People tend to think of their home as a comforting and safe place, but aging or the progression of a disabling medical condition can make your home a difficult place to navigate. Each room of the house poses its own risks, but many accidents are avoidable by simply modifing your home to meet your evolving needs.
"Most often the safety problems arise because people are doing things that they've been used to doing all their lives, and they're not able to do it in the same way anymore," explains Carol Siebert, an occupational therapist and member of the American Occupational Therapist Association. Falls in the house, for example, are a common source of injury among older people. A study from 2000 found that about 20 percent of older people with fall-related injuries ended up spending at least one night in the hospital.
Below, Siebert discuses the many modifications people can make so that they can carry out the daily domestic activities as safely and comfortably as possible.
Why are older people or people with disabling conditions at risk in their homes?
A lot of the time there's a struggle between the person's abilities and the demands of the environment. There are things people think about in terms of safety all the time, such as tripping over electrical cords. However when people have either a disabling condition or their skills change as part of normal aging, and their environment is built for healthy young person, there becomes a mismatch between the person's abilities and the environment.
You can't make an environment safe, short of putting somebody in a padded cage, but you can reduce risks. At the same time, you'll make it more likely that people will be able to do the things that they need to do.
How can someone modify the bathroom?
For many people, getting up from the toilet, which is usually the lowest seat in the house, is an issue. You can purchase commercially available seats to go on a toilet to make it higher. You can also go into a home improvement store and order a higher toilet bowl or there's a platform called a Toilevator that is a permanent installation that goes between the floor and the regular toilet bowl, and raises it up several inches.
For people who are shorter in stature, sometimes the easier solution is to leave the commode as it is, but simply have something to hold onto when they get up and down. Everybody's favorite grab bar is the towel rack. Unfortunately that is not the safest method, and often it breaks or comes out of the wall as the person is trying to get up. Luckily there are now designer grab bars that come in different colors and can also be used as a towel rack.
How can people modify the shower/bathtub?
One of the greatest risks is stepping over the side of a tub. Using a bath bench can be helpful because you can sit down and then swing your legs over. Or you can have a grab bar installed that's lined up with the side of the tub, so there's something to hold on to as you step over the side of the tub.
One simple thing when you're in the shower is just having something to sit on in the bathtub. It takes less energy to sit. It also means that you're not standing on wet, slippery surfaces. You might also want to have hand-held shower, so you can direct the water where you want it when you're sitting.
How can someone modify the bedroom?
If a person is using any kind of wheeled mobility device, whether it's a manual or power wheelchair or a scooter, having the amount of room that they need to be able to turn and get into and out of the bed is helpful.
Having a bed height that is compatible with being able to get up and down easily is important. One relatively new product is a rail that can be fastened to the bed frame or secured from under the mattress. When you say "bed rail" people think of what you see on a hospital bed. But really these rails are just something that can be used to pull toward or against when a person is moving from lying down to sitting or vice versa, or going from sitting on the side of the bed to standing.
The other concern is lighting, so it is best to always have the pathway from the bedroom to the bathroom lit. This way people can clearly see where they are going and their eyes don't have to adjust to a sudden bright light. The older people get the less they are able to handle those visual changes. Having a few night-lights can make a difference, so you're not tripping over the dog or things that you could have left in your way.
How can the kitchen be modified?
The things that are stored in a kitchen are very often either very breakable or very heavy, so keep the things that are used most often the most accessible. Try to make these things stored between hip and shoulder height. Sometimes that means installing other kinds of cabinets or, ideally, using a pantry.
One of the simplest things that can be done is to have a seated work area in the kitchen. There is no rule that one has to stand to cook. There's even a sink that's available that can be installed that raises and lowers. That's not the most inexpensive modification, but if there's a household where people enjoy doing cooking, that can be a reasonable expense.
With a stove, the ideal thing is to have front controls so you're not reaching across potentially hot burners. "I think of that particularly when I work with older women who've lost height because of osteoporosis," says Siebert. If someone's going to remodel a kitchen, they should consider installing a separate wall oven because when there's a stove-and-oven unit, one of the problems is that the stove is very low, so you have to reach. The wall oven should be counter-top level. If the door opens to the side, there should be a shelf below so hot pans can be pulled out onto the shelf. Drop-front wall ovens should have one oven rack at the level of a nearby countertop, so that pans can be easily transferred.
Other helpful items are dustpans and brooms with long handles to avoid bending, an electric, rechargeable can opener, and utensils with handles that you can grab comfortably. "We think of them as convenience gadgets," says Siebert, "but for individuals who have difficulty with grasping or with sensation that can happen with multiple sclerosis or arthritis, having simple devices can prevent frustration and injuries." Other modifications include drawer boards, which are cutting boards that pull out like a drawer, and pull-out shelves in lower cupboards.
Can stairs be dangerous?
Probably one of the biggest reasons that stairs are a problem is people tend to leave things on the stairs to take up later. This is particularly true for people who have difficulty going up and down the steps or who are just busy. They should designate another place to leave these items.
Having a railing on both sides of the stairs helps. For an individual who has had a stroke or has arthritis in a hip or a knee, having a railing on both sides means that you can choose to hold onto the railing on the side that you prefer to hold onto, whether you're going up or you're going down.
Are there any other home modifications that you recommend?
Another issue is the width of doorways and hallways if individuals use a mobility device, whether it's a walker or a wheelchair. Most bathroom doors are two feet wide, and that's barely the width of a walker.
Another thing you need is a working smoke detector. "I've been in so many homes where there either isn't one or the battery is dead," says Siebert, "and I had two former clients with limited mobility who died in house fires." Outdoors, steps present problems. Ramps are usually not very attractive, but things can be done with landscaping so that there's a more level surface to get into the house. Instead of having a flat walkway and then six or seven steps in front of the house, have a walkway that gently slopes.
Who can help guide home modification efforts?
Occupational therapists focus on the interaction between the person and the environment and creating an environment that allows the person to do what they want to do. Once modifications are made in the home, very often some training is needed, so that the person can operate effectively and efficiently.
Occupational therapists often work as part of a team. There are people with backgrounds in interior design that have taken an interest in environments that support aging in place or work for people with disabilities, as well as architects and builders. There's a certification that the National Home Builders Association now offers called "Certified Aging-in-Place Specialist"(CAPS).
When should people start considering home modifications?
Ideally it's something to think about when you have the most control over what happens. If an individual has just been diagnosed with a health condition that's progressive, it's very difficult to consider home modifications. Once a person is wondering: "What do I do now so I can live my life with this condition?" that's a good time to think about changes, so your home doesn't become a reason why you become less engaged and less active and independent.
If you can create environments now that are more likely to fit you as you approach 75 or 85, you won't be limited in your own house when you actually reach this age.
What kinds of modifications are covered by insurance?
For the most part, home modifications are an out-of-pocket expense, and this is a disincentive to make changes. Health insurance is predicated on a term called "medical necessity" and usually modifications are not deemed medically necessary. In fact, it's very rare for an insurer to pay for something like a bath seat.
Sometimes some of the support organizations, such as the Muscular Dystrophy Association or the MS Society, have some funding that may be available to help people purchase items. Sometimes there are programs at a state level, or there is community-development grant money for low-income or older or disabled homeowners to help them maintain their house or accommodate disabilities.
Where can someone purchase items for home modification?
Many of these products are advertised in catalogs, or they can be picked up at durable medical equipment dealers. "We don't want to turn our homes into hospitals," says Siebert, "and when I mention the word ‘grab bar' or even a bath seat, it conjures up an image of things that people see in institutional environments." But today, there are a lot more products available that have an appearance that's much more compatible with your home.