It started with a simple plan to replace a broken toilet. But as so many renovation stories go, one idea led to another, and soon Cash Anthony and Tim Hogan began to plan an entire bathroom remodel.
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Before even talking with their contractor, Anthony, 62, had realized they needed to do more than just pretty up the space. Anthony, who has had seven surgeries in two years related to degenerative disc disease, had already seen small problems with their current bathroom design.
"I began to realize the handles on things were not as convenient as they might be," says Anthony, of Houston. "So now our new plumbing is all single handle that turns on the water as well as adjusts the temperature." They also told the contractor they wanted to install grab bars in the shower and near the toilet. And they wanted enough room to maneuver a wheelchair, and no difficult-to-roll-over lip at the shower stall entrance.
But if these descriptions make you think her home now resembles a nursing home, think again.
"Oh, there's no sense of sterility here," says Anthony as she describes the bathroom, which includes some design elements of a London subway station: white subway tiles on the floor and walls. The countertops are bright red, and on the wall opposite the toilet is a 4-by-5-foot tile mural depicting foxes.
In fact, unless you were looking for it, the accessibility features would be hard to distinguish because they are so well incorporated into the design. And that's exactly what should happen when you do a remodel that helps people stay in their homes as they grow older, says Karen Richmond, a certified aging-in-place specialist and designer with the Neil Kelly Company in Portland, Ore.
"The goal is to create a comfort level for people of all ages, whether it's the toddler or the mom with the broken leg, or it's the grandmother who needs some assistance or help," Richmond says.
A boomer-driven trend
It's a concept sure to grow in popularity as boomers get older but have no intention of being aged out of their homes. Nearly 75 percent of people hope to stay in their homes as they age, according to a November 2010 poll of 1,616 people age 45 and older conducted by AARP. And the older people get, the more likely they are to want to stay put.
Wanting this and making it happen, however, are two different things.
The fact is that nearly 1.7 million Americans live in nursing homes and 1 million people reside in assisted living facilities, according to the American Association of Homes and Services for the Aging. And according to a recent study done by Cornell University, more than half of low-needs nursing home residents — an estimated 100,000 people — could instead be living at home if they only had the right support system in place. Having a house that is safe for them to maneuver is one of those criteria.
Why safety matters
Aging in place isn't just about comfort. In very basic terms, it's about avoiding falls. If an older person can avoid falling and breaking a hip, he can prevent a cascade of other health problems.
Problem is, keeping your balance gets harder as you age, says Diane Genaze, director of physical therapy at Rush University Medical Center in Chicago and a physical therapist. Aging in general changes the number of muscle fibers we all have, reducing muscle mass, Genaze says. Diabetes can affect your sense of touch, so you're no longer as sensitive to the way your foot hits a step as you used to be. Dizziness and inner ear disorders can alter your sense of balance. Arthritis makes you protect the joints that hurt, leading to reduced range of motion. Vision deteriorates, and you need more light not only to read the newspaper, but also to see your way to a dark bathroom in the middle of the night.
And then there's the simple matter of flexibility. "When you're younger, if you lose your balance you're going to readjust the position of your feet and use your core muscles to hold yourself up," Genaze says. "But older people have pronated feet that are stiff. You put all that together, and it doesn't matter that that throw rug was there for 20 years. It only takes once to slip and break your hip."
Hips are so prone to fracture because people tend to fall on their sides, Genaze says. Add to that osteoporosis, which weakens the bone, and loss of muscle padding, and one slip or trip can lead you down a long road of surgery, pain, recovery and physical therapy.
How can you make sure your home is a safe abode? Consider these ideas.
Focus on the bathroom
The bathroom should be the first target for an aging-in-place remodel, says Dan Bawden, owner of Legal Eagle Contractors in Houston, who supervised Anthony's remodel. Having a first-floor full bathroom is "crucial," Bawden says. If you don't currently have one, it might seem like a large expense. But compared to installing an elevator or chair lift, it could be more economical. Plus, those solutions don't address the problem of expediency: if you need to get to a bathroom right away, a first-floor location will be the most convenient.
The doorway should be a minimum of 32 inches wide, says Bawden. In most older homes, it's a narrow 24 inches. "My mom and dad are in their late 80s, and he couldn't get his walker through the bathroom door without crabbing it to the side," Bawden says.
This wasn't just inconvenient, it was dangerous. If you're on a budget, there are special hinges you can buy that will gain you a few inches in access. But ideally you'll reframe the doorway and install a new door.
In the bathing area itself, Bawden recommends a curbless shower with a bench and grab bars. But that doesn't have to look as antiseptic as it sounds. Think in terms of Anthony's bathroom: a tiled shower area with recessed shelves at arm's level to stop you from having to stoop down to the floor or reach up to a shower rack. Add a matching ceramic bench and grab bars that come in brushed nickel, chrome or bronze to match your faucet hardware. If you're on a budget, there are teak shower benches that look more upscale than the white plastic hospital variety.
Perhaps most important, don't forget about the toilet. Getting up from a seated position might take some effort, so add a grab bar and consider a taller-than-average model.
In the kitchen, think convenience
If you're gearing up for a kitchen remodel, Richmond recommends you take a close look at your flooring. Tile is hard to stand on for long periods, especially in you have lower back or hip pain. Richmond recommends opting for vinyl, linoleum, wood or cork flooring, which are more forgiving. Also consider adding seated work spaces, so you can still chop your vegetables but take a load off while doing it.
When looking at new appliances, opt for a side-by-side refrigerator featuring double doors, which is easier to open if you're in a wheelchair. Instead of an over-the-oven microwave, which requires lifting heavy dishes above your head, consider a countertop or drawer model. To avoid having to bend over, a separate cooktop affixed to the counter and an oven inserted into the wall is a better option than a traditional stove, where the cooktop is above the oven door.
For countertops, Richmond designs a contrasting color around the edges so that if your vision starts to wane, you'll still be able to figure out where the countertop ends, thus preventing spills. Bawden installs lots of lighting under cabinets and outlets along the backsplash to limit having to reach down toward the floor to plug something in.
Throughout the house
You need not only brighter lights, but also many of them. Consider adding recessed lights to rooms that have only a single light source, such as a floor lamp. Or if you're on a budget, just increasing the wattage in current light fixtures can help.
If you're replacing flooring, consider installing hardwood. It's a lot easier to roll a wheelchair on wood than on carpeting. And think about your heating system, too. Susan Welliver, 59, and her husband never turned the heat on in the summer, even though the temperature where they live in Eureka, Calif., rarely gets warmer than 70 degrees. But when her parents relocated from Florida to live with them, the furnace was kicking on more frequently than usual. "We wanted them to be comfortable and as warm as they needed to be, so we installed a very efficient heating system."
Outside the house
Until her parents moved in, Welliver never thought much of the four steps that led from her driveway to her back door. "It looked like nothing at all, but when you have trouble walking up stairs or are a bit unsteady, four steps becomes huge," she says. So her husband, a contractor, replaced the steps with a ramp.
"My father can drive the car up and then walk up the wood ramp. It's a nice gentle slope," says Welliver. "My dad uses a wheeling cart for the groceries and wheels it right into the house. Everything is very simple, and it's easy for him to be able to do anything that he needs to do."
Paying for it
The cost of aging-in-place remodels varies widely depending on what type of work you need to have done. An elevator is among the most expensive projects, running about $60,000, Bawden says. Chair lifts can run $6,000 and up, Richmond says. Kitchen or bath remodels vary widely depending on scope of the project and features selected.
But while a project like this might seem financially daunting, consider the alternative: A nursing home averages $84,000 a year for a private room, and assisted living will run you about $40,000 a year, according to the MetLife Mature Market Institute.
Making changes now can prepare you in case of an emergency. When Welliver's father developed a host of complications after heart valve replacement surgery, the hospital recommended he go into an assisted living facility. Welliver instead suggested her parents move in with her, but it was months before the necessary renovations could be done to create an accessible bathroom and entryway.
And if you're like Anthony's husband, an aging-in-place home can help you make a promise you've made to yourself.
"My husband says they're going to have to carry him out of this house in a box," Anthony says. "So I guess we're going to be here awhile."
Cynthia Ramnarace writes about families and health. She lives in Rockaway Beach, N.Y.
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