re
determined to do, it’s important to plan ahead so as to incorporate appropriate modifications that will meet your changing
needs as you age. If you take the time
to plan home modifications before you need them, you can ensure they are
designed properly and add value to your home. Aging
in Place Specialists are available to help.
America is aging at a tremendous rate. 10,000 people in the U.S. turn 65 every day, a rate that will continue for 20 years. By 2050, over 20% of Americans will be over the age of 65. Unfortunately, elder abuse is a growing problem.
Elder mistreatment is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. This includes failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm. The specificity of laws varies from state to state, but broadly defined, abuse may be:
- Physical - Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need.
Emotional - Inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts.
Sexual - Non-consensual sexual contact of any kind.
Exploitation - Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.
Neglect - Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder.
Abandonment - The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.
Elder abuse can affect people of all ethnic backgrounds and social status and can affect both men and women. Victims of elder abuse are known to experience depression, anxiety and other mental health issues. Elders who experienced mistreatment, even modest mistreatment, had a 300% higher risk of death when compared to those who had not been mistreated.
Sadly, it is known that in 90% of all reported elder abuse cases the abuser is a family member. Researchers have estimated that anywhere from five to twenty-three percent of all caregivers are physically abusive. Most agree that abuse is related to the stresses associated with providing care.
While we don't know all of the details about why abuse occurs or how to stop its spread, we do know that help is available for victims. Know the warning signs of a possible problem so that you can make a call for help if an elder is in need of assistance.
While a single sign does not necessarily indicate abuse, some tell-tale signs that there could be a problem are:
- Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
- Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
- Bruises around the breasts or genital area can occur from sexual abuse.
- Sudden changes in financial situations may be the result of exploitation.
- Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
- Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
- Strained or tense relationships, frequent arguments between the caregiver and elderly person
If you think someone is in danger,contact the Eldercare Locator for state specific information at 1-800-677-1116.
I recently returned from a trip to visit my parents who are considering selling their home and moving closer to one of us kids. Since they’ve lived in their house for the past 47 years, the prospect of going through closets and drawers filled with accumulated belongings (let alone a basement where we’ve all stashed our mementos) is daunting. As I started to discuss a plan of attack with my mother, it became obvious how overwhelmed she was. After all, my parents’ possessions have been gathered over a lifetime and hold many memories for both of them. An oversized embroidered tablecloth evokes a memory of one of our family Thanksgiving celebrations; the silver tea service reminds my mother of the many parties she has hosted. But even though she no longer uses these items, she is reluctant to get rid of them. How could she possibly decide what to keep and what to throw away? How could she be assured that once she got rid of something, she wouldn’t regret it? The more I urged her to discard those things she no longer used or needed, the more uncomfortable she became. I, who have now moved six times in the past 40 years, tried to reassure her that sometimes paring down one’s possessions can be freeing. Not surprisingly, that bit of advice was less than reassuring so I did some research to find more expert advice that would help her decide what she could live without.
The following are excerpts from an article, "Just Say No to Too Much Stuff", found on Family Circle.com. It’s a list of 18 things you can get rid of today along with some great ideas on how to let the things you don’t need go. I think you’ll find this article helpful whether you’re de-cluttering, spring cleaning or, like my parents, considering a move from that much beloved home.
Just Say No to Too Much Stuff
Stuff. For many of us it's worse than any four-letter word. That's because "stuff" can weigh you down and hold you back, says Gail Blanke, author of Throw Out Fifty Things. And, in the end, much of what we accumulate in life isn't all that important. As Marilyn Bohn, author of Go Organize!, points out, "No one ever says, 'I wish I'd kept more stuff.'" Here's how you can share and bless others with all of your stuff—and end up with a cleaner, more peaceful home while you're at it.
1. Kitchen Utensils
Is your utensil drawer so full you can barely open and close it? You're not alone. When Robin Austin started cleaning her kitchen in preparation for a move, she found she had plenty of duplicate utensils, the result of a new marriage that combined households and six kids. Many of us also buy new utensils but forget to get rid of the old. Here's a smart way to figure out what you're really using, from Motherboard Mom Jeanne Smith, Overland Park, Kansas: Toss everything—all the spatulas, rubber scrapers, pie servers, and so on—into a box. As you use a utensil from the box, put it back in the drawer. After a month, check what's left in the box. Keep those once-a-year items that remain in the box, like a turkey baster or candy thermometer. But donate the rest.
2. Coffee Mugs
Another item many moms find hogging valuable cupboard space: coffee mugs. "We had over 20 coffee mugs," says Kansas mom Dawn Schnake. She and her husband each chose four mugs to keep and donated the rest to a church rummage sale. "Even if you received something as a gift, it's okay to let it go," says organizer Marilyn Bohn. "You only need to keep what works for you."
3. Plastic Containers
Mary Pankiewicz, owner of Clutter-Free and Organized in east Tennessee, suspects that plastic containers have a secret life (probably hanging out with those AWOL socks and hangers). How else can you explain why so many lids and bottoms don't match up? She suggests holding a "lid party" to match up those errant tops and bottoms. Pankiewicz recently took her own advice. "I had 25 lids with no bottoms and six bottoms with no lids," she says. After swapping with friends, she recycled the rest of the mismatched items.
4. Little-Used Kitchen Stuff
When was the last time you used that Bundt pan? If it was months ago, maybe you should give it to a friend. That's what Suzy Ayres and a pal did when they performed a joint kitchen cleanup. They took everything out of their cabinets and only put back what they used regularly. "The things that we left out that didn't get used much, we had to choose. If we put one thing back in the cabinet, we had to pick one thing to donate," Ayres says. The two also traded items: "She had lots of muffin pans and I didn't."
Got vases from the last three Valentine's Day bouquets? Take them back to the florist, says Marla Cilley, who lives in Transylvania County, North Carolina, and runs the flylady.net, an Internet site devoted to housecleaning and organization. "It takes away your creativity and takes over your mind," Cilley says.
• Check the expiration dates on everything in your pantry, fridge, or freezer. If it's about to expire, put it on the menu for that week, says professional organizer Bohn.
• Motherboard Mom Dawn Schnake gives her sons what they call "muffin pan snacks" to get rid of those almost-empty bags of cereal, crackers, and chips. She fills each of the 12 muffin cups with a different snack and throws in some veggies, cut-up fruit, and cheese cubes. "The boys think they've sat down to a feast," she says—and she gets her pantry cleaned out.
• If you know you're never going to use an item—and it's still good—give it to your local food pantry.
• Have an "Eat Out of the Pantry or Freezer" week, says Marla Cilley, flylady.net. You'll be surprised at how creative you can get with your menu planning when you're only using the ingredients on hand. She also suggests this as a way to inspire creativity and frugality: "When you throw away food, imagine you're throwing dollar bills in the trash can!"
They don't mold and don't appear to go bad, but spices don't last forever, not even cayenne pepper. (Cinnamon's an exception to the rule.) "Dried is one thing, tasteless is another," says organizer Blanke. Give your spices the smell and taste test and if they've gone bland and boring, dump them. To find out how old your McCormick or Schilling brand spices are, go to http://mccormick.com/Spices101/HowOldSpices.aspx. And when you buy new spices, mark down the date on the package with a Sharpie.
Computers were supposed to usher in a paperless society, but it hasn't happened quite yet. "Most of us are still drowning in paper," says organizer Pankiewicz. She suggests an annual cleanup. Check with your accountant about how long to keep important papers like tax returns but, in general, materials that support tax returns (receipts and so on) can be tossed after seven years.
Do you have a stack of magazines by your bed that you haven't read? If two months have passed and they're still sitting there, consider donating them to a retirement home, hospital, doctor's office, or school. Many take magazines for art projects (if not for reading material). Organizer Bohn suggests tearing out articles and putting them in a folder you can grab when you know you'll be sitting and waiting (think doctor's office).
It's a common bad habit: Grab the mail, flip through it for anything interesting, and then set it on "the pile" that accumulates until the day you start searching for overdue bills. "Scan and stand" is the system recommended by organizer Pankiewicz. "Standing is the trick," she says. Don't be tempted to sit down: Bring in the mail. Leave your coat on. Find a place by the wastebasket, recycling bin, or shredder, and stand and handle each piece of mail. Put bills in a basket or pretty gift bag, take magazines to where you read them, scan any newsletters and bulletins for important information, and discard the rest. "Your goal is to make the mail disappear," she says.
11. Unread Books
"Books are our friends," says organizer Blanke. "I know my husband won't ever get rid of his dog-chewed copy of Rudyard Kipling's Kim that he's read 50 times." So, keep your favorites—the ones you'll read again or you use for reference—neatly in a bookcase. In fact, if you're a book-lover with a big collection, a whole wall of books can make a dramatic statement and keep them organized. But, if you have lots of volumes that you have no intention of reading any time soon, donate them. Blanke suggests giving them to www.booksforsoldiers.com. "You really are paying it forward when you donate things," she emphasizes.
Here's a sad truth: You're probably not going to lose the weight to fit into those 10-year-old clothes you have in the closet. Just give it up and give them away, says Pankiewicz. This doesn't mean you're giving up on ever being healthier or thinner, it just means you aren't going to be held hostage by some old clothes that don't fit, need repair, or were on sale (but you never liked). Donate them all and we guarantee you'll feel "lighter."
13. Kids' Clothes
Michaela Freeman, a mom in Oklahoma City, Oklahoma, keeps clothes for her children a year after the end of each season in case things still fit. What doesn't is passed to friends with young children. "How can you put a price on helping another person?" she asks. She's benefited as well. Friends with older kids pass clothes on to her youngsters
14. Kids' Artwork
Of course every piece of artwork your child ever did is a masterpiece. But that doesn't mean you need to keep it. If it's not something you want to put on the wall or in a portfolio to save, take a photo and toss it. You can develop a digital "art gallery" or put photos in a photo album and you'll take up a lot less space. After all, think about it: If you keep four pieces of paper per week per child, by the time they've graduated from high school, you'll have one huge collection, points out Bohn. "Take a picture and let it go!" she says.
Power cords, USB cords, and other paraphernalia for electronics clog up our desks and cabinets, says Chris McKenry, owner of Get It Together LA!, a professional organizing company in Los Angeles. "It's a jungle," he says. "And there's not room for the things you need." Sort through that "jungle" and match cords to gadgets. Old cell phones can be donated to women's shelters. Other old electronic items, like some printers and computers, should be properly recycled. "It's against the law in some cities to put electronic waste in the trash," warns McKenry. Check with your city for E-waste collection sites. Ditto for old VHS and cassette tapes. McKenry suggests transferring them to your computer for digital storage and then putting the tapes in E-waste collections.
"Most of us have way too many towels and sheets," says The Fly Lady. "Some people no longer even have beds that the sheets fit!" She recommends two sets of sheets per bed and keeping the extra set under the foot of the mattress or in a drawer in the bedroom to free up room in the linen closet.
Check your medicine cabinet for expired prescription and over-the-counter drugs, but don't flush them or throw them in the trash. Instead, take them to your local pharmacist for proper disposal.
•Carol Showers Brown, mom to three in Manassas, Virginia, taught her kids to donate toys. "We lived in Bangkok and the orphanages there were so grateful for toys, even used ones." Her kids would fill a basket with toys to give away several times a year. "It worked really well because the kids picked out what toys they were ready to part with," she says.
•Remember that preschool song of "Clean up, clean up"? At Diana Dawson's Austin house the song was more likely "Wade through it," she says. That's why she set "dump-it deadlines"—if the kids' stuff wasn't picked up by a certain time on a certain date, she would gather their things and donate them. Sure enough, the first time she had to follow through with her daughter. "The most difficult were the books on the floor, and I donated those to her elementary school," Dawson says. "The school librarian told her she appreciated the donations and other kids enjoyed her books." Her children and a group of neighborhood kids also put on their own garage sale of their toys to raise money to adopt a family at the holidays.
•Mom Michelle Speak has donated many of her children's toys as they've outgrown them, but not all. "I've kept the toys I can imagine my grandchildren would play with." Put the special, keepsake toys away in a well-labeled box.
For those who use a wheelchair or other mobility device, doors and doorways frequently present a challenge.
DOORWAY WIDTH: Although the standard interior doorway width is 32”, many doorways are narrower and unable to accommodate a wheelchair or walker. Particularly in older homes, bathroom doorways are often only 24” wide. Given that a standard wheelchair is 24-27” wide you can easily imagine the problem. If you take the wheelchair width, allow an additional 1 ½” on both sides of the chair for finger clearance, then add a couple more inches for maneuvering anything other than a straight approach into the room, a doorway needs to be minimally 32” and preferably 36” to allow for ease of entry. So what are the solutions to the narrow door problem?
1. Replace the entire door and frame with a wider doorway. This is the most costly solution and involves cutting the wall to accommodate a larger door – either a pocket (sliding) or swing door. Depending on the size and layout of your bathroom, this solution may not even be possible because of vanity or fixture placement. Opening up a doorway might also require moving the electric switches often found near the doorway entrance. Anticipated costs could run to $1,000 or more depending on your choice of door (pocket assembly, solid or hollow core, etc.) along with any electrical or plumbing shifts required.
2. Add Swing Away Hinges. These hinges will replace the existing hinges on your door and enlarge the doorway opening by almost 2”. Depending on the size of the existing doorway, this may provide the necessary minimum width for a wheelchair to get through. If clearance is still tight, you may want to attach some plastic laminate to the doorway so the wheelchair won’t damage it. You can easily find these hinges online. Prices range from $20 - $50/pair depending on the finish selected.
3. Remove the Door Stops. The door stops are those narrow lengths of wood attached to the inside of the door jamb which are designed to create a stop for hinged doors when they close. By removing those stops you will add another ¾” clearance to the doorway. Alternatively, you might want to cut back the stops so that they only are placed on the jamb 3-4' off the ground, allowing them at the top of the door but giving the clearance at the bottom where the wheelchair passes through.
4. Remove the door and door stops. If privacy is not an issue, you can simply remove the pins from the hinges and lift off the door. Or you can remove the hinges and other hardware, fill in the holes and repaint the doorframe. By removing the existing door and stops you will gain an additional 2 ¼”-2 ¾” of clearance.
DOOR HARDWARE: It’s not difficult to push open a door or pull it shut if there is no excessive weight involved and the hardware is easy to grasp. Most locks, however, require fine dexterity and finger strength making them difficult to use for anyone who has arthritis. Lever hardware is preferable to any kind of small twist knob. Push button locks or sliding bolts are fairly easy for anyone to operate. There are also magnetic card readers, remote controlled locks and push-button activated combination locks available on the market, all of which work wellfor most people.
THRESHOLDS: Any change in floor level greater than ½” can create a tripping hazard. Thresholds can be either ramped or removed so they do not create any type of barrier. In many cases you may be able to install a small, beveled ramp that abuts the edge of the threshold. Alternatively, you may need to remove the threshold which entails cutting or prying up the threshold material itself and filling in the floor, or replacing a taller threshold with one that has a lower profile.
When deciding which doors to modify for accessibility, consider easy access through at least one entrance door and all doors along the route between your bedroom and kitchen, dining, bathroom, and living area. Those doors leading to seldom used rooms like guest rooms may not need to be modified.
You do not need to have aging infirmities or be a wheelchair user to be faced with a challenge when negotiating stairs. Leg or back injuries can also make stair climbing painful if not impossible. One of the best options for handling the stairways found both inside your home and out is a stair lift.
Stair lifts are chairs that ride on a rail up and down a staircase. While stair lifts are usually not practical for wheelchair users, they are ideal for those with strength, balance, respiratory or cardiac problems. The user approaches the chair, sits down, presses the button and off they go.
There are many models of stair lifts but they all have basically the same features and operate the same way. A standard installation involves bolting a rail to the stair treads (not the wall), attaching a chair to the rail, and mounting call/send switches at both the top and bottom of the staircase.
There are many different types of stair lifts: straight rail stair lifts, curved rail stair lifts, indoor as well as outdoor stair lifts. They can be purchased new or used.
Stair lifts can be built for staircases with outside or inside curves and can also be set up to handle flat landings with turns. Most stair lifts have a seat belt, locking swivel seats and safety switches which will stop the unit's travel if the stair lift comes in contact with obstacles, pets or people. Some manufacturers have folding hinged tracks that allow the track to fold out of the way when the stair lift is not being used. The illustration below shows various workable configurations for stair lift equipment. Basically they can be set up to work with any staircase.
Stair lifts are no longer bulky pieces of equipment but rather have been redesigned to be as unobtrusive as possible and to fit in with your decor. You can now choose seat styles ranging from traditional to modern and select between upholstery fabrics and colors.
The costs of stair lifts vary and can range from about $1,500.00 to $3,000.00 for straight units and $5,000.00 to $20,000.00 for curved units.Stair lifts can also be rented for those whose physical condition is likely to deteriorate in the foreseeable future to the point where accessing the seat becomes impossible, or if you only need a short term solution. To be able to use a stair lift the user needs to be able to stand at least well enough to do a standing transfer on and off the seat at the top and bottom of the stairs.
Do your research first to determine those features you’d like – it’s easy enough to get manufacturer’s information and general pricing online. Once you’ve found a company that installs the product you like, you can ask for their assistance in determining the appropriate configuration for your specific situation.
The bathroom is the biggest safety hazard in our home. It also presents the greatest challenge when designing access for those with limited mobility. If you are building a new home or completely redesigning an existing bath, you often have the ability to enlarge the bathroom so as to make it more functional and accessible. In an existing home, however, enlarging your bath might not be possible or might mean sacrificing an adjoining room. So how can you improve a conventional bathroom so that it becomes safer and easier to negotiate for all?
Below is a picture of a fairly standard bathroom – where all fixtures are lined up next to each other.
Looking at the picture above, let’s identify those items that could be changed to update the bathroom and improve safety, accessibility and style.
- The tub can be removed and in its place, a shower with preferably no curb or a small curb can be installed so it can easily be stepped into. You can purchase a pre-fabricated acrylic or fiberglass shower that will nicely fit the space of the old tub, or have a tiled shower built in that space. The important thing is that the shower floor be at the same height as the bathroom floor so there are no steps to maneuver.
- Don’t forget to install grab bars in the shower. There are numerous choices of “designer” bars out there to complement your bathroom fixtures.
Check out the picture below. These homeowners started off with the right idea by removing the tub and replacing it with a shower. But not only is there a curb to step over but also the shower floor is slightly lower than the bath floor – not by much but enough to cause a problem for someone with a knee injury or a mobility issue. And while there are the correct number of grab bars (one placed at the entrance to the shower and one along the long wall), the diagonal bar is slanting in the wrong direction to be of any assistance when needed for help in getting up from the shower chair.
While grab bar placement depends on a number of factors including wall structure, plumbing layout, and each user’s physical characteristics, there are general guidelines you can follow:
On the short wall where you enter the tub/shower – install an 18”-36” vertical bar no more than 9" from the edge of the outside tub wall, with the bottom of the grab bar approximately 32" to 36" above the floor.
On the long wall – either a 24” angled bar (helpful in getting up from a bath chair or tub floor) installed at a 45 degree angle, sloping up towards the shower head, with the lowest point approximately 9” above the rim of the tub OR a 24" - 48" long grab bar, installed horizontally 33" - 36" above the floor.
Just don’t assume your installer knows the right height for you. The best thing to do is to walk in and out of your tub or shower a few times to find a comfortable height before the bars are installed.
Here are some more ways to update a conventional bathroom:
- In new shower installations, select tile with a high anti-slip rating which is good for small children as well as adults. You can coat your existing floor tile with an anti-slip agent very inexpensively. Check your local tile supply stores for these anti-slip coatings.
- Get rid of your old toilet and install a comfort height one. They are a couple of inches taller than a standard toilet and make getting on and off much easier for anyone who is tall, has back or joint pain, or has diminished physical abilities.
- Look for some new vanity designs where the cabinets are open underneath, or consider a wall mounted sink
- Change your faucets to those with lever handles. Faucets that have a single lever to control the water flow are best for people who have problems with their hands. There are also new “touchless” faucets where the water starts to flow when you place your hands in front of a sensor. These faucets are now available with prices ranging from $40 – $500+.
The pictures below are all of small bathrooms that started with conventional layouts but have been stylishly renovated for comfort, safety and accessibility.
And one last thing. While none of these pictures show entrances to the baths, bathroom doors - particularly in older homes - are often narrower than the other doors in the house. Pocket doors, which slide into the wall rather than swinging open, can be used to increase doorway access but they are not inexpensive to install and involve construction. They also are difficult for some people to physically open and close. If you only need a couple more inches to make your doorway more accessible, a simpler, less expensive option is to use offset hinges. Offset hinges will provide an additional 2” of clearance and are installed as a replacement to the existing door hinges.
There are numerous housing models being developed in an effort to meet the requirements of Baby Boomers as they strive to maintain vibrant, active lifestyles. Recognizing that growing older can bring on increased isolation and loneliness as social connections lessen, these housing efforts emphasize independence and social networking and focus on a community approach to independent living.
Senior Cohousing Communities are adult communities developed by people with a common vision. Senior cohousing revolves around custom-built neighborhoods organized by the seniors themselves in order to fit in with their real needs, wants, and aspirations for health, longevity, and quality of life. This is housing built by seniors, not for them. Physically the communities are a combination of small homes, courtyards and open spaces and include a common facility that serves as a social center with a dining room, kitchen, lounge and other recreational facilities. Residents in cohousing communities meet regularly to develop policies and all decisions are made by consensus.
Continuing Care Retirement Communities (CCRCs) offer a continuum of care in one location, starting with independent living, progressing to assisted living then nursing care. Residents move from one setting to another as their needs change. Most CCRCs require a one-time entrance fee and then monthly payments, although there are some CCRCs where no entrance fee is required and you pay a monthly rent. The nice thing about a CCRC is that once you buy into the community, you are provided with housing for life. CCRCs offer a range of services – transportation, housekeeping, personal care and health care – along with many social opportunities.
Village network is a relatively new community approach to helping seniors remain in their own homes. A community defined by a specific geographic boundary utilizes a combination of volunteers and staff to coordinate services available to its residents. Residents aged 50 + become “members” of the network and can access these services at an affordable price provided by professionals who’ve been vetted by the group. These services might include medical care, legal assistance, home repairs, transportation, personal shopping, as well as group social outings. This concept is also known as a Virtual Retirement Community. Avenidas Villagein Palo Alto, CA is an example of this type of community. Among the services Avenidas Village provides to San Francisco Bay area seniors are discounts on transportation, free emergency preparedness reviews, medical advocacy and volunteer opportunities. Participating seniors also have access to members only amenities such as a website, social and cultural activities and a directory of fellow members.
We can talk about universal design and show picture upon picture of upscale new products designed for aging-in-place, but the fact that the question, “Won’t accessibility modifications decrease the value of my home?” continues to be asked, tells me that we’re not yet done with the conversation.
Simply put, accessibility modifications that are poorly done will definitely decrease the value of your home. On the other hand, accessibility modifications grounded in good design will increase its value. Like all home renovations, if a project is done well it will appeal to others. If not, it will become a negative when you try to sell your home. The determination of a home’s value is not a science but rather an art that combines an objective comparison of size and features to other homes in the neighborhood, with a subjective evaluation of any extra amenities that might set your home apart from the others.
So why are modifications directed at making a home safer and more comfortable for its occupants given such a bum rap? I think that part of the problem is the perception that accessibility modifications will look institutional. Until quite recently, most people’s exposure to walk-in showers, grab bars, and ramps came through visits to family in nursing homes or hospitals. Certainly the majority of builders have not included these features in their model homes, nor do we see interior design magazines focusing on ways to handle accessibility modifications. We’re left thinking that anything other than the current trend in home design is a negative. It’s ridiculous, really, that we’re forced to modify our homes to accommodate aging rather than have our homes built with a view to the long term. If architects and builders had given any thought to an aging population, they might not have designed and built so many step down showers, step up entrances, 28” doorways or 5’ x 8’ bathrooms – all features that are difficult to maneuver as we age and become more infirm.
We can probably all agree that updated kitchens and baths add value to a home so let’s look at some common accessibility modifications to those two rooms to assess how these modifications might affect home value.
Since most adults encounter problems maneuvering into a bathtub as they get older, the most common accessibility modification for those who want to age in place is to replace the tub with a shower, preferably one that is “curb-less”. A curb-less shower has no step or curb separating it from the rest of the bathroom floor but rather is at the exact same level as the rest of the bathroom. The shower floor is imperceptibly pitched to a center drain and often additional trench drains are set along the edge of the shower floor to deter any water from the shower running into the bathroom. When consideration is given to the design of a curb-less shower, it becomes an enhancement to any bathroom and a pleasure for everyone to use.
The kitchen is another area of the home often requiring modification for accessibility as most standard kitchens are not well designed for someone in a wheelchair or using a walker. To allow for everyone to use a kitchen comfortably, there should be counters of varying heights, easy to reach top shelves and pull out bottom shelves, front control appliances that can be used while seated, non-slip flooring, and contrasting edged counters. Below is a picture of a kitchen specifically designed for all ages and abilities (universal design). There is nothing in this kitchen to detract from home value. In fact, it's just the opposite - most people see a very functional yet beautifully renovated kitchen.
The important thing to note is that while accessibility modifications are done to accommodate those with disabilities, when well thought out and well designed the results are attractive and usable for all. When
you think about it, if you design a home that everyone can use comfortably, no matter their abilities or disabilities, you’ve opened up the market of those who would be interested in purchasing your home. And there’s nothing negative about that.
As we talk about universal design and modifying our homes so that everyone in the family is comfortable and able to retain their independence, let’s not forget to take a look at our closets.
Closet rods are normally set at about 66" off the floor so if you’re of average height or taller, you’ll have no problem reaching them. But what if you were a child or in a wheelchair? Could you reach that rod? In fact, closet rods set at 20-44” off the floor are better suited for everyone. You can either lower existing rods, install additional rods at a lower height, or install add-on rods. An add-on rod hooks on to an existing closet rod but hangs at a lower height. The advantage of an add-on rod is that is can be easily removed should your needs change or you move.
For a more permanent solution you can install a pull or swing down rod. This rod is installed at the traditional 66” off the floor height but with the push of a button or by pulling a cord, the rod swings down to your level. For maximum utilization of closet space, install a swing down rod at the same height as your current closet rod then re-install the existing rod at a lower height.
There are also numerous closet organizing systems that offer storage options at all height levels. You can choose either drawers or wire baskets to make storing certain items of clothing or accessories easier. Make higher drawers shallow. Lower drawers can be deeper. If you choose wooden drawers, use d-shaped or u-shaped handles that are easy to grip. If someone in your home uses a wheelchair, keep the drawers no more than 30” off the floor. Also plan on adding some low, shallow shelves to your closet. Shelves should be no more than 18” deep to prevent items from getting pushed to the back of the shelf and out of view.
Make sure your closet is well lit. Get rid of that old ceiling light with a pull switch. You can even install lights that turn on automatically when the closet door is opened. And speaking of doors, make sure the closet doorway is at least 36” wide. For easy of entry, either remove the door completely or replace it with side by side swinging doors or a pocket door that can slide inside the wall and out of the way. If you are remodeling your bedroom area, try to include a walk-in closet. Both the doorway and the center aisle of the closet should be 36” wide. That way anyone in a wheelchair is able to access clothes stored on both sides of the closet.
Universal design is becoming the new buzz word in construction. It's about creating attractive space that can be used by everyone regardless of age or ability. A home designed using the principles of universal design accommodates to everyone's needs and abilities and allows all to live in equal comfort and safety. Universal design features are easily incorporated into new home pre-construction but can also be applied when planning home renovations. As an added bonus, these features only increase your home's value.
Universal design features would include:
1. Zero step entries where at least one entrance is step free. This makes it easier for those who have difficulty with stairs without the need for a ramped entrance to accommodate a wheelchair. Everyone benefits from a step-less entrance.
2. Single story living where the kitchen, living room, a full bathroom and bedroom are all on one floor.
3. Wider doorways and hallways. Doorways that are at least 36" wide are easier to maneuver when carrying laundry baskets, moving furniture, or bringing packages in and out of rooms.
4. Lever style handles and rocker light switches. This make opening doors, turning on faucets and switching on lights easier for everyone regardless of age and ability.
5. Reachable switches and controls. Light switches should be mounted at 42-48" above the floor and electrical outlets 18-24" off the floor. A thermostat should be mounted no higher than 48" above the floor.
6. Windows that require minimal effort to open and close.
7. Multi-level kitchen counters that everyone can reach and that allow a cook to sit while working in the kitchen.
8. Easy access kitchen storage - adjustable height cabinets and pull out shelving.
9. Bathrooms with low or no-threshold showers, comfort height toilets, and non-slip flooring.
There are so many universal design products now made for the home that with a little research, planning and thoughtfulness you can turn your home into one that is comfortable for every member of your family.
Question: I’ve put tub strips on the bottom of my bathtub to keep from slipping but the tile on the bathroom floor itself gets slippery when it gets wet. Is there anything I can do to make my floor less slippery?
Answer: Today most builders and remodelers install non-slip tile on bath and shower floors to prevent exactly the problem you describe. If you are not planning on changing your floor tile, there are numerous topical applications designed to invisibly increase traction and make your tile, marble, stone, and even wood floors non-slip when wet. The coating does not change the flooring’s color or texture. You can find non slip coatings for your bathroom floor in tile stores or online. Look for the names InvisaTread, SureStep, Grip, It, or Tile Grip, just to name a few. All are easy to install – clean the floor, spread the coating over the floor so that the floor remains evenly wet, let it sit for 20-30 minutes then rinse. Similar to any sealant, the coating will need to be reapplied every couple of years depending on how frequently you wash your floor.
Question: We have two steps leading to our front entrance. My husband is now in a wheelchair and it’s impossible for me to maneuver his chair on these steps. Do you have any suggestions?
Answer: There are many lightweight aluminum ramps on the market that will take care of this problem. First, figure out how long a ramp you need by measuring the total height of the steps. For every inch of height, you will need 1 foot of ramp. So for example, let’s say that each step leading to your front door is 4” high. You will need a ramp that measures 8’ long. You can easily find sources for ramps by going online. You’ll find solid ramps, ramps that fold up (suitcase ramps,) and ramps with and without handrails. The differences have to do with the weight of the ramp, its length, whether or not you need handrails, and how portable you'd like it to be. Just make sure you don’t skimp on the length of the ramp – if you are in between two sizes go UP. You don’t want to feel as if you are losing control of the wheelchair because the ramp is set too steeply. You might also want to consider creating a landscaped, bermed walkway . Your walkway can be sloped from the front door, will provide the same ease of access as a ramp but be much more attractive.
It's easy to understand why we put off the decision of whether or not to downsize. Most of us have a strong emotional attachment not only to our home itself, but to the lifestyle it connotes. And while it's one thing to give up extra closets, a gourmet kitchen, or additional space in the garage, it's quite another to no longer be able to host big family celebrations or have the ability to house all the kids and grandkids when occasions arise. Then there's the work of finding a new place to live followed by cleaning, packing and moving - no wonder this decision causes so much anxiety.
As a result, many people make the mistake of waiting too long before finding a smaller, more easily managed home. They put off a decision until an illness or financial crisis occurs at which point they are forced to make a move while under stress. Being proactive and having the time to plan a move while you're still in good health will greatly reduce the trauma of downsizing.
So how do you decide if the time is right for this major change in lifestyle? Ask yourself these questions:
1. Are you living in all of the house or just a few rooms?
2. Does your home's design and layout fit your present and future physical needs? What would it cost to make necessary changes?
3. Is the upkeep of your home creating a financial burden?
4. Is routine home maintenance becoming too difficult for you to do?
5. Are you having problems finding service people to help you take care of your home?
6. Have most of your family and friends already moved out of the area?
There are many good reasons to move into a more streamlined home. A smaller house means lower property taxes, insurance, utility and maintenance costs. Your time and money will be freed up for other activities, hobbies and travel. If you decide that downsizing is right for you, take the time to do your research and figure out exactly where you'd like to move before putting your existing home on the market. If the thought of sorting and packing is overwhelming, hire a move manager to help you execute it all (see the National Association of Senior Move Managers). And make sure to investigate all your options -- you might be pleasantly surprised at the variety of housing choices out there.
What are some of the more interesting new gadgets that have come on the market designed for the Boomer consumer and their Senior parents?
PRESTO A machine that allows you to receive email, photos and other documents without having to use a computer. From their website: "... simply pick up printed messages from the tray, read and enjoy. No checking a computer for messages or struggling with email attachments. It's all done automatically. Nothing to do or learn." In addition, the PrestoConnect interface allows other family members to either create reminders or to-do lists and set a schedule for delivery to the machine.
I've actually seen a Presto in use by one of my clients, an 83 yr. old woman whose family lived out of state. The machine doesn't take up much room, is no larger than a normal sized printer, measures about 18" long x 15" wide and weighs approximately 13 lbs. My client placed the Presto on one of her kitchen counters and was delighted to be able to receive pictures of her great grandchildren and notes from her daughter throughout the day. If I remember correctly, she even had crossword puzzles automatically delivered to her each day.
CLEARSOUNDS Amplified phones, cell phones, wireless TV headsets plus other assistive devices for those experiencing hearing loss. From their website: "With the prevalence of hearing loss on the rise, the need for good amplifier phones will become more and more important."
Between an increase in life expectancy, side effects of certain groups of medications, and noise exposure, hearing loss in the U.S. is increasing. Occupational hearing loss remains a serious problem and recreational hearing loss from firearms, jet skis, snowmobiles, personal sound systems, etc. is on the rise. According to the National Institutes of Health, approximately 1/3 of all hearing loss can be attributed to noise exposure (NIH 1990). Clearsound has developed an appealing array of updated equipment for those with mild, moderate and severe hearing loss. Wireless headsets, cell phone neck loops, portable phone amplifiers are all things that an aging Boomer would be familiar and comfortable with.
TABSAFE Medication Dispenser. The Winner of the 2011 CES (Consumer Electronics Showcase) Awards Showcase for Design and Innovation in Health & Wellness. From their website: "TabSafe is a personal medication management system that securely stores medications to be dispensed on a specific time schedule. TabSafe has been designed to reduce the most common medication errors, and therefore increase the wellness and independence of its users."
Medicine cartridges are programmed with the dosage and time the medication is to be taken. The dispenser sends visual and audible reminders for medication adherence with verification of completion and also provides three follow-up alerts to prevent missing a scheduled dosage.
Additionally, there has been an onslaught of remote monitoring technologies that address the need for on-premise continuous watching and fall detection. The new technology can monitor motion and sound and send out periodic alerts to family or other caregivers. These systems usually include simple, stylish devices worn in a variety of ways (on the wrist, around the waist or neck, on a belt) and utilize GPS and wireless technologies for tracking movement. Caregivers are automatically notified if the wearer of the device falls. Look for Lifecomm (personal emergency response system), Sonamba (well-being status monitoring), BeClose (remote monitoring), Wellcore (fall detection), and Grandcare Systems (remote monitoring).
What remains to be seen is whether or not the Boomer market will actually purchase these products. No one yet understands why those who are so ready to buy new computers, smart phones, ipads, digital cameras, and flat screen tv's are reluctant to spend money on motion detectors, remote care management devices and personal emergency systems either for themselves or their parents. Aging-in-place technology has come a long way. We now have to educate the consumer as to its benefits.
Let me be honest. I hate that piece of equipment known as the toilet commode. For those of you who don't know to what I'm referring, here's a picture:
I believe the commode was originally designed to be used near a bed for those who could not make it into the bathroom (hence the portable potty), and for that use it's quite functional and appropriate. However, the commode is also being used by people who are having difficulty raising and lowering themselves onto the toilet. This unattractive apparatus is often placed over an existing toilet in order to raise the seat height and afford some stability while sitting and standing. You'd be amazed at how many homes of Seniors I go into - of all financial means - where I find this particular piece of equipment. And while I can appreciate the fact that the commode is prevalent because it is inexpensive and requires no professional installation, I'm surprised that so many find it an acceptable solution to the problem. For me, the thought of walking into my bathroom every day and seeing this contraption over my toilet is simply depressing.
Fortunately, there are a couple of options to improve toilet height that actually combine function with design. Numerous manufacturers now offer comfort height toilets which are about 2-2 1/2" higher than standard height ones. Standard height bowls are about 14" from the floor plus seat, while the comfort height bowls are usually 16-17" from the floor plus seat. The extra height really does make a huge difference in safety and comfort when attempting to sit or stand. Ask anyone who's tall, has bad knees, or a bad back. And most importantly, the cost difference between a standard and a comfort height toilet is minimal.
So which would you prefer to look at every day?
Commode placed over toilet
Comfort height toilet
A wall hung toilet is still another way to raise toilet seat height. During installation, the toilet can be set at a custom height for ease of use. I particularly like the fact that they're easy to clean around. Note though, that cost and installation of a wall hung toilet is more expensive than a comfort height one. Would anyone guess that the bathroom below is designed specifically for someone with mobility issues?
Wall hung toilet
And while I'm on the topic of bathroom equipment, another piece of equipment frequently found in homes is the shower chair. This plastic and aluminum chair is designed to be placed in an existing tub or shower for those who want or need to sit while showering. The only problem is that this chair takes up a lot of space in a standard sized tub, often needs to be shifted around when a spouse wants to shower or bathe, needs to be removed when cleaning the tub, and does nothing to enhance the style of the bathroom.
Instead, today's solution is a fold-down seat that can be installed on the back wall of the tub/shower. When not in use, the seat folds back up against the wall and takes up no floor space. When needed, however, it easily pulls down in place. These seats are installed in the same way grab bars are installed - with heavy duty anchors to hold the seat securely in place. Check these out:
Replacing standard issue equipment with new plumbing fixtures and accessories can not only make a huge difference in the look of your bathroom but also in the way you feel. Really - who wants to be reminded on a constant basis of their physical disabilities? Happily we now have many product choices and no longer need to rely on the old standbys. It should be our goal when renovating to accommodate aging in place that our homes stay design friendly and not deteriorate into repositories for free standing, temporary equipment.
Rising costs and lack of public subsidies have made assisted living facilities expensive. According to the Genworth 2010 Cost of Care Survey, the national median monthly cost of an assisted living facility (one bedroom, single occupancy) is $3,185 per month. In general, 75% of this cost is paid by residents out of personal funds or family assistance. The national median daily rate for nursing home care is $185 for a semi-private room, $206 for a private room or approximately $70,000 per year. About 1/3 of all nursing home residents pay from their own funds.
Contrast that to the cost of renovating your home. A small ramp will cost under $500. Bathroom remodeling, including replacing the tub with a walk-in shower, should run approximately $15,000. For those who might need a stairlift, they can be found for under $2,000 on up depending on the configuration of your stairs. Bottom line - for well under $20,000 you can prepare your own home for your future needs.
So the big question is how to pay for home modifications. In today's market most people are experiencing a loss of equity in their homes which makes a line of credit or a reverse mortgage not feasible. Medicare does not pay for any home renovations - not grab bars, comfort height toilets, non-slip floor coatings, wider doorways or accessible vanities. Instead, Medicare will pay for medically necessary durable medical equipment as prescribed by a doctor. Translated this means that wheelchairs, toilet commodes and shower benches are covered but none of these items are particularly attractive or add any value to your home.
There are, however, some resources that might help defray the costs of accessibility modifications.
1. Long Term Care Insurance. While traditional health insurance does not provide for home modifications, many long term care policies include some coverage. If you are a senior and had the foresight to have purchased long term care insurance, check out your policy. If you are a baby boomer, make a note to yourself to investigate the benefits of a long term care policy. Given the increasing cost of health care and the age to which we now live, long term care insurance might be something you want to carefully consider.
2. Department of Veteran Affairs. The VA has four types of home modification programs depending on the level of disability. For more information on these VA grant programs or to obtain grant application forms, you can contact the VA at 800-827-1000 or visit the VA's website at www.va.gov
3. Community Development Block Grants (CDBG). The Community Development Block Grant program enables local governments to undertake a wide range of activities intended to create suitable living environments, provide decent affordable housing and create economic opportunities, primarily for persons of low and moderate income. Contact your local county or city government to find out the status of money available for accessibility modifications.
4. Tax Savings. Tax deductions are allowed for certain modifications such as the installation of ramps, widening doorways, modifying kitchen cabinets, installing bath fixtures, etc. To do so, the cost of the modifications must be treated as a medical deduction and be certified by a physician as being required for health reasons. The renovations also can't add to the property's overall value. Check with your accountant for details.
5. State Assistive Technology Projects. Several states have initiated home modification programs through their statewide Assistive Technology program. These programs can provide trial equipment as well as low-interest loans for the purchase of assistive technology or home modifications for individuals with disabilities.
6. The U.S. Department of Agriculture (USDA). The USDA has created the Rural Development Home Repair Loan and Grant Programs (aka Section 504 programs) to provide assistance to those who live in areas with a population less than 10,000. This program offers low-interest loans to homeowners of all ages and grants to those aged 62+ who meet certain income criteria, in order to help with home repairs or modifications for disabilities. Check out www.rurdev.usda.gov
7. Area Agencies on Aging (AAA). Some Area Agencies on Aging have funds to modify homes. Contact your local AAA to find out if programs are available in your area.
8. Centers for Independent Living. The term "center for independent living" means a consumer-controlled, cross-disability, non-residential private non-profit agency that is designed and operated within a local community by individuals with disabilities and provides an array of independent living services. These centers provide information and referrals on how to get funding in your area. To locate a center near you, visit www.ilru.org/html/publications/directory/index.html
We're frequently asked to help locate funding for clients residing outside of Florida. If you know about other funding sources for home modifications that are particular to your locale or state, we'd all love to hear about it.
If you're 55+ years old and plan on remodeling your home, you may want to include some universal design features that will not only make your life easier as you age but will also enhance your home's value.
1. Adapt the lower floor of your home for one level living where possible. This includes a full bathroom
and laundry area on the first floor.
2. Use hard flooring surfaces like wood, laminate, stone or tile. Carpeting often becomes an obstacle to
those using a walker or a wheelchair.
3. Increase the doorway widths to a minimum of 36". Wider doorways work for everyone whether
maneuvering strollers, carrying laundry baskets & other bulky items, or accommodating a wheelchair.
4. Use light colors when decorating. Lighter colors are easier to see and contrasting light colors help with
depth perception issues.
5. Install handrails on both sides of stairs.
For the Kitchen:
1. Install cabinets with pull out lower shelves and adjustable upper shelves; use easy to grip knobs or pulls.
2. Vary the height of your counters - some counters can be as low as 30" (table height) while others can be
the more standard 36" height. This allows ease of use for all ages and physical abilities.
3. Choose colored or patterned borders at counter edges.
4. Install task lighting under cabinetry
5. Purchase a side-by-side or drawer refrigerator and a cook top with front controls. Look for the newest
trends in pull out dishwashers and drawer microwaves.
For the Bath:
1. Install a stall shower with no threshold or a low threshold for ease of entry; consider a built-in shower
2. Use non-slip tile for shower and bath floors.
3. Place designer style grab bars at shower entry and along side walls.
4. Replace your standard height toilet (15") with a comfort height (17") one. Those 2" make a great
difference for those with back problems or with any physical disability.
5. Replace old faucets with lever handled faucets.
A NORC, A Naturally Occurring Retirement Community, is a demographic term used to describe a community not originally built for older adults that now has a significant proportion of residents over the age of 60. These communities were not originally created to target the needs of Seniors living independently in their homes, but rather evolve naturally as adults age in place.
NORCs exist in single family neighborhoods, subsidized housing complexes, private condos or co-ops, and apartment buildings. They can be grouped into two main categories: housing-based or vertical NORCs which are found in apartment buildings or complexes, and neighborhood-based or horizontal NORCS which are found in neighborhoods comprised of single or two-family homes.
3 factors contribute to the evolution of a NORC:
1. Residents deciding to remain in their homes as they age
2. Seniors moving to specific locales where they have access to climate, services and amenities appealing
to their age group
3. Younger residents moving out of an area for either job or family related reasons
So why would those of us interested in aging-in-place care about a NORC? Because the population density of older residents creates an opportunity to develop targeted services and programs that enable adults to remain in their homes and neighborhoods as they age and their needs change. Similar to a Home Owners Association (HOA) where dues are collected to pay for certain services, ie lawn mowing, roof replacement, exterior painting, a NORC can form an organization to offer support services designed to specifically meet the needs of its residents.
Best estimates place the number of communities in the United States that could be classified as NORCs in the thousands. AARP estimates that more than 25% of Seniors currently live in NORCs.
On example of a NORC is Boston's Beacon Hill Village. It got started when its first president, Susan McWhinney-Morse, discovered that she had an aversion to the idea of taking older people out of the community where they had lived for years "in order to cluster them where they could be warmer and play golf". She has lived in Beacon Hill since 1964 and raised four children there. She and 11 other longtime residents created a membership organization for people aged 50 and older to help them stay in their homes as long as they wished. Almost 500 members pay annual dues of $600/year for an individual or $850 for a household (with membership subsidized for those who can't afford it). The yearly budget, about 40% of which is provided by donors and foundations, provides services that include grocery shopping and home maintenance. Beacon Hill now has a staff that acts as a concierge service of sorts. The staff connects people to caterers, dog walkers - any service requested. The group also refers residents needing home health care services to a provider it has vetted and with which it has negotiated discounts.
Contrast the Beacon Hill NORC with the 1st NORC program which was established in 1986 at Penn South Houses and supported by UJA/Jewish Federation of NY. This NORC in Manhattan is a 10 building, 2,800 unit, moderate income housing co-op. The $15 a year membership dues combined with grants and city and state funding provides most of the program's annual budget. That money pays for wellness programs, cultural services, on-site nurses, social workers and other health professionals.
The funding for NORC programs generally comes from some mix of private and public sources, combining revenue and income from residents, philanthropies, government agencies, and corporations. The programs are the result of partnerships with local community housing and neighborhood organizations, health and social service providers, non-profits and businesses. Scope of services offered can include referral services, emergency and preventive health care programs, meal programs, transportation assistance, educational programs, social activities, information and counseling, and home modifications. The NORC model is designed to enhance existing services while responding to any gaps in the senior service network.
And while each NORC program may provide a unique scope of services, they are all designed for one purpose - to maximize the health and well-being of the residents so they can maintain independence and stay in their homes for as long as possible.
The idea of Seniors banding together and taking the initiative to create service programs designed for the greater good of their own neighborhoods is extremely appealing. In fact, Seniors play a critical role in a NORC program's success for they are not only the clients but also the program developers, leaders, supporters, and ambassadors as they work to define and integrate appropriate services into their communities. Power to the People !!
As the concept of the Accessory Dwelling Unit (ADU) has been developing, so has that of the tiny or little house. A well designed little house is like an oversized house except all the extra space is removed. Superfluous space is considered a burden so anything not working towards meeting specific needs or enhancing quality of life is removed. All space is designed to be strictly functional.
Jay Shafer has been building tiny homes ranging in size from 50 to 750 square feet since 1997. These tiny houses include living and sleeping areas, kitchens and bathrooms. Jay's decision to focus on small, hand-built houses has more to do with minimalism, sustainability, efficiency and affordability than it does with creating a housing model for seniors but the principles could certainly be applied and the floor plans modified to suit an older client. Prices for a tiny house vary with size and amenities. A basic one room summer cabin might cost $15,000 or less. Spending at least $30,000 will allow for a year round home complete with working bathroom and kitchen.
On his website www.tumbleweedhouses.com, Jay writes that "How each house gets used depends on the occupant's particular needs. What one person would enjoy as a quiet studio in their backyard, another couple might choose to inhabit as a full time residence. What some people see as the perfect weekend hideaway in the country, others will use as a beautiful free-standing addition to their existing home for accommodating an elderly parent, an adult child, guests, or as office space."
From the Tumbleweed Tiny House 2010 Catalogue
Model: Whidbey Total Square Feet Including Optional Bedroom: 557 square feet
The Whidbey's kitchen includes a dishwasher, full size range with oven and built in microwave. The tank-less water heater is tucked away out of view and there is a washer/dryer combo in the kitchen. If the front steps were removed to create a zero step entry and the bath expanded so as to include a walk-in shower, this little house could easily serve as a choice for aging-in-place. Cost:Materials for the one bedroom version are approximately $43,000 and with the optional bedroom $50,000.
In 2005, after many homes in the Gulf Coast were destroyed by Hurricane Katrina, architects were challenged to design some low cost emergency housing. Marianne Cusato built the original 308 square foot Katrina Cottage which became a prototype and was later adapted to about two dozen versions designed by a variety of architectural firms.
Lowe's teamed with designer Marianne Cusato to create this, first of its kind, Katrina Cottage located in Ocean Springs, Mississippi. Lowe's now offers prepackaged Katrina Cottage kits including plans and all materials for construction.
Katrina Cottage - Original 308 square feet
Katrina Cottages are typically small, ranging from less than 500 square feet up to about 1,000 square feet. While size and floor plans vary, Katrina Cottages share many features. They are mostly prefab houses constructed from factory-made panels and can be built quickly and economically. Several of the cottages have options that allow them to be expanded over time. The cottages were designed with durability in mind and meet both International Building Code and most hurricane codes.
The living area of this Katrina Cottage has no interior walls. Instead square pillars and long curtains frame a space used for sleeping. The Murphy bed can be folded up against the wall during the day.
Katrina Cottage - Expanded Version 517 square feet
Designer: Geoffrey Mouen
This Cottage is equipped with a generously sized
dressing area to add efficiency and comfort for the
Like Jay Shafer's tiny houses, the Katrina Cottages need "tweaking" in order to work for those who want to age-in-place. Raised porches and stepped entrances need to be eliminated. Bathrooms need to be enlarged to allow for ease of maneuverability and bathroom fixtures need to be carefully selected for safety and comfort. With some minor adaptations, however, these smaller homes are a strong addition to the Senior housing market.
With 78 million baby boomers beginning to retire, the stock of accessible housing with need to expand -- but to what? More 55+ retirement communities OR mixed use walk-able neighborhoods with a variety of housing styles, sizes and amenities? Hi-rise condos OR communities of tiny houses? Construction of new housing declined sharply as the real estate market collapsed in 2007 but when the market starts to recover, what trends will we see in housing being marketed to seniors?
First let's define accessible housing. The word "accessible" usually conjures up images of people in wheelchairs or with some mobility issue. However when used to describe housing, the term generally refers to housing which is designed to be functional for the people living there. Accessibility includes all the features in a home that allow every member of the family to perform all the functions anyone else performs. That would include entrances without steps, bathrooms large enough for everyone to move around in, showers and tubs that are not difficult to enter, wide doorways and hallways, and counter tops and cabinets that everyone can reach.
You'll also hear the terms universal design and multi-generational housing applied to accessibility. A house based on the concept of universal design will allow all members of the family and any visitors, young and old, to use all spaces comfortably, safely, and independently. Universal design extends beyond structural features like wider doorways and roll-in shower stalls to include appliances, household equipment, and even product packaging.
So what are some of the new housing models we're beginning to see and how do they fit into the concept of accessible housing for seniors? The most interesting to me are the tiny houses and the ADUs (accessory dwelling units). You might have already read about these ADUs which are being marketed to consumers as MEDCottages (aka Granny Pods) and prefab In-law units. The self-contained, prefab in-law unit ranges in size for 300 to 1800 square feet, includes features that support aging in place, and incorporates universal design along with electronic monitoring and medical care equipment options. All are pretty much built in a factory, prepared for on-site assembly, trucked to your location and set on a foundation.
FabCab is a timber-frame prefab In-law cottage with universal
An advantage to using a modular unit for an add-on apartment is that it can be disassembled into a few intact sections that can be easily relocated -- not really a viable option for a stick-framed addition.
Another entry into the ADU market is the MEDCottage, basically a mini mobile home that rents for about $2,000 a month. You can park one in your backyard, hook it up to your water and electricity and it becomes a free standing spare room for your elderly parents. The State of Virginia is so solidly behind this concept that the State government eased zoning restrictions so as to allow more of these units to be placed in neighborhood backyards.
The inventor of the MEDCottage, Rev. Kenneth Dupin, says that the MEDCottage was designed with a floor plan and technology that appeals to Americans' independent nature. The goal being to extend independence for people who otherwise would be placed in a nursing home. These ADUs are complete with a kitchen, bedroom and bathroom as well as options for advanced medical monitoring equipment. Technology includes: safety lighting along the floors, a lift that can move an immobile person to the bathroom, and monitoring systems that let you remotely check temperature and heart rate, among other things.
MEDCottage exterior MEDCottage interior view
So what are some of the benefits of ADUs? "From many angles, the ADU concept is a sound one," says Susan Duncan of the National Resource Center on Supportive Housing and Home Modification at the Ethel Percy Andrus Gerontology Center at the University of Southern California. "An ADU occupies the same space as an apartment but makes it into a private, freestanding home. Privacy is something we all strive for. And families are happier because the TV can be as loud as you want without disturbing the grandkids doing homework."
As for the downside, since these prefab room additions are relatively new, we don't have sufficient cost data to compare this type of construction, delivery and installation against more conventionally built home additions. Also there is concern that with families being so busy today, the opportunity for the ADU resident to socialize will be limited unless careful planning is done to ensure adequate chances to be around other people. "It might seem a bit odd to park your loved one in a shed in the backyard," says Dupin. "Still, having the family nearby and maybe having grandchildren running in and out of the Cottage could potentially improve an elderly person's quality of life."
ADUs may not be for everyone but they will be a viable alternative and part of our housing choices in the future.
Grab Bars. Just those two little words send people running. For some reason there is a stigma attached
to this very practical product. My older clients think grab bars are a mark of infirmity. My younger
clients think they don't yet need them. Truth is, all grab bars do is provide something solid to hold onto should your shower or tub floor get slippery. Grab bars are a much safer alternative to the bars on your glass shower doors or the ceramic towel bars mounted in most bathtub/shower configurations. If you
had to grab one of those shower door bars to keep yourself from falling, you'd most likely pull the door
onto yourself. If you grabbed the standard wall-mounted ceramic towel bar, you'd pull it out
of the wall. Neither scenario is a particularly pleasant one.
Maybe the aversion to grab bars results from the fact that the ones we mostly find in the local building supply stores are institutional looking: stainless steel, rounded and thick. There are actually a number of new grab bar choices that can more stylishly integrate into your home design.
Let's start with color. Grab bars now come in a range of colors including black, red, blue, green, yellow, pink, tan and white. There's nothing institutional about these bars:
Not only does a colored bar liven up the bathroom and offer some design opportunities, when placing a colored bar on a contrasting wall these bars can also be seen more easily by anyone who is visually impaired.
Next there are numerous finishes, in addition to polished chrome, to match the existing hardware in your bathroom.
Don't like the straight bars? There are some interesting shapes to choose from.
This grab bar folds back to the wall
And also varied functional combinations.
Here's a circular grab bar with an integrated soap dish
Here the grab bar has an attached towel bar
Remember though, that a grab bar is only as good as its' installation. If not installed properly, it will
give you no more security than that shower door handle or ceramic towel bar. There are special anchors
that can be used to mount a grab bar on a wall that does not have proper blocking. Look for WingIts®, recognized as one of the world's strongest fasteners, which can be found in your local building supply
store or online. These fasteners allow for grab bar placement virtually anywhere and can be installed through drywall, tile, acrylic or fiberglass tub surrounds. The nice part is that these anchors eliminate
the need to tear open and reconstruct walls and substantially reduce the cost of proper grab bar installation.
All of us who work in the field of Elder Care are aware that the biggest obstacle to successfully keeping people in their homes is denial. If we can’t get our clients to acknowledge their own limitations, all the professional services we offer are useless. And this refusal to accept the obvious extends far beyond the senior population. Baby Boomers (and I can speak to this as I am a Baby Boomer myself) definitely don’t want to talk about aging. We live in a society that treasures youth, so Boomers put more energy into staying young than preparing for their future. Unfortunately, the attitude of “not me” is more prevalent than not.
I’m reminded of a client: a man in his late 80’s who still managed the stairs in his 3 story townhome. I was called in to check for safety issues particularly as related to areas that might precipitate a fall. Aside from there being no grab bars in his shower, slippery type tile on the shower and bathroom floors, and lack of a handrail on one section of the stairs, the old shag carpeting on all 3 flights of stairs was coming loose and buckling in several locations. When I suggested that the stairwell carpeting needed to be replaced so that he wouldn’t trip and fall down the stairs, he balked. I don’t need any help,” he said. “Look at what I can do.” He then proceeded to launch into a half dozen jumping jacks to show me how physically fit he was. Once I explained that safety had little to do with age, that a child could trip on loose stair carpeting, and if he fell that, in itself, could spell the end of his independence, he settled down to listen.
Here are a few facts relating to falls:
- One out of three adults age 65 and older falls each year.
- Falls are a primary catalyst for hospital admissions among Seniors, and many of the Seniors admitted to a hospital never go home.
- Adults over the age of 65 have a very high rate of injury due to falls. In fact, falls are the leading cause of brain injury in this age group.
- Falls are responsible for over 40% of nursing home admissions.
- 70% of accidental deaths in people over 75 yrs of age are caused by falls.
- Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling.
So what can we do to protect our independence and reduce the chance of falling in our homes?
1. Reduce tripping hazards – remove books, shoes, laundry, and toys from stairs; make sure electrical
cords run along the walls and not across the room
2. Install handrails on both sides of stairs and steps.
3. Increase the lighting and the top and bottom of the stairs; put bright lights over all porches and
4. Frequently used items should be stored in easy-to-reach places so that using a step stool or chair is
5. Small rugs are a hazard. Either remove them completely or tape them to the floor with double stick tape.
6. Have nightlights in the bedroom, hallways and bathrooms.
7. Use non-slip strips, non-slip coatings, or non-slip tile in bathtubs and showers
8. Install grab bars in showers and tubs
Falls can happen to anyone, but as we age the likelihood of accidental falls increases and becomes a challenge for those wishing to remain in their homes. Evaluating your home now and implementing the safety measures mentioned above, can substantially reduce the chance of long term injury in the future.
As the old saying goes, "An ounce of prevention is worth a pound of cure."
We frequently get calls from out of state family looking for assistance for older family members who live here in Florida. In most cases the parents want to stay in their homes while their adult kids think it might be time to bring them back to live with them or move them into assisted living. We're initially asked to go into the parents' home to evaluate the physical layout for safety, but in time the conversation turns to the need for additional resources. Assistance might be needed for anything ranging from help with simple tasks like shopping, driving, and cooking to those involving personal hygiene and companionship.
Enter the home health agencies who offer a range of services designed to meet the needs of those who are aging or dealing with chronic illness. In South Florida alone, there are over 1,000 private home health agencies licensed to provide private duty home health care to people in need. That number is staggering. How do you decide which to use for care? How do you begin to compare the level of services offered and evaluate the quality of those services? What questions should be asked before bringing a stranger into your home?
I asked Scott Greenberg, Statewide Board Member of the Florida State Guardian Association and Vice President of the local chapter, Member of the Legislative Committee of the PBC Partnership for Aging, and President of Comforcare Home Care, a private home health company, for help in answering these questions.
"There really are differences in agencies and finding the right agency for you can be daunting but taking the time to make an informed choice is very important," says Scott. He suggests beginning with the following questions when interviewing potential providers:
- How long has your agency been in business? Is this your primary business or one of many types of services you provide?
- Do you provide an assessment of a client's needs by a nurse or other licensed professional? If so, is there a fee?
- How do you screen your caregivers? How do you match them to a client?
- How are your caregivers trained and do they receive any specialized training beyond the state requirements?
- Are your caregivers bonded? Are they covered by workers compensation? Do they have liability insurance?
- What procedures do you have in place if a caregiver is late or calls in sick?
- What funding sources does your agency accept? Do you require a deposit? Will you accept assignment from my Long Term Care Insurance or will I have to pay you and wait for reimbursement from my insurance company?
- What are your rates and are there differentials for nights, holidays and weekends? (more questions..)
I then asked Scott to explain how his own agency is an example of quality service so as to better understand what to look for when evaluating other companies.
"All our caregivers are our employees and covered by workers comp, bonded and covered by both supplemental auto and liability insurance. We provide references on request and can even arrange an interview with a caregiver if desired prior to providing service. We conduct specialized training in areas such as Jewish Cultural Traditions as well as keeping kosher for those to whom that is important. We contracted with the Alzheimer's Association to conduct a higher level of training for our caregivers than the state requires. 20 years of combined experience, advocating for senior causes, and being an active volunteer in the community is a differentiator for us and you should look for help from people with that same level of commitment to excellence."
Let's remember that aging in place is an achievable lifestyle choice that might require some additional help where necessary. Combining a safe and comfortable home environment with appropriate home health care will allow most seniors to stay in their homes rather than having to move into a facility.
Whether we like to think about it or not, every one of us will have to decide where we want to live as we age and become more frail.
Each time I give a presentation or workshop I ask the question, "How many of you want to move into a nursing home when you get old?" Not one hand is raised in answer. The truth is that I've not met anyone who would prefer to move into a nursing facility if they had a choice. The overwhelming response is that people want to stay in their own homes for as long as is practically possible.
And staying at home can be a financial savings. The average cost for assisted living these days is upwards of $80,000 a year depending on what area of the country you're in. In contrast, modifying your home so you can remain there safely and in comfort is substantially less expensive. Some safety modifications like grab bars, good lighting, handrails, and portable ramps cost less than $1,000. Other age-in-place renovations that would rearrange your interior to accomodate more comfortable usage might cost anywhere from $3,000 on up. Even more extensive bathroom renovations can be done for well under $20,000. The point is that creating a home that you can live in for your lifetime is a one-time expense costing far less than 1 year in an assisted living facility.
So what are some common obstacles to remaining safe and comfortable in your home? Stairways, steps, narrow doorways and hallways, standard bathtubs, lowboy toilets, tiny bath and powder rooms all become issues. Every time I'm called in for a consultation, I'm asked to first look at the bathroom which can no longer be comfortably maneuvered, after which I'm shown some array of stairs that have become difficult to manage.
The good news is that with 10,000 people turning 65 years old each day, architects, designers, builders, and manufacturers are acknowledging the needs of this powerful group and are working to offer new home designs and products that will appeal to the lifestyle of today's Baby Boomer and Senior.
The best way to deal with those infirmities in all our futures is to plan for them now. Cynthia Leibrock, who has taught courses in architecture at Harvard University and is an age-in-place advocate, has said that one can eliminate disability by design. It's a great message and within all our powers to accomplish.