Introduction

Life, Unavoidable

As years pass and we grow older and wiser, we also go through physical changes that may lead to difficulties interacting with our home environment. These kinds of changes may include decreased mobility, dexterity and flexibility as well as reduced strength or sensory acuity. Normal activities such as using the stairs, bathroom, or kitchen may become difficult to use safely or at all. Our normally-comfortable place of rest may seem more like a hazardous obstacle course instead of a safe haven.

Because of these unavoidable life changes that often accompany aging, a significant concern people have as they grow older is that they will have to leave their home. Leaving one’s home can mean leaving behind a supportive network, a comfortable and familiar setting, and oftentimes, a sense of self.

However, aging and changes in abilities (regardless of how they occur) does not necessarily mean you have to leave your home or lose your independence—as your needs change, so should your home environment. Modifications can be made to your home to help accommodate the physical, mental and psychological changes that can come with getting older. This is known as “aging in place.”

Why Age in Place

The Center for Disease Control defines aging in place as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.”

The main goal of aging in place is to make changes to your home which creates a safe, usable, and enjoyable space that you can reside in easily. Remaining at home as you age will allow you to maintain your daily routine, as well as enjoy the independence to which you have become accustomed. You can choose to receive the care you want in the manner in which you want it. Put simply, aging in place will allow you to lead a healthier, happier life in a safe environment.

Planning Ahead

There are many benefits to modifying your home to age in place, but most people don’t think about making changes until it is too late, and they are forced to leave the place they love. Early planning will allow you to explore all the options and make the changes most suited to your needs. This strategic planning will reduce the overall amount of stress and cost to you and your family.

Essentially, this book is a list of aging in place ideas and guidelines to help motivate and steer you through the various modifications you can make to your home. These ideas range from home remodeling projects to more simple do-it-yourself changes, but all are relevant to making your home a safe, manageable, and happy place to reside no matter what the future holds.

Chapter 1: Home Exterior

When people think of aging in place, they tend to only think about modifications to the interior of the home. However, limited range of motion can make getting in and out of your home increasingly difficult, and exterior modifications should be made to help make accessibility easier. Making the appropriate alterations now will help prevent accidents associated with improper access.

Entrances

Falling is one of the greatest dangers to one’s ability to age in place. The Center for Disease Control and Prevention estimates that every year one out of three adults (over the age of 65) will experience a fall. For older adults, these falls can often lead to complications and more serious injuries. Therefore, fall prevention is a number one concern for aging in place, and this particular vulnerability can be easily remedied with proper planning.

One way to alleviate future complications is to reduce the threshold at your main entryway to a height of ½ inch or less in order to help prevent falls and injuries. This can be done by replacing the existing

door sill with a lower one, or by raising the porch to meet the sill.

The doorway itself should be a minimum of 36” wide to allow for easy entry by foot, by wheelchair, or assisted by a walker. If the doorway cannot be changed, consider using offset door hinges which will increase the clearance of a narrower doorway.

Round door handles can be a challenge for people with arthritis or a weakening grip. A lever-style handle takes less force and enables one to simply press down to open, as opposed to grasping and turning. Likewise, if steady

hands are an issue, using a numeric keypad lock can be easier than inserting and turning a key.

Stairs and Ramps

If you have stairs leading up to your entryway, they can be very unsafe if wet and not adequately surfaced. There are several ways to make steps safer for everyone to use, regardless of physical condition. Simple solutions such as applying a textured surface to each step and installing a handrail on either side of the stairs will drastically reduce slipping.

However, for those with impaired mobility, a step-less entry such as ramp is preferable. While steps pose a difficulty for those with a wheelchair or walker, ramps provide everyone with easy and universal access. Ramps can be designed to complement the style of your home while also making it a cinch to enter and exit. If you choose to install a ramp, it should slope gently and provide plenty of walking and

Figure 1: A grab bar combined with an easy-to-open lever handle makes entering your house uncomplicated.

turning room. Ramps should have no more than an 8% grade, though a gentler incline may be preferred and obtained with a 5% grade, which translates to a 1 inch vertical rise for every 20 inches of horizontal distance. The surface of the ramp should be slightly rough to improve traction and minimize slipping, and it should feature handrails on either side.

While there are varying factors to consider when installing a ramp, the most important is to have a licensed contractor design and build it to fit your specific situation.

Lighting

Adequate lighting is a crucial design element in general safety. Installing lamps by your entryway is a simple addition that will help identify obstacles and reduce falls. Better yet, placing motion-sensor lights by all exterior doorways and along pathways is an easy, inexpensive, and efficient way to improve overall safety.

Garage and Parking:

The garage is not just a place to park and protect your vehicle, but oftentimes is used as a workshop or for storage. These garage suggestions will help you attain a safe and functional space.

Garage floors tend to be slippery, so think about adding a non-slip coating to your garage floor. This will make maneuvering easy and reduce chances of injury. Another way to reduce accidents is adequate illumination, so make sure to brighten dark garages with plenty of motion-sensor or overhead lights.

Having sufficient space to move, with or without a wheelchair, is also important. You should have a minimum of 5 feet of room between vehicles, and between vehicles and the side walls, to better facilitate getting in and out of your house and car. This amount of space also allows for the use of lifts, if needed.

If you do not possess a garage door opener, consider having one installed to help make access to your garage and home much more convenient and safe.

Figure 2: Ramps should have no more than an 8% grade and should feature handrails on either side.

Chapter 2: Common Areas

Over time, the common areas in your home can become dangerous places with obstacles such as throw rugs, poor lighting, and long hallways. By making these areas easily accessible and serviceable you will create a more pleasant home environment for yourself and loved ones. Many of these suggestions for modifying common areas (such as the living room, family room, or den) are applicable to all rooms of the house.

Doors and Hallways

Your interior doorways should be large enough to accommodate regular foot traffic as well as the potential use of a walker or wheelchair. A minimum width of 32” will make your doorways wheelchair

accessible, though a minimum width of 36” is suggested for maximum ambulatory ease. As mentioned previously, all house doorknobs should be replaced with lever handles to make opening any door struggle-free.

For long hallways, the addition of a handrail will assist with walking and the placement of a chair at the beginning or end provides an option to rest. Ample overhead lighting in your hallway is always important, and an accessible light switch should be installed at both ends.

Flooring and Furniture

Take a look at your floor—is the carpet loose or ripped in any places? Ragged carpet or loose flooring increases the chance of injury, and

should be kept in good condition. If carpeted, use low-pile (less than ½” high) density, with a firm pad underneath to reduce the likelihood of accidents. When choosing new flooring, keep in mind color and texture contrasts to help indicate changes in surface levels.

Area rugs are dangerous accessories to have in the home as they can easily be tripped over or slipped upon. Instead of troublesome rugs, opt for non-slip flooring applications or cover the area with low-pile carpeting.

Rearrange your furniture to create an open and navigable space. If transitioning between sitting and standing poses a difficulty, you can add risers to your furniture to lessen any strain involved.

Lighting

Low-lighting inside the house reduces visibility and increases the chances of accidents. Ideally you should have a lot of windows with easy to operate hardware to provide natural light. Another important element is to have plenty of flexibility with your lighting options. There should be lighting choices for each room and controls in order to adjust the level of brightness. If you prefer not to add multiple light fixtures throughout your house, consider using task lighting in work areas and closets, which will help

Figure 3: The simple addition of a handrail to your hallway makes it easy for anyone to navigate.

with specified illumination where you need it. Also, easily accessible light switches will help ensure safe entry into a room. Rocker or touch light switches are the most convenient and simplest to use, and some even have lighted switch plates which makes them easier to find in the dark. Consider purchasing a couple night lights to plug in around the house for extra illumination.

Chapter 3: Kitchen

For many people, spending time in the kitchen is a favorite and joyous pastime. Not only can the kitchen be a social place, it is necessary for daily food preparation, so don’t let getting older prevent you from using your kitchen to its full potential. With a few modifications, you will be able to maneuver safely and use all your kitchen appliances with ease.

Kitchen Appliances

The most common kitchen modifications for aging in place are height adjustments of often-used appliances. These changes will help prevent injury by reducing the amount of time spent bending and

leaning. Raising the height of your dishwasher or lowering your sink will make your kitchen experience easier and more enjoyable. Motorized and adjustable-height counters and sinks can be installed to make the kitchen more user-friendly for those who use wheelchairs.

You should provide sufficient counter space for dish landing adjacent to or opposite all appliances. Accented colors on the edge of countertops will increase visibility and provide clear orientation to the workspace.

Utilize microwaves and dishwashers with easy to read controls, convenient functions, and universal designs. Side by side refrigerators provide easy access to both

compartments, plus the narrower doors are simpler to use with a smaller swing radius.

Kitchen Cabinets

Make upper cabinets more accessible by adding pull-down shelving. These innovative additions can greatly reduce the amount of reaching required to access top shelf items. Another basic way to improve kitchen cabinet accessibility is to change the handles. Using “D” shaped handles and drawer pulls make them easier to grasp and will allow you to open and close them easily. Replacing lower cabinet shelves with pull-out drawers and adding a lazy susan to hard-to-reach corner cabinets will also make it easier to reach items without straining while also increasing the amount of storage available.

Figure 5: Pull-down shelving brings top shelf items safely to your fingertips.

Figure 4: The combination of a raised dishwasher and lowered sink significantly reduces back strain.

CHAPTER 4: The Bedroom

The bedroom is a place of rest and retreat and should be treated accordingly as you plan your future. A clutter-free and open floor space will make movement uncomplicated and keep injuries to a minimum. Be sure to leave plenty of space around beds, dressers, and nightstands to accommodate mobility.

Bedroom Access

The ideal location for the bedroom would be on the main level of the home. This way, you have unhindered access to your room as well as all other rooms in the house. If this is not the case in your home, consider adding an additional bedroom to the main floor, converting another room to a bedroom, or installing a chair lift to facilitate an easier journey up and down the stairs.

The Bed

You begin, and end, every day in your bed. As you age, you may find getting in and out of bed becomes difficult, but a few small changes can help. An inexpensive installation of a side rail or safety handles will allow easier access and reduce the possibility of falling. Clearing a path and rearranging your furniture to create a wide berth of space around your bed will help to accommodate for any adaptive equipment that may be needed in the future.

A good mattress is important and should be at a comfortable height—if you use a wheelchair you will want

the mattress height to be flush with the height of the wheelchair for stress-free movement in and out of bed. If you have circulatory or respiratory issues, consider an electric bed that allows you to raise the top and bottom portions of the bed independently.

The Closet

A disorganized closet can lead to accidents if heavy items are stored up high or if you have to strain for frequently used items. Organizing your closet is an easy and cost-effective way to prevent future injury. Adjustable closet systems are available at most home improvement stores and can be easily customized and installed for your specific needs. Lighting, of course, is an important feature to prevent mishaps and a dark closet can be easily remedied with LED stick-on lights, or the installation of an overhead light fixture.

Figure 6: Easily installed safety handles can help you get in and out of bed without trouble.

CHAPTER 5: The Bathroom

The bathroom can be a very dangerous place for aging seniors, as more falls and accidents happen in the bathroom than in any other room of the house, but there are simple and inexpensive ways to guard against injuries. When you design a safe environment in the bathroom, you design a safer future for yourself and your loved ones.

The Shower and Bathtub

The floor of a shower or tub is slippery and the risk for falls is great. Placing a non-skid mat in the shower will reduce slipping and the installation of grab bars inside and outside of the shower will ensure a safe entrance and exit. A mounted shower seat is a practical solution, as well as making sure the shower doors are made of safety glass or plastic.

If needed, many companies offer a large variety of walk-in tubs that can replace your existing tub. Roll-in or no-threshold showers are another great option for those who use mobility equipment. These special showers have a wide opening with a low threshold that provides plenty of room to maneuver with or without a wheelchair.

The Toilet

The height of the toilet can make a large difference in how safe and comfortable your bathroom can be. By having a toilet that sits higher off the ground, you will put less strain on your legs, knees, and back. You can achieve proper toilet height by replacing your toilet altogether, or by investing in a less expensive seat extender. These extenders attach to the top of your toilet and can raise the seat height

by 4-6 inches. Installing grab bars by the toilet is another simple way to help you safely stand and sit.

Other Bathroom Considerations

Wall supports and grab bars throughout the bathroom is an excellent way to guarantee a safe bathroom experience from beginning to end. Adding a contrasting edge border to your countertops may help with visibility and reduce falls as well.

A telephone installed in the bathroom can bring help fast if you slip and fall in the bathroom. A wall phone hung near your shower, tub, or toilet is ideal, but be sure to pick

Figure 7: This is a great example of a no-threshold shower, complete with safety grab bars and a mounted shower seat.

Figure 8: Well-placed grab bars in the bathroom can be functional as well as stylish.

a place that you can reach even if you are lying on the floor. Write down or store important numbers in the phone so that you have the option of calling for help with the push of one button.

Water burns are another concern, as they can happen in a matter of seconds. Keep your water heater dialed in to 120 degrees, or install an anti-scald device that will prevent your water from getting too hot.

CHAPTER 6: Laundry

Laundry rooms are often basic with minimal amenities, but that does not mean doing laundry needs to be difficult. There are many ways to make your space work for you and to make the chore of washing clothes as easy as wearing them.

Layout and Appliances

Move any objects that hinder access, and always make sure that you are able to get in and out of the room easily. Also, often-used items (such as detergents and dryer sheets) should be in close proximity and easy to reach.

Roll-out, adjustable, or open shelving are all great ways to make everything easier to access. Fold-down shelves located next to the dryer or by countertops are convenient and can also be collapsed when not in use.

Front-loading washing machines and dryers are the best choice when planning a manageable laundry room. Since they require less movement to load than other kinds of machines, they reduce strain on your back. Consider purchasing laundry pedestals, with or without

built-in cabinetry, to raise the machines to a more accessible level.

CHAPTER 7: In-Home Mobility Devices

Figure 9: Front-loading machines are the easiest to use, and pedestals can be added to increase the height of the machines and reduce back strain even more.

Figure 10: Corner grab bars can help you navigate and maintain balance in a small laundry room.

Most experts will tell you that living in a one-story home is the best way to go, but that’s not always an option for everyone. If you have a two-story home and believe that the staircase may pose a problem for your mobility needs in the future, there are several ways this issue can be resolved. The simplest solution is to add sturdy hand rails on both sides of the stairway, but oftentimes more thorough and accommodating changes have to be made.

Dumbwaiter

A dumbwaiter is a great solution for those who have relatively minor mobility challenges and just need help transporting heavy items between floors. Most dumbwaiters take up very little space and can carry loads up to 200 pounds. They are relatively inexpensive compared to their more involved counterparts and some come with DIY kits for easy installation.

Stair Lift

A stair lift is a motorized device designed to transport you up and down a staircase easily. It is one of the most common pieces of aging-in-place equipment as it is a practical and affordable way to deal with the issue of staircase mobility. They can be tailored to any type of staircase, though the installation may be more expensive if your staircase is curved.

While the lifts can be customized depending on your needs, there is generally two different styles—the first is built with a chair that you ride up (see figure 11) and the other has a platform that you can either stand on or roll a wheelchair onto. The platform variation usually has folding edge flaps which drop down and act as ramps to allow for variations in floor levels.

These flaps also prevent the wheelchair from going over the edge of the platform. Most come with a safety strap to ensure security and are usually self-operated, but if needed, you can purchase one that requires another person to operate.

Elevator

If you need something larger and roomier than a chair lift, the next option is an elevator. By installing an elevator, you can significantly reduce time on your feet while also safely transporting heavy bags, laundry, and packages instead of carrying them up the stairs. Elevators can be expensive to install, but are considerably cheaper than paying for a homecare assistant or relocating to a one-story home. If you have sufficient room, an elevator may be the most versatile and permanent solution to mobility challenges. If you don’t have adequate space inside the house, consider building a shaft along the exterior of your house with the doors opening into your home. This would provide ease of access without crowding the interior of your home.

Conclusion

Figure 11: Self-operated chair lift

As you have seen throughout this guide, the ways in which you can prepare for your future are numerous, and the advantages from doing so are wide-ranging and abundant.

Preparing to age in place provides peace of mind while offering additional financial and social benefits. All the changes you make to your home are investments toward a happier and safer future for you and your family. Modifying your home to age in place will also increase the value of your house while making the property more marketable when it comes time to sell.

Additionally, the increasing demand of people who want to age in place has led to innovative home designs, sleek equipment, and tailor-made options to make your home suit your personal style. It is no longer necessary to sacrifice elegance for safety, nor form for function.

Regardless of your age or physical condition, it is never too early to prepare for the future you desire. I hope that this comprehensive guide has encouraged you to take control of your own quality of life at home, so that you can make changes now that will help you later.