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.

 

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.

 

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. 

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.

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

9.    Purchase an inexpensive shower bench or chair which can be taken in and out of the 

      tub or shower as required.   

 

 

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.   

 

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

 

 

 

 

9.    Purchase an inexpensive shower bench or chair which can be taken in and out of the 

      tub or shower as required.   

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.  

  

 

   Susan Luxenberg 

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

  

   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.  

 

   

         

 

 

 Susan Luxenberg

   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.

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

 2. Replace cabinet doorknobs with latches that open to the touch

     Other areas of the house. 

   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

 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.

  

                                                     

  

   

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.   

 

 

 

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. 

 

 

 

 

 

 

                       

 

 

 

  

 

 

 

 

 

      

 

 

 

 

 

    

 

               

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                     

 

 

 

 

 

 

 

 

 Susan Luxenberg

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

        

 

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

                     

                                                                                                                   

                                                                                                   

 

 

 

 

         

 

 

      

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                

                       OR  

 

 

 

 

 

 

 

                                                                              

                                                                                                                        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

 

      

                                            

           

 

 

 

 

 

 

 

 

 

 

 

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:

 

 

                                                                      

                                                

                                           

                                           

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                    

        

 

           

 

 

 

 

 

 

 

 

 

                                                 

 

 

                                                                                       

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                            

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Susan Luxenberg