According to AARP’s "Home and Community Preferences" survey, 3 out of 4 adults age 50 or older say they want to stay in their homes and communities as they age. And many do: Nearly 9 in 10 care recipients live in their own home, in someone else’s home or in their caregiver’s home. Some homes are well-suited for aging and providing care, but many require modifications.
When my parents needed 24-hour care and moved in with me, we didn't have the budget to build an addition or completely revamp the house. But with some research and advice, I found easier, affordable ways to make the home safe and navigable. And I continued to adapt as their needs changed. Eventually, I was able to fully remodel a bathroom for Dad’s safety, as well as get entry threshold ramps.
The goal is to help loved ones be as independent as possible at home, for as long as possible. To tailor your or your loved ones’ residence for care at home, you can start with a home assessment by an occupational therapist, physical therapist, geriatric care manager (aging life care specialist), certified aging-in-place specialist (CAPS) or qualified professional via the area agency on aging or Department of Veterans Affairs.
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Some tips to get you started:
1. Make basic home modifications.
Use universal design principles to ensure the home is comfortable and safe for people of all ages and abilities. Make any alterations easily adaptable, since needs and abilities change over time. A safe home doesn’t have to be unattractive — modifications can be beautiful and stylish. If you engage a contractor, find one who has proven experience in this arena. You can search for a contractor who has the CAPS designation in the National Association of Home Builders Directory. Also, considers AARP’s HomeFit Guide and HomeFit AR app to walk through the home and determine needed changes.
Consider the following improvements:
- No-step entry. This eases entrance to the home for those who use wheelchairs and walkers and makes it easier to carry medical equipment, groceries and suitcases inside. If this isn’t possible, consider a threshold or full ramp, or a lift.
- First-floor bedroom and bathroom or an elevator. Stairs may become difficult as well as unsafe. If you are unable to create a first-floor bedroom/bathroom, you might consider an in-home elevator.
- Bathroom grab bars and a raised toilet seat. Making the bathroom safe and accessible is a top priority. A shower chair can also be helpful, and, if possible, a curbless shower is best.
- Laundry on same floor as bedroom/bathroom. If the laundry room is in the basement, it might be time to create one upstairs.
- Wide doorways and halls. I had offset door hinges installed, allowing just enough extra room for a walker or wheelchair to get through.
- Reachable outlets, controls, knobs and switches. Light switches, thermostats, faucets, cabinet and doorknobs can be lowered and outlets raised to be easily reached from a seated or standing position.
- Variable countertop heights. In the kitchen and bathroom, the counter height may be more comfortable for some people to stand up or use a stool without bending over and straining their backs, but others may need to sit in a chair or wheelchair.
- Easy-to-use handles and doorknobs. Lever handles are easiest for arthritic hands.
- Increase lighting. Dim areas can cause falls.
2. Keep safety a top priority.
Every year, 1 in 4 Americans over the age of 65 fall, so fall prevention is paramount. Many of the modifications listed above help prevent this kind of accident. And sometimes a very simple adjustment can help. For example, I took the wheels off my dad's chair so it wouldn’t move when he stood up. We have a sunken living room, and a visiting friend once fell off the edge and fractured her ribs. To prevent this from recurring, I lined up furniture along the edges so Mom and Dad couldn’t slip from there.
Preventing a loved one from getting lost is also critical. Monitors and alerts can be a big help when someone has dementia. I placed a motion sensor in the hallway, so I was alerted if Dad, who had Alzheimer’s disease, passed by it. In addition, I placed a floor mat with an alarm next to his bed. For Mom, I had bed and chair-seat alarm pads. Even a simple door alarm, found in your local hardware store, can give you peace of mind. These alarms can also help prevent falls if your loved one isn’t safe walking around the home alone.
Medical equipment and mobility aids, including canes, walkers, wheelchairs and shower chairs, are often key to preventing falls. Lift chairs, entry ramps and wheelchair lifts can be helpful, too.
3. Caregiving devices and apps are rapidly changing care at home.
Try using technology these ways:
- Medical alert systems (or personal emergency response systems). A wide variety of options are available, including GPS tracking and automatic fall detection.
- Monitors, alerts and alarms. Alerts include motion sensors, video camera and audio monitors, floor mat and bed pad alarms, door alarms, stove burner alerts and smart medication organizers/dispensers. Integrated systems are available that combine all of these options. A smart home and security system can be synchronized so that you can lock and unlock doors, check and change the temperature in a loved one's home, monitor who goes in and out, and even raise or lower window blinds from a distance.
- Health tracking tools. Apps and devices that track blood pressure, blood sugar, weight, nutrition and other health issues are readily available, and some can send reports to your loved one's doctors.
- Apps can aid communication among your caregiving team members, create medication lists, and provide caregiving tips or resources. There are also apps to set up transportation and find paid caregivers.
- Connections. Technology that helps fight isolation in the home makes it easier for your loved one to visit with friends and family via video chat and smart speakers.
4. Look into home-based services.
Investigate what assistance may be available via your area agency on aging, Veterans Affairs Department or other community-based organizations. Physical, occupational, speech and music therapy can be provided at home. Housekeeping, chore services and meal delivery are often the first supports people need as they age. Other useful services for home-based care include mobile doctors, X-rays and lab tests, and dialysis; home health aides can help with activities such as bathing, dressing and toileting. If your loved one is a veteran, ask about home-based primary and the home health services from the VA.
5. Do your homework when hiring paid caregivers.
It's wonderful to have help, and there are many caring and dedicated people willing to provide it. But, of course, there are others who are not so reliable. Mom had several falls due to untrained paid caregivers, and one stole her jewelry. When hiring caregivers, be sure to do background checks and get references, and carefully monitor their work. Stop by — preferably at unexpected times — to check in on professionals or volunteers going to the home.
As your loved one's needs change, you can creatively increase support in the home. Dad lived with me for six years; he died, at age 94, in his own bed, surrounded by his daughters, with the support of hospice care, provided through the VA. I’m so grateful I was able to adhere to his wishes and care for him at home. Looking back, while it was challenging, I have no regrets, and, overall, it was an extremely rewarding experience.