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Long Term Care: When to Plan and How to Pay

Long-Term Care: When to Plan and How to Pay
 
Preparing for the possibility of long-term care for a loved on is a scenario no one wants to envision. But, with  63% of seniors needing long-term care, everyone must consider it. As we grow older, it’s wise to put a plan in place to ensure our aging loved ones will be cared for in the best possible way. While you may be open to being a caregiver, taking on the role unexpectedly can be a considerable burden. This article will help you understand steps to take to plan and pay for long-term care.
 
Planning for Long-Term Care

When you help a friend or family member make decisions about the possibility of long-term care, it won’t be easy. It can be hard for our aging loved ones to accept the potential of needing in-home care or moving into an independent of assisted living facility. However, make sure to point out to them that by planning, they have a substantial say in their future. You have time to:
●     Examine family history to see what kind of care may be needed. For example, if your loved one has had more than one close family member — like a sibling or a parent— diagnosed with dementia, their risk increases significantly.
●     Start making healthy lifestyle choices that will postpone or prevent some of the common conditions that cause seniors to need long-term care. A healthy diet and daily exercise, along with quitting smoking and limiting alcohol, can add 5, 10 or even 15 healthy years onto a life.
●     Reduce the chance an in-home injury could occur by installing non-slip flooring in bathrooms and kitchens, moving bedrooms to first floors or installing a stair lift. More than 3 million seniors go to the ER each year due to accidents in the home. Not only could an injury due to a slip or a fall require physical therapy to recover, but it could also result in the long-term consequences of a traumatic brain injury (TBI).
 
Planning for long-term care is part predicting the future and part preventing it. Help your loved one understand that planning is a type of prevention. If you take steps to prepare for the worst-case scenario, you’ll actually be focusing your energy on how to make their golden years the best years yet.
 
Paying for Long-Term Care

Deciding on ways to pay for long-term care is crucial if you want your planning to make a difference. If your loved on is adamant they have in-home care, but the two of you don’t work out how to cover the costs, they could be facing a great deal of disappointment when the time comes. Figuring out how to pay for long-term care means looking closely at insurance and assets.  
 
Once they understand their insurance options, the next step in planning for costs involves helping them analyze their assets and cash flow. This can be an uncomfortable conversation, especially for seniors who come from a generation where finances are an extremely private matter. Emphasize this is a judgment-free conversation, focusing on helping them free up funds for long-term care by:
●     Including long-term care in their retirement planning, from deciding when to retire to how much they will need to put into a 401(k).
●     Considering a reverse mortgage, which involves understanding the pros and cons. On the one hand, a reverse mortgage will give your loved one cash in-hand without needing an excellent credit score rating. This can help with making home modifications for accessibility or hiring an in-home caregiver. On the other hand, there could be negative implications to their estate or a spouse or partner who will remain in the home after they leave.
●     Selling a life insurance policy is another way to pay for long-term care’s costly daily expenses and medical support. If care isn’t needed, then the policy stands as-is. Many seniors consider this option to be a win-win.
 

As our life expectancies increase, so does the potential for long-term care. It’s scary and even overwhelming for seniors to think about, so knowing they have the support and guidance of a caring friend or family member means a lot. Your loved one deserves to feel loved in their golden years. Planning for long-term care— even if it is never needed— provides invaluable peace of mind. 


Article by June Duncan, the co-creator of the website Rise Up for Caregivers, which offers support for family members and friends who have taken on the responsibility of caring for their loved ones. She is author of the upcoming book, The Complete Guide to Caregiving: A Daily Companion for New Senior Caregivers.

Benefits of Hiring an Accessibility Specialist

If you or a loved one are reaching the point in life where either a move or upgrades to a current home is necessary, working with an accessibility specialist can be like finding a pot of gold at the end of the rainbow.  

Maybe you or someone you know would like to be more independent but are having difficulty maneuvering the barriers found in most homes. Narrow doorways, stairs and steps, standard bathtubs, slippery floors are all common barriers to safety that most people struggle with as they get older.  An accessibility specialist can help with these issue. These professionals deal with all of the aspects of home remodels in order to allow those who are aging but don’t want to move away from their home, or those with disabilities but who want to maintain their independent living conditions succeed in their desires.  Although there are a large number of independent and assisted living facilities available in most areas, an overwhelming number of people would prefer to spend the golden years of their lives in the home where their children may have grown up, or where they’ve created decades of good memories and connections.  
 
If you do need some help, who should you call?  What type of training should an accessibility specialist have?   There are only a few programs that offer specialty training in designing and remodeling home environments so as to help those who choose, remain in their homes safely and comfortably. There is more to this than meets the eye and these specialists have learned to look not just at a specific environment but also the people who will be living there. This is precisely what differentiates an accessibility specialist from a contractor - their ability to link specific ailments with specific solutions and to project long term changes as one ages that might affect ones safety and independence within a home environment.  Keep in mind that even simple things like grab bars should be installed based on an individual's physical condition.  

The National Association of Home Builders offers a short course known as the Certified Aging in Place Specialist (CAPS), designed to train contractors in the technical and business management side of renovations as well as the customer service skills which are needed for these types of transaction. 

The University of Southern California Leonard Davis School of Gerontology offers an online course in Home Modifications, dedicated to promoting aging in place and independent living for persons of all ages and abilities. This five week program covers home assessments and safety checklists, construction techniques, funding resources, and also includes required coursework in the ethics of dealing with a vulnerable population.  After successful completion, the Program grants an Executive Certificate in Home Modification (ECHM).

What can you expect once you’ve located a trained accessibility specialist?  The Specialist will meet with you in your home to help define your needs, and then complete a full written assessment that includes suggestions for improving safety and comfort.  Recommended changes will vary widely from home to home, based not only on home layout but also on each individuals physical requirements as well as budget realities. Afterwards, you will be shown some plans and/or be given written suggestions to suit both your short term and long term needs. Depending on the size and complexity of your project, you may be offered a floor plan which will help you to visualize the concept in the way that it will appear once complete.  The suggestions can include every aspect of your home living, both inside and out.  For example, a ramp leading up to your home will help with stairs if they become hard to navigate or if you have to use a wheelchair.  Seats in your shower along with an accessible and removable shower head, lowered shelves to hold grooming supplies and a handle to help you in and out of the tub or shower unit can all be changes that will help accommodate your right to privacy and good hygiene. You might also need to think about expanding doorways, adjusting the height of your countertops, or making storage more accessible.  Arrangements can be made to reconfigure or bring in specialty equipment for ease of use.  It’s possible that your floors may need to be changed (from a deep pile carpet which can catch wheelchairs or even cause a tripping hazard) to low pile carpets or laminate for better traffic movement.  Better lighting can help you see in the dark, and motion sensor lights can alleviate the need for reaching for light switches.  There are so many different things to think about that someone trained in the process will help to ensure nothing is overlooked and can make suggestions that haven’t even entered your mind.  Renovations can be a large expense and quite the production; you want to get it done right the first time.  Your accessibility specialist will also give you an estimated budget for the renovations you’d like done so that you can determine which are affordable and which ones might need tweaking.

Since most accessibility specialists have dealt with numerous renovations, they can often lead you to competent and efficient businesses and contractors able to handle the suggested modifications.  From electricians to carpenters to plumbing suppliers, an experienced accessibility specialist has set up a good relationship with a variety of tradespeople and can let you know which ones will be right for your particular job and one that will do the work based on your budget.


Article by Jon Reyes, a guest writer from Vidalux. Jon is a specialist writer and has extensive knowledge in everything related to steam showers, saunas and hydrotherapy benefits.

10 Common Home Barriers that Challenge Aging in Place, Part 1

The longer I am involved in helping people remain in their homes as they age, the clearer the repeating issues become.  I have found that there are 10 barriers within a home that consistently challenge everyone as they get older.  These barriers wind up causing safety issues because as we age our ability to maneuver safely around them diminishes.  


In the next few blogs I am going to address all 10 issues.  This, Part 1, will tackle the top three:

1.  STEPS AND STAIRS - This refers to both exterior and interior steps. In a perfectly designed home for aging- in-place there would be no stairs or steps anywhere. In Florida many single story homes, while designed for retirees, were designed with changes in floor level. Consequently,there might be a step or two from dining to living room or steps down leading from an entrance hall to the rest of the house.  With aging comes deterioration of our vision and depth perception making these areas particularly unsafe.

The solution for both singular steps and flights of stairs are railings, stair treads that delineate stair edges, and upgraded lighting.  You'll see in the pictures below some examples of these solutions that include battery operated lighting particularly useful for stairs, and colored stair treads which work well on exterior stairs - both inexpensive solutions to major issues.  

                    
         



    


 


                                         STAIR TREADS

BATTERY OPERATED LIGHTING


For those who can no longer manage stairs at all, in addition to standard portable sutcase ramps there are numerous threshold ramps that are lightweight, some of which adjustable so they can adapt to 1 - 4 steps, and can be easily moved from front to side or back doorways.


                                 

                                                







                                     




FREE STANDING THRESHOLD RAMP               LIGHTWEIGHT SUITCASE RAMP


2. NARROW DOORWAYS - For a doorway to be accessible and comfortable to get through while in a wheelchair or using a walker or when helped by a companion, it needs to be at least 32" wide.  Many interior doorways would fail that test!  In Florida we face a common issue of 24" bathroom doors.  Once one can no longer walk through a doorway unaided, a 24" doorway is extremely uncomfortable if not impossible to maneuver.  
 
The obvious fix is to enlarge the doorway by cutting the wall so as to widen the door opening then install a new door, preferably a pocket door which allows for complete access.   Keep in mind that to do so may also require shifting the vanity location which is often located adjacent to the bathroom door, so while this may be the only option available it is also a costly one.  An inexpensive option which may prove helpful is to swap the existing door hinges with swing away ones. These will allow for an additional 4" of clearance when getting through a doorway since these hinges allow the door to swing clear of the jamb and set it tight to the wall.  The pictures below show both options.











SWING AWAY HINGES TO REPLACE EXISTING DOOR HINGES

                            


     

                   

                 


SPRING ACTION POCKET OPENER/CLOSER





POCKET DOOR


3. TOILETING- Why oh why were standard toilets designed at the height they are?  One does not have to be old to have difficulty standing up or sitting down on them.  Just ask anyone with a bad back or a knee injury how comfortable those efforts are. The CDC has released a study showing that 75% of falls in adults over the age of 85 occur in the home and of those falls 52% occur in the bathroom around toileting.  

The solution is to replace your older standard or lowboy height toilet with a comfort height one.  Comfort height toilets are 17" high compared to 14-15" height of a standard one and those 2-3" really make a difference.   Are these toilets expensive?  Not really.  Both Kohler and American Standard offer comfort height toilets starting at about $200.  Just make sure when shopping you use the term "comfort height" and not ADA.  As soon as the salespeople hear ADA they search for an unnecessarily expensive and specifically designated toilet.

If a 17" height is still not enough, a toilet riser (basically a little platform) can be built under the toilet to bring it to a more comfortable height.  You will see pictures below of varied toilet configurations.


            


               

      






COMFORT HEIGHT TOILET           TOILET PLACED ON FLOOR RISER


Another options to install a wall hung toilet, a more popular choice in Europe than in the U.S. The benefits of a wall hung toilet are that one can set the height to individual preference and cleaning under it is easy.  These toilets also take up little room in a bathroom as opposed to a floor mounted toilet which usually has a much larger footprint than the toilet bowl warrants.

Note: for those who require additional help when maneuvering on and off a toilet, wall mounted grab bars can be set on either side of the toilet on the wall behind it.  These bars function like the arms of a chair and offer great security for those with either balance issues or when transferring from wheelchair or walker to toilet seat. There are a couple different styles differing widely in price.  


                  

















MODERN FOLD DOWN BARS               TRADITIONAL FOLD DOWN BARS
                                                      TOILET ON CUSTOM BUILT FLOOR RISER




Next:  Part 2, Commonly found barriers within a home #4-6  




  Susan Luxenberg
  HomeSmart LLC

Home For the Holidays 2014

Note:  I originally published this post a couple of years ago, but believe the information is important enough to re-post each year at holiday season.  Statistics remind us that fall prevention is key to independence as we get older, and features in a home that pose no problem when we're at our physical best often become more difficult to negotiate with aging frailties.   


It’s holiday time which means that you may be either visiting or being visited by your parents.  This is a perfect time to assess your parents’ safety and comfort whether in your home or theirs. 

I recently gave a presentation at a senior complex and spoke about safety concerns that could be found in almost every home.  That triggered a lively conversation about the problems these seniors encountered when visiting their kids:  no grab bars in the bathroom, slippery shower and tub floors, no place to sit down when showering, steps that were not clearly delineate, stairs without handrails, or poorly lit hallways or staircases.  Most of those I spoke with said that they were reluctant to ask their adult kids to make any permanent changes to their own homes or install any special equipment, etc.  I have no doubt that if their kids thought about it, they would be happy to provide their aging parents with safer, more comfortable surroundings.  And truthfully these modifications would benefit everyone in the home. 

So here’s a simple list.  None of these items are costly and all can be done quickly:
 1.    Reduce tripping hazards by removing books, shoes, laundry, and toys from stairs; 
       ensure there are clear pathways through all rooms  
2.    Install handrails on stairs and steps; bright colored tape can be applied at the edge 
       of steps and stairs to delineate floor level changes. 
3.    Increase the lighting at the top and bottom of the stairs; put bright lights over all 
       porches and walkways 
4.   Store frequently used items in easy-to-reach places so that using a step stool or 
      chair is not necessary. 
5.   Small throw rugs are a hazard.  Either remove them completely or tape them to 
      the floor with double stick tape. 
6.   Have night lights or battery operated lights in the bedroom, hallways and
      bathrooms. 
7.   Apply non-slip strips or non-slip coatings in bathtubs and showers  
8.   Install grab bars in showers and tubs, appropriately anchored (no suction ones, 
      please!!)
9.    Purchase an inexpensive shower bench or chair which can be taken in and out of the 
      tub or shower as required.   

 After all, an injury from a fall is one the biggest dangers the over-65 population faces and one that often results in a loss of independence.  Implementing the safety measures mentioned above can substantially reduce the chance of injury to your parents and allow for a safer, happier holiday season for all.

Happy Holidays!


Susan Luxenberg, Pres.
HomeSmart LLC

Aiding the Caregiver

We talk about adapting or building homes for aging in place as being critical for safe and independent aging,   most often with the focus on the aging client themselves. Adaptations include replacing tubs (when climbing over a tub wall gets too difficult ) with walk in showers, or installing comfort height toilets to counteract the difficulties many people  encounter when getting up from a seated position, or adding bars that help with balance issues.  Without question, all of these measures contribute greatly to safety and independence as we age. It's important to acknowledge that creating a barrier free environment will also positively impact the types of caregivers we attract and the quality of care we may receive in the future.
 
We recently adapted a home for a client who required a wheelchair for mobility.  Her biggest problems centered around her bathroom.  Between the narrow doorway and overall configuration of the space, she was unable to get her wheelchair inside the bathroom, relying  instead on her caregivers carrying her (or more accurately dragging her) through the bath in order to use the toilet. She admitted that she had considered renovating her bath to accommodate her failing health, but as she explained, her caregivers were "wonderful and willing to compensate and carry her throughout the home when necessary." It came as an unpleasant surprise and rude awakening when one of her aides dropped her en route from doorway to toilet, prompting our client to call us for help.  Our initial conversations included her main caregiver who admitted she did not like having to carry our client at all and was worried not only about the client's safety but her own. She expressed that if we could not provide solutions to the restrictive bathroom configuration, she would need to resign for fear she would ultimately injure her client. 
 
So let's acknowledge that if we want to retain quality caregivers, we need to set up safe, easy to negotiate spaces not only for ourselves but for them as well. Caregiving is often a difficult, stressful job and the last thing any responsible caregiver wants is to cause harm to their loved one, or get injured themselves and unable to do their job.
 
And while we're on the topic of caregiving, I recently received an email from a reader who found himself thrust into the role of family caregiver when his wife was diagnosed with a rare and deadly cancer three months after giving birth to their baby daughter.   Happily, his wife ultimately won her battle and survived the ordeal.  What they went through however proved to be such an extreme learning experience for them both, that he wanted to share his thoughts about effective caregiving in the hopes it would benefit others.   
 
“In the beginning it was an intense whirlwind of emotion and confusion as I did not fully understand what exactly needed to be done.  I had to quickly learn what was required of me and go above and go beyond these requirements for my wife.  I had to remain strong for my wife, my daughter, and myself. 
 
During my trials, and the trials of the many other caregivers I met along my journey, many lessons were learned.  Here are some of the best tips for being a caregiver that I have learned from my experiences.
 
USE RESOURCES TO BECOME INFORMED
 
Knowing all the options you have regarding treatment and all possible outcomes will help you feel more prepared for any decisions you might have to make.  Write any questions you may have down so that you don’t forget them when you are with the doctor.  Remain organized with your information and your questions, and don’t be afraid to ask about even the most minor things. 
 
ESTABLISH PRIORITIES
 
Prioritize everything that needs to be done. You may find yourself overwhelmed with everything, but prioritizing will help you organize and can make the entire experience easier.   
 
ASK FOR HELP
 
Consider hiring and/or enlisting the help of others for those things you don’t absolutely need to be responsible for.  Friends and family are often eager to help, but they really don’t know what would be most helpful.   A little direction can go a long way.  Asking for and accepting their help can make things considerably easier on you and your loved one. This alone will go a long way towards lowering your stress levels and helping you focus on things you need to get done. 
 
TAKE TIME FOR YOURSELF
 
When a loved one is ill and everything falls onto you, taking some time for yourself can make you feel selfish.  This is not the case however and can actually be very beneficial.  Taking this time to unwind can lower your stress levels, and allow you to focus greater attention to your loved one as well as the many things that need to get done.  If you fail to take any time for yourself, your stress levels will remain high and your ability to do anything will be greatly reduced.
 
USE TOOLS TO REMAIN ORGANIZED
 
There are many things that can help you remain organized and focused.  Clutter and disorganization will lead to higher stress levels and an inability to fully understand what needs to be done and where priorities lie.  Keeping a notepad handy to jot down reminders will help immensely.  Keep all important paperwork and information sorted into folders in one place nearby.  This way you never find yourself frantically looking for that one piece of paper with the important information you need at the last minute. 


 
 Susan Luxenberg
 President
 HomeSmart LLC






 
 
 
 
 

 

Home for the Holidays 2012

Note:  I published this blog post last year around Thanksgiving but believe the information is important enough to post again.  Statistics remind us that fall prevention is key to independence as we get older, and features in a home that pose no problem when we're at our physical best often become more difficult to negotiate with aging frailties.    

It’s holiday time which means that you may be either visiting or being visited by your parents.  This is a perfect time to assess your parents’ safety and comfort whether in your home or theirs. 

I recently gave a presentation at a senior complex and spoke about safety concerns that could be found in almost every home.  That triggered a lively conversation about the problems these seniors encountered when visiting their kids:  no grab bars in the bathroom, slippery shower and tub floors, no place to sit down when showering, steps that were not clearly delineate, stairs without handrails, or poorly lit hallways or staircases.  Most of those I spoke with said that they were reluctant to ask their adult kids to make any permanent changes to their own homes or install any special equipment, etc.  I have no doubt that if their kids thought about it, they would be happy to provide their aging parents with safer, more comfortable surroundings.  And truthfully these modifications would benefit everyone in the home. 

So here’s a simple list.  None of these items are costly and all can be done quickly:
 1.    Reduce tripping hazards by removing books, shoes, laundry, and toys from stairs; 
       ensure there are clear pathways through all rooms  
2.    Install handrails on stairs and steps; bright colored tape can be applied at the edge 
       of steps and stairs to delineate floor level changes. 
3.    Increase the lighting at the top and bottom of the stairs; put bright lights over all 
       porches and walkways 
4.   Store frequently used items in easy-to-reach places so that using a step stool or 
      chair is not necessary. 
5.   Small throw rugs are a hazard.  Either remove them completely or tape them to 
      the floor with double stick tape. 
6.   Have night lights or battery operated lights in the bedroom, hallways and bathrooms. 
7.   Apply non-slip strips or non-slip coatings in bathtubs and showers  
8.   Install grab bars in showers and tubs, appropriately anchored (no suction ones, 
      please!!)
9.    Purchase an inexpensive shower bench or chair which can be taken in and out of the 
      tub or shower as required.   

 After all, an injury from a fall is one the biggest dangers the over-65 population faces and one that often results in a loss of independence.  Implementing the safety measures mentioned above can substantially reduce the chance of injury to your parents and allow for a safer, happier holiday season for all.

Happy Holidays!

  Susan Luxenberg
  President
  HomeSmart LLC




Recent Questions: Kitchen Lighting Levels

Question:  We are about to remodel our kitchen and want to incorporate universal design ideas for aging in place. We’ve read that we will need increased room lighting, but we don’t know how standard lighting is calculated let alone increased lighting.  Can you give us an idea of how to determine correct lighting for our new kitchen?

AnswerA well-lit kitchen layers and blends four different types of light: general or ambient lighting in the ceiling, task lighting over sink, cooking and work areas, display lighting in cabinets, and possibly some decorative lighting, like lamps, chandeliers, or wall sconces. The most important lighting to consider for the purposes of aging in place is both general and task lighting.

I recently worked with clients who also were remodeling their kitchen. They had already gone to a kitchen designer/contractor for a new layout but wanted me to review their plans with an eye towards aging in place, and one of the questions that came up was that of adequate lighting.  

My clients' windowless, 10’ x 12’, galley kitchen had a single ceiling fixture and there was no task lighting at all.  And while the new plan called for under cabinet lighting, there was no plan to change, or add to, the ceiling lighting

After researching the question of illumination levels, I found the simplest calculation to be 8.5 lumens per square foot – walls, ceiling, and floor included.  This calculation pertains to general lighting levels only and excludes any under cabinet lighting, which is considered to be task lighting.   

So here’s an example:

A 10’ x 15’ by 8’ kitchen has a walls/floor/ceiling surface area of around 700 square feet.  An 8.5 in/sf target suggests you might want to build in the capacity to generate at least 5950 total lumens.  A basic 50 watt PAR 30 bulb produces about 660 lumens, so I’d use about 9 of them to light up that kitchen.


As for task lighting, islands, areas over the sink and stove, and counter tops require more concentrated, direct lighting since they are work areas.  Every section of kitchen counter top needs task lighting. Such lighting can be provided by under cabinet lighting attached to the wall cabinets or by small pendant  

fixtures.  When planning for task lighting, remember to allow for separate switches rather than a single switch which will allow you to turn on only that counter top lighting that you need rather than all the fixtures at once.   
                                       
  
 
   Susan Luxenberg 
  President
  HomeSmart LLC

Home Safety Checklist

 June is Home Safety month highlighting the need for fall prevention within the home.  Just to set the stage,

  • 1/3 of the population over the age of 65 falls each year and the risk of falls increases proportionately with age.  Half of seniors over the age of 80 fall annually.
  • Those who fall are two to three times more likely to fall again.
  • About half (53%) of the older adults who are discharged for fall-related hip fractures will experience another fall within six months.
  • Falls are the leading cause of death due to injury among the elderly 87% of all fractures in the elderly are due to falls.    
  • 55% of all falls take place inside the home.

Outside of our homes we often have to deal with uneven pavements, crossing lights that change too quickly and force us to hurry, sidewalk and step materials that get slippery when wet, stairs without railings, and poorly lit entrances to name just a few commonly found 
hazards.   Our homes, however, are under our control which gives us the opportunity to remove risks to our safety.   So what can we do within our homes to reduce unnecessary hazards that contribute to our risk of injury and falls?  

Home Safety Checklist

EXTERIOR ENTRANCES AND EXITS

 Check driveways, sidewalks, and walkways to make sure they're free from cracks and 
  uneven surfaces
 Steps should have a non-slip surface
 Handrails are installed on both sides of stairs 
 Install outdoor lights at all entrances
 Outside walkways and sidewalks should be well lit
 Make sure the entrance threshold is not a tripping hazard
 Door knob, lock, key, peephole & package shelf all work and are easy to use
 Place stickers on glass patio doors to prevent walking into them

KITCHEN AND BATHROOMS

 Sinks & tub faucets, shower controls and drain plugs are accessible & manageable
 Under sink hot water pipes are covered
 Task lighting is sufficient
 Grab bars installed in shower/tub area
 Non-slip treads or coating installed in shower/tub
 Mirror height is appropriate to sit & stand
 Kitchen shelves are reachable without step stool
 There is a surface adjacent to stove for hot food placement
 Scatter rugs are secured with non-slip, double sided rug tape
 Adjustable height shower head is installed
 There is a fire extinguisher in the kitchen

INTERIOR DOORS, WINDOWS, STAIRS, HALLS

 Doorways are wide enough for entry
 All windows and patio doors open easily, are easy to lock & operate
 Stair railings run full length of stairs on both sides and extend slightly beyond them
 Stairs have adequate lighting
 Light switches are installed at the top and bottom of stairs
 There is contrast/texture for floor level changes
 Doorway thresholds are not a tripping hazard
 Runners and scatter rugs have non-slip pads or rug tape
 There are clear pathways in all rooms
 Carpeting should lie flat and be securely fastened
 All stairs to be in good repair, not loose, broken, missing or worn
 Pathways, exits, and halls are clear of miscellaneous items, toys, and cords

HEAT, LIGHT,VENTILATIONS, WATER TEMP CONTROLS, SMOKE AND CARBON MONOXIDE DETECTORS, PHONES

 Thermostat is easy to read
 Extension cords are tied and out of the way
 Add nightlights to increase visibility especially in hallways, bathrooms and bedrooms
 Maintain a light or light switch within easy reach of the bed
 Always turn on a light before entering a room
 There are no scald valves on all faucets
 Smoke detectors/CO detectors are in place
 Phones are located near bed, sofa, chair
 Doorbell & phone are loud enough to be heard


  Susan Luxenberg
  President
  HomeSmart LLC



  

Recent Questions: Tub Options for Aging in Place

Question:  I plan to renovate my guest room and bath for my elderly mother who frequently comes to visit.  I had intended to remove the bathtub in that bathroom and install a walk in shower for her but she prefers a bathtub over a shower so I’m now uncertain what to do.  I don’t want to spend money renovating the bathroom only to have to renovate again in the future.  Are there bathtubs that work with the idea of aging in place or should I try to convince her that a walk in shower is the better long term choice? 


Answer:  Walk in showers are great for everyone, young and old, but there are a few bathtub options that will also work for your mother and are designed for aging in place.   

   There are walk in tubs that you get into through a door in the tub wall.  Once inside the tub, the door latches shut and seals tightly so you can fill the tub with water. There are a number of manufacturers offering walk in tubs with varied features, such as hand sprays, grab bars, anti scald valves, locking mechanisms, hydro jets, etc.   Not all walk-in tubs are the equal so it’s important to research what each manufacturer has to offer.  There are tubs with inward swinging doors and those with outward swing.  There are larger tubs and smaller tubs to suit different areas of the home.  There are tubs with dual drainage systems, presumably to drain water faster, and those with single drains.  You can easily familiarize yourself with these products by researching online.  Walk in tubs are also not flush to the bathroom floor so while they only present a small step, there still is a need to step over a small threshold in order to enter the tub. The big negative to a walk in tub is that you can’t get out of the tub until all the water drains out.  So if this is the option you choose, I’d suggest also installing a heat lamp above the tub to take the chill off while waiting for the tub to drain.  


 











   A less costly option is a standard tub that has a ledge built into the side.  Rather than climbing over the tub wall (a task that gets increasingly difficult as we age), you sit on the ledge and swing your legs into the tub.  Some bathtub manufacturers are now including an option for grab bars to help with getting up and down in the tub.  Alternately, grab bars could be mounted on the wall within easy reach when sitting in the tub. 

















   
   If your tub is in good shape or you do not want to replace it at this time, there are bath lifts that fit right into the tub and raise and lower into the bath via a remote control.  The only problem with this option is that you’re basically dedicating your tub to bathing and not showering because the lifts are too cumbersome to be taken in and out of a tub easily.  For that reason, you might consider adding a hand held shower head low enough on the wall so as to be reachable while sitting in the tub. 




         
 
 









   
Of course we cannot predict what's physically in store for any of us as we age.  If built properly, walk-in or curb-less showers are an optimal solution because one could easily get into the shower in a wheelchair, if necessary.  But then again, not all curb-less in showers are equal either. All too many "curb-less" showers are built with 4"-6" curbs, which doesn't really solve any problem for someone who can't step over a threshold or manage a step. The other issue has to do with size.  I recently was asked to redesign a curb-less shower that  replaced a 29" x 59" bathtub.  The space was so constrained that it was impossible for the owner, a large man in a large wheelchair, to comfortably maneuver the shower space and keep water in the shower rather than all over the bathroom.  

Recommended minimum dimensions for a residential walk in shower are 36" width x 60" length.  42" width is better and 48" width is ideal.  However, there are people who prefer larger showers and others who need assistance while bathing.  A shower 5 feet by 5 feet allows enough space for a person in a shower wheelchair and an aide.  So if you're working against space constraints and don't have sufficient room to build a shower that meets minimum requirements, a curb-less shower is not the answer and one of the tub options might, in fact, be best.


 Susan Luxenberg
 President
 HomeSmart LLC

Renovating a Condo for Aging in Place

   For those who live in condos and are looking to make aging-in-place renovations, there are special considerations to be taken into account when planning a project.

   For any renovation that would require a permit, the condo association must grant approval.  The documentation required for review varies according to each association, but usually includes a description of your project, associated drawings or plans, and information on your contractor, including certificates of insurance.

  Your first step then is to find out about the approval process either through the condo association directly or via the management company of the building.  They not only can supply you with a list of submittals required and rules for renovation, but also the dates when the association meets for plan review. 

   From my experience, the most stringent requirements imposed by condo associations have to do with restricted work hours.  Their biggest concern is that your neighbors are not inconvenienced by the work being done in your home.  Many condo associations also impose additional restrictions on the contractor, such as what entrance and elevators can be used, where parking is allowed, procedures for debris removal, areas for material storage, etc.  Make sure you give this information to any contractor pricing your job.  It’s important they understand the restrictions so as to be able to set up an orderly approach (and realistic costs) for your renovation. 

   It makes common sense that it may be difficult to obtain approval for any structural changes to your condo considering that your condo is only one unit tied to the structure of an entire building.  Often there are hidden utilities behind walls and over ceilings that feed other units.   Even if approved, structural changes may be prohibitive when compared to similar renovations to a single family home. 

   Keep in mind that each association is different in their requirements so do not rely on assumptions from a contractor or be intimated by stories from friends living in other locations.

   And while it may seem like an additional burden and a frustrating delay to have to go through your association’s approval process, if you understand an association’s requirements before committing to a remodeling project, you’ll save yourself both time and money in the long run.


  Susan Luxenberg
  President
  HomeSmart LLC

 
 

Low Cost Modifications for Aging in Place

   We know that people are reluctant to face their own aging limitations.  We also know that very often seniors are not willing to spend money to improve their own comfort in their homes.  Taken together it’s quite a challenge to get an aging senior to make needed changes for safety and convenience.   

   Many who plan on aging in place are simply not interested in remodeling their homes no matter how much more comfortable they’d be.  They would rather live with a barrier, or put together some temporary “fix”, than pay to solve the problem.  I’ve lost count as to how many bathrooms I’ve walked into where a standard folding chair is balanced half in and half out of the bathtub, its purpose to aid someone no longer able to step into the tub to take a shower.  Needless to say, a precariously balanced metal folding chair is not an appropriate (or safe) solution.   

   So if we’re to convince these seniors to make some changes for their own good, we need to start small, with modifications that can be accomplished quickly, without major disruption, and relatively inexpensively.  

   Let’s start with the bathroom since it’s the place in the home where most falls occur.

 1.  Add a seat to the shower or tub
 2.  Replace a stationary shower head with a hand held one
 3.  Create non-slip tiles throughout bathroom and shower/tub by applying non-skid 
    coatings readily available in tile stores
 4.  Install higher watt bulbs in fixtures to improve vision
 5.  Add grab bars to shower, tub, and toilet areas; colored grab bars are available if 
    needed to increase visibility
 6.  Remove scatter rugs 
 7.  Remove glass shower doors and replace with screw mount shower rod and shower 
    curtain
 8.  Replace door knob and faucet knobs with levered handles 
 9.  Replace door hinges with swing away hinges to increase doorway width
10.  Replace standard toilet with comfort height one making it easier to rise without loss of
    balance 

    Next is the kitchen where the goal is to eliminate stretching and bending as much as possible.

 1. Lower upper cabinet shelves where possible. Place dishes and often used items on an 
    easily reachable shelf
 2. Replace cabinet doorknobs with latches that open to the touch
 3. Increase lighting above the sink, stove and work areas
 4. Make sure there is a heat resistant surface adjacent to stove, oven and microwave to 
     place hot pots and dishes 
 5. Adjust refrigerator shelves so the lighter foods are placed on top, heavier ones at 
     waist level
 6.  Install single lever faucet at kitchen sink
 7 . Coat ceramic floor tiles with non-skid coatings
 8.  Remove or tape down throw rugs 
 9.  Place microwave on counter for easy access 
 10. Install pull out drawers and pop up shelves in bottom cabinets for heavier appliances, 
      eg. mixer 
 11. Make sure all appliances are working properly and controls are easy to read and/or 
      marked
 12. Store food in closed plastic containers for ease of selecting and carrying

     Other areas of the house. 

 1.  Install low profile thresholds or “ramps” wherever threshold exceeds ½”
 2. Install railings at any step, on both sides of stairs,  and along hallways
 3. Increase stair lighting 
 4. Install non-skid stair treads, especially to exterior stairs 


   What I’ve found with my own clients is that getting someone to accept the need to modify their home is a process that moves from denial, to reluctant acceptance, to reliance on the improvement.  Once we’re able to convince a senior that the modification is necessary, they ultimately come to realize how it benefits their life.  It’s a struggle, but it’s worth it.    


  Susan Luxenberg
  President
  HomeSmart LLC

When To Use A Porch Lift

 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 750 lbs. 

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 pad accordingly. 

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 porch.   

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 permission. 

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.

   
Susan Luxenberg
President
HomeSmart LLC


Tub to walk-in shower conversion

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 sufficient. 

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. 

Who knew that something as boring as a shower drain could become such a style statement?  

Here’s a picture of a sloping trench drain as barrier between the wet shower floor and the dry bathroom floor. 



Here’s 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 problem. 


 
There’s even a trench drain available, QuaRTZ,  that has an option to include rechargeable, 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.   


 
Regardless 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. 


  Susan Luxenberg
  President
  HomeSmart LLC

Modifying Narrow Doorways

 
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.
 
 
 Susan Luxenberg
 President
 HomeSmart LLC
 
 
 
 
 
 
 

Managing Stairs: The Stair Lift

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.
 
 
 
 Susan Luxenberg
 President
 HomeSmart LLC
 
 

Improving a Conventional Bathroom

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.     
 
 
 
 
                
Susan Luxenberg
President
HomeSmart LLC
 
 
             
 
 
.
 

Design: Closets

 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.
 
 
 
 Susan Luxenberg
 President
 HomeSmart LLC
 
 
 
 
 
 
 

New Technology

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.
 
 
Presto  
 
 
 
 
 
 
 
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.
                     
wireless amplified headsets
                                                                                                                   
amplified phonecell phone neck loop                                                                                                   
 
 
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.
 
TabSafe medication dispenser
         
 
 
      
 
 
 
 
 
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.
 
 
  Susan Luxenberg
  President
  HomeSmart LLC
 
 
 
 
 
 
 
 
 

Design: New Ways To Solve Old Problems

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:
 
standard toilet commode
 
 
 
 
 
 
 
 
 
 
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?
 
                                                
                       OR  
 
 
comfort height toilet
 
 
 
 
 
                                                                              
Commode placed over toilet   
                                                                                                                        Comfort height toilet
 
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.  
                 
                                            
standard shower chair           
 
 
 
 
 
 
 
 
 
 
 
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:
 
 
                                                                      
                                                
folding teak shower seat                                           
 folding wood shower seat                                          
 
 
 
 
 
 
 
 
 
 
 
 
 
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.
 
 
 Susan Luxenberg
 President
 HomeSmart LLC                                    

Design: Grab Bars

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.
 
 
 Susan Luxenberg
  President
  HomeSmart LLC
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